SPF Project


Funded by: International Budget Partnership

Programme Manager: Khuzwayo August

Sector: Health

For more than two and half years, SPF has supported rural and informal settlement communities in Buffalo City to engage and advocate 10 clinics for improved primary healthcare services. The impact of this work is clear in the Asivikelane results. Most residents say that the healthcare service and medicine they needed were available to them at their last clinic visit.


But inefficiencies at clinics are also apparent, with residents subject to long waits, often more than two hours. The results from Asivikelane Health serve to strengthen the advocacy efforts of communities and SPF as we continue to work closely with clinics to address service delivery challenges.

The second Asivikelane Health release highlighted the enormous daily load being carried by clinics, with some reported a patient-to-nurse ratio as high as 80:1. The shortage of human resources is placing a strain on clinics and residents are feeling the effects. 35% of residents reported waiting longer than two hours to be assisted and in 5 out of 10 clinics residents said the clinic did not open on time. 21% of residents said the clinic did not provide any information on COVID-19 prevention or vaccinations. It is clear that more needs to be done to protect communities against this virus. 

We continue to work closely with clinics to address operational issues and promote the use of community healthcare workers to supplement capacity at clinics. 

In the third release of Asivikelane Health we are pleased to report that our advocacy efforts since the start of this campaign are influencing the quality of service at clinics. Between June and August, the percentage of residents that waited longer than two hours to be assisted has nearly halved from 40% to 22%.  

We engage each clinic about the Asivikelane Health results every month and they’ve responded constructively to the feedback from communities. For example, clinics have posted expected wait times on their noticeboards to improve communication with patients. Where medication was unavailable to residents on the day of their visit, clinics found a way to deliver medicine to them following day. 

But some clinics continue to struggle, and COVID-19 has placed strain on already ailing primary healthcare system. The need for improvement remains significant. We plan to expand Asivikelane Health to cover more clinics and districts in the coming months in the hope that we can enable more residents to effect change in their communities through this campaign.

In the fourth round, we expanded Asivikelane Health from 10 to 25 clinics by adding additional clinics from across Buffalo City and the OR Tambo district in the Eastern Cape. The major improvements in waiting times at the 10 clinics previously reported on have been sustained, with 96% of these residents reporting that they spent less than 3 hours at the clinic. However, waiting times in the 15 new clinics are particularly poor, with 67% of residents in the OR Tambo district waiting more than 2 hours to be assisted, while 58% spent more than 3 hours at the clinic in total. Some patients told us that they even forgo clinic visits and treatment because of the long wait.

Extensive waiting times come at a significant cost to residents, most of whom live in rural and impoverished conditions. They travel long distances to clinics and the prolonged wait steals time out of their day; time which could have been spent seeking work to meet their family’s needs. Residents also risk being exposed to other infections while waiting. Women and children face a specific safety risk because public transport is limited in rural areas and travelling after hours is unsafe.

Reasons for long waiting times include the lack of medicine dispensing staff, poor patient file management, nurses taking long breaks and clinics not opening on time. There are several low or no cost ways that clinics could address these problems, such as

1.       Pre-packaging of medications for chronic patients,

2.       Efficient patient file management and

3.       Appointment booking system to reduce congestion at clinics.

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