Between August and November 2016, field workers met people with HIV at five public clinics in South Africa’s North West Province. All of them had been treated a few months earlier in the district’s main hospital. The researchers wanted to see a clinic visit the way a patient lives it, so the field workers stayed with each person through the whole visit and wrote down when every wait and every service began and ended. They mapped 15 visits this way.
The typical visit took 3.3 hours inside the clinic, plus an hour of travel there and back. Of those 3.3 hours, 2.9 were spent in queues, and there were typically five separate queues to get through, from registration to the nurse or doctor to the pharmacy. The time actually spent with clinic staff, counting even fetching the file and booking the next visit, came to a median of 25 minutes. In a quarter of the visits, people spent more than five hours at the clinic.
The field workers also wrote down what went wrong. Three people had to queue for the nurse or doctor a second time, because when they reached the pharmacy their file was missing prescription information. One woman was told to come back the next day for her medicines. She had been at the clinic the day before too, so she made three visits on three consecutive days. Two people referred to specialists were turned away because the referral note didn’t say enough. One participant on crutches struggled to keep standing in line; another, short of breath, struggled to walk from one queue to the next.
“You find yourself arriving at the clinic around 05H45 or 06H45,” a 48-year-old man told the researchers, “but you only finish late around 16H00 or 15H00.” On the day the field worker timed his visit, part of his long wait came because his name was mispronounced when he was first called, so he didn’t know it was his turn.
The direct cost of a typical visit came to about 1.8% of a household’s monthly income in the district, and after 12 of the 15 visits the next appointment was less than four weeks away. The researchers judged that many of the delays “appear to be correctable.” A woman who used a wheelchair described what waiting was like: “You might tell someone that you have been waiting for long and they shout at you, so I don’t want to be shouted.”