NORTH WEST STATE OF HEALTH JUNE 2021 ANALYSE THE DATA GATHER GENERATE EVIDENCE SOLUTIONS RITSHIDZE CYCLE OF COMMUNITY-LED MONITORING ENGAGE ADVOCATE DUTY FOR BEARERS CHANGE 1 Q R U E A T R R T A E U r J R MONITOR be an Q m ua 2 IMPLEMENTATION ce ry e – & IF NO D M – CHANGES.. r a e r c b h o t c O Ritshidze quarterly monitoring cycle J u ly – e S n e u p J t – Q e l m ri U b p 3 A er A R R E T T E R R A 4 U Q DEVELOPING THE REPORT The North West Province State of Health Report has been developed using data from Ritshidze and outlines community priorities for improving HIV, TB and other health services in the province. Ritshidze is a community-led monitoring system developed by organisations representing people living with HIV including the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+). Community-led clinic monitoring is a systematic collection challenges, generate solutions that respond to the of data at the site of service delivery by community evidence collected, and make sure the solutions are members that is compiled, analysed and then used implemented by duty bearers. Giving communities the by community organisations to generate solutions to ability to monitor the quality of service provision and problems found during data collection. In Ritshidze, highlight performance problems is an indispensable people living with HIV are empowered to monitor services strategy for improving HIV and TB service delivery provided at health facilities, identify challenges, generate across South Africa. Through Ritshidze we have begun solutions that respond to the evidence collected, and to more systematically document the failures in make sure the solutions are implemented by duty bearers. quality HIV service delivery as well as gaps in terms In Ritshidze, people living with HIV are empowered to of implementation of a May 2019 circular issued by monitor services provided at health facilities, identify the National Department of Health (appendix 1). 2 RITSHIDZE NORTH WEST – STATE OF HEALTH – JUNE 2021 LONELY PARK CLINIC PROVINCE AND DISTRICT SITE NAME IMPLEMENTING PARTNER Bafokeng CHC Aurum Health Research Bapong CHC Aurum Health Research Boitekong Clinic Aurum Health Research Hebron Clinic Aurum Health Research Letlhabile CHC Aurum Health Research Mogwase CHC Aurum Health Research Bojanala Platinum Bojanala Platinum District Municipality Tlhabane CHC Aurum Health Research Grace Mokgomo CHC Aurum Health Research Jouberton CHC Aurum Health Research Park Street Clinic Aurum Health Research District Kaunda Dr Kenneth Dr Kenneth Municipality Potchefstroom Clinic Aurum Health Research NORTH WEST WEST NORTH PROVINCE Lonely Park Clinic Aurum Health Research Montshioa Stadt CHC Aurum Health Research District Molema Municipality Unit 9 CHC Aurum Health Research Ngaka Modiri Ritshidze monitoring takes place on a quarterly basis in April and May 2021 (quarter 3). All Ritshidze’s data at 400 clinics and community healthcare centres across collection tools, our data dashboard, and all raw data are 27 districts in 8 provinces in South Africa — including available through our website: www.ritshidze.org.za 14 facilities across North West: 3 in Ngaka Modiri Further data specific to stockouts and shortages of Molema, 7 in Bojanala Platinum, and 4 in Dr Kenneth medicines, vaccines, and contraceptives is outlined in this Kaunda. We collect data through observations, as well report. It was collected by a secondary team led by the as through interviews with healthcare users (patients, Treatment Action Campaign (TAC), the Stop Stockouts adherence club members, key populations) and Project (SSP) and Ritshidze at 56 facilities across North healthcare providers (facility managers, adherence club West in May 2021, based upon ongoing reports of major facilitators, pharmacists). Data in this report was collected challenges in regard to the availability of medicines. RITSHIDZE NORTH WEST – STATE OF HEALTH – JUNE 2021 3 PARK STREET CLINIC TLHABANE CHC LONELY PARK CLINIC 4 RITSHIDZE NORTH WEST – STATE OF HEALTH – JUNE 2021 BOJANALA PLATINUM NGAKA MODIRI MOLEMA DR KENNETH DR RUTH KAUNDA SEGOMOTSI MOMPATI INTRODUCTION There is now less than a decade to make the goal to eradicate AIDS by 2030 a reality. UNAIDS scaled up their targets to the new 95-95-95 initiative that now aims for 95% of people living with HIV know their HIV status; 95% of people who know their status on treatment; and 95% of people on treatment to have suppressed viral loads. The latest figures in North West show that 89.6% know has not been enacted by many of the facilities we monitor. their status, out of which only 60.5% are on antiretroviral The North West public health system has been in a state of therapy (ART), out of which 90.5% are virally suppressed. This crisis for many years. Of major concern is the persistant and translates to 54.2% of all people living with HIV receiving widespread stockouts crisis across the province that causes ART in the province and 49% of all people living with HIV 1 people to be sent home from the clinic empty handed, being virally suppressed . In comparison to all other South or with shorter supplies of essential medicines than they African provinces, the North West has the lowest percentage need. We hear too many reports of people waiting long of people on ARVs and the lowest percentage of people who days at clinics only to be told there are no medicines when are virally suppressed — 15% less people on treatment and they finally get their turn at the pharmacy. The health crisis 17% less people virally suppressed than KwaZulu-Natal who is worsened by severe understaffing and shortages of is doing best. This points to major challenges with regard healthcare workers that mean patients must wait in long to getting enough people to start and stay on treatment. queues for many hours to access the services they need. One major reason for the failures in reaching 95-95-95 is the The North West State of Health report takes a detailed look poor quality of HIV services available in the public sector. Poor at the challenges people living with HIV face in the province. HIV outcomes can be directly linked back to gaps in service The report focuses on the following critical themes: stockouts delivery and poor quality public health services. Two years ago, and shortages of medicines: shortages of staff and long in May 2019, the National Department of Health announced a waiting times; challenges with long term ART adherence; slate of policy changes in a circular to remove barriers to care challenges specific for key populations; confidentiality for and support accountability of health workers (see appendix 1) people living with HIV: ensuring the safety and confidentiality — however the reality is that, still two years later, this directive of index testing and poor TB infection control. 1. https://www.thembisa.org/ RITSHIDZE NORTH WEST – STATE OF HEALTH – JUNE 2021 5 1. Shortages + stockouts of medicines + Efforts should be taken to minimise the impact of patients reported they or of global supply chain disruption. The DoH and someone they knew left clinic 23.5% partners should monitor global demand for essential without the medicines they needed medicines and horizon scan for impending issues so facility reports of stockouts as to improve international forecasting and inform of ARVs the national health sector of proactive measures 79 to promote supply security. Increased use of buffer facility reports of stockouts stocks, alternative suppliers and other measures of TB medicines may also need to be more widely used where 17 supplies of medicines are particularly uncertain. facility reports of stockouts + The department of health should share, on a periodic 78 of vaccines basis, with civil society/public supplier performance metrics (i.e. pharmaceutical companies and facility reports of stockouts CCMDD suppliers) and SVS performance metrics. of contraceptives 71 + The provincial department of health should establish an emergency response team/ standard Recommendations: operation procedures to manage crisis situations. + The department should develop a provincial We call on them to include clinic committee strategy to address the continued and ongoing members, all PLHIV Sector organisations, as stockouts and shortages of medicines and well as other civil society organisations. other medical tools and supplies. + The department of health should + This plan must address the impact of human resource prioritise pharmacist training in SVS shortages, poor management, and infrastructure where and other supply chain systems. these impact on the ability of facilities to order and + Pharmacist assistant contracts were discontinued store supplies. Increasing the number of pharmacy at the end of March 2021. We call on the staff in facilities must be a priority as they are often the department to reinstate them, fully recognising first to acknowledge a short supply of medication. that they are the first to notice when stock + There must be effective and immediate communication is running out. This would also help relieve of stockouts, between national and provincial professional nurses of their additional roles departments of health and to clinicians and patients. and free them up for their primary tasks. Stockouts and shortages of ARVs, TB medicines, multiple times, yet the problem persists. Ritshidze contraceptives and other medicines cause disruption, monitoring reveals ongoing complaints regarding confusion, cost, and can detrimentally affect stockouts and shortages of medicines and medical treatment adherence. Yet in the North West, there tools at sites across the province. Across clinics, is an ongoing crisis of stockouts and shortages. This 23.5% of people left, or knew someone who left, a crisis has been raised with provincial duty bearers clinic without the medication that they needed.