Patients and providers experience of waiting times in a sub district in the city of Johannesburg

Abstract

Background: In South Africa, about 7,1 million people were living with HIV (PLWHIV) in 2016, of which 63% were co-infected with tuberculosis (TB). The country also has the largest antiretroviral treatment (ART) programme coverage in the world. The adoption of the World Health Organisation (WHO) Universal Test and Treat (UTT) policy resulted in increased ART initiation to 3,9 million by 2017. However, the resultant demand on Health Care Providers (HCP) services is a challenge with long queues and waiting times at the point of care. A number of interventions have been done to reduce the waiting times but little is known about how ‘waiting’ is experienced by those most immediately affected – patients and HCPs. Objectives: The study investigated patients’ and providers’ experiences of waiting times and how these experiences may impede or enable access to, and utilization of TB and ART services at health care facilities in a sub district in City of Johannesburg, Gauteng between 2008 and 2012. Methods: Both quantitative and qualitative secondary data drawn from the Researching Equity in Access to Health Care (REACH) study were analysed. Descriptive quantitative data analysis was conducted using Stata 14 while thematic content analysis was done in Microsoft Excel.

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Results and Discussion: From 13 facilities (3 ART,10 TB), quantitative data were drawn from exit interviews with 325 ART patients and 283 TB patients. Furthermore, qualitative data were collected from facility observations, and in-depth interviews (IDIs) were conducted with eight patients seeking access to treatment [ART (n=2), TB (n=1), TB/HIV (n=2) and ART/TB (n=3)]. IDIs were conducted with 17 HCP (8 ART and 9 TB). ART patients experienced unacceptably longer waiting times (1-8 hours with most patients waiting between 3-4 hours) as compared to TB patients (0-2 hours with most patients waiting between 10–29 minutes). The long waiting time in the ART services impacted negatively on the patients and HCPs and thus affected perceptions of quality of care, safety, and retention in care, resulting in poor access and utilization for patients; as well as anxiety and heavy reliance on task shifting for HCP which was inappropriate at certain times. However, some benefits of the long waiting time for the patients include peer encouragement and education on treatment compliance while in the queues. TB patients also experienced adverse effects of seeking treatment, not related to the long waiting times, but rather to the need to make frequent clinic visits which had an impact on affordability and convenience. HCPs also identified the shortage of staff as one of the major contributory factors to long waiting time. Conclusion and Recommendations: Long waiting time is of concern at ART clinics, while frequent clinic visits (often daily) tend to negatively affects TB patients’ access to care, due to affordability issues. HCPs’ and patients’ views were, however, different towards the same problem, thus, this can inform planning for interventions and policy. Efforts should be made at facility level to reduce waiting times in line with prevailing norms and standards. Health related messages could be facilitated through use of novel mass media (including the use of television). Furthermore, appropriate task shifting policy should be developed, and support for the psychological well-being of workers should be enhanced