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Evaluation of Ritshidze community-led monitoring programme in South Africa

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BACKGROUND: Community-led monitoring (CLM), where civil society collects data on services for people living with HIV to advocate for improved services, is an emerging and powerful approach to improving quality healthcare. In 2019, the Ritshidze CLM programme was launched in South Africa to monitor HIV, TB and other health service delivery to advocate for improved primary healthcare services for all people in the country. We compared CLM measures of service delivery after year 1 and year 2 of the programme to determine Ritshidze''s impact.
METHODS: Between July 2019 and September 2021, data were collected from 427 public health facilities in 30 health districts. Survey data taken from observation, patient and facility managers were gathered electronically by community monitors using the CommCare application. Priority indicators were analyzed, focusing on seven metrics: antiretroviral therapy (ART) collection and access; HIV treatment; tuberculosis; facility staff and attitudes; access to prevention, care, and support; infrastructure; and COVID-19 disruption. Longitudinal trends were calculated by the average of the quarter-by-quarter percentage change in each metric between October to December 2020 and the same period in 2021.
RESULTS:
Between quarter 4 (July to September) 2020 and quarter 4 2021, large changes in several indicators were observed. The largest changes were in access to PrEP (9.2% average quarter-to-quarter increase) and GeneXpert testing (5.4%), treatment literacy on viral load (6.5%), healthcare workers asking about gender-based violence (5.1%), and information on GBV services (5.1%) (Figure 1). In this same time period, the percent of clinics reporting any COVID-19 disruption decreased an average of 5.2% each quarter.
CONCLUSIONS: Results from the Ritshidze CLM programme show early promise and suggest that CLM's can positively contribute to improving the quality, accessibility, and acceptability of HIV, TB and other health services.