Patients and providers experience of waiting times in a sub district in the city of Johannesburg
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Date
2019
Authors
Ratshefola (Makgabo), Mamothe Machaka Helen
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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
Description
A research report submitted in fulfilment of the requirement for the degree Masters of Public Health in Health Systems and Policy to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2019