TB: stakeholder engagement

Ad-hoc Committee- TB-related matters (WCPP)

09 December 2022
Chairperson: Ms W Philander (DA)
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Meeting Summary

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In this virtual meeting, the ad hoc committee on TB in the Western Cape Provincial Parliament met with various stakeholders on the functionalities of the TB caucuses on provincial, national, regional and global levels. The Western Cape Provincial Parliament unanimously agreed to establish an Ad-hoc Committee on Tuberculosis (TB). This decision follows several engagements with various stakeholders since February last year. As with other provinces, TB is an endemic disease in the Western Cape.
The Global TB Caucus enlightened the Committee on its mission to achieve a sustainable political response to TB. At the global level, they work in partnership across countries to target groups such as the G20 with coordinated messaging and calls for action. At a regional level, parliamentarians work together within their regions and regional platforms to learn, share ideas, and agree on joint and individual actions that will enhance the response to TB in their nations and regions. At the national level, they focus on building groups of parliamentarians to form a national TB Caucus. They said the infrastructure developed to respond to COVID could be converted to respond to TB and other diseases.

Talking of the value of parliamentary advocacy in TB, it stated that parliamentarians are uniquely positioned to echo the voices of affected communities and can advocate directly at national, regional or global levels and so affect change. Parliamentarians can push motions on TB based on available evidence and help in budget tracking to ensure the funding allocated to health reaches the intended ministries. Parliamentarians can also advocate at the national, regional and global levels. At the regional level, through the Pan African Parliament and African Union, among other platforms, for TB to be part of the health agenda.

The South African National Aids Council (SANAC) informed Members the aim of their structure is to build consensus across government, civil society and all other stakeholders to drive an enhanced country response to the scourges of HIV, TB and STIs.

SANAC stated the TB caucus is a unique network of political representatives. TB Caucus members work collectively and individually to support the TB response at different levels of government, including at regional and global levels. Caucus members play a role in ensuring that the commitments made to end TB by 2030 at provincial, national and global platforms are delivered. The TB caucus operates at four levels: provincial, national, regional and global.

The caucus aims to accelerate progress to end the TB epidemic through targeted actions at the global, regional, national and provincial levels. Members play a crucial role in holding governments to account and ensuring that commitments are delivered to End TB by 2030. Members of Parliament work to raise the political profile of TB and enable cross-cutting policies to transform the TB response. The caucus members can play a key role in communicating TB messages on all platforms when engaging media, constituencies or community dialogues to fight the stigma associated with TB. They can also play a role in TB advocacy by advocating for allocation of ring-fenced TB budgets and reporting TB expenditure and advocating for more funding from private sector/business.

The Western Cape Department of Health reported a sharp decline in the number of people tested for TB during quarter 2 of 2020. Recovery to pre-covid-19 levels would be difficult to achieve, and it would be harder to reach undiagnosed people. There were very few people who were coming to test. Monthly stats on ART remain lower than pre-COVID. Remaining on ART is gradually improving but the trajectory is not as steep as pre-COVID.

The Committee was taken through the Reset, Recovery, and Resurgence Strategy. Over the next two years, the Resurgence outlook would focus on balancing COVID-19 demand with core health services. Reset outlook over the next ten years would lead towards UHC reform and mitigation of social determinants. Over the next five years, the Recovery outlook would be on ensuring reform occurs across service delivery, governance, public health policy and universal coverage.

The Department further indicated that the TB response plan aims to raise the sense of urgency and awareness of TB as the leading cause of death in the Western Cape province for over a decade. It plans to reduce the number of new TB infections; increase the speed and number of those diagnosed, enable early initiation of treatment and provide support to improve treatment completion rates; and meet the global and local commitments to end TB by 2035. The key intervention is to strengthen the TB response. Focus areas would be on prevention, adherence support and counselling, case detection, and linkage to care.

Members commented that the Global TB Caucus presentation gave Members an insight into what is happening around TB matters. Members said it was clear the WCPP was being asked to take up the fight against TB and do more to push for vaccines, do more awareness campaigns and establish more partnerships. Members asked about protocols around mask-wearing for people with TB, preventative primary health care, why the SA TB Caucus was not operational after it was established and the impact of TB on provinces ultimately.

For the SATB Secretariat, members wanted to know if there were any lessons learnt from the Covid-19 and HIV responses to fight TB because the response during Covid-19 and HIV came from many sectors. Members wanted to understand if people were going to be rigorously subjected to tests; and asked how the target of SANAC of wanting to end TB by 2030 would be achieved, especially looking at the current strained environment.

Members wanted to understand from the Department of Health if mother-to-child transmission was still considered because it was a big thing during the HIV pandemic. They asked about drug-resistant TB, what was being done to protect families from persons who have contracted TB, if isolation was enforced, and if there were lessons to be learnt from past TB trends. The Committee asked to be provided with insights into how the Department planned to address social determinants.

It was said more than 140 people die of TB every day in SA; there is no reason for that because it is preventable and curable. The fight against TB needs commitment from all political parties and there is a need to look at the legislation or policy dealing with TB. It needs a multi-sectoral effort that also should include the private sector.

Meeting report

Briefing by Global TB Caucus

Ms Deborah Ike, General Manager for the Global TB Caucus, informed the Committee their mission is to achieve a sustainable political response to TB. At the global level, they work in partnership across countries to target groups such as the G20 with coordinated messaging and calls for action. At the regional level, parliamentarians work together within their regions and regional platforms to learn, share ideas, and agree on joint and individual actions that will enhance the response to TB in their nations and regions. At the national level, their focus is on building groups of parliamentarians to form a National TB Caucus. These national groups are the backbone of their advocacy.

Talking of the value of parliamentary advocacy in TB, she stated parliamentarians are uniquely positioned to echo the voices of affected communities and have the ability to advocate directly at national, regional or global levels and so affect change. Parliamentarians can push motions on TB based on available evidence and help in budget tracking to ensure the funding allocated to health reaches the intended ministries. Parliamentarians can also advocate at the national, regional and global levels. At the regional level, through the Pan African Parliament, Africa Union, etc, parliamentarians can push for TB to be part of the health agenda, can hold their government accountable (UNHLM targets, Abuja Declaration, SDGs), advocate with other ministries for social protection for people affected by TB, and can work with communities and in their constituencies to raise awareness about TB and campaign against stigma and discrimination.

She further stated that resource mobilisation is possible and funds for diseases’ response are available because since the start of the COVID-19 pandemic, the global community has mobilised over $15 trillion and the annual funding gap for TB is $3.3 billion – this is around 0.01% of the funds mobilised for COVID-19. As a collective, we have the ability to urge ministries of finance, health and development to prioritise and dedicate adequate funding towards health and TB - and not reduce TB budgets in the wake of COVID-19; press our governments and relevant multilateral agencies to promote and ensure global access to medicines, vaccines, medical equipment, and to fund the Research and Development (R&D) needed to face not only COVID-19 but also TB and other infectious diseases; and to advocate for the post-COVID-19 world, and ensure that there are contingency plans to ensure that the infrastructure developed to respond to COVID can be converted to respond to TB and other diseases.

She indicated they could ensure there is social protection for people affected by TB (work with ministries of social services and other government arms, donors, CSOs); work with CSOs and TB-affected communities in budget consultations and tracking (they can bring to your attention issues that need to be brought forward or addressed); and increase media attention for TB because the media is a powerful tool that can be used to push our agenda: hold press conferences, media briefings, write letters to the editor, etc., and invite them to participate in open parliament sessions.

On cases studies in Africa, Ms Ike reported that through continued advocacy efforts by the national caucus and civil society to push for an increase in health financing for the three disease areas, the Global Fund Kenya allocated 5.8- billion shillings towards the TB, HIV and Malaria response. Zimbabwe pushed for an increase in domestic allocation for health to 14% of national budget and there was public HIV and TB testing by Caucus members to reduce stigma and mobilise communities to have positive health-seeking behaviours. Zimbabwe is currently pushing for a strengthened TB workplace policy. Nigeria is currently working on TB legislation. There is capacity building of parliamentarians and a joint statement of intent to End TB in Nigeria. During a legislative forum on TB organised by Stop TB Partnership, over 20 parliamentarians of the AIDs Tuberculosis and Malaria Control Committee in Nigeria agreed on a statement of commitment to End TB in Nigeria. Nigeria collaborated with the National TB and Leprosy Control Programme and Nigeria Parliamentary TB Caucus. Parliamentarians of the caucus also participate in virtual and physical meetings, nationally and internationally where possible, to gain knowledge, information and experience on health in general, TB and other infectious diseases.

In her closing, she stated the regional work plan for the Africa region is currently being finalised and would be shared in early 2023 for national caucuses to domesticate. There would be a TB-only UN HLM in 2023. Parliamentarians were urged to take the lead in ensuring a strong in-country advocacy towards the HLM 2023.

See attached for full presentation

Briefing by SANAC/ National TB Secretariat

Dr Nkhensani Nkhwashu, Executive Manager: NSP Implementation, SANAC, informed Members that the aim of the structure is to build consensus across government, civil society and all other stakeholders to drive an enhanced country response to the scourges of HIV, TB and STIs. The SANAC Secretariat exists to implement the objects of the SANAC Trust established in terms of the Trust Property Control. The National Strategic Plan  (NSP) 2017- 2022 is a roadmap that enables organisations and individuals to pull together when responding to the HIV, TB and STI epidemics using one set of national goals and objectives.

She said some of the goals of the NSP are to accelerate prevention to reduce new HIV and TB infections and new STIs; address social, economic and cultural factors that add fuel to the HIV, TB and STI epidemics; ground the HIV, TB and STI programme in human rights principles; and mobilise resources to support achievement of the NSP and ensure a sustainable HIV, TB and STI programme.

Ms Matsiliso Sopoli, TB technical advisor, SANAC, briefed the Committee on what the TB caucus is about. It is a unique network of political representatives. TB Caucus members work collectively and individually to support the TB response at different levels of government, including at regional and global levels. Caucus members play role in ensuring the commitments made to end TB by 2030 at provincial, national and global platforms are delivered. The TB caucus operates at four levels: provincial, national, regional and global.

The caucus aims to accelerate progress to end the TB epidemic through targeted actions at the global, regional, national and provincial levels. Members of Parliament play a crucial role in holding governments to account and ensuring that commitments are delivered to End TB by 2030. Members of Parliament work to raise the political profile of TB and enable cross-cutting policies to transform the TB response. The caucus members can play a key role in communicating TB messages on all platforms when engaging media, constituencies or community dialogues to fight the stigma associated with TB. They can also play a role in TB advocacy by advocating for allocation of ring-fenced TB budgets and reporting TB expenditure and advocating for more funding from private sector/business.

She further said Members of Parliament could work with research institutions on new findings on TB and to work with community-based structures; call for all government departments and other sectors outside government to play a role in the TB response; and support implementation of the multi-sectoral accountability framework on TB (MAF-TB). The SANAC mandate is to coordinate and advise on the overall country’s TB response. IMC resolved that the SA TB Caucus be institutionalised within SANAC.

SANAC provides support to provinces on some of the following matters:

•provincial caucus work and launch of caucuses
•conduct induction workshops for the TB caucus members
•support Members of Parliament to track progress on the implementation of caucus activities
•support Members of Parliament with topics for debate in the legislature
•support Members of Parliament on TB outreach programmes in the province

Lastly, she said TB causes had already been launched in Gauteng, Limpopo, Mpumalanga and the North West.

See attached for full presentation

Briefing by the Western Cape Department of Health

Dr Vanessa Moodley, public health registrar for service priorities coordination directorate, reported a sharp decline in the number of tested people for TB during quarter two of 2020. Recovery to pre-covid-19 levels would be difficult to achieve, and it would be harder to reach undiagnosed people. There were very few people who were coming to test. Monthly starts on ART remain lower than pre-COVID. Remaining on ART is gradually improving but the trajectory is not as steep as pre-COVID.

Dr Nousheena Firfirey, deputy director for health in the service priorities coordination directorate, took the Committee through the Reset, Recovery, and Resurgence Strategy. The Resurgence outlook over the next two years would focus on balancing COVID-19 demand with core health services. The Reset outlook over the next ten years would lead towards UHC reform and social determinants mitigation. The Recovery outlook over the next five years would be on ensuring reform occurs across domains of service delivery, governance, public health policy and universal coverage.

The Reset agenda is on providing the right care, at the right time, in the right place, at the right price, and putting people first; to be a resilient system, with connected value-based leaders, acting as stewards for people’s health and well-being, and building a health system for every person; and to aspire to become a people-centric health system, trusted, and equitable towards a healthy society.

Dr Firfirey further indicated that the TB response plan aims to raise the sense of urgency and awareness of TB as the leading cause of death in the Western Cape province for over a decade. It plans to reduce the number of new TB infections; increase the speed and number of those diagnosed, enable early initiation of treatment and provide support to improve treatment completion rates; and meet the global and local commitments to end TB by 2035. The key intervention is to strengthen the TB response. Focus areas would be on prevention, adherence support and counselling, case detection, and linkage to care.

She stated the strategy for a localised trigger response to HIV and TB stemmed from key recommendations made by the Programme Review Working Group, where it is indicated due consideration must be given to the social and structural drivers of HIV and TB; there should be expansion of 90-90-90 targets to include a focus on prevention; and that there should be a localised focus on priority areas in defined geographic areas. The expansion of the 90-90-90 targets would intensify the HIV and TB response with the aim of reaching the global targets for HIV and TB through the implementation of a Whole-of-Government and Whole-of-Society Response.

In her conclusion, she stated the goals of the National Strategic Plan 2023 – 2028 are to break down barriers to achieving HIV, TB and STIs solutions; maximise equitable and equal access to HIV, TB and STIs services and solutions; build resilient systems for HIV, TB and STIs that are integrated into systems for health, social protection and pandemic response; and to fully resource and sustain an efficient NSP led by revitalised, inclusive and accountable institutions.

(Graphs were shown to illustrate trends in TB diagnosis; HIV testing and positivity rates; trends in TB testing and diagnosis; and public health – social ecological framework)

Discussion

Deliberations with the Global TB Caucus

Mr F Christians (ACDP) commented that the presentation gave Members an insight into what is happening around TB matters. The presenter is asking the WCPP to take up the fight against TB because it has been with us for a long time and more should be done to push for vaccines, do more awareness campaigns and establish more partnerships. The WCPP should provide assistance.

Mr P Marais (FF+) said it was shocking to hear SA is behind in the TB fight. Many people have died of HIV due to TB. The presentation is about reactivating SA to participate in regional caucuses, and he wanted to know why SA was “not in the game”. He said the WHO spent money on Covid-19 vaccines and asked why that has not been done for TB. He wondered if it was because TB mainly affected the poor. It is seldom one finds rich people get infected by TB. He asked why there was no protocol for people with TB to wear masks. More initiatives should be on preventative primary health care. He asked the presenters what role primary health care could play in helping prevent people from getting TB because it appears the focus was on curative measures.

Ms Ike responded that if the funding was sufficient, TB could be prevented, but what was more important was legislation or policies against the stigma and discrimination. More funding is needed in the fight against TB to prevent further spread of the disease and re-infection.

Ms Sopoli affirmed health facilities screen people coming for TB testing. The issues are beyond the Department of Health in SA. This matter needs a multi-sectoral approach, just like HIV and Covid-19. Other government departments should take part as well. There are many interventions and the Department of Health needs support from other sectors to fight TB.

The Chairperson wanted to know why the SA TB Caucus was not operational after it was established, but lapsed later, and what is the process for the re-establishment of the SA Caucus. She asked about the impact on provinces ultimately, and if there is a mechanism for the provinces, particularly the Western Cape, to access global funding.

Ms Ike responded that it was encouraging to learn the Global TB caucus was established by Lord Nick Herbert together with Dr Aaron Motsoaledi, SA’s Minister of Home Affairs, former Minister of Health. The fact we do not have strong political leadership in SA, is probably due to re-elections [and the loss of membership]. This has implications for TB response in SA and other provinces. There is a need for parliamentarians to activate what there is because SA is a strategic country. We need to have parliamentarians, or one Member, to act as a champion; a parliamentarian who is willing and capable of driving this response in SA to relaunch the national caucus. The previous parliamentarians doing work on the caucus were lost after the election. If the Members of the Ad Hoc Committee could identify a champion, that would help in the relaunch of the caucus. There would be implications for funding if there was no existence of a national caucus in SA. So, it is important for the Committee to identify a champion so that the SA caucus could be revitalised.

Mr Marais remarked it was not clear why SA and Botswana, countries that are affected the most by TB, were not in the Global TB Caucus. He wanted to understand if the parliamentary caucus should come from the national parliament and if the Western Cape would be welcomed to be part of the regional TB caucus because it was the most affected province by TB.

Prof Harry Hausler, Chief Executive Officer of TB HIV Care, explained the provincial TB caucus was something that has been discussed with the provincial government. TB is a major burden in the Western Cape. More than 140 people die of TB every day in SA; there is no reason for that because it is preventable and curable. The fight against TB needs commitment from all political parties and there is a need to look at the legislation or policy dealing with TB. It needs a multi-sectoral effort that also should include the private sector.

Ms Ike added that if any province or sector wants a national or provincial caucus, there are guidelines to help the caucuses to be launched and support would be provided by the Global TB Caucus.

Deliberations with the SATB Secretariat

Mr Marais wanted to know if any lessons were learnt from the Covid-19 and HIV responses to fight TB because the response during Covid-19 and HIV came from many sectors. He wanted to understand if people were going to be rigorously subjected to tests.

Ms Sopoli responded that they were advocating for political leadership. The health department cannot fight TB alone. That is why there is a need for multi-sectoral accountability, just like during Covid-19 and HIV. If TB receives the same approach, the community would be aware of TB and hold government accountable.

Dr Nkwashu said the NSP has different goals and a specific one that speaks to TB. Some of the targets have not been met and they are now being set according to the current status of the TB.

The Chairperson asked how the target of SANAC of wanting to end TB by 2030 would be achieved, especially looking at the current strained environment.

Ms Sopoli responded that they were not on track to end TB by 2030, according to the Global TB Strategy. That is why they were calling for more interventions for curing TB. Progress made on TB was lost and resources were directed to Covid-19 and HIV when they arrived. SA has the highest rate of HIV and TB. That was the reason for the multi-sectoral call.

Mr Marais stated he was disappointed with the presentation. He wondered if the response to Covid-19 resulted from money that came from different directions because nothing has been stated about budget preparations and control in the presentation. He said the Western Cape could be trusted in this matter if it was given money – this was demonstrated in the way it managed Covid-19.

Prof Hausler said using mobile technology for testing allows people in communities to check their status and take the necessary steps. The public TB dashboard in the Western Cape could be used by any organisation or government department to identify TB hotspots in the province. People should have also been tested for TB when they came for Covid-19 tests, but that opportunity has been missed. There are a number of interventions that could be implemented and lessons learnt from Covid-19 and HIV.

Deliberations with the Western Cape Department of Health

Mr Marais wanted to understand if mother-to-child transmission was still considered because it was a big thing during the HIV pandemic. He asked if nurses visit patients to ensure they use medication when it comes to cases of drug-resistant TB because people do not like visiting day clinics and hospitals. He asked what was being done to protect families from persons who contracted TB and if isolation was enforced.

Dr Moodley replied that there were guidelines on mother-to-child transmission, including wearing masks during breastfeeding because breastfeeding should not be disrupted. Drugs for resistant TB are available and are effective. That is why it is advisable for people who have contracted TB to stay at home and wear masks to protect family members. There are health workers who visit people on drug-resistant TB drugs.

Mr A van der Westhuizen (DA) asked if any lessons could be learnt from past TB trends.

Dr Moodley responded that the introduction of ARVs brought down the burden of TB, but the arrival of Covid-19 contributed to the increase in TB infections because services were reduced and many patients did not come to the clinics. But where services have been restored, the tests were done and infections are attended to. But the increase in TB is not expected to spike that much because ARVs are still in use, some drugs are still effective, and testing is still done. She said the 2016 data had been updated because the figures presented were about cases from 2017 to 2021.

Prof Hausler added that TB deaths decreased due to the introduction of ARVs. There is a need now to increase the number of people tested, regardless of symptoms, for diagnosis and get people on treatment to prevent further transmissions.

The Chairperson asked the Committee to be provided with insights into how the Department planned to address social determinants.

Dr Firfirey answered that the Department has a programme review committee on TB/HIV. The conversation has already started on how various sectors could work together to address TB in the province. Work is ongoing towards the provincial implementation which would be localised in certain areas, starting in a rural hotspot and a metro hotspot before spreading to other areas.

Committee Resolutions

The Committee resolved it would engage with the HIV Awareness Unit of the Department of Health regarding voluntary testing. The Department has indicated it would be able to assist the Committee in giving its input on the matter and the invitation would be extended to all WCPP caucuses.

The Committee further resolved Members should provide inputs for the terms of reference of the draft Committee programme, considering what was presented and discussed in the meeting.

Lastly, Members were asked to provide inputs for matters to be included in the Committee programme, and to think about ideas to be part of the regional TB caucus.

Adoption of minutes

The Committee considered and adopted its minutes dated 7 October 2022.

The meeting was adjourned.

 


 

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