US funding cuts to health and HIV services threaten lives
Save TAC! Save Ritshidze! Save Lives
5 March 2025, Johannesburg — Today, in large part due to the activism of TAC, South Africa has 5.8 million people living with HIV on antiretroviral (ARV) treatment, the world’s largest HIV programme. TAC activists fought hard for this. Over the years, we mobilised thousands to march in the streets, we have slept outside our politicians’ offices, we won vital court battles, we have spoken relentlessly in the media, we have held sit-ins and vigils, and we have faced intimidation and arrest. Our milestones have been many and are recognised globally.
For the last decade as the ARV programme expanded a major focus of TAC has been on pushing for accountability in our clinics and hospitals. Our 280 branches spread across the country all adopted a clinic — where our nearly 10,000 members, all users of the public healthcare system, monitored and advocated for change locally. The more we monitored, the more we saw the near collapse of our public healthcare system — as well as a retention in care crisis as many people living with HIV were stopping their ARVs.
To more consistently gather evidence on the dysfunction in our clinics and how this causes people to stop going for health services — in 2018, TAC led the development of the world’s largest community-led monitoring system. Known as “Ritshidze”, for the last 7 years we have been systematically collecting data at more than 450 clinics every three months.
This is not a small-scale operation. Today in total we have surveyed nearly 350,000 public healthcare users and 200,000 people living with HIV. It is data collection that shows people’s real challenges. These data are publicly available in real time and are used to generate community-owned solutions that are fed back to facilities, district, provincial, and national health officials as well as to the PEPFAR-funded implementing partners supporting these facilities and districts.
This is not just about data gathering, but accountability to communities, where health department officials and PEPFAR-funded implementing partners must explain their plans to address the problems.
Since we began, the data shows many wins. Among these are:
- a 2.5-hour reduction in average waiting times, known to be a cause of dissatisfaction that pushes people out of care
- a 42% increase in people getting a 3-month supply of ARVs
- a 47% increase in people using pick-up points, both key ways to make ARV collection easier and quicker and help support long-term retention
Where no changes are made to the problems Ritshidze uncovers, TAC leads campaigns in order to demand improvements.
Recently, for example, TAC led a campaign to pressure poor performing district health departments to increase ARV refill length. This led to 77% more people getting a 3-month supply of ARVs in the Thabo Mofutsanyana district. A further campaign led to a public commitment by the Minister and Deputy President to roll out 6-month supply of ARVs on World AIDS Day 2024.
What is clear is that this system of community-led monitoring and advocacy at all levels is an essential tool to fix our public health system, get everyone tested and on treatment, and reduce HIV and TB deaths.
However, now the future of TAC and Ritshidze is under threat because of the executive orders made by U.S. President Trump and the subsequent suspension then termination of funding to South Africa. Ritshidze has lost our main funding source. As a result we are in the process of retrenching hundreds of staff members doing critical work to monitor facilities and hold the health department to account. We have also already seen HIV treatment services disrupted on the ground as PEPFAR supported healthcare workers were pulled out of clinics and drop-in centres and mobile services were shut down. This will greatly exacerbate the existing crisis in our health system.
“The withdrawal of PEPFAR supported NGOs from our clinics has led to the departure of 15,154 clinic staff with years of institutional knowledge. The immediate impact is of waiting times getting longer, people living with HIV going home with just 1 or 2 month’s worth of pills, and some people being turned away from clinics because they don’t have a transfer letter after the drop-in centre or mobile services they were using had shut down. The crisis in our clinics is only going to get worse, and many more people might stop treatment. It is extremely concerning, and the long-lasting impact will be of increased deaths and more HIV infections,” says Sibongile Tshabalala, TAC’s National Chairperson.
Yet instead of being able to assess the immediate impact and conduct surveys to highlight the risks in our clinics that will lead to people being turned away, or stopping treatment, the work of Ritshidze ground to a halt after being handed down a stop work order.
“The work of TAC and Ritshidze is more crucial now than ever. We should be using our established presence in communities and clinics as well as our community-led monitoring teams to monitor the existing and emerging issues, but much of our funding has been suspended,” says Anele Yawa, TAC General Secretary.
“We’ve had to take drastic measures to avoid the closure of TAC altogether, beginning retrenchment processes and redesigning our structures to dramatically scale down the size of the future organisation. We will try to merge the TAC and Ritshidze structures so that we can keep monitoring a smaller group of clinics and have the branches and teams ready to run campaigns to push for improvements. But the reality is that we don’t have enough money for this yet. Just as the situation is worsening in our clinics, our ability to monitor and expose the challenges has been cut.”
With limited resources and during our retrenchment processes TAC will continue to collect stories that expose the realities in our clinics following the U.S government funding suspension. Follow our website and social media channels as we start to publish testimonies that highlight the impact on the lives of people living with HIV and other public healthcare users.
For more information or to arrange interviews contact:
Ngqabutho Mpofu: 072 225 9675 | ngqabutho.mpofu@tac.org.za
Xabisa Qwabe: 076 850 6736 | xabisa.qwabe@tac.org.za
For more information:
