The health ministry is pushing for the national health budget to be ring-fenced and is looking at the establishment of South African National AIDS Council (SANAC)-type implementation bodies that function separately from the department and have oversight over all the role-players, deputy health minister Dr Molefi Sefularo revealed yesterday.

Sefularo also invited delegates at the tuberculosis meeting in Cape Town yesterday to think about how the health department could harness the expertise situated in many government-funded bodies such at the Medical Research Council, to address the health burden in South Africa.

"Might we need a separate body to oversee everybody in the area of tuberculosis," he asked.

Answering questions from the media during a break in the meeting, Sefularo said the Ukukuhlamba incident where children died after drinking contaminated tap water and receiving sub-optimal health care was an example of the "awkwardness where a subsidiary of government failed and the same department is called on to investigate the circumstances".

He said SANAC was a good example of a body that represented all the stakeholders and oversaw everybody "driving them towards a mandate to deliver".

"This has made us think that we need distinct agencies with specific authority and oversight," he said.

Sefularo said the current Standards Office which is situated in the department and responsible for among others the monitory of patient safety and quality of services was almost defunct and completely under-resourced. "We are looking towards creating an independent National Health Standards Authority," he said.

Sefularo said that by ring fencing the health budget, there was a hope that "we would among others get more money for AIDS and less AIDS for the money".

He said there had been problems created by the system of "fiscal federalism" whereby the national government determines policy and it is left up to the provinces to determine how many resources they commit to a particular programme. This has seen the TB control programme not receiving the priority it should in many provinces.

Sefularo was not prepared to commit to specific timelines, but said they wanted to see the ring-fencing happening by the next budget cycle.

Responding to a presentation by Kevin De Cock of the Centres for Disease Control in Kenya, that serious research needed to go into the model of testing everyone for HIV and treating them with high-active antiretroviral therapy on diagnosis as a means of prevention, Sefularo said he was "broadly in support".

He said health minister Dr Aaron Motsoaledi was on a fundraising drive with the goal to initiate people living with HIV onto ARVs at a much earlier cut-off than the current CD4 count of 200. Also, the ministry wanted to see HIV testing introduced as standard practice at all TB sites and TB testing at all HIV sites.

In a frank assessment of government's TB programme, Sefularo acknowledged that there had been very little progress with low treatment success rates, high default rates and death rates. He warned that the country was in danger of not meeting the Millennium Development Goals as a result of these poor outcomes.

Sefularo said he felt "anxious and concerned" upon learning that TB was the number one cause of death in eight of the nine provinces with 13 out of every 100 people in South Africa dying of the disease - and most of them in the economically active part of the population.

Under former health minister Manto Tshabalala-Msimang and her Director General Thami Mseleku, the health department resisted attempts to treat multidrug-resistant (MDR) TB patients in community settings or to integrate HIV and TB services.

Yesterday Sefularo stated unequivocally that the two services had to be integrated and that they were preparing final guidelines which rethink the current policy of hospitalizing all MDR TB patients. He said the department was looking towards Peru and Philippines with the intention of adjusting the hospitalisation policy allowing, where appropriate, for multi-drug resistant TB patients to be treated in the community.

Research has shown that many TB infections are happening in the healthcare settings - with healthcare workers and people living with HIV at high risk. "At a National Health Council meeting (provincial and national health ministers' meeting) two weeks ago we learnt to our horror that infection control has collapsed and virtually disappeared in healthcare institutions," Sefularo said.

TB Facts

SA has the highest number of confirmed MDR TB and XDR TB in Southern Africa

TB has increased almost three fold in the last 10 years

SA is among the 10 worst performing countries on TB control - worse than Mozambique with much less resources

In 2007 SA ranked 5th in terms of the number of incident cases

SA is second only to Swaziland among 15 countries with the highest TB incident rates per capita and corresponding incidence rates of HIV-positive TB cases

The current cure rates is 65% - the WHO recommended rate is 85%