by: Natsayi Chimbindi
The epidemics of tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) in sub-Saharan Africa often occur in the same population, with high prevalence levels leading to an increased demand of healthcare services in South Africa. Hlabisa sub-district, which has a high burden of both epidemics, is no exception. The rapid increase in antiretroviral treatment coverage entails an increase in TB treatment coverage due to cross-referrals which could lead to longer queues, shortened patient-provider contact times, and other factors decreasing the acceptability of services and patient satisfaction. The Hlabisa HIV Treatment and Care Programme has been ongoing since 2004 offering care in 17 nurse-led primary health care clinics. TB and HIV care are integrated through physical proximity and cross-referral between the two programmes. However some patients still need to walk for an hour or more to get to the clinic.
A study called Researching Equity in Access to Health care (REACH) undertook a fieldwork project from March to October 2009 in four primary health care clinics in the Hlabisa sub-district and Hlabisa hospital, collecting data for three conditions including HIV and TB focusing on people utilizing services for ART and TB treatment. A structured questionnaire was administered by four trained fieldworkers to a total of 600 patients after they had finished accessing TB or ART treatment at the selected primary health care clinics. The primary care clinics included were: Madwaleni, Nkundisi, Mpukunyoni, Ezwenelisha and Hlabisa (Gateway and Philanjalo).
A section of the REACH study asked questions to assess the acceptability of health care services and patient satisfaction which included patients’ overall satisfaction with the service, issues of respect, privacy and confidentiality, ability to easily report missed doses to a health worker and health worker attitudes and other dimensions such as patients’ perception of the queues at the facility to see the doctor or nurse, patients’ perception on cleanliness of facilities and their ways of improving service provided. Written consent was obtained from patients aged 18 years and above who were on HIV treatment for at least two weeks and patients on TB treatment for at least two months who came to the primary health clinics for treatment.
Preliminary results show that overall satisfaction with care was excellent with almost all patients (97% TB and 95% HIV) reporting being “very satisfied” or “satisfied” with the service they received on the day of the interview. However, satisfaction levels were substantially lower for some specific dimensions of satisfaction and were generally significantly lower for HIV treatment than for TB treatment care. Slightly more than half (52%) of HIV patients and 40% of TB patients agreed that some staff do not treat patients with sufficient respect. However, when asked whether they themselves were treated with respect by their health care worker, the majority (93% HIV and 96% TB patients) agreed they were treated with respect. A higher proportion of patients accessing HIV (65%) than TB (40%) treatment and care agreed that the queues to see a doctor or nurse were too long. Regarding staff-patient communication, 5% of TB patients but 10% of HIV patients did not find it easy to tell the health worker when they had missed taking tablets and 15% of patients reported that health workers were too busy to listen to their problems. Patients on ART and TB treatment should feel free to discuss with their health provider about missed doses and their problems as these affect adherence to treatment which is optimum for patients’ well-being. High levels of privacy and confidentiality were reported by patients attending primary health care clinics for HIV or TB treatment care.
More than a fifth (21%) of the patients agreed that the facilities (including waiting area and toilets) were dirty and some patients were requesting more seats in the waiting area and a water dispenser and cups. Regarding means of improving services in the clinic, more HIV than TB patients reported the need for shorter queues (57%); having more health workers (57%) and having better patient facilities (toilets, waiting room area etc) (67%) as ways of improving service at the facilities. Other suggestions that came from patients were provision of food parcels, transport and easy access to medicines especially for TB patients.
While patients are generally satisfied with the health delivery system for HIV and TB treatment care in this rural setting, there are however evident areas requiring improvement. These include shorter queues for patients accessing care, better treatment procedures or processes, more sympathetic staff attitudes and respect towards patients as well as improved cleanliness in health care facilities.