Where challenges cannot be addressed at a clinic level, or there is resistance from clinics to fix them, we escalate the issues to duty bearers at district, provincial or even national level. The first stage is district level.

Early TB detection remains key to successful TB treatment as well as the prevention of onward transmission. Yet a key driver of excess morbidity and mortality amongst people living with HIV is that symptoms of TB are often overlooked by healthcare workers and vital TB tests are not always available at the clinic level.

Six simple interventions are at the heart of how clinics can be part of turning the tide on TB infection. By following a checklist of good practice, clinics can be safer for patients and staff. However most clinics are failing to implement enough of these measures, putting people at risk of getting TB whilst waiting at the clinic.

People who miss appointments or stop taking their treatment often report being treated badly by healthcare workers when they return to health facilities. This fear of being reprimanded discourages people from going back to the clinic to seek support and receive their treatment.

The growing crisis in many of South Africa’s clinics has reached a point where patient care is being compromised and with it deepening worry that people living with HIV are being pushed out of treatment. Allowing PLHIV to collect their medication refills outside of the clinic can improve this experience and reduce the risk of people disengaging from care.

One of the biggest challenges now facing South Africa’s HIV response is how to support many more PLHIV to engage or re-engage and then stay on treatment. One way to make it easier for PLHIV to adhere to treatment is to provide a longer supply of medicines.

To mark World AIDS Day 2020, the Ritshidze project is launching a detailed report into the state of the public healthcare system in Gauteng. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the Gauteng Department of Health and other duty bearers at a community meeting in Soweto today.

The Ritshidze project today released a new website with resource toolkits on how it uses community-led monitoring to improve the quality of HIV and TB service delivery. Ritshidze — one of the most extensive community-led clinic monitoring systems — was developed by networks of People Living with HIV in South Africa to hold government and aid agencies to account to fix our broken public healthcare system.

The first step in the Ritshidze model is to gather evidence at the clinic and in the community. Find out more about where, when and how we collect data and who is involved in the data collection efforts.