PEPFAR cuts leave clinics short of staff

Cuts in the United States President’s Emergency Plan For AIDS Relief (PEPFAR) funding in February have left clinics short of staff, a survey has found. Archive photo: Ihsaan Haffejee

A health monitoring organisation has found that in areas with a high number of people with HIV, US funding cuts have led to staff shortages and overburdened clinics.

The cuts in the United States President’s Emergency Plan For AIDS Relief (PEPFAR) in February this year have created a massive shortfall in funding to South Africa’s HIV programmes. After several months, the National Treasury agreed to fund about R753-million to cover some of the shortfall. (Measuring the total PEPFAR shortfall is complicated, but it is roughly R7-billion.)

A report by Ritshidze over three months shows that PEPFAR cuts to HIV programmes have led to reduced staff and longer waiting times for ARV medicines.

Ritshidze is a South African community-led clinic monitoring organisation. From April to June this year Ritshidze monitored over 325 facilities in 16 districts across six provinces. Most were PEPFAR-priority districts or formerly PEPFAR-supported districts where contracts have been cut. Thousands of patients and people living with HIV were surveyed, as well as staff at the clinics.

Nearly half the staff surveyed reported that capacity in clinics had been reduced, because PEPFAR-funded health workers were not working there anymore or were working less. 85% of managers reported that their clinics faced staffing shortages, though only one in five blamed shortages on PEPFAR staff cuts.

Patients surveyed also reported challenges with staffing at clinics. Over 60% reported that there were too few staff. These shortages have got worse since PEPFAR cuts.

The worst-performing districts from patient reports on staff shortages were Johannesburg, and three Free State municipalities: Lejweleputswa, Mangaung, and Thabo Mofutsanyana.

The surveys also found that waiting times in several districts have increased due to staff shortages. A fifth of healthcare users said that waiting times were longer than usual. This was particularly bad in the Mangaung district (with 72% saying waiting times were longer), Buffalo City (34%), and King Cetshwayo in KwaZulu-Natal. About 35% of people said it took longer to collect ARVs since February.

The report also found that disorganised filing systems frequently caused delays and increased waiting times.

Staff reported that HIV testing has been hit. 20% of surveyed staff said that following PEPFAR cuts, there were fewer staff to provide HIV testing or not enough test kits were available.

Ritshidze said with less HIV testing, it becomes harder to identify people with HIV who need to start or restart treatment. There are about 1.1 million people with HIV who are not receiving treatment, according to the health department.

TAC and Ritshidze have recommended that people be given a six-month supply of ARVs in all provinces. Currently patients get a one- or three-month supply.

Health department spokesperson Foster Mohale had not responded to a request for comment by the time of publication.

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