Over the past decade, South Africa’s HIV response has come a long way — from the dark days of AIDS denialism under then President Thabo Mbeki, to the establishment of the world’s largest treatment programme. However, this achievement only reflects half of the story. The full picture of South Africa also reveals that more than 2.7 million people living with HIV are still not on lifesaving HIV treatment – either never having known their HIV status, never started treatment, or more worryingly having started on treatment and then stopped. This can be directly linked back to the crisis in our clinics.
In response to this crisis, in 2019, TAC led the establishment of Ritshidze – that is now the largest community-led monitoring system in the world. Ritshidze gives communities the tools and techniques to monitor the quality of health services provided at clinics. At its peak, Ritshidze was gathering evidence at more than 550 clinics across eight provinces in the country. Ritshidze gives us the data to back up the stories we all know about. It is led by those of us whose lives and health depends on public clinics and hospitals – with an aim to improve overall health service delivery, including HIV and TB services, and services for members of key populations.
“We are not making a flippant statement or trying to cry wolf, but we have a crisis in our health system which will have a devastating impact if not addressed. Recognising this crisis, together with other organisations representing people living with HIV, we started “Ritshidze” to monitor the quality of public health services in our highest HIV-burden clinics and advocate together for the changes needed. Together, we will play our part in bringing to light the reasons so many people are falling out of HIV treatment in the country and why so many in our communities never enter care in the first place”
Interviews and surveys are conducted with public healthcare users, people living with HIV, people who use drugs, sex workers, and the LGBTQIA+ community, as well as with facility staff like facility managers and pharmacists. The issues tracked range from waiting times, staff shortages, and infrastructure, to the friendliness of staff and denial of care, to how easy it is to collect ARVs and how well staff explain viral load test results.
This maturing programme, that uses systematic collection of data at clinic level, is an important tool to identify problems as people in our communities experience them. With the data we can better analyse problems, identify trends and patterns, and from this, be able to push for appropriate solutions. It gives us vital information and insights that guide our advocacy.
Along with the collection of quantitative data, Ritshidze collects people’s stories, and records these as audio-visual and written accounts. Recording our community members’ stories means they stand as first-hand accounts and are also an important way to give people an opportunity to be heard.
Ritshidze places a strong emphasis on engaging duty bearers, bringing this information to the attention of those in power, and holding them accountable for acting on it. After each round of monitoring, the teams feedback to facility staff and health department officials at district, provincial, and national levels, as well as PEPFAR agencies and district support partners.
Community accountability meetings are also held that provide space for the community to address government officials. This is an opportunity for communities to talk directly to those in power, telling their personal stories of the challenges they face. There is no room for duty bearers to deny that changes are needed. This is not just data, but accountability to communities.
Find out more: www.ritshidze.org.za
