World TB Day: defeating a silent deadly enemy
Everyone must be responsible for ridding country of this scourge
ON THE eve of World TB Day on Saturday, we need to ask why South Africa has not yet come to grips with tuberculosis and what we can do to eliminate a disease that has for too long destroyed lives, families and communities. A few years ago while doing fieldwork in clinics across South Africa, I asked groups of healthcare workers about the big issues that concerned them. I heard many interesting responses, but one that recurred was Ebola. TB was never mentioned. I was surprised and shocked.
Why, I wanted to know, was Ebola the biggest worry for community health-care workers.
“Because,” I was told repeatedly, “if Ebola gets here, we will all die.”
Today, I revisit this memory. South Africa has the highest TB incidence in the world. It has been so for a long time. And so it remains.
While diseases like listeriosis and Ebola grab headlines and instil fear in millions, TB remains a silent, lurking killer that receives scant media attention.
Yet on any given day, more South Africans die of TB than have so far died in total of the more sensational listeriosis. One can count on the fingers of one hand the number of South Africans who have succumbed to Ebola.
This is a sobering thought as South Africa marks the World Health Organisation’s World TB Day.
TB continues to place a significant social and economic burden on communities across the country. It cuts a lethal swathe through poor communities, killing about 270 people every day. This is equivalent to a Boeing 737 crashing in South Africa every day, killing everyone on board.
TB deaths do more than destroy families and weaken the fabric of communities. They directly impact the national economy, taking a toll on a health-care system that’s fragile at best, on mining, construction and the larger labour force. And this by a disease that’s fully curable if diagnosis and treatment protocols are followed.
Nearly 9% of all deaths in South Africa are from TB and more than 400 000 South Africans catch it every year. But only an estimated 53% of people with TB come through treatment successfully. This is in spite of effective diagnostics and drugs freely available to treat the disease. Why?
It comes down, mainly, to implementation failures in the TB care continuum. About a third of South Africans with the disease are either missed at diagnosis or are diagnosed but never start treatment. This results in around 150 000 untreated individuals. Additionally, a quarter of those who start treatment don’t complete it due to a combination of patient-, health system- and medication-related challenges.
Now, 2018 is a year of change for South Africa. Changes at the very apex of decision-making have imbued the nation with a feeling of fresh optimism and a can-do attitude. The nation’s new leadership has pledged itself to accountability. It’s time to hold ourselves accountable for TB and to hold those who we have charged with addressing it accountable and end it. All leaders, politicians, health managers, civil society and the broader community are accountable for writing tuberculosis into the history books.
Accountability extends to ensuring adequate funding, not just on a historic basis, but also for innovative approaches to ending TB. It includes accountability for quality health services and sanctions where these fail. Civil society and communities are responsible for supporting those with TB and for both demanding the services required and access to them.
The government and its many partners are significantly invested in addressing this scourge.
The government supplies both the drugs and health-care workers on the ground to test people for TB, administer drugs and aid patients through their treatment to recovery.
Total national investment in fighting TB in South Africa is more than R4 billion a year. Admirably, 90% of that investment comes from the state and its taxpayers, higher than in similar countries. Strong and effective policies and protocols are in place. South Africa is known as an early adopter of new technologies and continues to offer patients access to the best diagnostics and drugs available worldwide.
We are fortunate to have several vocal advocates for the fight against TB in South Africa.
The most prominent of these is Minister Aaron Motsaoledi, who has brought TB from the shadows into the global spotlight. Part of this effort has culminated in the first UN High Level Meeting on TB, bringing the problem of the disease to the attention of heads of states around the world. South Africa, as India demonstrated last week, can use this political moment to galvanise a “whole society response” to deliver on ambitious targets.
The theme of World TB Day 2018 is Unite to End TB. For South Africans, unity and partnership are potent weapons in this war. We must take the big issues by the horns, ask difficult questions and demand accountability from each of those involved in creating a TB-free South Africa. For this is a life and death matter for the nation. We must stand up – and stand united – for 400 000 South Africans who get TB every year.
WHILE DISEASES LIKE LISTERIOSIS AND EBOLA GRAB HEADLINES AND INSTIL FEAR IN MILLIONS, TB REMAINS A LURKING KILLER THAT RECEIVES SCANT ATTENTION