Clinics in crisis while politicians celebrate World AIDS Day

  • Findings released of TAC survey of 254 clinics

JOHANNESBURG, 30th NOVEMBER 2017 – As we head into World AIDS Day 2017 it is clear there is nothing to celebrate for the vast majority of people dependent on the public healthcare system in South Africa. Our public healthcare system remains deeply dysfunctional. Our HIV and TB response is being undermined by mismanaged and underfunded provincial healthcare systems and shortages of healthcare workers. Our clinics, plagued with poor TB infection control, long waiting times, dirty toilets, shortages of staff and medicine stockouts, are in crisis.

Through our nearly 200 branches, the Treatment Action Campaign (TAC) monitors hundreds of clinics and community healthcare centres across the country. Our members are the people who need the public health system to work, so we are the first to notice when it doesn’t. Following the success of our TB infection control survey conducted earlier this year, last month TAC rolled out a monitoring tool in order to evaluate the state of the public health facilities that have been adopted by TAC branches (each TAC branch in the country has adopted at least one healthcare facility).

The monitoring tool has 23 questions based on the services and quality of service that a primary healthcare facility should offer. The questions, developed in consultation with TAC members, are designed to address the key concerns for users of the public healthcare system – and as such should be seen as complimentary to the more systematic and operational monitoring conducted by the Office of Health Standards Compliance (OHSC). The monitoring was conducted by TAC members trained in the use of the tool. 

A total of 254 facilities were monitored in seven provinces across the country. Here are some of the initial top-line findings of the survey:

ProvinceNo. of facilities surveyed
Eastern Cape24
Free State36
Western Cape30

Waiting times: At 69% of facilities people had to wait for more than an hour to be seen and at 34% of facilities the wait was more than two hours which is very disruptive for people. Though generally poor, waiting times were variable and a minority of facilities did very well.

Waiting timeNo. of facilities
More than 2 hours81
1 to 2 hours83
30 to 60 minutes54
Less than 30 minutes17

(Results from 19 facilities were uncertain and therefore excluded from this analysis).

Toilets: 247 of the surveyed facilities had toilets, 4 did not, and in three cases we were uncertain of the data and excluded it from our analysis. Of the 247 facilities with toilets, the toilets were rated as clean and with toilet paper in only 137 cases. Thus, out of 251 facilities with ratings, around 55% had clean functional toilets and 45% did not.

Waiting areas: 160 facilities (66%) had enough seats in the waiting area and 82 (34%) did not (data from 12 facilities were excluded from this analysis). Waiting areas in 202 facilities were classified as clean while waiting areas at 48 facilities were classified as not being clean.

Staffing: In one of the most notable findings, less than half of facilities were considered to have sufficient staff. 122 of 242 facilities were classified as not having enough staff and 120 as having enough (12 facilities were excluded from this analysis due to concerns about the data). At the very least, this finding shows that a substantial number of people dependent on the public healthcare system perceive facilities as being understaffed. At slightly more than half (58%) (141/244) of facilities staff were generally considered to be friendly, at 30% (74/244) staff were classified as sometimes friendly, and at 12% (29/244) staff were generally considered not to be friendly.

While this is not a scientific survey and the results are not generalisable to the rest of the public healthcare system, it does give a useful snapshot of the realities faced by people who are dependent on the public healthcare system and identifies a number of red flags requiring urgent intervention.

Our findings are generally consistent with the damning reports produced by the OHSC. They reflect the same widespread dysfunction and mismanagement that has allowed crises such as the oncology crisis in KwaZulu-Natal and the Life Esidimeni tragedy in Gauteng.

Today we are only presenting some primary analysis of our survey. We will in time publish further analysis on TB infection control at facilities and variation between provinces and between facilities. We are also sharing the data openly for anyone wishing to do their own analysis or follow-up.

As TAC, we understand that the underlying cause of much of this dysfunction is political. For years corruption and cadre deployment has chipped away at the fabric of our public service and the morale of public servants. While some progress can be made by technical interventions and the introduction of new medicines and tests (especially for TB), we will not be able to turn around the fundamental decline of our public service and our public healthcare system without a major political intervention. Such a political intervention will have to include a clear and unambiguous anti-corruption and anti-cadre deployment campaign that is driven by a President, Cabinet and provincial Premiers that are non-corrupt and committed to serving the public interest ahead of private or party interests.

“We need government to invest much more in healthcare workers and all the other workers and managers that we need to run our healthcare system. We need to ensure that all facilities are fully staffed and have all the equipment and infrastructure required. We cannot afford for any of these funds to be wasted through corruption or mismanagement that is destroying our public service. We need a healthcare system that is welcoming and that takes into account all the needs of our people, including the need many people have for mental healthcare services,” said Sibongile Tshabalala, TAC National Chairperson.

“The results of our branch monitoring demonstrates the crisis we are facing in primary healthcare and only goes to prove that there is nothing to celebrate this World AIDS Day,” said Anele Yawa, TAC General Secretary. “Instead of attending extravagant and expensive World AIDS Day celebrations – with money that could have paid for more health workers, new equipment, or even facility refurbishment – TAC urges politicians to join the real struggle for decent healthcare, where it matters, on the ground.”

For more information and to arrange interviews contact:

Lotti Rutter | | 072 225 9675

Leonora Mathe | | 078 150 0481

Samara Ragaven | | 071 645 7579

The full data set can be accessed here:  

The clean CSV data set will be sent upon request.