Memorandum: It’s time to declare TB a National Health Crisis!
As the TB Accountability Consortium and Treatment Action Campaign, we reignite calls for the government – through the National Department of Health — to declare the TB epidemic a national public health emergency.
As South Africa’s biggest killer, with more than 54 000 people dying annually – 31 000 of them people living with HIV – and an estimated 280 000 infected each year, TB remains a significant public health threat.
According to the 2022 World Health Organisation (WHO) TB Report, South Africa has made progress in areas within the TB care cascade. We see decrease in incidence, an increase in notifications and number of people in care but mortality rates still remain a challenge despite advances from 2015 within the interventions of the National TB Programme.
The South African Constitution enshrines the mandate to the government to take action to save lives. And it is through these political determinants that every South African has the right to health, further stipulated within the National Health Act. As a consortium of public health activists, advocates, researchers, civil society groupings working in the TB space, we argue that the government is failing in this duty and calling it to account.
The calls to address this pressing health emergency were first made in 2021 by the
Treatment Action Campaign (TAC). To date, however, no significant action has been taken.
The Consortium is a collective of organisations fighting the scourge of TB in South Africa’s public health sector. We see first-hand the challenges around TB in South Africa. While South Africa leads the way in medical innovations of TB, the implementation of South Africa’s TB response lags behind. Ahead of World TB Day, it is still alarming that people are continuing to die from a treatable and preventable disease and we urge the South African government to take immediate action and acknowledge TB as a national emergency.
Despite noble intentions and rigorous planning, there remains a critical need for implementation of the programme that will reduce TB’s hold on our communities.
In the context of a decreased fiscal space; a clear path and strategy needs to be forged in ensuring that TB is made a priority. Despite being a leading cause of death, TB funding allocations are difficult and unclear. The broader fiscal crisis suggests that key elements to the TB and HIV response like HR and service capacity are severely constrained and without specific priority, TB deaths will increase.
We also call on the state to continue engaging the US government to reauthorise the US President’s Emergency Plan for Aids Relief (Pepfar). We recognise the potential inimical effects of the current impasse, which would be felt through more needless deaths, not dollars on a spreadsheet.
According to the HST District Health Barometer 2022/2023, despite the target of 90-90-90, provincial TB performance remains suboptimal. Around 77% of patients put on treatment end up completing treatment. Through the use of this data, we can gain deeper insights in interventions yet we are particularly concerned by the lack of response of those living with TB or their comorbidities they face eg. Diabetes.
While we acknowledge the improvement in political will with the establishment of the TB Recovery Plan, we note it was supposed to be an emergency plan implemented between April 2022 and March 2023 in 12 HIV and TB high burden districts to regain lost ground caused by the COVID-19 disruptions. It would be remiss of us not to ask: What successes and achievements have been attained in these districts so far? When are we rolling out the TB Recovery Plan to the remaining 40 districts that were excluded from the plan?
As the TBAC and TAC, we have four key asks from the South African government, and particularly the Minister of Health:
1. Safeguard TB funding within increased District Health Services allocation: The government possesses powers to ringfence funding allocations including the TB Recovery Plan.
2. Enhance accountability: Government has to refocus its Constitutional obligations in progressively realising the right to health for all and for setting out frameworks that will save lives. 54 000 people living in South Africa should not be the casualties for government failing this mandate.
3. Strengthen inclusive decision making: With all the information afforded to us, government needs to improve multisectoral engagement, ensuring communities are in the rooms where decisions are made. As referenced in the 2023 TBAC State of TB Report, bi-directional decision-making is the only way in which the realisation of the National Strategic Plan for HIV/TB & STI’s 2023-2028 can be fulfilled. Let communities lead, let the data be available for communities affected.
4. Strengthen political will: The Deputy President as the Chairperson of SANAC must provide effective political leadership to ensure that our NSP is a living document and we meet our targets on HIV and TB treatment.
The urgency of the situation is undeniable, as TB continues to pose a significant threat to
public health in South Africa. The call to action is clear: it is imperative to refocus efforts, allocate necessary resources, and implement the TB Recovery Plan with renewed determination to stem the tide of TB.
With our partners, we issue a unified call to the government, imploring them to declare TB a
national health emergency. We call on everyone to join our call and help us get the
government to understand the severity of this issue.
Recognising the inextricable link between HIV and TB, we call on the State to roll out Multi-Month Dispensing across all the clinics in our country, as highlighted in the policy. Of the 8 million PLHIV, an estimated number of 6 million are on ART, while the other 2 million is not in care. We call on the Department of Health to speed up the initiation and retention of the other 2 million to ensure that we save lives.
In the trust of change only happening as a collective and in the enduring belief in the people of South Africa being afforded all human rights as the day of commemoration approaches tomorrow, we call on our government and fellow citizens to work tirelessly to ensure that TB is recognized as a national health emergency.
Signed:
TB Proof
TB HIV CARE
SANAC Civil Society Forum
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