This week — as the aid community observed World Tuberculosis Day — all eyes turned to South Africa, which despite its booming economy continues to suffer at the hands of an old and persistent enemy.
A decade after launching a national strategic plans to eradicate TB, little has changed.
Along with Mozambique, it’s one of only two countries among the 22 high-burden nations profiled by the World Health Organization where incidence rates per 100,000 of the population have continued to rise in the past few years: 993 in 2011, compared with 493 in 2002.
The disease is also still the leading cause of death in South Africa.
WHO estimates some 31,000 people died from TB in 2012 — a figure that doesn’t include those with both TB and HIV.
But even faced with these statistics, the fight against TB seems to remain on the sidelines of government and donor aid efforts.
South Africa had a national budget for TB prevention and treatment totalling $475 million in 2013, of which 97 percent was funded by the government — with the rest of the bill footed by foreign aid.
This is seen as a sign that the country is these days less reliant on donors to combat the disease. However, an official from a community-based advocacy group told Devex that this perception that the country is now rich enough to fund its own anti-TB efforts is in fact hurting the campaign — putting organizations that help combat the disease in an unnecessary struggle for funds.
Peter Mabulane, community services manager for the South African National Tuberculosis Association, explained that while the government has the money, it does not extend it to NGOs like SANTA, which must instead rely on donations from private individuals and businesses.
But funding from both sources is increasingly in short supply.
Indeed, many international donors are starting to phase out their bilateral development programs in South Africa. The United Kingdom, for example, announced last year that it will no longer provide bilateral aid to the rainbow nation beyond 2015. And Denmark too will only honor current projects, but has no plans to introduce new programs.
The European Union, on the other hand, has decided not to cut aid to South Africa under its Development Cooperation Instrument for the time being, despite the country meeting new criteria for nations that should no longer be receiving EU bilateral aid — although experts believe this is only because EU-funded programs have been so successful.
Meanwhile, many remaining donor aid programs in the country are more focused on tackling HIV and AIDS, which also continues to represent a huge problem in the country.
“Everybody is funding HIV and AIDS ... but funding is not very high for TB, to be honest,” Mabulane said.
USAID's budget for TB control for South Africa in 2012 amounted to just $10 million. This pales in comparison to the budget the agency allotted for HIV and AIDS programs in the same year, which topped $469.9 million. Other actors such as the U.K. Department for International Development and Irish Aid meanwhile don't have a particular program that is specifically focused on TB.
Ray of hope
This unequal attention given to HIV and AIDS and TB in South Africa — and others argue to global health in general — is a source of frustration for many, including Mabulane, who underlined the need for the government and international donors to treat both diseases equally.
“TB is equally dangerous as HIV and AIDS ... But how often do you hear new developments on TB? It's very rare,” he said.
Anti-TB treatment has remained virtually unchanged since the 1990s, even if new strains of TB are becoming more resistant and the fact that a full course of treatment takes 2 years, which risks many patients coming off treatment over time and rendering it ineffective.
But there's a ray of hope for South Africa’s TB sufferers.
Organizations are increasingly finding the government recognizing the importance of tackling TB in its health agenda. This, Mabulane said, is largely thanks to new health minister Aaron Motsoaledi, who is also the new chair of the Stop TB Partnership — an international body of international organizations, NGOs, research and funding agencies, and businesses all working to eradicate the disease.
Motsoaledi noted in a recent op-ed for the Financial Times: “In South Africa, we know that TB is not just a health issue. It hurts our economy.”
Mabulane is encouraged: “To be honest, TB was not a priority of the government. But when the new minister came [in], it started to have some recognition. He keeps on mentioning it. He plans to integrate HIV and TB in one place. I think with this attitude, we are winning the war … 70 percent of TB patients are HIV-positive. Once you ignore the other, then the other takes over. So you have to treat them as twins.”
However, Mabulane cautioned that there should still be a unit focused on each of the diseases to avoid one undermining the other, as is often the case at present.
In addition, the government’s new strategic plan for 2012-2016 has some TB advocates concerned since it integrates HIV and AIDS, TB and sexually transmitted infections in one, as opposed to previous plans where TB was a standalone program.
Miners a top concern
Motsoaledi identified three vulnerable communities that need to be reached in the fight against TB in South Africa: people in prisons, mine workers and those living in peri-mining communities.
Of the three, miners are particularly at risk.
TB is rife in mining areas, where workers live in overpopulated camps and lack the nutritious food that could help build up their resilience against the disease.
And this does not only concern South Africa, but also neighboring countries, where more than 30 percent of TB infections in the region can be linked to mining.
Mabulane said: “We have a lot of TB patients who cross over, then we don’t know what happens.”
This is one of the reasons why health ministers from Lesotho, Mozambique, South Africa and Swaziland — together with various stakeholders from the development and mining sector — gathered in Johannesburg on Tuesday to discuss how they can curb TB among mining communities across the Southern African Development Community.
“Hopefully one program that could be built across — and understood across — the SADC [will come out of the meeting], so when you go to Zimbabwe or Botswana [the treatment is] not gone totally, because there is a [similar] program running in both countries, too,” Mabulane said.
Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.