Today 24 March is World TB day. It is a day to reflect on the continuing importance of TB in our Region and to review our strategies to combat the epidemic.
The theme for this year is “Actions for Life: towards a world free of tuberculosis”. For the African Region, the theme coincides with the declaration of TB as an emergency by Ministers of Health during the last Regional Committee held in Maputo, Mozambique in August 2005.
The TB epidemic in our region is indeed of emergency proportions. Approximately 2.4 million new TB cases and 500,000 deaths occur every year. With only 11% of the world population, the Region contributes over 25% of the global TB burden. Latest available data shows that TB incidence in the region has been increasing by 3% per year compared to a global average of 1%. In southern and East Africa, the rate is 4% due to the direct impact of HIV co-infection on TB incidence. The data also indicates that most countries in the region have not yet reached the World Health Assembly and Abuja targets of 70% case detection and 85% treatment success rate.
Many factors are responsible for the current situation. At political and operational level, TB has been accorded relatively low priority by countries with regard to resource allocation. Access to DOTS services is still limited. Participation of the private sector and community groups in the delivery of TB services is still low. Public health delivery systems upon which TB services rely tend to be poorly distributed and malfunctional. In particular, laboratory networks and facilities for diagnosis are still highly centralized and lack trained staff and basic equipment. Scarce trained human resources for health exacerbate the already limited access to TB control services. Lastly, despite recent significant inflows of additional financial resources, many country programmes still have inadequate financial and material resources to deal with the worsening TB epidemic.
At epidemiological level, the HIV/AIDS epidemic has become the most important risk factor for active TB. At the same time, access to HIV prevention, treatment and care interventions, including ARVs for dually infected patients is still very limited. The proportion of patients defaulting from treatment is also the highest among WHO regions.
Efforts are being taken to respond to the epidemic. To date, all countries in the African Region have adopted the internationally recommended DOTS Strategy. Approximately 80% of the population has access to DOTS services, especially through the public health sector. Case detection and treatment success rates have been increasing and global estimates indicate that even though incidence is increasing, the rate of increase has slowed down.
Despite these significant gains, the size and trend of the epidemic remains alarming. We must therefore intensify efforts to increase access to TB prevention, treatment and care services. Participation of all public and private health facilities and providers in the delivery of TB control services should be intensified and expanded; Laboratory networks should be decentralized; access to joint TB/HIV interventions, including universal access to ARVs for dually infected TB patients should be scaled up. Increased involvement of patients and communities in the planning and delivery of services are essential for scaling up TB control activities in our Region. We must also pay attention to actions against key social determinants of health, especially poverty. The poor and marginalized are often the most afflicted by TB and the least able to access basic diagnostic and treatment services.
In conclusion, it is clear that despite significant progress being made in controlling TB in the Region, the epidemic continues to be a matter of great concern. However, there is reason for hope. DOTS services are now available in almost all countries and both case detection and treatment success rates have been rising.
We must now build on these gains and urgently address the remaining challenges. In the context of the emergency resolution, TB control should be prioritized and adequate resources allocated for its control. National governments should set up national, provincial and district committees to oversee development and implementation of short term operational emergency plans of action to improve performance on key control indicators. A district by district analysis of key TB control indicators and available health facilities should be made and urgent actions taken to improve cure rates and introduce TB diagnostic and treatment services in all public and private health facilities. Collaborative TB/HIV interventions must become the standard of care for all dually infected persons in all countries. Patients and communities should be empowered to contribute to the planning and delivery of TB control services, and national partnerships should be set up to mobilize resources and stakeholders
We should also pay attention to interventions to address health system weaknesses, especially through decentralization of services, development of human resources for health and efficient monitoring and evaluation systems. Addressing poverty as one of the key social determinants of health must become one of the strategies for fighting the TB epidemic in our Region. TB control must therefore be prioritized in poverty reduction papers and medium term expenditure frameworks in countries.
WHO and collaborating partners will continue to provide technical support to scale up effective interventions and will also advocate for research on new shorter treatment regimens and tools for TB control.
I thank you for your attention.