Ritshidze, the world’s largest community-led monitoring system, is in jeopardy following the cuts to U.S development aid announced in January. 

Established in 2019, Ritshidze monitored service delivery and the availability of essential medicines at over 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,” says Anele Yawa, the general secretary of the Treatment Action Campaign (TAC), which developed and implements Ritshidze. 

He explains that 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, says community-led monitoring helps to strengthen the health system. It enables 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 how much health services people need. It also builds really important bridges and communication pathways and trust, between communities, people using the services, facilities and the programme,” says Rees. 

Community-led monitoring identifies local problems early, while also acting as a warning system for the Department of Health, she explains. 

“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. 

“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 tells 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,” says Yawa.

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, they had to take drastic measures. This included retrenchments and redesigning their structures to scale down the size of the organisation.

Yawa says they merged the TAC and Ritshidze structures so that 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 says. – Health-e News