Community monitoring by Ritshidze has revealed significant challenges in South African clinics following US Pepfar funding reductions, including prolonged waiting times in the Free State and acute staff shortages in Limpopo. Data collected from hundreds of facilities highlights a broader decline in basic services across multiple provinces. Provincial health departments are responding with staffing initiatives and digital upgrades.
In the aftermath of the 2025 Pepfar funding cuts, the community-led group Ritshidze, affiliated with the Treatment Action Campaign, surveyed 326 public health facilities across 16 districts in six provinces from April to June. The findings indicate a system-wide deterioration in essential services, particularly in the Free State, Limpopo, and Mpumalanga's Ehlanzeni district.
In the Free State, data from 57 facilities in Lejweleputswa, Mangaung, and Thabo Mofutsanyana districts showed 84% reporting insufficient staff, with 40% citing vacancies, 25% inadequate positions, and 10% reduced Pepfar partner involvement. Waiting times averaged 5.25 hours province-wide, reaching nearly seven hours in Mangaung, often attributed to staff shortages and inefficient filing systems. Notably, 44% of facilities described their filing as in bad condition, rising from 38% earlier in the year, with 80% in Mangaung affected. Only 9% noted fewer staff for HIV viral load tests.
Mondli Mvambi, Free State health department spokesperson, emphasized ongoing vacancy fillings and strategies like six-month medication dispensing for stable chronic patients. He highlighted digitization efforts, including a piloted electronic registration system in Dihlabeng and Lejweleputswa, and noted the report's joint preparation with the department for an action plan. The department also reported successes such as appointing 483 student nurses and registering 3.8 million patients.
Limpopo's 60 surveyed facilities in Capricorn, Mopani, and Vhembe districts revealed 80% facing staff shortages for similar reasons, with waiting times ranking fifth longest at 4.33 hours in Capricorn, where 17% of users reported worsening delays. Filing systems were strong, with only 7% in bad condition, and 4% affected for HIV testing. No response was received from the Limpopo health department.
In Mpumalanga's Ehlanzeni district, monitoring at 20 sites showed 80% staff shortages, 19 vacancies mainly in data capturers and nursing, and waiting times longer for 16% of users. Viral load result explanations dropped to 76% from 82%, raising treatment literacy concerns, while 30% had poor filing. Karabo Nkosi, Mpumalanga health spokesperson, affirmed trained HIV management staff and a service agreement with Right to Care, placing 49 nurses and 146 data capturers in Ehlanzeni, alongside the TIER.NET electronic system.