Address by Deputy President and Chairperson of SANAC Kgalema Motlanthe at the World TB Day 2014, Kokosi Township, Carletonville
Programme Director;
The Minister of Health, Dr Aaron Motsoaledi:
MECs of Health;
Deputy Chairperson of SANAC, Ms Steve Letsike;
Ladies and gentlemen:
We are assembled here in Kokosi Township to commemorate World TB Day, as it is being done all over the world today.
Maybe, our commemoration is unique this time around, because it happens as we prepare to exercise one of the most fundamental rights found in modern democracies such as ours: the right to vote.
South Africans will once again exercise this right on the 7th of May and elect a government of their choice, continuing with the tradition started 20 years ago on the advent of the first democratic elections.
The principles of our democracy are enshrined in our Constitution, which among other things enjoins Government to provide good quality health care to all citizens, thereby ensuring that citizens live healthy long lives, even in the face of epidemics such as those caused by TB and HIV.
Although it has long been acknowledged that the huge burden of disease due to TB infection is the leading cause of death in our country, the latest report by Statistics SA shows that we are beginning to make progress in this regard. For instance, it reveals that TB related deaths have declined by 2%, which, small as it may appear, is an encouraging advance progress on which we must build going forward.
We understand the symbiotic relationship between HIV and TB, demonstrated by the high TB and HIV co-infection rates that, although slightly declining, remain high at about 65%.
Government has upped the ante on its response to the epidemic and this is encapsulated in the five year National Strategic Plan for HIV and TB launched by President Zuma in 2011.
The plan is unique in many ways, including for the first time providing a single strategic response to the twin epidemics of TB and HIV.
The plan has an ambitious vision of ensuring "zero infections, death, zero stigma and zero discrimination” from TB and HIV by 2032. This has galvanised the entire world to rally for a similar end goal.
We have, over the past three years, been laying out carefully designed strategic interventions aimed at turning the tide against TB. In 2011, we intensified efforts to find people infected with TB, quickly, and ensured that they are initiated on TB treatment. Active case finding, rapid diagnosis and immediate initiation of treatment renders newly diagnosed patients non-infectious in a matter of days. Consequently, the pool of infectious people in the community decreases thus improving our chances of successful treatment.
Ladies and gentlemen;
We unveiled an ambitious roll-out of the GeneXpert technology, which enables diagnosis of TB infection within 2 hours, unlike previous methods which took a long time to yield results. We are glad to announce that, as of October 2013, every South African has access to GeneXpert. Our GeneXpert roll-out continues to account for more than 50% of current global GeneXpert tests in the world.
In 2012, we commenced interventions that targeted "populations” at high risk of TB infection. We were here in Carletonville, to highlight mineworkers as one such group with an elevated risk of TB infection.
You will recall that we impressed upon the mining industry to recognise that mines are not islands. They are part of communities. The industry should therefore work together with neighbouring communities to combat socio-economic challenges and ill-health, including those caused by diseases such as TB and HIV.
In 2013, we continued with the focus on populations at high risk of TB, by going to Correctional Services facilities. We were concerned by the high TB infection levels among inmates, which can be more than 400 times than those found in the general population.
We have started a process to make GeneXpert technology available in these centres, and developed guidelines on the management of TB and HIV. All inmates will be screened for TB on admission and exit from Correctional Services facilities, and those with TB signs will be tested, again, using GeneXpert.
This year we are continuing with the focus on high risk populations by targeting communities that are in close proximity to mines, hence our presence here in Kokosi. These communities, often referred to as "peri-mining” communities, which are generally informal in nature, constitute another "hotspot” for TB.
As we focus on peri-mining communities' we will consolidate interventions that we have been implementing since 2011 into a comprehensive response against the TB epidemic, scaling up the response for wider impact.
We have managed to secure substantial resources from the Global Fund to expand our programmes. We were awarded a grant of about US$54 million, equivalent to more than a billion South African Rand. The resources will enable us to scale up our response in three critical areas of concern.
These are:
1. Decentralisation of Multi Drug Resistant-TB initiation and management of treatment: We will improve access for underserved Multi Drug Resistant-TB patients by decentralising treatment initiation in the country from 31 to all 52 districts and increase treatment service points from under 100 to 2,500 sites, through the existing Primary Health Care ward based teams. This will happen through a rapid establishment and scale up of nurse-led Multi Drug Resistant-TB treatment management teams at ward level as proposed by the National Strategic Plan (NSP).
2. Increased TB/HIV case finding within Correctional Service Facilities: All of the 242 Correctional facilities will be capacitated to provide regular TB and HIV screening and treatment covering all inmates within the Correctional Service centers (about 150,000) as per guidelines for the management of TB and HIV in Correctional Service facilities.
X-ray and TB data-management capacity will also be strengthened. Infection control interventions will include training of focal persons and risk assessments from which plans will be developed to be implemented by government. We will expand TB and HIV awareness efforts in Correctional Service facilities, using the Kick TB and HIV approach in order to generate demand by inmates for services.
3. Strengthened TB control in the mining sector: We will increase TB/HIV case finding within targeted and vulnerable peri-mining communities (such as Kokosi Township) in 6 districts with a high concentration of mining. Tailored same-day TB/HIV screening and diagnostic services using mobile units with evening and weekend opening hours will be provided. Confirmed cases will be linked to care.
We will strengthen TB and HIV awareness efforts in these 6 targeted districts, using the Kick TB and HIV approach to generate demand. Also, the Medical Board for Occupational Diseases (MBOD) will support the Department of Mineral Resources and other statutory agencies to monitor compliance to applicable laws and regulations in the mining industry, including the requirement for regular screening for TB and HIV and access to treatment for more than 500,000 mine and contract workers in the country.
Programme Director;
As indicated previously, mineworkers are at particularly high risk of contracting TB because of a convergence of occupational and lifestyle-related risk factors.
These include the high prevalence of silicosis resulting from prolonged exposure to silica dust in mine shafts; accommodation in overcrowded hostels; circular migration between home communities and mine locations; mining-related occupational hazards; high levels of HIV infection and poor access to or usage of routine health services, particularly among contract workers.
The mining industry in South Africa is heavily dependent on labour migrants from rural areas and surrounding countries, with up to 40 percent of workers migrating annually between South African mines and Lesotho, Swaziland and Mozambique. The frequent migratory movement of mineworkers, across provincial and national borders, extends the high risk of contracting TB and Multi Drug Resistant-TB to communities surrounding mines and to the communities from which the workers originate and to which they return.
This pattern of movement constitutes the most significant challenge in planning effective health services provision and ensuring adherence to treatment. Thus, a coordinated regional approach involving key stakeholders, especially in Lesotho, Mozambique, South Africa and Swaziland, is critical to containing the spread of the epidemic in the sub-region.
To this end, Heads of State of the Southern African Development Community (SADC) signed a Declaration on TB in the Mining Sector in August 2012, recognising the particular vulnerability of miners to HIV/TB as a result of their occupation and lifestyles.
The Declaration noted a number of challenges experienced by current and ex-mineworkers, their families, as well as communities affected by migration, which need to be urgently addressed.
These include:
- Non-harmonised treatment regimens;
- Absence of effective cross-border medical referral systems;
- Absence of an effective recording and reporting (M&E) system that will ensure follow up and monitoring of TB infected miners across the SADC region;
- Inadequate or absence of mechanisms for financial compensation of mineworkers and ex-mineworkers with TB, silicosis and other occupational respiratory diseases.
Ladies and gentlemen;
A regional meeting will take place tomorrow, which will be attended by Ministers of Health, Labour, Minerals, Finance, mining employers, employees (including ex-miners) and development partners from SADC, to enable us to take stock of our efforts in implementing the provisions of the SADC Declaration. We will announce additional strategies on how to elevate our cross-border management of TB at the meeting.
In conclusion we have brought services closer to the communities that have limited access through the use of mobile services. I would like to encourage everyone to make use of these services. Those who have not yet tested for HIV and/or screened for TB are encouraged to do so. Knowing one's status enables one to take appropriate measures to maintain health and well-being.
Let us remember that TB is curable, therefore there is no need to despair. Adhering to treatment, eating healthy food and maintaining a healthy lifestyle all contribute to a long and healthy life. Let us work together towards the achievement of our goal of zero new infections, zero HIV and TB related death and zero stigma and discrimination.
I thank you.
