Message of WHO Regional Director for Africa, Dr Matshidiso Moeti
World TB Day on 24 March every year, is a stark reminder of the significant burden of this disease despite the existence of effective control interventions.
This year’s theme is “the clock is ticking” because the TB response urgently needs to be accelerated to reach the targets set in the Sustainable Development Goals and to realize the commitments made by Heads of State at the first-ever UN High Level Meeting on TB in 2018.
There were an estimated 2.5 million TB cases in the African Region in 2019, accounting for 25% of the global burden. More than 500,000 African lives are lost to this disease every year. This is inexcusable, when TB screening and treatment is available for free in all countries. Too many people are pushed into poverty when they contract TB due to lost income, transport costs and other expenses. The Democratic Republic of the Congo, Kenya, Uganda and Zimbabwe have carried out TB costs surveys that show that households of people infected with TB are spending over 50% of their income on TB-related costs. This is well above the marker of 20%, which indicates catastrophic expenditure.
In recent years, some countries have made significant progress. Between 2015 and 2019, Kenya, Mozambique, Sierra Leone and the United Republic of Tanzania reduced TB deaths by over 30%. Ethiopia, Kenya, Namibia, South Africa and the United Republic of Tanzania reduced new TB cases by 20%. However, overall progress in the WHO African Region remains slower than the milestones set for 2020.
In the United Republic of Tanzania, the reductions were achieved using initiatives to increase case detection among miners, to engage traditional healers to collect sputum and refer patients living in remote areas, and to scale-up community screening and TB control activities. There is high coverage of TB preventative therapy (92%) among people living with HIV, and stakeholders are engaged, including the private sector, backed by strong Government leadership and resource allocation for TB interventions.
In Kenya, progress has been achieved through robust multisectoral partnership, domestic resource allocation for activities at the sub-national level, rapid uptake of global WHO guidelines and recommendations, and expanding diagnostic capacities. The integration of TB services into other programmes such as HIV, maternal and child health, nutrition and diabetes clinics has also reached people who otherwise may have been missed.
Across the Region, the challenges in TB prevention and control are significant. Only 56% of people with TB are on treatment and TB control budgets continue to be drastically underfunded. Governments in the African Region are contributing 24% of these budgets on average and international organizations like the Global Fund are providing 34%, leaving a 42% funding gap. South Africa has the highest domestic funding in the Region, at 77%.
The COVID-19 pandemic has compounded difficulties in accessing TB services. For instance, in South Africa, monthly notifications of new TB cases fell by more than 50% between March and June 2020. In some countries, TB staff and testing equipment were reallocated to the COVID-19 response. At the same time, some mitigation measures were introduced, such as limiting the need for TB patients to visit health facilities by providing one month’s worth of TB medicines and using video messaging to continue with directly observed treatment.
There is also the rising challenge of drug-resistant TB, which is estimated to affect 77,000 Africans each year. Among these, only one in three are diagnosed, and around 20,000 are put on treatment.
Collective action across sectors is crucial to address the challenges and accelerate progress towards ending TB by 2030. Determinants of health such as poverty, undernutrition, indoor pollution, tobacco smoking, and co-morbidities such as HIV continue to drive the TB epidemic in the African Region. This is why WHO has developed the multisectoral accountability framework and is supporting all countries to update their TB policies and to implement WHO guidelines. We are also working with countries to monitor programmes in real-time, to identify challenges and advise on strategies to address them.
Today, I call upon governments and partners to bridge the financial gap for the TB response in Africa so that the Region can get on track to reach the SDG targets for this disease, for the benefit of African populations and future generations.
Learn more:
Global Tuberculosis Report 2020