TB treatment plan slated
THE CAPE Metro Health Forum says the number of people on tuberculosis treatment could be on the increase in the province following the phasing out of treatment adherent supporters, popularly known as Dots supporters.
Dots, which stands for directly observed treatment for tuberculosis, is a World Health Organisation strategy which encourages the directly observed therapy as a means to improve the TB cure rate and prevent recurrence and drug resistant TB. The internationally recommended strategy for TB control has been implemented on a national level in South Africa for years.
Damaris Kiewiets, chairwoman of the forum, said the discontinuation of these lay health workers had not only drained the healthcare industry of crucial skills, but there could be more defaulters and subsequent TB-related incidents.
Mark van der Heever, spokesman for the department, said it had opted for an integrated strategy, which also used antiretroviral adherence support. The strategy focused on client empowerment and treatment literacy rather than direct observation of swallowing of pills, as suggested in the Dots model.
But Kiewiets said the new strategy did not work because workers were now required to look at every ill member of the family instead of only TB patients. “The requirement of doing assessments for the entire household has shifted the focus of these workers. In most cases they end up missing TB cases or not paying enough attention to TB as they come across other health challenges…
Kiewiets, who described this year’s commemoration of World TB Day as the saddest day in the Western Cape, said although the department wanted to paint a “good picture” as a caring department that built healthy communities, the communities had no say in health matters.
“During her budget vote this week our health MEC (Nomafrench Mbombo) said it would be her priority to foster sustainable relationships with communities and encourage active citizenry. How are they going to foster those relationships if they take away the people that help the very communities. They not only robbed those Dots supporters of their daily bread, but our communities are suffering and dying from a disease that could have been controlled better, using proven strategies. To us that’s like hypocrisy.”
This week Mbombo said part of her mission as the head of health in the province was to strengthen the community health worker programme. “Currently we have more than 2 000 community health workers which we intend to expand. A key part of improving quality is also amplifying the voice of the patient and the community.”
Van der Heever said the switching of Dots supporters into adherence community care workers was done based on needs assessment. Following an audit by the department, there was a need to have a structured integrated programme, and volunteers who met recruitment criteria of Grade 10 were taken into the new programme. The province has about 700 of these health-care workers.
Van der Heever denied the claim that there was an increase in the number of defaulters, saying “both TB defaulter rate has improved in the metro and so has the TB cure rate”. The incidence of drug-sensitive TB was about 629 new cases per 100 000 people last year and the department had successfully treated 87 percent of TB cases.
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