(Johannesburg) The theme of this year’s World AIDS Day is “Communities make the difference”, an idea that underpins a new model of community-led clinic monitoring in South Africa. “Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold both the South African government and international donors like PEPFAR accountable, to improve overall HIV and TB service delivery.
“Ritshidze has been developed and designed in response to the crisis in public clinics. It gives communities the tools and techniques to monitor the quality of HIV, TB and other health services provided at clinics and escalate performance problems to relevant decision makers in order to advocate for change,” said Lotti Rutter, from the Health Global Access Project (Health GAP). “This type of community-led clinic monitoring is an indispensable strategy for improving the health services that people living with HIV receive.”
South Africa has both the world’s largest HIV epidemic and largest HIV antiretroviral treatment (ART) programme. There are currently 4.8 million people living with HIV on antiretroviral therapy. However, 2.9 million people are still in need of treatment, and the country is currently off-track in terms of meeting the UNAIDS 90-90-90 targets. Among other challenges, the rate of new HIV infection (particularly among young people) is far too high, and about one in three people who start treatment are lost to the health system after 12 months. This reality is being fueled by multiple, systemic failures in the health system.
“Through our community monitors and the existing branches of PLHIV led organisations Ritshidze will monitor more than 400 high HIV burden clinics across the country. People living with HIV need the public health system to work, so they are the first to notice when it doesn’t. Ritshidze empowers communities to monitor the health services they receive and to advocate for the changes needed,” said Sello Mokhalipi from Positive Action Campaign.
Community-led monitoring is a system of community-developed and community-owned data collection and monitoring at the site of service delivery, followed by development and implementation of advocacy solutions to respond to the evidence generated. Through the Ritshidze Project, communities will carry out observational surveys, and talk to healthcare workers, patients, and people living with HIV. The evidence they collect will be used to advocate for changes with decision makers such as the Department of Health and the PEPFAR.
“Already we are generating evidence that points to serious challenges. People wait for hours to be seen, only to be sent home empty handed or without all the medicines they need. In many cases the nurses and doctors are overworked and under-resourced. People living with HIV are often shouted at for missing appointments or sent to the back of the queue. In some cases, the status of people with HIV has been disclosed without consent. Buildings are falling apart and equipment is missing. Poor infection control means people can get TB at the clinic. And the clinic committees people rely on to solve these problems either do not exist or do not know what to do. The reality is that the healthcare system is broken and clinics are in crisis,” said Sibongile Tshabalala, from the Treatment Action Campaign (TAC).
The Ritshidze Project is being implemented by organisations representing people living with HIV—including the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law. The project has received support from UNAIDS and PEPFAR.
On Friday 29 November 2019, the newly appointed UNAIDS Executive Director, Winnie Byanyima, accompanied the Ritshidze team to a clinic monitoring visit and a community meeting in the township of Soshanguve. Members of the community shared their experiences of accessing HIV and other health services.
After monitoring Block X Clinic in Soshanguve, engaging with the Ritshidze Project team and talking to community members, Ms. Byanyima said: “It is communities who know what they need. It is communities who must tell those who pay for services what they want. Everywhere I go I see communities treated as though they should be grateful, not as people with rights. But I see you saying these are our rights. I thank the people of TAC and Health GAP who have put this project out here. This is just the beginning.”