Minister of Health at Stop TB Partnership Coordinating Board meeting, Hanoi, Vietnam

Notes for Dr Aaron Motsoaledi MP, Minister of Health at Stop TB Partnership Coordinating Board meeting, Hanoi, Vietnam

4 May 2010

General remarks

Honourable vice Prime Minister in the People’s Republic o` Vietnam, Mr Nguyen Thien Nhan
Honourable Minister of Health in the People’s Republic of Viet Nam, Dr Nguyen Quoc Trieu
Chairperson of the STOP TB Partnership Coordinating Board, Proffessor Rifat Anton
The Vice Chairperson of the STOP TB Partnership Coordinating Board, Dr Jeremiah Chakaya

Fellow board members, and in this regard, I wish to acknowledge Ministers and Deputy Ministers of Health and/or Social Welfare on the Coordinating Board, especially those present today:

* Prof Kyaw Myint, Minister of Health, Myanmar
* Dr Meliton Arce Rodriguez, Deputy Minister of Health, Peru

Although our membership to this Coordinating Board is by virtue of South Africa’s status as one of the High Burden TB countries in the world, we feel humbled and honoured by the invitation to serve on the STOP TB Partnership Coordinating Board. We recognise the important work that the Partnership has embarked on since its inception in 2001. We recognise the successes enjoyed by the world in the fight against TB, not least, due to the contributions made by amongst others, this partnership.

We however recognise that the journey towards the goal of ridding the world of TB is still a very long one, especially with the important milestone for the attainment of the Millennium Development Goals (MDGs) by 2015 almost upon us already and yet, with still a lot required to be done to reverse pain, suffering and death in the world due to the combination of poverty and major diseases, including TB and HIV and AIDS. Indeed, our country, South Africa, is engulfed by the twin problems of TB and HIV and AIDS, both feeding on each other to producing devastating consequences to our citizens.

Both our government and civil society organisations have, possibly in a manner not seen before, joined forces to respond decisively to the TB and HIV and AIDS joint epidemics. We have recently launched the HIV Counselling and Testing (HCT) Campaign, an intervention that will mobilise all sectors of our communities to join in the fight against HIV and AIDS to get counselled and tested. The campaign has set a target of 15 million South Africans to be counselled and tested for HIV by June 2011. I will return to this point later when we address the agenda item on TB and HIV management.

TB, which is also among the targeted conditions to be addressed through the HCT campaign, is similarly receiving attention. We launched, during the TB month of March this year, a social mobilisation campaign dubbed “Kick TB 2010”, jointly with civil society organisations, including the Archbishop Desmond Tutu’s TB Centre following the announcement that was made, on my behalf, at the Union’s Lung Conference in Mexico last year December.

The campaign is drawing on the universal language of sport, which in the past has been used to unite nations divided by deep schisms, teach tolerance, fair play and tackle a variety of social issues. But this time, we will use sport to address an important public health. We have been opportunistic, but with good intentions, and will exploit the excitement to be brought about by the biggest soccer or football spectacle ever to be hosted on our continent - the FIFA World Cup. We will use the World Cup to address the massive TB problem that we have in our country.

Soccer balls with captivating cartoon character drawings on different segments of in the first instance, 250 000 soccer balls depicting different TB symptoms, for example, weight-loss, coughing, night-sweats, loss of appetite and chest pain, are being acquired and distributed amongst primary school learners.

The campaign will run at least for a year and at the end, we hope to have a more TB knowledgeable population of young people who will serve as agents for education and information to the South African community to assist in the fight against TB. Our success on this, and other interventions we have planned, including the HCT campaign, will be weakened without the support of our international friends, including the STOP TB Partnership. We look forward to working you in the global fight against TB and HIV and AIDS.

Agenda Item 3: Responding to the TB-HIV co-epidemic (11h30 – 12h30)

South Africa is one of the countries facing the devastation of the dual TB and HIV epidemic. We have more than six million South Africans already confirmed as HIV positive.

WHO informed us during the review of our TB programme in July of 2009 that, about 490 000 South Africans contract TB each passing year. We welcome the proposed Compact for stopping people living with HIV dying of TB between the STOP TB Partnership and UNAIDS.

In this regard, let me focus on two recommended activities from the compact:

First, the objective to increase political commitment and resource mobilisation for HIV and TB integration as indicated in the Compact:
The support to countries most affected by HIV and TB to develop specific plans to reduce the HIV and TB burdens is most welcome.

In this regard, let me briefly share with you an ambitious campaign to promote counselling and testing for HIV, TB and other chronic diseases that His Excellency, President Jacob Zuma launched with me a few days ago.

The HIV Counselling and Testing campaign (HCT), seeks to do the impossible as we hear from some of the sceptics, namely, to mobilise 15 million South Africans to be counselled and tested for HIV between now and June next year.

At the same time, South Africans will be screened for TB and other chronic ailments, including hypertension and diabetes. We expect to find an additional 1,6 million new HIV positive cases and about 100 000 new TB cases. Although the government is mobilising resources to see the campaign through we can always do with additional support. We therefore hope that the support intended to be provided to high burden countries through the Compact will also find its way to us.

Second, promoting the inclusion of TB in National AIDS Commissions or Councils is a recommendation that we have already embraced following the World Health Organisations (WHO) review of our TB programme. Our AIDS Council, South African National AIDS Council (SANAC), has formally resolved to incorporate TB in its work. A Special Task Team to oversee the TB and HIV co-infection issues is being established in addition to the existing five HIV-specific Task Teams.

In addition, we will establish a South African STOP TB Partnership to allow all civil society organisations working in TB, usually small in size, to have a platform to engage with government and share ideas on how to strengthen our efforts in the fight against TB. We invite the STOP TB Partnership to support us in this important effort based on best practice from other parts of the world.

Finally, we understand the need to create a special HIV and TB Task Force between the STOP TB Partnership and UNIAIDS. This however requires some reflection in order to determine if the envisaged work for this Task Force is not already being addressed by existing structures, especially those that have overlapping membership between the STOP TB Partnership and UNAIDS.

Agenda Item 4: Accelerating the scale-up of M/XDR TB (14h00 – 15h30)

Although the large caseload of TB patients South Africa has should have prepared us for a corresponding load of drug-resistant TB patients, the actual numbers that we see are quite staggering.

We had about 7 000 MDR and XDR TB patients diagnosed in 2008. It is very clear that our response to the TB problem is not adequate. We therefore welcome the review of current ways utilised in scaling up the management and control of MDR TB with the view to improve them.

Our government has, in the context of responding to the general TB programme demonstrated political will which lead to additional resources being made available to address MDR-TB. However, the bulk of the resources were mainly used to increase the number of MDR beds, which currently stand at around 2 000.

You will agree with me that with the magnitude of MDR-TB we have, adding beds cannot be the main element of our response. In any event, it is quite costly to provide hospital beds, especially for complicated conditions such as MDR-TB. For example, with the generous support of about U$S12 million granted to us by the Global Fund, we can only provide an additional 300 beds.

We therefore have to seek other scale-up methods, including the inevitability of treating MDR at community level. This is complicated and we are not sure that there are clear cut approaches and strategies on the management of MDR at community level.

Unfortunately, the proposed scale-up recommendations from the STOP TB Partnership Retreat does not seem to address this, at least, not adequately. We hope the task teams’ future endeavours will give the matter of community-based management of MDR-TB some serious attention.

I should also point out the need to strike a correct balance between addressing MDR-TB without undermining ordinary TB control and management. We should remember that in many respects, MDR-TB is an indication of a weakened TB control and management programme.

Issued by: Department of Health
4 May 2010