Speech by Deputy President Kgalema Motlanthe during World TB Day
24 Mar 2012
Minister of Health, Dr Aaron Motsoaledi;
Minister of Mineral Resources, Ms Susan Shabangu
Deputy Minister of Health, Dr Gwen Ramokpopa
CEO of Gold Fields Mine; Mr Nick Holland
Members of SANAC;
President of NUM; Mr Senzeni Zokwana
Mayors & Councillors;
Ladies and Gentlemen:
Thank you for joining us on this World TB to raise awareness about the disease and to discuss coordinated responses aimed at eradicating TB within this lifetime.
Today we are gathered here not only to commemorate World TB Day, but also to mark two critical milestones in our comprehensive efforts to address the dual epidemics of HIV and TB in our country.
Over the last couple of years we have moved our response from an emergency-type set of interventions, to a strategic, robust and evidence-based programme.
Today is a day on which we will not only reflect on challenges caused by TB and HIV infection, but we will also report progress made and reaffirm our plan of action going forward towards our vision of the elimination of TB in our lifetime.
Gathered here today are various sectors and stakeholders ranging from mine workers, union leaders, community development agencies, health workers, mining management and government representatives.
These are people from all walks of life who have committed themselves individually and collectively to the elimination of TB in our lifetime; people who share our vision of an AIDS-free world.
Assembled here, are the various sectors and stakeholders who are working together to address a range of challenges, posed by the scourge of TB infection, TB and HIV co-infection and the social determinants thereof.
Most importantly, present here today are individuals who have heeded the call to take responsibility for their health; these are community members who have been using the services being provided here today and health workers who are providing services today.
We thank you and salute your efforts.
This is a gathering that demonstrates the tenacity of our character as South Africans; once we have identified a challenge we bring our collective wisdom, energy and commitments to bear on whatever threatens our well being, sustaining our efforts in innovative ways until we triumph.
TB continues to be a major epidemic that confronts South Africa across our geo-political space. It is an age old disease that modern medicine has not been able to eradicate.
There are several reasons for this. Firstly we have long known that TB is a disease of poverty. Even though TB is an airborne disease, which means that anybody can become infected those most vulnerable are the poor and those who work under poor conditions.
Secondly, medical science has not produced new TB drugs in routine use in the past 50 years.
Thirdly, it is only a year ago that a new tool to diagnose TB was invented – over the past 100 years or so we have been reliant on x-rays and microscopes to diagnose TB.
Fourthly, even though the drugs we have do work, we are now seeing a significant amount of resistance to these drugs, hence the increasing
number of people with multi and extremely drug resistant TB.
I am optimistic because of the progress we have made and will report on the first critical milestone alluded to earlier.
During the national World TB Day event last year the Minister of Health announced three major initiatives aimed at reversing the tide against TB. These were:
- Household based intensified TB case finding;
- The use of the new GeneXpert to improve the quality and time taken to diagnose both drug sensitive TB and drug resistant TB and
- The in-patient treatment of people with drug resistant TB.
We promised that we would report on progress on these initiatives at today’s event:
In the period between World TB Day last year and now, we have managed to visit over 100 000 households with known TB patients.
The objective of these visits was to screen the contacts of known TB patients and to provide HIV counselling and testing.
From these households, about 160 000 people were screened and we identified 3 000 contacts with TB and 3 200 who are HIV positive.
Most of these patients would not have been identified through our routine processes and this is an improvement that will assist us in early detection and treatment.
The ward based Primary Health Care outreach teams that the Department of Health are in the process of establishing will take this work further by strengthening the programme in all provinces and institutionalising this process of intensified TB/HIV case finding.
We will also to monitor the extent to which women attend antenatal clinics, and children are immunised.
With regard to the GeneXpert, South Africa leads the way globally. We have procured more than 50% of the global supply of Genexpert tests.
From March 2011 to February 2012, South Africa has conducted almost 300,000 (from the global total of 592,000) Genexpert tests.
Of these, 17% of people tested were found to have TB. This is a significantly higher yield than the usual yield of between 4-9% using old technology. Additionally, 7% of those who tested positive were found to have drug resistant TB.
These results show that we can find significantly more people with TB using this new technology.
Early diagnosis enables us to start treatment on time with a higher chance of minimising transmission of TB to others and improved health among those who complete their treatment within the prescribed time frame.
With regard to the hospitals for drug resistant TB, all 9 units that were built with funding from the Global Fund are now fully operational. This means that these patients will receive care in well equipped facilities for long term care - a right guaranteed to them by the Constitution.
You may wonder why we are having this event at this mine.
This is a gold mine and most of us may not be aware that gold mines have three times the amount of TB compared to the general population.
We need to intensify our efforts in the mining sector and to collaborate with the mining companies, workers, the unions, the communities surrounding the mines as well as other countries in Sub-Saharan Africa in order to develop sustainable strategies to control the spread of TB.
In this regard, the Minister of Health has been engaging employers, organised labour and all other role players for managing health in the mines.
Government reaffirms its commitment to work in close collaboration with all stakeholders to change the mining industry from being a hotspot for TB and HIV. And in this regard we urge mine owners to do the following:
- Ensure that all mine workers, particularly in the gold mining sector, are screened and tested for TB and HIV over the next 12 months as elaborated in our National Strategic Plan for HIV, TB and Sexually Transmitted Infections;
- Equip mine health facilities with gene expert technology to ensure rapid testing for TB;
- Upgrade some of the existing health facilities in the mines to provide treatment and care for Multidrug resistant and extremely multidrug resistant TB;
- Open mine health facilities to provide care and treatment to members of communities; and neighbouring mines where access to health care is limited.
Regarding the second milestone, I would like to remind you that that during the launch the National Strategic Plan for HIV, TB and Sexually Transmitted Infections on World AIDS Day on the 1st December last year, the President announced that the implementation plans for this critical strategy would be launched today so that implementation can start in earnest on 01 April 2012.
The National Strategic Plan for HIV, TB and Sexually Transmitted Infections 2012-2016 states our vision as well as the targets we have set for the next five years:
The 20 year vision articulated in the plan is as follows:
- Zero new HIV and TB infections;
- Zero new infections due to HIV transmission from mother to child;
- Zero preventable deaths from HIV and TB; and
- Zero discrimination associated with HIV, STIs and TB.
And the targets that we set for the next 5 years are:
- To reduce the number of new HIV infections by half;
- To ensure that at least 80% of people who need treatment for HIV are receiving it. and that at least 70% of these people should be alive and still on treatment after five years;
- To halve the number of new infections and deaths from TB;
- To ensure that a legal framework exists and is used to protect the rights of people living with HIV; and
- To eliminate stigma related to HIV and TB.
Indeed substantial work has been done in the development of implementation plans in all 9 provinces and across all the national government departments.
This is a mammoth task which will require on-going review and robust monitoring, including completion of a thorough costing exercise and development of a robust Monitoring and Evaluation Framework for a multi-sectoral response.
To achieve these 5 year targets, we will build on the work which started in earnest during the implementation of the 2007-2011 National Strategic Plan; our focus will be on scaling up all the critical interventions to achieve coverage and impact.
Particular attention will be paid to ensuring that the services are comprehensive, of the highest quality and delivered in a manner that respects the rights of beneficiaries.
To strengthen the sustainability of our interventions, we will focus on mainstreaming HIV and TB across all spheres of government.
This means that HIV, TB and STI interventions will be included in the work of all departments in line with their core mandate and their comparative advantage.
All sectors and stakeholders working in collaboration with government including development partners will have to demonstrate the same shift and alignment.
In order to support this mainstreaming approach, the South African National AIDS Council will ensure that the national Secretariat is strengthened in order to support the establishment of well functioning Provincial Councils on AIDS.
In turn the Provincial Councils once functional will focus on establishing and strengthening District and Local AIDS Councils.
The second most critical area of our focus for the first year of implementation is the provision of comprehensive health services in informal settlements across the country.
Research has identified these areas as high transmission areas “for HIV and TB and it is not difficult to understand why this is so. We are acutely aware of the living conditions in these settlements and a plan of action led by the Department of Human Settlements will unfold to improve the social conditions of communities in dire need.
To curb the rate of new infections we will embark on a number of initiatives. These will include providing a comprehensive school health programme for our learners as well as young people out of school.
Ladies and Gentlemen,
We need to address the scourge of violence against women and girls in a decisive way. This is a societal problem that requires all of us to join hands to address it.
Gender-based violence and HIV infection are intricately interlinked; let us address this challenge across all facets of life.
We have also committed to ensuring that treatment is extended to all those who need it; through the programme of re-engineering primary health care, strengthening community systems and work-place programmes we are confident that we will achieve the targets we have set for ourselves.
Our commitment is not just about making sure people get treatment, but that they lead healthy lives overall and are supported to adhere to their treatment for the rest of their lives.
Lastly, we want to prioritise the human rights and access to justice component of our interventions.
Stigma and discrimination have a negative impact on our efforts to expand health services. Human rights violations still occur in spite of the knowledge and services available to our people.
It is clear from our recent reviews that more needs to be done to ensure that the rights of those living with HIV and TB are respected.
We will embark on a country-wide, well organised campaign to address stigma and discrimination. This has been identified as one of the key activities in this first year of implementation.
Such a campaign will also focus on increasing knowledge on rights among the community and establishing mechanisms to ensure that where such rights are violated, there is redress and justice.
Judging from what is elaborated in our National Strategic Plan for HIV, TB and STI’s, we have a great deal of work ahead of us.
We have also identified many other interventions that can only be implemented over the medium to long term and these are elaborated in the operational plans of provincial and national departments.
Government is committed to do everything possible to ensure that we win this fight, and working together, we can indeed.
Today we have demonstrated yet again that we are taking responsibility.
Our path towards the elimination of TB in our lifetime will not be easy; our vision of an AIDS free world is possible. Let us walk this path with commitment, conviction and compassion.
We can and will win this fight!
These twin epidemics will be subdued by our resilience, commitment and strength as we take them on.
We are on path to eliminating TB in our lifetime and are moving towards the attainment of our vision of an AIDS free world.
With this strength of spirit and commitment, we can all rest assured that: NOTHING CAN STOP US NOW!
I thank you. \
Issued by: The Presidency
24 Mar 2012
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