28 March 2008, Dannie Kuys Stadium, in Upington, Siyanda District, Northern Cape
Programme Director
Honourable Premier Dipuo Peters
Honourable MEC Selao and other MECs
Honourable Guests
Ladies and Gentlemen
The bacterium that causes Tuberculosis was discovered on 24 March 1882. This is why each year, we commemorate World TB Day on 24 March. Because the 24th of March this year fell on Easter Monday, we decided to commemorate TB Day today.
We could have selected a district that is doing very well on TB but we decided on Siyanda District because there are particular challenges that are being experienced here. We want to use this occasion to mobilise the community and other stakeholders to work more closely with the Department of Health to deal with the challenge of TB in this district.
As we know, TB is not a new health problem. It has been with us for many centuries, both in South Africa and globally. We also know that TB is a social disease. Whilst it is caused by the TB baccilus, poor social conditions contribute to the activation of the disease. These social conditions include poverty, poor nutrition, overcrowded housing, poor working conditions such as in dust filled mines and general stress. In addition, smoking tobacco products and compromised immunity also increase the chances of contracting TB.
I have had the privilege to visit families here in Siyanda that have been affected by the disease and listened to their stories. The visits reminded me that unless we improve lives of our people, we will not succeed in our plans to control this disease.
Over 340 000 people in South Africa have TB. Although represents a very large caseload, but it also reflects active TB case finding on the part of the public health sector in particular in South Africa.
Besides the pain and suffering on individual patients and their families, it also creates a burden on the health system and the economy of the country. It is therefore in everyone's interest that we reduce the burden of disease from TB as quickly as possible. Certainly, we can do this if we work together.
This is also the message in the theme for this year's World TB Day: Stop TB because you can. This means that each and every one of us has a role to play in stopping TB. Let me give you some example of what can be done.
Firstly, ensure that anyone who has TB symptoms visit a health professional without delay. These symptoms include: coughing for longer than two weeks; weight loss; and night sweats.
Secondly, ensure that we eat healthy foods, get plenty of exercise, do not smoke, use alcohol responsibly and don't do drugs.
Thirdly, ensure that we follow these simple steps to prevent others from being infected such as covering our mouth when coughing or sneezing because one cough generates about 3 000 droplets and one sneeze tens of thousands of droplets which may lead to infection of others.
We need to ensure that these droplets dissipate in the air as quickly as possible by opening windows to increase ventilation especially in closed spaces like taxis and cars but also in the home.
On the part of the Department of Health, we have been tackling TB with vigour for the past decade. Soon after the WHO introduced the DOTS strategy in 1996, South Africa adopted and implemented the strategy. In line with the objective of this strategy, I can report that:
In 2005, we designated four of our high burden health districts which also had poor outcomes as TB crisis management districts. These are: City of Johannesburg in Gauteng; Amatole and Nelson Mandela Metro in Eastern Cape; and eThekweni metro in KwaZulu-Natal.
After extensive consultation with stakeholders, we finalised and launched our 2007-2011 national TB strategic plan in November last year. This plan sets out in some detail what needs to be done to further strengthen our TB control programme. It addresses, amongst others, issues related to healthy lifestyles, infection control, community participation and intersectoral collaboration.
In successive State of the Nation Addresses, our President, President Thabo Mbeki has committed government to improving TB outcomes. This year, the President committed all of us to reducing the defaulter rate to 7% and to train health professionals in TB diagnosis and management.
Also, in light of the challenges presented by extremely drug resistant TB, the Department of Health has made available R400 million to provinces to strengthen the TB programme.
With all the Plans and resources invested, the question is: are we doing any better today in TB control than a few years ago? The definite answer is yes. Let me illustrate this with a few examples.
During the first 6 months of 2005, the national cure rate was 54.9%. For the same period in 2006, it increased to 62.9%. The same trend can be seen with the percentage of TB patients who have successfully completed their treatment. These are patients who are cured but for a variety of reasons had not had the final sputum taken and assessed. For the first 6 months of 2005, the successful completion rate was 68.3%. This increased to 73.6% in the first 6 months of 2006.
Similarly the defaulter rates have also improved. Our latest data suggests that the national defaulter rate is 8.8% for the first two quarters of 2006 - down from 9.7% for the same period in 2005. We are determined to meet the target of 7% as set by our President.
Already, the Msinga sub-district in KwaZulu-Natal which includes Tugela Ferry (and Church of Scotland Hospital) where first cases of XDR TB were reported in the country has achieved a zero percent defaulter rate.
To contain further spread of drug resistant TB, we took a decision to isolate in health facilities those patients already infected with this TB strain. Most of these patients developed drug resistant TB because they previously defaulted TB treatment. In this sense, these patients are at high risk to default treatment for MDR/XDR TB. There are very few drugs available to treat MDR and XDR TB and if patients become resistant to these drugs as well then we will have no alternative treatment available.
Extended hospitalisation of MDR and XDR TB patients was not an easy decision to take. But it is in the interest of the public as well as these patients that XDR and MDR patients remain in hospital until they are discharged. We therefore condemn the incidents in the Eastern Cape where patients escaped from a TB hospital.
We are making efforts to make hospital isolation for patients as comfortable as possible. The R400 million that have been allocated should be used to improve the environment in these facilities. Let me provide some examples: in the Brooklyn Chest hospital in Cape Town for example patients have a gym, occupational therapists, and social workers who have developed a daily programme that includes vocational training. We are trying to ensure that all other hospitals have similar facilities as well.
The successes we have recorded thus far in addressing drug-resistant TB are to a large extent because of the dedication and hard work of our staff. I therefore would like to extend my gratitude and thanks to them. As the Department of Health we are committed to continue to improve their working conditions.
I wish to take this opportunity to formally launch the TB defaulter tracing programme which is now allocated an additional R33 million through cooperation with the European Union.
All provinces have established TB tracer teams which are typically composed of nurses and community health workers to follow-up patients that default treatment. These teams visit homes to find patients so that they can be put them back on treatment. To further strengthen this programme, the national Department has deployed additional 72 teams in sub-districts which have poor TB treatment outcomes.
These teams are going to assist us in addressing the challenge of adherence to prescribed treatment and the resultant multiple and extremely drug resistant TB are our biggest challenges. If we improve TB treatment outcomes, drug resistant TB should decrease.
Districts in which we have deployed these teams have already reported some successes. By February, an average of 86% of the defaulters in these districts were traced and 53% were started on treatment.
The team leaders are all here with us today and I now invite them to join me here on stage so that you can know them, and most importantly provide them with the support they need as they undertake this important task.
In conclusion programme director I would like to call upon all South Africans to join us as we undertake the task to stop TB. We all have an obligation to create a society that is free of suffering from TB. Let us STOP TB because we can.
I thank you.