SPEECH BY THE MINISTER DR MANTO TSHABALALA-MSIMANG ON WORLD TB DAY

24 March 2002

Ladies and Gentleman, I am happy to join you in celebrating this important day in our health calendar here in Botshabelo. I would like to first thank those who are working hard in controlling TB in this area. I am aware that you are performing well in this area with a cure rates of 66.9%. This event should therefore encourage you to work even harder to reach the target of 85 % cure rate that we have set for ourselves.

We need to work together to address the challenge of treatment interruption rate in order to reach the target of less than 10%. I am convinced that there is clear commitment to address the challenge of drug shortages and build on the existing resources. There is a need for more community volunteers (DOTS supporters) to assist in tracing patients that default treatment and this challenge requires a response from all of us gathered here as a community.

Last year, the World TB Day highlighted the empowerment of people who without their active participation, there can be no TB control. The theme for this year highlights the plight of the poor. Once thought to have been eradicated by modern medicine, tuberculosis has made an alarming come back in recent years, driven mainly by poverty and poor conditions that still exist in many developing countries including South Africa, the global challenge of HIV and AIDS as well as the spread of drug resistant strains of TB.

Countries with the highest burden of TB including South Africa met in Washington last year and committed themselves to achieving certain targets within specified timeframes. We pledged that by the year 2005 we should:

ears 2006 - 2010 The ultimate objective of the Washington Commitment is to eliminate TB as a global public health problem by the end of the year 2050. We are working hard in improving our TB control programme to ensure that we meet these targets. In January this year we launched the Medium Term Development Plan which encompasses these targets in Mpumalanga. Subsequently a series of workshops were held in all provinces to assist the provinces to draft their own plans within the framework of the Medium Term Development Plan. The commitment to improve TB control and to work towards meeting these targets has been remarkable in most provinces including the Free State. The provinces are expected to finalise the plans for implementation in 2002/2003 financial year. As most of you know, tuberculosis is the most common opportunistic infection and the most frequent cause of death in people living with HIV in this country. Approximately 50% of TB patients are infected with HIV. TB accelerates progression from HIV infection to full blown AIDS. On the other hand, HIV increases the risk TB infection developing into a life-threatening disease. Because of the similarity of symptoms in TB patients and people living with AIDS, some people may not know that these two diseases can occur independent of each other. It is important to realise that although HIV increases the risk of developing TB, not all HIV-positive people have TB. Anyone can get TB irrespective of ones HIV status. But it is estimated that only 10% of TB infection amongst people with healthy immune systems will ever lead to people becoming sick from TB. What is most important is to know that even in the presence of HIV infection, TB can be cured. People with TB or HIV face similar problems of stigmatisation, fear and discrimination and have shared needs for counselling, care and support. TB, HIV and AIDS find fertile ground to spread and they fuel one another in conditions of poverty, underdevelopment, overcrowding and poor nutrition. We therefore need to integrate our services and provide a comprehensive package of TB/HIV/AIDS/STI prevention, care and support at a district level. In an effort to mobilise more resources to fight these major infectious diseases, we have submitted an application for funding from the Global Fund to fight HIV/AIDS, TB and Malaria. We have requested a total amount of about R176 million which will be used for phased implementation of TB/HIV/STI prevention, care and support in South Africa. TB, HIV and AIDS training districts, which have been successfully piloted in four provinces, will be set up in all the provinces. These districts will provide voluntary counselling and HIV testing services for TB patients. Cotrimoxazole prophylaxis will be given to all HIV positive patients to prevent opportunistic infections as well as treatment for those infections. People with HIV infection will get early screening for TB. Those found to have TB would then be treated immediately and regular follow up and screening will be provided to those found not to have TB. As you know, the theme for this year is STOP TB, FIGHT POVERTY. The theme emphasizes the close link between these two major challenges. Poverty fuels TB in that many poor people live in conditions that predispose them to development of TB. These conditions include overcrowding, poor nutrition, inadequate diet and inaccessibility of health services. On the other hand, tuberculosis fuels poverty. As a result of illness TB patients are often stigmatised and their families often plunged into a spiral of poverty as they lose jobs and other means of survival. The majority of people with TB are in their most economically active years and are in most cases breadwinners in their families. While they are ill, their mostly inadequate household income is reduced and without treatment, they may die plunging families further into the conditions of poverty. It is therefore important to seek treatment quickly when you realise that you have TB symptoms. TB symptoms include a cough that does not go away for more than three weeks, unexplained loss of weight and bad night sweats. Treating and curing TB at first attempt is important because it prevents the spread of TB, improves productivity by reducing absenteeism due to severe illness and averts TB death among workers thereby improving skills retention. The main challenge facing TB treatment is that medication has to be taken for a long period of up to 6-8 months. Many people therefore fail to take their tablets correctly or to complete the course because they feel better during the first few months of treatment or they have no sufficient food to sustain such medication. They than develop Multi-Drug Resistant TB. This is a form of TB, which is much more expensive to treat because it does not respond to the drugs normally used to treat TB. Ordinary TB treatment costs about R310 and in most cases it does not require hospitalisation. Because, MDR TB patients have to be in hospital for about two months and they take more expensive drugs, the total treatment cost, including hospitalisation, runs up to more than R20 000 per patient. To address this problem, we are training members of the community who work as volunteers to provide support to TB patients by making sure that they take their tablets every day, complete their treatment cards and also educate people about TB. This approach is called Directly Observed Treatment Short-course (DOTS) and it is the only proven strategy for TB control and treatment. DOTS programmes are run in communities, clinics and places of work and I would like to call upon all of us to assist by offering our services in our respective localities. Our President, President Thabo Mbeki has declared 2002 as the Year of the Volunteer - for Reconstruction and Development and called upon all who consider themselves as patriots to respond to this call. We can respond to this call by coming up and be trained as DOTS supporters. In fact this is not something new within our communities. We were raised with the principle of Ubuntu where we taught to care about others. This spirit lived on during the days of our struggle when the spirit of comradeship brought communities together during the most trying times in our history. As the government, we are committed to playing our part and provide all the citizens of the country with necessary health care services to combat TB. We will also embark on a nationwide anti tuberculosis drive to ensure that public campaign to combat TB is sustained throughout the year. We are moving swiftly in improving especially TB hospital services and ensure that government gets value for public money that is paid to independent organisations to provide TB control services to our people. In this effort, we have done a forensic audit of the South African National Tuberculosis Association (SANTA) national office. The audit has found some serious irregularities. We are considering the best options we need to take in addressing these problems. We will be releasing these findings including the corrective actions that we are going to take. The government cannot win the fight against tuberculosis alone. We are therefore looking forward to building partnerships with many sectors especially the mining industry and prisons where the risk of TB remains high. We are also seeking partnership with the private health sector and other national and international partners. This will help us build a powerful network of resources and increase our ability to deliver effective TB control interventions. In conclusion, let me take this opportunity to inform you that South Africa is to host the 14th Conference of the International Union Against Tuberculosis and Lung Disease (IUATLD) Africa Region. The conference hosted by the Department of Health will be held in Durban from 11-14 June 2002. And delegates from all over Africa and other countries are expected to attend. The theme of this conference is " Access to care in tuberculosis and lung health" and it will address many important issues pertaining not only to tuberculosis but also to asthma, child lung health and other lung diseases including those related to the use of tobacco products. Our advances with regard to tobacco control are well-known and we will use this conference to share our experiences in this regard. This year's World TB Day marks the beginning of a campaign against TB that is envisioned with an emphasis on the number of people with TB detected each year. It also emphasises the need to increase the proportion of those treated successfully. This campaign will run until the year 2005 and each year on the 24th March we will review progress towards meeting our goals as a country. I would like each and everyone of us here today and the rest of our countrymen and women to educate ourselves about TB and work together to conquer TB. Thank you