Pretoria - The country's health sector is under strain from the high prevalence of multi drug resistant tuberculosis (MDR-TB).
The sector may buckle under the pressure of treating about 10 percent of the total number of global patients with the deadly strain of the disease.
While there were no official figures for the current number of infected people in South Africa, the figures for 2013 showed the 10 691 people on treatment represented 10 percent of people receiving treatment around the world.
“This is despite the fact that we are hardly even two percent of the worldwide population,” the national Health Department’s TB-HIV director, Dr Norbert Ndjeka said.
In 2014, 11 500 people were on treatment on the national TB programme, signifying an increase from the previous year’s figures, he said.
He explained that MRD-TB and the more deadly extremely drug-resistant strain, XDR-TB remained largely under-diagnosed and under-reported.
“We will not be able to meet the Millennium Development Goals plan to decrease the incidence by 50 percent,” he said, adding that the figures were scary.
Ndjeka and other experts on health had a discussion on issues and developments around TB in the country on Thursday, at a summit organised by Discovery Health.
The health professionals and academics who sat on the discussion panel called for a shift in the mindset of stakeholders dealing with the epidemic.
“We need to revise how nurses, doctors and other health practitioners are trained, so they recognise the danger posed by TB and respond appropriately,” Professor Mike Sathekge said.
Sathekge, who chairs the Medical Research Council, said it was time to think out of the box in the treatment of TB.
Professor Linda-Gail Bekker of the Desmond Tutu HIV Centre, said there was an urgent need to concentrate on the control of TB and the management of patients infected.
She spoke about “shared air” and said spaces like public transport, classrooms and prison cells were breeding grounds for the quick spread of infection.
“Stakeholders other than those in health need to be roped in as we fight this monster,” she said. “Housing, for instance, needed to be on board to ensure houses did not perpetuate the spread of TB.”
“We are not doing well with TB; we are failing. As much effort as had been put into fighting HIV was needed to combat TB. With HIV, we know how transmission occurs, we understand how it spreads but we have no idea what happens with TB, which has been around for much longer,” she said.
The World Health Organisation’s head of TB programme, Dr Sanni Babutunde, agreed that the TB battle was underfunded.
He said: “It is grossly underfunded. Not enough money is put into research, innovation, implementation. The fight against TB is struggling.”
Discovery Health’s chief medical officer, Dr Maurice Goodman, said bolder goal setting was important.
“We need more tangible goals leading up to 2015,” he said.
The speakers said there were too many gaps in information and very little research being done around the epidemic, nor were there efforts to encourage behavioural change among infected people.
Alcohol abuse and drinking were among the factors that interrupted treatment adherence and led to defaulting.
They talked about the issue of adherence and health well-being, with Goodman reiterating: “We need to think out of the box and find a way to make people do the right thing.”
That there were no programmes which encouraged behaviour change was a let-down, the experts said. It was a weakness in the health system, they said, adding that there was no mechanism to motivate the general population to avoid infection and spreading of the disease.
He said government had initiated a plan to decentralise TB treatment by taking it into the communities.
Treatment had all largely been doctor-driven and hospital-based.
“People lose so much during the treatment phase. They lose an income, they lose relatives and sometimes spouses,” Ndjeka said.
Taking treatment closer to home was the best option, he added.
Going back to the basics was what had to be done, and innovations and health facilities had to become agents of change.
Goodman said marketing around TB had to be enhanced, activists had to work hard towards uniting the country in the fight against the disease. Partnerships between governments, non-governmental organisations, universities and academics, had to be consolidated if TB was to be wiped out, Ndjeka added.
Pretoria News