Foolish to try and fix TB without fixing health systems

This issue of the NSP Review has been published to coincide with the 46th Union World Conference on Lung Health in Cape Town. TAC and SECTION27 welcome all foreign delegates and activists to this conference. We hope that your presence here will help build political commitment to tackling TB in a country where in 2014 over 89,000 people died of TB and where there is a deepening problem of drug resistant TB. These were mostly poor people and black people, an indictment on our health system and government 21 years after the end of apartheid.

This NSP Review has three main sections; a section on the major challenges that confront us in ending TB; a section on the state of provincial health systems in South Africa, and a special feature on the work and leaders of the TAC in Khayelitsha, a sprawling township of almost 400 000 people on the outskirts of Cape Town that we encourage you to visit.
The three sections are intricately connected. It is foolish to think that we can Stop TB if we don’t analyse the causes of our failing public health systems in SA and elsewhere. For example, on page 3 we question how it can be that a pioneering and inspirational Minister of Health like South Africa’s Dr Aaron Motsoaledi, can be staring down such failure when it comes to the implementation of his vision in South Africa’s provinces.

We highlight the crisis in the Free State province. According to department of health statistics, in 2013 the leading cause of natural deaths in the Free State was TB. We find that the problem lies in politics and in a political party, the African National Congress, that generally places the protection of its cadres in government, however corrupt or incompetent they may be, before public health.The evolution of the response to TB and HIV has to be towards strengthening public health systems and mobilising communities to understand health and health systems. Community TB treatment literacy is vital. This means moving towards greater accountability and community involvement in governing health systems.

What organisations like the STOP TB partnership overlook (at our peril) is that without an organised activist civil society working in the field of TB, HIV and health this will not happen. Our feature on TAC in Khayelitsha illustrates this point perfectly. 16 years ago Khayelitsha was TAC’s first branch. Today there are over 60 branches in Khayelitsha alone and more than 250 across the country! TAC branches are composed of people with HIV and TB, users of the health system, intimately aware of how it works or doesn’t.

In Khayelitsha over the years TAC has worked with health professionals and Doctors without Borders in particular to introduce programmes for Prevention of Mother-to-Child transmission, then antiretroviral treatment; it has distributed millions of condoms leading to a decline in Sexually Transmitted Infections. Now it has evolved into an organisation which whilst keeping its focus on HIV is looked to by the community to address many other challenges in the health system, most recently the problem of neo-natal mortality, disability and substance abuse. Which brings us to a painful matter.

Whilst world leaders pay lip-service to the importance of civil society whether in relation to HIV, TB or Ebola, it does nothing to ensure its sustainability.

TAC is now having to retrench staff and close offices all over South Africa. The ultimate price for this will be in lives lost. So we urge you to rise to the challenge issued by Canadian AIDS activist and former United Nations Special Envoy for AIDS in Africa Stephen Lewis whose Foundation has recently announced a U$1million donation to TAC and challenged others to do the same. The ball’s in your court.

To make a donation to TAC visit www.tac.org.za