The efficacy of community-led monitoring: successes, lessons learnt and opportunities for improvement from the Zimbabwean context

Abstract

Community-led monitoring (CLM) is vital in the global HIV response as it enables community participation and evidence-based advocacy for improved health service delivery. CLM is “an accountability mechanism for HIV responses at different levels, led and implemented by community-led organizations of people living with HIV (PLHIV), networks of key populations (KP), other affected groups” [1]. It is a form of social accountability, where citizens hold duty bearers accountable for the services they provide. Evidence highlights its effectiveness in bridging gaps between healthcare providers and communities, addressing systemic inequities and strengthening accountability [2]. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) supported CLM coordinated by Family AIDS Caring Trust (FACT) commenced in 2021, driving community-led action to improve services at 246 health facilities in 21 districts of Zimbabwe. It was initiated by civil society organizations in collaboration with PLHIV and KP communities, who determined its scope and priorities. Districts were consultatively selected with consideration of epidemiological burden and CLM coverage. CLM targets PLHIV, adolescent girls and young women and KP, including sex workers, men who have sex with men and sexual minorities. It involves 718 community health monitors (CHMs) selected by communities based on representation and levels of their literacy and commitment. CHMs utilize Kobo Collect surveys and community score cards to monitor availability, accessibility, acceptability, appropriateness and quality of HIV-health services. Data are collected and synchronized from various tools, drawing insights that are disseminated and actioned on a quarterly basis at the facility and district levels.