Ritshidze, “Saving our Lives!”

Ritshidze is committed to improving the quality of HIV and TB service delivery for people living with HIV in South Africa. A major barrier to solving the problem is a lack of accountability, compounded by the fact that the people who are most motivated to demand it are not capacitated to do so. Conversely, adequately trained government officials do not receive much-needed information from the communities they serve. The solution is a mobile app called CommCare, a technology that supports community-led clinic monitoring. 

The project uses community-led clinic monitoring as an accountability tool that ensures that the National Department of Health makes the best possible use of PEPFAR funding (amounting to ZAR 10 Billion) intended for public health facilities across the 27 highest burden districts in the country. If scaled globally, it could improve real-time reporting on the readiness of fragile health facilities to provide quality care.

Over the past decade, South Africa’s HIV response has come a long way—from the dark days of AIDS denialism under then President Thabo Mbeki, to the establishment of the world’s largest treatment programme. However, this achievement only reflects half of the story. The full picture of South Africa also reveals that more than 2.7 million people living with HIV are still not on lifesaving antiretroviral treatment. Despite the implementation of the “test and treat” policy in the country in 2016, the reality is that many people living with HIV are not on treatment—either never having known their HIV status, or more worryingly having started on treatment and then stopped. Compared to other countries in the region who are on track to reach epidemic control like Malawi, Zimbabwe, and Botswana, South Africa is lagging far behind.

Using the CommCare mobile app, Ritshidze observes a five stage monitoring cycle comprising:

1. Evidence gathering: Community Monitors collect both qualitative and quantitative data from clinics and the community using standardised monitoring tools in the CommCare app. Once the surveys submitted, CommCare identifies anomalies for further verification.

2. Data Analysis: Raw data is then analysed using a reflection form. The facility report is downloaded from the dashboard and a review meeting is held to discuss the findings.

3. Solution Generation: the review meeting is used to generate and document solutions that are informed by meaningful engagements with the PLHIV Sector and the community at large. 

4. Engaging Duty Bearers: Solutions are proposed at a meeting with the facility manager and clinic committee and their commitments are documented. Further monitoring will take place to check progress.

5. Advocacy: If commitments are not met and little progress is made, Ritshidze advocates for change.

The target population is people living with HIV. At its peak, Ritshidze monitoring will take place at 400 clinics and community healthcare centres across 27 districts in 8 provinces in South Africa. The selected facilities cover nearly half of all people living with HIV on treatment in the country, with a focus on sites with large treatment cohorts and where data shows poor linkage and retention rates.

 Ritshidze is 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+).

The best way to demonstrate alignment is to quote the eligibility criteria for the Global Fund Prize viz:  Ritshidze is a  'solution that... support(s) community health workers and service users at the last mile in reporting the availability and stock-outs of essential medicines and related commodities, ensuring life-saving health products are available and accessible at health facilities (with a key focus on HIV, TB & malaria within the COVID-19 context).' To be certain, in addition to monitoring medicine shortages, Ritshidze also assesses clinic conditions, patient safety, access to information and testing for PLWHA, key populations, and youth .

The solution is implemented in several sites and has been tested by the app developers on other projects.