J Radebe: World Tuberculosis Day

24 March 2007

Programme director
Mayor of Nelson Mandela Metro
My colleague MEC for Health
Distinguished guests
Ladies and gentlemen

Today is a very important day in the health calendar. South Africa is today
joining the rest of the world in observing World (Tuberculosis) TB Day. World
TB Day is an annual event that is held to raise awareness about this disease
which, according to the World Health Organisation (WHO), kills at least two
million people in the world every year, thus the theme for this year is 'TB
anywhere is TB everywhere.'

TB is one of the major health challenges currently facing South Africa. The
most affected provinces are Eastern Cape, KwaZulu-Natal, Gauteng and Western
Cape which contribute about 80% of the total TB burden in the country.

In addition to bigger population size of these provinces, the major factors
of TB incidents are:

* migration of patients, mostly due to migrant labour
* lack of TB awareness and late detection of patients
* lack of awareness about necessity to complete treatment
* increasing number of patients with multi-drug resistant TB
* inadequate coverage of Directly Observed Treatment Strategy (DOTS)
* inadequate financial and human resource support for the TB control
programme
* poor access to laboratory services.

Realising these challenges, the Department of Health developed the National
TB Crisis Management plan to improve detection and cure rates and reduce
treatment default rate in the country. Nelson Mandela Metro was identified as
one of the four districts with both high number of TB cases and low cure rates
and these districts are focus areas for the TB Plan. The other districts are
Amatole also in the Eastern Cape, City of Johannesburg in Gauteng and eThekwini
Metro in KwaZulu-Natal.

The Plan seeks to improve systems that are necessary to support the TB
control programme. This includes better co-ordination of interventions at
national, provincial and local levels, improving laboratory services to reduce
turnaround time for specimens and increasing efficiency of data collection and
tracking of patients. The other component of the Plan is social mobilisation
and communication campaign. The main challenge with TB is to improve awareness
about the symptoms, encourage testing and assisting the patients to complete
their treatment for the period of six months.

Failure to complete TB treatment poses major challenges particularly with
the development of drug resistant strains of TB. Government spends at least
R400 per patient for treating ordinary TB. For multi-drug resistant TB, the
cost of treatment dramatically increases to R24 000 per patient (including
hospitalisation and more expensive drugs). We therefore have to intensify our
efforts to raise awareness about the symptoms of TB and encourage health
seeking behaviour. We have to mobilise support for TB patients to assist them
to complete the six months treatment programme.

In this regard, I would like to thank the DOT supporters who are here today.
Your work is probably the most critical component of our TB control efforts in
the country. Please continue to assist our people to complete their
treatment.

Government is responding also to the challenge of Extreme Drug Resistant
(XDR) TB which has arisen mainly as a result of patients failing to complete
treatment. We have ensured that the medicines (Capreomycin and
Para-aminosalicylic acid or PAS) necessary for treatment of XDR TB are
registered and are available in the country. We have paid particular attention
on strengthening infection control precautions at our health facilities in
order to reduce possible transmission of TB in these facilities. Infection
control measures are aimed at reducing direct or indirect contact transmission
by isolating patients, creating adequate bed floor space and improving
ventilation in wards.

Drug Resistant-TB Units are also being improved countrywide to deal with
infection control. Where it is not possible to extend the facility, wards are
identified in hospitals for accommodating additional patients and the necessary
structural adjustments are made. In addition to the resources available in
provinces, we have allocated an extra R3,6 million to complement infection
control renovation projects that are underway in various provinces.

These hospitals are being fitted with extractor fans and ultraviolet light
filters which remove and kill the bacteria circulating in the air thereby
preventing cross infection in health facilities. For extra protection,
respirator masks are given to health workers and visitors in the hospital and
patients are provided with surgical masks. We have to now look at improving the
recreational facilities and introduce skills development programmes as drug
resistant TB patients have to spend a relatively long period in the
hospital.

We are working with various experts and partners both locally and
internationally to respond to the challenge of TB and its drug resistant
strains. As a result of this partnership, I am glad to announce that the
Department of Health will next week welcome a TB expert from the World Health
Organisation in Geneva who is joining our endeavour to address the challenge of
XDR TB in the country.

This expert will provide technical assistance and advice with regard to
training on clinical management of XDR cases, infection control and improvement
of surveillance system and laboratory services. He will assist in efforts to
conduct an epidemiological assessment of the high number of cases that were
reported in Tugela Ferry in KwaZulu-Natal. We have taken the route of
partnership because we realise that the challenge of TB in the country cannot
be resolved only through addressing whatever deficiencies that may be existing
within the health system.

Efforts to address social challenges such as poverty and malnutrition,
overcrowding and inadequate housing are crucial to the success of our TB
control programme. Improvement of treatment outcomes is dependent on more
resources being invested into research and development of new diagnostics as
well as drugs with better TB treatment outcomes. The theme for this year
reminds all of us in the world that we are vulnerable to TB. It is therefore
our collective responsibility to combat this disease. We need to remember that
TB is curable. What is critical is to ensure that patients adhere to
treatment.

Government is committed to play its role and work together with all
stakeholders both locally and internationally to contain the spread of TB as
well as multi-drug resistant and extreme drug resistant TB and ensure effective
management of cases that have already been reported.

Thank you.

Issued by: Department of Health
24 March 2007