Opinion: Treat us better if you want us to keep coming backPHOTO: Ritshidze Project

Opinion: Treat us better if you want us to keep coming back

Comment & Analysis

People who miss appointments or stop taking their treatment often report being treated badly by healthcare workers when they return to health facilities. This fear of being reprimanded discourages people from going back to the clinic to seek support and receive their treatment.

Monitoring done by Ritshidze (a community monitoring project) from October to December 2020 shows that poor staff attitudes remain a major barrier to seeking and staying in care. Reports of staff reactions to patients who missed a facility visit for ARV collection were often unwelcoming, unempathetic, or at worst human rights violations.

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Across clinics, out of 7 162 patient responses, only half (54.6%) of patients thought the staff members were always friendly and professional.

The graph below outlines the worst-performing sites where we think investigations should take place into the allegations of poor staff attitudes.

 

Alt text: This is a table that shows the worst performing sites in response to the questions “Are the staff friendly and professional?” at the clinic. Link to an accessible data table: http://bit.ly/StaffAttitudeDec20
Graph: Ritshidze

One woman living with HIV told us that every visit to the clinic is a nightmare. The name-calling is insulting, an irritation, and “makes me so cross and makes me want to cry”. She says she’s routinely spoken to rudely by the administrative staff members in particular. She feels singled out when staff members tell her to produce an appointment card even though she has never been issued one and she says she’s not familiar with the clinic’s system having only moved to the area recently.

“They will tell me that because of that card they can’t help me and then they just let me sit,” the woman says. “Sometimes I sit till late in the afternoon, even though I come there early. They don’t care that I am hungry and I don’t have a lunchbox or money to buy food. They just cheek you and say things like ‘don’t waste my time’ or ‘we have a half-day today so don’t come with your problems’.”

This is a bar chart that tells us when a patient misses a visit, what happens the next time they come to collect ARVs. Out of 4963 responses, 678 people said staff are welcoming back; 518 say staff reprimand you; 410 say staff counsel you on adherence; 839 says staff ask why you miss an appointment; 545 say staff send you to the back of the queue
Graph: Ritshidze

Of the nearly 5 000 survey responses, only 13% (676) of people living with HIV said that staff members were welcoming when they came to collect ARVs if they had previously missed a visit. Many reported being punished, with 545 reporting being sent to the back of the queue.

Another 518 people living with HIV reported being reprimanded for missing a visit. This compares to only 410 people living with HIV who report that staff will provide counseling on adherence if you return to the clinic after missing a visit.

The graph below shows the responses from people living with HIV to what happens when you miss a clinic visit by province, listed from best performing to worst performing.

This is a table that shows when a patient misses a visit, what happens the next time they come to collect ARVs, per province. Link to an accessible data table: http://bit.ly/MissAppointmentDec20
Graph: Ritshidze

 

The graph below shows the clinics where the most people living with HIV report being reprimanded and shouted at for missing a clinic visit.

This is a table that shows when a patient misses a visit, what happens the next time they come to collect ARVs. It is filtered to show the clinics with the most responses that the staff reprimand you. Link to an accessible data table: http://bit.ly/StaffReprimandDec20
Graph: Ritshidze

 The graph below shows the clinics where the most people living with HIV report being sent to the back of the queue after missing a clinic visit.

This is a table that shows when a patient misses a visit, what happens the next time they come to collect ARVs. It is filtered to show the clinics with the most responses that the staff send you to the back of the queue. Link to an accessible data table: http://bit.ly/BackofQueueDec20
Graph: Ritshidze

So, what should be done?

  • All staff should be trained to provide a friendly and welcoming environment for all patients, whether accessing HIV prevention, accessing ART, or, most especially, returning to care after a treatment interruption.
  • No people living with HIV should be sent to the back of the queue if they miss an appointment.
  • “No “referral letter” should be required for people to transfer to a new facility
  • The provincial Department of Health must carry out investigations into all allegations made regarding health personnel failures — including bad attitudes — and that following this investigation disciplinary action be taken where appropriate and compensation be paid out to victims of neglect or ill-treatment.

*Setshogelo is a Project Officer with Ritshidze and Tshabalala is the National Chairperson of the Treatment Action Campaign (TAC)

Note: The Treatment Action campaign participates in the Ritshidze project. Spotlight is published by SECTION27 and the Treatment Action Campaign but is editorially independent, independence that the editors guard jealously. The views expressed in this article are not the views of Spotlight.

**This data set was presented to an Operation Phuthuma meeting on 5th March 2020. You can view the full presentation here. For more updates from Ritshidze, you can follow them on twitter, facebook and instagram.

*Data related to the Western Cape has been excluded from the above. This is whilst ongoing discussions with the Western Cape provincial department of health continue in order to allow for Ritshidze to proceed with monitoring. Until this negotiation has concluded, Western Cape DOH has refused to allow Ritshidze to engage in