8 November 2007
The Department of Health welcomes the hosting of the 38th Union World
Conference on Lung Health in our country. We believe that this is an important
conference that will once again highlight the need to intensify interventions
against various lung diseases affecting our nation and the world.
We expect that there will be fruitful discussions about the important role
of tobacco control in the prevention of lung diseases. We believe that we have
played our role as a country in the development and adoption of the Framework
Convention on Tobacco Control which we have since ratified. As you may know,
South African government has been widely acknowledged as a leader in the effort
to stop the use of tobacco products.
On the TB front, we are pleased to announce that we have made significant
progress in the development of the new Tuberculosis National Strategic Plan for
2007 to 2011. The document we are presenting to you today is an outcome of
extensive consultation with local and international stakeholders in the area of
TB as well as HIV and AIDS.
The plan is aimed at strengthening South Africa's response to the challenges
of TB as well as Multi-Drug Resistant and Extensive Drug Resistant TB. The plan
directs that routine culture and first line drug sensitivity testing be done
for all high risk groups such as re-treatment TB patients, new TB patients who
remain sputum smear-positive after two months and symptomatic close contacts of
confirmed multidrug-resistant tuberculosis (MDR-TB) patients. Second line drug
sensitivity testing will be conducted on all confirmed MDR-TB patients.
All confirmed extensively drug-resistant tuberculosis (XDR-TB) patients are
referred to an MDR-TB Unit for hospitalisation for a period of at least six
months and thereafter discharged for ambulatory care at the nearest health
facility with ongoing treatment and psychosocial support provided.
This will require strengthening of community based care and follow up
systems at community level. Enforced hospitalisation or quarantine of patients
with XDR TB is only justifiable as a last resort within a human rights
framework after all reasonable voluntary measures to isolate the patient have
failed. Monthly reviews and monitoring of patients are being conducted at the
MDR-TB Units until completion of treatment at the end of 24 months. Infection
control in all the TB, general hospitals and primary health care facilities is
being strengthened.
The new TB Plan also acknowledges the close connection between TB and HIV and
AIDS in our country and provides for interventions to deal with the challenges
posed by co-infection.
The plan requires that all TB patients be offered voluntary HIV counselling
and testing. Those who test HIV positive will be offered cotrimoxazole
routinely. Ongoing psychosocial support and early diagnosis and treatment of
other opportunistic infections will also be provided and anti-retroviral
treatment (ART) should be made available to all TB patients who are eligible.
The plan also directs that a package of care for HIV positive patients should
include routine screening for TB, treatment for those with TB and TB preventive
therapy for those found not to have TB.
While the number of TB cases remains high, there is steady improvement in
successful treatment completion rates and in the cure rates. Both the cure
rates and successful treatment completion rates improved from 50% and 60%
respectively in 2001 to 57,6% and 70,8% respectively in 2006. During the same
five year period, the death rate has been fairly constant at between six to
seven percent and so was the treatment failure rate around 1,5%. There have
been steady declines in the transferred out and not evaluated rates.
Progress has also been witnessed in the four districts that were identified
as high focus areas because of high caseload and low cure rates. These
districts are: Amatole district and Nelson Mandela metro in Eastern Cape,
Ethekwini Metro and City of Johannesburg. The new TB Plan sets clear targets
and indicators that are guided by international targets. Over the next five
years, we will improve our case detection rate to 70%, cure rate to 85% and
treatment success rate to more than 85%. The budgeting for this plan has been
done using the World Health Organisation (WHO) Planning and Budgeting tool and
covers the five-year period and much of the funding will be from the provincial
equitable share health allocation.
To illustrate that government is serious about curbing the TB epidemic, we
have made available to provinces a total of R400 million in this year's
adjustment budget to deal with MDR and XDR-TB. In the national department's
budget bid for 2008/09, we have requested for additional funding from National
Treasury to assist in the fight against TB. The development of this plan and
allocation of additional resources for its implementation demonstrates the
commitment of the Department of Health to respond adequately to the challenge
of TB. There is, however, a need for new TB diagnostics and drugs to bolster
the ability of all affected nations to succeed in controlling TB. We hope that
this conference will discuss and take a firm stand in the dire weakness in the
worldâs response to TB.
Clearly government has an important role to play in the fight against TB.
However, communities, the private sector, development partners also have
critical and complementary roles to play. Without a comprehensive response that
includes all of us, we cannot succeed in the fight against TB. We therefore
call on all partners to work together to ensure that the number of people that
contract TB is significantly decreased within the next five years.
Enquiries:
Mr Thami Mseleku
Director General
Issued by: Department of Health
8 November 2007
