S Belot: Launch of Tuberculosis Crises Plan

4 July 2006

Program Director
Ms Mokgosi
Ladies and gentlemen

In August 2005, the World Health Organisation’s (WHO) AFRO Regional
Committee unanimously resolved to declare Tuberculosis (TB) as an emergency in
Africa. 46 Ministers of Health attended this meeting in Maputo. Recognising the
deep concern about the gravity of the epidemic, the resolution warned that
unless ‘urgent extraordinary actions’ are in place the situation will worsen
and the 2015 Millennium Development Goal TB target will not be met.

At this meeting, Member States were urged to:

1. Develop and implement, with immediate effect, emergency strategies and
plans to control the worsening tuberculosis epidemic.
2. To rapidly improve tuberculosis case detection and treatment success
rates.
3. Accelerate DOTS coverage at district and national levels.
4. Accelerate the implementation of interventions to combat TB and HIV
epidemic, including increasing access to anti-retroviral (ARVs) for co-infected
patients.
5. Expand national partnerships for TB control, especially public-private
partnerships.
6. Improve the quantity and quality of staff involved in tuberculosis control
and
7. Implement strategies to reduce patient default and transfer out rates to 10%
or less.

Ladies and gentlemen, South Africa our country is part of the African
continent and as such has a pivotal role to play in fighting this disease. It
is for this reason that TB was acknowledge as a crises in this country. In
November 2006, the National Health Council (NHC) requested provinces to
identify poor performing districts and draft a crises plan of action to improve
the situation. Districts were chosen based on the data analysis done in
2003.

Program Director, the Free State Province has an incidence of 6 675 TB cases
per 100 000 of the population (2004 case finding) and lies fourth when the TB
case burden is taken into account in the country. The proportion of patients
cured in the province is 63,1% in 2003 and 66,6% in 2004 which remains lower
than the National Target of 85%. 7,2% of patient’s default of treatment and
this is also above the national target of 5%. In the Free State the highest TB
case burden is in the Lejweleputswa District, which is the gold fields’ area.
The death rate is also the highest in the country with Xhariep District being
the most affected in the province.

The TB/HIV co-infection also a big feature of the TB program in the province
set against this background; allow me to briefly mention some of the challenges
currently faced by the Free State TB Program:

* There is inadequate resource allocation to the TB program resulting in
planning and implementation of the TB activities being compromised.
* Poor monitoring and supervision of TB activities by district and primary
health care management.
* Low index of suspicion for tuberculosis by health workers resulting in late
detection of cases.
* Late presentation of cases by patients due to lack of awareness of symptoms
and stigma attached to the disease.
* Poor adherence to treatment due to lack of understanding of the importance to
complete treatment and lack of continuous support for patients on
treatment.
* Poor referral of patients between hospitals and primary health care
facilities.
* Poor collaboration with private sector.
* Long turnaround time of sputum results in some rural areas
* Patients being lost to follow up – cross border and migrant workers.
* Lack of support for data capturers resulting in poor quality of data and late
reporting in certain areas.
* Increase in Multi-drug Resistance TB cases referred from the mines and
lastly
* Poverty and poor living conditions also play an important role.

In March of this year, we launched the Operation Kgutlela campaign on World
TB Day. This campaign aims to bring all the TB defaulters back to the TB
program. Operation Kgutlela will be reviewed in September 2006, whereby the
best performing district will be chosen based on the lowest defaulter rate. The
Monica Norman Floating Trophy in Recognition of Commitment and Dedication to TB
Control will be given as an award to the achievers. I want to encourage all
stakeholders, staff and clients in this process to ensure the success of the
project by contributing fully.

Ladies and gentlemen, allow me to unveil the Provincial TB Crises Management
Plan. This provincial plan has been developed for implementation in the Fezile
Dabi district as a matter of priority to strengthen the management of TB in
this district. We have targeted this district specifically as it has the lowest
cure rate in the province and a high proportion of TB cases that is not
evaluated. The rest of the province will follow as a matter of urgency. Our
plan rests on an eight point plan and it deals with:

1. Strengthening of program management and supervision at all levels:

We have recognised the need for the appointment of additional staff at both
district and sub district level. 10 sub-district TB coordinators will be
appointed to assist with the supervision and monitoring of TB activities and
each district will appoint a TB information officer. An In-patient Care
Coordinator will be appointed to monitor the management of TB at hospital level
and a principal medical officer will be appointed to act as a technical advisor
and will interact with general practitioners in an effort to improve
communication and training.
2. Improving TB case finding by the rollout of the PALSA plus project.
3. Ensuring a patient-centred approach to the care for TB patients via the TB
Free Project which aims to strengthen Department of Transport (DOT) support
program in an effort to improve patient counselling and contract tracing.
4. Expand the public–private partnerships by improving collaboration with the
private sector through meetings and the training of medical practitioners. We
also will engage with private companies to support awareness initiatives in the
province. To all delegates here today, this means that you need to support the
TB program by implementing campaigns and projects in the workplace, encourage
staff to go for testing and counselling and support treatment regimes, commit
time and resources to ensure a TB free workplace and environment for staff and
provide support to families.
5. Intensify community awareness campaigns through billboards, radio talks and
a door-to-door campaign.
6. Improvement of treatment compliance and the reduction of the defaulter rates
by continuous defaulter tracing, focussing on the training of volunteers.
7. Ensuring participation of other key programs (HIV, Hospitals, Laboratory
services etc) and other Government Departments.
8. Building capacity for the prevention and proper management of multi-drug
resistant TB patients.

In conclusion, I am pleased to announce that we have allocated an amount of
R8 million to the project in the province in the hope that we will contribute
to improving the TB cure rate in this province significantly with the
implementation of the crises plan. We will implement the plan in all five
districts and we are also very excited at the prospect of some of our sport
stars in future signing up to form part of the communication and social
mobilisation campaigns that focus on improving awareness and TB cure rates with
messages targeted at specific, vulnerable groups. I want to invite stakeholders
here today, to become an active partner in the fight against TB.

Finally, may I take the opportunity to invite our patients who are
defaulting on their TB treatment back to the program, Many of these people have
full lives to live and can contribute significantly to society as a whole.
There is no shame in having TB, there is no blame by receiving treatment, and
there is only hope, courage and joy by being cured.

I thank you.

Issued by: Department of Health, Free State Provincial Government
4 July 2006