Mantoe Phakathi
MBABANE, Apr 22 2009 (IPS) – The Swazi government s slow response to a fast-growing tuberculosis epidemic has eroded the possibility of controlling it.
Themba Dlamini, the National TB Control Programme manager, says there has been a nearly ten-fold increase in the last 20 years from about 1 000 TB cases per year in 1987 to over 9,600 cases in 2007. Swaziland also has the world s highest HIV prevalence rate; people living with HIV/AIDS are significantly more vulnerable to catching tuberculosis.
This escalation of TB cases can be attributed to the HIV/AIDS epidemic, said Dlamini. 80 percent of the TB cases are also co-infected with HIV.
The country is falling short of meeting the World Health Organisation (WHO) TB treatment rate of 85 percent. Its treatment success rate is 42 percent, while the case detection rate stands at 57.7 percent against a 70 percent detection target stipulated by WHO.
Many patients are defaulting on treatment because they feel the TB treatment takes long and it gets worse when they are also taking antiretroviral drugs, said Dlamini. Food insecurity is another big challenge how does a person take drugs on an empty stomach?
With the advent of strains of multi-drug resistant strains (MDR-TB) and extremely-drug resistant (XDR-TB) strains of the disease, Dlamini said it becomes even more difficult to treat TB patients who are co-infected with HIV.
Yet despite the escalating number of TB patients seeking treatment at health centres, there are no clear infection control measures in place in public health facilities. Dlamini admits there is an increasing number of nurses who get infected with TB in the course of duty.
According to the Swaziland Nurses Association (SNA) president Bheki Mamba, the lack of infection control measures at clinics and hospitals means nurses are vulnerable.
What s worse is that there are no clear policies on how government would assist nurses who get infected with TB at work, said Mamba. We also need safety precautions to be put on the walls so that TB patients could see what is expected of them when they visit clinics and hospitals.
Hopes were high that Swaziland would raise an alarm on the disease on World TB Day. But in his official address on Mar. 24, the Deputy Prime Minister, Themba Masuku, remained noncommittal on when the Swazi government would declare tuberculosis a national health emergency.
We are aware of the plans underway to declare TB as an emergency this we shall support in line with the Maputo declaration in this regard, said Masuku.
Since the 2005 Maputo Declaration in which African health ministers declared TB as a continental emergency, two countries in the SADC region Malawi and Namibia have already declared TB a national emergency. Once TB is declared an emergency it would mean an increase in human resources, strengthening and decentralization of TB services, active finding and vigorous sensitisation of communities on the disease.
This also entails the review of progress in the response every six months until the situation is put under control, said Dlamini.
With the high burden of TB Swaziland is faced with, Sister Diane DalleMolle, director of the Cabrini Ministries, an organisation currently assisting 1,500 TB patients in the Lubombo region, expected Swaziland to follow suit this year.
It was real denial by government of the reality of the TB situation in the country, said Sister DalleMolle. I expected Swaziland to be first to tell the world that indeed we have a problem .
National TB Programme manager Dlamini hinted that a declaration may be in the pipeline.
We needed to do serious lobbying to convince the Ministry of Health and the National Disaster Management Agency (NDMA) that indeed TB is an emergency, said Dlamini. Now I can say the Ministry of Health is convinced that TB is an emergency but the contingency plan was not yet approved on World TB Day.
He said that the minister of health, Benedict Xaba, was still developing a contingency plan to deal for approval by the NDMA and then Cabinet, paving the way for increased resources to tackle the disease head on. He stressed that TB is a priority for government.
Along with other African Union members, Swaziland committed itself to spending 15 percent of its budget on health as per the Abuja Declaration. And its health budget allocation has increased from 10 percent in 2008, to 11.5 percent in the present financial year. Minister of finance Majozi Sithole was quick to point out to parliament that the budget for the Ministry of Health would increase to 17.2 percent after contributions from donors were taken into account.
For the first time, TB is the third priority after water and sanitation and HIV/AIDS at the Ministry of Health. TB used to rank as one of the lowest in the priority list, explained Dlamini.
However, because of the global economic meltdown, it looks like the Kingdom is yet to plunge into deeper problems considering its heavy dependence in foreign aid. Already the Global Fund to fight AIDS, Malaria and TB has called for a 10 percent reduction on the $5 million allocated to the TB programme for the next two years.
The situation might change in the future but for the next two years the Global Fund has requested us to reduce by 10 percent because of the global economic situation, said Dlamini.
Cabrini s Sister DalleMolle said donations from individuals from overseas have decreased by 75 percent. Although I suspect we won t stop doing what we have to do, some of our programmes will have to go, she said.
Long before the global economic crisis Swaziland was no longer attracting adequate donor funding because the Kingdom is classified as a middle-income country. According to World Food Programme (WFP) officer in charge Robina Mulenga, the global economic meltdown found Swaziland already struggling to attract international donors because of the middle-income status. This is despite the fact that more than two thirds of the population live on less than a dollar a day.
Now we have to start looking for money within the country because Swaziland is not considered to be in a desperate need for aid, said Mulenga.
She said WFP realises the need for food assistance to food insecure TB and AIDS patients as part of their treatment. But the global economic meltdown will affect our resources, said Mulenga.
