Ritshidze, the world’s largest community-led monitoring system, is in jeopardy after the cuts to US development aid announced in January, writes Chris Gilili for Health-e News.
Established in 2019, Ritshidze monitored service delivery and the availability of essential medicines at more than 450 clinics in 25 health districts across eight provinces in the country – every quarter.
Its purpose is to document, report and escalate service delivery issues at primary health facilities. The findings are published in reports that are publicly available.
But now, the entire system is at risk.
“We had to retrench more than a hundred people and are left with a quarter of the community monitors to do the work,” said Anele Yawa, general secretary of the Treatment Action Campaign (TAC), which developed and implements Ritshidze.
He said the USAID cuts immediately shrank their footprint to just 16 priority districts with high HIV prevalence. Beyond the devastating impact of job losses, the constriction of Ritshidze’s reach has wider implications for the health system.
The role of community-led monitoring
Dr Kate Rees, public health specialist at Anova Health Institute, said community-led monitoring helps to strengthen the health system, enabling people to monitor the provision of health services from the perspective of those who receive and use them.
“It’s a way of looking at how responsive health services are and what services people need. It also builds really important bridges and communication pathways and trust, between communities, people using the services, facilities and the programme,” she said.
Community-led monitoring identifies local problems early, while also acting as a warning system for the Department of Health, she added.
“For example, if something worrying is happening at facility level or more widely, it helps to hold the department accountable by providing evidence on how communities are experiencing health services.”
Impact of cuts on monitoring
Despite these challenges, Ritshidze was able to produce a report on the impact of the funding cuts on health services (and as reported in MedicalBrief on 22 October).
“We pushed ahead on a shoestring budget, building a new same-day exit survey tool to capture challenges in real-time, keeping our community monitors in the field to ensure that the voices of people using the public health system were not lost,” Yawa told Health-e News.
Previously, Ritshidze would work on a three-monthly cycle – gathering evidence at the facility, analysing the data, generating solutions and engaging the community monitors during their feedback meetings. However, since the funding cuts, this has become a six-month cycle because the workload has doubled.
“We couldn’t hold the usual sub-district and district feedback meetings that have always been our most effective way to get things changing for people who rely on these services,” Yawa said.
These meetings include Ritshidze facilitating feedback to the clinics where they do their monitoring work.
A need for greater funding
To avoid shutting down Ritshidze altogether, the organisation had to take drastic measures. This included retrenchments and redesigning structures to scale down the size of the organisation.
Yawa said they merged the TAC and Ritshidze structures so they could 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 sustainably and continue to expose the challenges has been cut,” he said.
See more from MedicalBrief archives:
Dramatic drop in condom distribution raises HIV concern
Queues, shoddy service plague Free State healthcare – Ritshidze report
Survey confirms difficulties of SA’s key populations in accessing healthcare
Report shows deteriorating conditions at Free State clinics
KZN leads in some health services, lags in others – Ritshidze repor