B Hlongwa: Launch of TB Crisis campaign

4 August 2006

Programme Director,
The honourable Minister of Health,
Distinguished guests,
Ladies and gentlemen,

TB can be cured! This is the simple but powerful message that must guide us
today and in the actions that we are going to take in the future.

This campaign that is being launched here today is an indication of the
serious nature of the epidemic and its impact in our society but also of the
serious response from government to combat it and to ensure that we can put
hundreds of thousands of patients on the road to recovery.

We are calling it a “crisis” and rightly so. The incidence of TB is growing
in South Africa and especially in Gauteng. We are now standing at 550 cases out
of every 100 000 of the population. Our cure rates are low at 64 percent better
than the national average, but still far below the targets set by the National
Tuberculosis Crisis Plan and the World Health Organisation.

We call our response a “battle plan” and rightly so. We have to face this
challenge with every means at our disposal combining the advances in medical
science with the commitment and dedication of both the patient and the broader
community.

But, it is a battle that we can win. And the sooner we start the better our
chances of success. I strongly believe that many of our health challenges can
be met through the strengthening of the triangle that exists between patient,
the health care system and the community. TB is a classic example of how this
relationship can make a measurable impact on a potentially devastating
disease.

Quite often I am asked by members of the private sector on what contribution
they can make to improve the quality of health care in our province. There are
many instances where business is already supporting important health
initiatives through sponsorships and financial support to some of our key
institutions.

I am very pleased to note the presence and the active involvement of South
African Business Coalition on HIV and AIDS (SABCOHA). We are all aware of the
significant work that it is doing on HIV/AIDS in mobilising private sector
support and raising country-wide awareness of the serious challenges involved.
I trust that SABCOHA will inject a similar sense of urgency and professionalism
into our TB campaigns.

In Gauteng we are already making huge strides with TB Free, a Sanofi-Aventis
project that is training community health workers on the Directly Observed
Therapy (DOT) treatment and producing promotional material such as leaflets,
banners and t-shirts. We have already branded some taxis in Johannesburg to
carry strong TB messages. Other companies such as Primedia and Sandoz have come
to the campaign with sponsorships for our pro-mobile unit.

I want to call on the private sector to increase their involvement in our TB
campaigns and to look for opportunities to support our efforts. Health
promotion and information is a critical element of our response but it is a
time-consuming and costly process that requires consistent funding and ongoing
support.

Each and every company, each and every employer in Gauteng can make a
contribution to the battle against TB in their own workplace without resorting
to huge expenses. The most obvious intervention is to determine the TB health
status of employees and to ensure that those at risk have the opportunities and
the resources to access the free treatment they can receive from the healthcare
facilities in our province. And then, to monitor the progress and to ensure
patients continue the treatment, uninterrupted, for at least six months, until
they are cured.

The business sector should also take into account that TB is the one disease
that can not be divorced from the broader socio-economic profile of the
community. Thus, the global research has shown that failure to complete
treatment can be attributed to a wide range of factors including high levels of
poverty, food insecurity and the inability of families and communities to
support patients and ensure compliance.

From a purely financial perspective our “battle plan” should make perfect
sense. Government currently spends about R400 per patient to treat ordinary TB.
However, should this patient default on the treatment and his condition changes
to multi-drug resistant TB, the cost shoots up dramatically to R24 000 per
patient due to the need for more expensive drugs and possible hospitalisation.
This represents a staggering 60 fold increase in the budgets that we have to
commit to TB treatment – an expense that can be avoided by simply returning to
basics.

TB is not a high-tech disease that requires dramatic interventions, shiny
machines and state-of-the-art technology to overcome. Far rather it is a
grass-roots condition that requires daily commitment, dedication and regular
observance.

In our “battle plan” against TB we are not using “smart weapons”, Stealth
bombers or sophisticated surface-to-air-missiles. TB is a battle for the foot
soldiers, for the ordinary riflemen and women who conquer and occupy space
minute by minute, centimetre by centimetre. This is how most battles are won in
real life and this how we intend to win the TB battle in Gauteng.

In this campaign everybody can be a combatant either on the frontline as our
medical staff is doing so admirably in hospitals and clinics in Gauteng or as
support staff to provide the vital sustenance to patients in homes, in the
workplace and within your circle of friends.

It all starts with early detection and here friends and family can play a
life-saving role by looking for and recognising the tell-tale symptoms of TB –
incessant coughing for more than weeks, sweating at night, loss of weight and
appetite and tiredness.

Once these symptoms are observed patients should be taken to the nearest
clinic to be checked out and placed on treatment. From here family and
community support becomes a vital element of the recovery process to ensure
that people with TB complete their six months treatment.

Ladies and gentlemen,
In Gauteng we are serious about meeting the challenges of TB head-on. We are
keenly aware of the fact that we have a high incidence of TB cases and an
equally high rate of defaulting in treatment. Johannesburg, where we are today,
contributes no less than 44 percent of the TB cases in Gauteng with a cure rate
of only 62,5 percent and a default rate of close to 10 percent.

Clearly, we can improve on these figures and I am glad to say that we have
already started to turn the tide around. We have strengthened our human
resources through the appointment of an acting project manager, TB
co-ordinators in all the sub-districts and designated TB nurses in all primary
health care clinics. We are sending more and more nurses and health workers on
specialist courses to ensure the early detection of TB cases.

We are strengthening the laboratory network and accelerating the turn around
time for sputum analysis. We have now established patient support groups in
most sub-districts and broadened our counselling and education network aimed at
patients, families and close friends. We are improving our defaulter tracing
system to ensure that patients complete the treatment programme.

Our community health workers and our DOT supporters remain the heartbeat of
our programme and we will continue to strengthen this vital network and the
laudable work done by the many dedicated non-governmental organisations (NGOs)
and volunteer groups.

We will increase our public awareness programmes with the help of local TB
committees, our door-to-door campaigns and the excellent support we receive
from local radio stations and the print media. TB is a national priority that
transcends racial, language and political divides and it thus requires a
national response.

Ladies and gentlemen,
The National TB Crisis Management Plan recently introduced by the Department of
Health is a significant initiative to address the TB challenge in a
comprehensive way. A budget of R36,8 million has been allocated to improve the
detection and cure rates and to reduce the treatment default rate in the
country.

An important element of the national strategy is that it sets clear targets
against which we can measure our progress. For instance, in Johannesburg we
have to improve the smear conversion rate from the 2004 baseline of 72% to 80%
by the end of this year and the cure rate from 61% to 70%.

I believe these are reachable targets if all the participants in the health
triangle - patients, health care provider and community support commit
themselves to this effort. Let us redouble our efforts and strengthen our
commitment.

Let us remind ourselves constantly that TB can be cured. This battle can be
won.

I thank you.

Issued by: Department of Health, Gauteng Provincial Government
4 August 2006