In this open letter to Minister of Health Dr Joe Phaahla, TB activists call for the disease to be made a political priority and demand multisectoral departmental accountability. They outline six demands for implementation by the end of this year. The letter was submitted on the final day of the South African TB Conference being held this week in Durban.
Dear Honourable Minister Dr Joe Phaahla,
TB is the leading cause of death from an infectious disease in South Africa and we have noted that only 4 out of around 70 political parties contesting in the national elections have mentioned TB as an important health priority that needs to be addressed in their manifestos.
The elections outcome indicates a seismic shift that says one thing about the South African voters. They said to ALL political parties #Sikhathele about you taking us for a ride. We are tired of empty promises that keep the poor majority as beggars for services, including lack of political will to end TB.
As a Minister of Health supported by the Director-General and all staff in the Department of Health and its entities, your tenure must be remembered for your leadership to turn the health fortunes of South Africans around.
We applaud you for driving the National Health Insurance Bill to be adopted as an Act of Parliament. However, if the fight against TB to make South Africa a TB Free Society is not realised, your efforts will be forgotten because you would have failed because TB, as is the case at the moment, remains a public health threat that kills more than 50 000 people in South Africa annually. Yet TB is a curable disease.
#Sikhathele to be preaching the same things to you Minister and your officials and nothing is being done to demonstrate action that recognises that we have an emergency on our hands.
As TB advocates and champions, we know that more is needed than improved TB programme outcomes, because there are organisational and institutional barriers to health equity at a macro level. TB is not only the responsibility of the health department, it is in the realm of those who have the political decision-making power. With an estimated 280 000 new infections each year and 54 000 deaths, TB remains a significant public health threat. Policies that improve the social determinants of health must be implemented.
We call on the South African government, to make TB a political priority, and a multisectoral departmental responsibility. We don't want favours for us as civil society, we want mutual respect and meaningful engagement. The Constitution affords everyone equal rights, and access to healthcare. Our advocacy is to ensure that this Constitutional obligation can be realised. We highlight that the National Health Act states that "the right to health is not fully realisable without other constitutional rights being realised".
As a TB advocacy collective, we have the following key asks for implementation by 1 December 2024 from the Minister of Health - as the outgoing Minister, please ensure that your hand-over report for the next Minister includes the following demands that must be met:
1. Targeted universal testing for TB must be implemented in all provinces and scaled up to provide routine annual TB disease testing for people living with HIV, as well as testing of all close contacts of people with TB, and people treated for TB in the previous 2 years. Provincial plans to implement targeted universal testing for TB should be released, with clear guidance on how training will be provided to all health workers, including community health workers.
2. A national public-facing TB dashboard should publish the number of people tested for TB and the proportion testing positive per sub-group, specifically for TB contacts, with data on the number of people started on TB treatment and TB preventive therapy compared to TB targets as per the NSP on a monthly basis. Communication campaigns to raise awareness about the new eligibility criteria for TB testing must be implemented in local languages. These must include stigma reduction messages.
3. Expansion of shorter-course, safer TB medication:
Short-course treatment for drug-susceptible TB in children and drug-resistant TB must be available at every TB clinic.
Short-course TB preventive therapy as outlined in the 2023 National Guidelines on the Treatment of Tuberculosis Infection should be accessible to all people living with HIV, close TB contacts, and other high-risk groups, including people with silicosis, people who previously had TB, health workers, and prisoners in correctional facilities.
4. Each person diagnosed with TB should have access to high-quality TB counselling to strengthen treatment literacy and to help identify those in need of referral for additional psychological and social support, including nutritional support packages, in order to ensure TB patients remain in care and complete their treatment.
5. Increased civil society engagement in policy development and implementation: The Deputy Director-General: HIV and AIDS, TB, Maternal & Women's Health should schedule quarterly meetings with the SANAC Civil Society Forum TB Task Team to review progress of implementation of the National Strategic Plan for HIV, TB and STIs 2023-2028, and TB Recovery Plan, as well as review of the Global Fund project reports. The outcome of these engagements should be processed through relevant government structures, starting with SANAC Plenary so that we move from TALK TO MEANINGFUL AND LIFE CHANGING ACTION. We are tired of being taken for a ride through boardroom engagements that do not result in action. Failure to do things differently will result in us mobilising society for drastic action to see results from our talk. #Sikhathele to just be talking!
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6. Safeguard TB funding within increased District Health Services allocation: Provincial TB budgets must ensure that TB services are protected despite financial constraints, and must be shared with civil society organisations for full transparency regarding budget allocations, to monitor funding for implementing the National Strategic Plan for HIV, TB and STIs 2023-2028, and TB Recovery Plan.
We hope that the fortunes of the elections result in you coming back to your position so that we can finish with you what we have started. However, if this is not the case, make sure that you provide to the Minister who will take over from you this letter and advise him to act with greater speed than you did.
We appreciate your consideration and look forward to your response.
Respectfully submitted on behalf of, among others, South African National AIDS Council Civil Society Forum, TB proof and Show Me Your Number.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this open letter are not necessarily shared by the Spotlight editors.
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