Community Led Monitoring began as a simple idea. If people who use drugs could document their own experiences of health and harm reduction services, then the gaps in the system would finally become visible. What followed over two years was a journey that reshaped how information is gathered, how advocacy is done, and how communities and services speak to one another.
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The early months focused on laying the foundation. SANPUD led the induction and training of community monitors, while Tsohang prepared for implementation on the ground. The first pilot in Ekurhuleni revealed important truths. Survey tools were too long and not always easy for community members to engage with. Many people had limited knowledge of opioid substitution therapy and hepatitis. Referral systems were unclear. Harm reduction services were present in some districts but not in others. Weekly reflection meetings were introduced from the start and became a central part of the model. They allowed challenges to surface quickly and created a rhythm of continuous adjustment.
As the work progressed, the focus naturally shifted. Data patterns began to show where the pressure points were. This opened the door to advocacy and education. Hepatitis awareness sessions were held in hotspot areas. Opioid substitution therapy education created space for honest conversations about treatment and stigma. Human rights discussions helped people understand their right to healthcare and dignity. These sessions were deliberately focused. Each theme was given its own space so that communities were not overwhelmed with information. Participation grew as a result.
Referrals increased during this period. The demand for opioid substitution therapy became especially clear. Many people requested referral but found that centres were full or operating at capacity. This was one of the first signs that Community Led Monitoring was revealing structural issues that required more than local solutions.
By early 2024 the work entered a new phase. The focus shifted from collecting data to strengthening the systems behind it. One of the most significant developments was the creation of an internal referral tracking tool. It recorded who was referred, where they were referred, whether they accessed the service and why referrals sometimes failed. This changed the nature of the work. It was no longer about counting referrals. It became about understanding what happened after the referral was made. Follow up became a core part of the model because it built trust and exposed gaps that would otherwise remain hidden.
Relationships with stakeholders deepened during this time. Sensitisation sessions were held with service providers. Engagement with Civil Society Forums and Technical Working Groups ensured that community voices were present in broader discussions. The model grew into an ecosystem that included data collection, referral systems, advocacy campaigns and capacity building.
Across districts the data showed consistent patterns. Harm reduction coverage was limited. Demand for opioid substitution therapy was high. Transport costs made access difficult. Stigma in healthcare settings discouraged people from seeking care. Knowledge gaps were common. These were not isolated incidents. They were structural challenges that required sustained advocacy.
The partnership between SANPUD and Tsohang grew through mentorship. Tools were adapted. Reporting structures were strengthened. Referral systems became more formal. Advocacy planning matured. Tsohang now steps into full leadership with practical experience and strong community relationships.
Community Led Monitoring has shown that when people who use drugs document their own realities, services improve and conversations shift. The next phase continues this work with a strong foundation and a clear sense of purpose. Readers can explore the full report for a deeper understanding of the journey and the lessons that will guide the work ahead.