SA’s TB recovery doesn’t necessarily need a bigger budget, just reprioritisation

According to the Department of Health, just over 208 000 cases of TB were diagnosed in South Africa in 2020.

31 March 2022

The global theme for World Tuberculosis (TB) Day this year was “Invest to end TB. Save lives”.

The thinking behind the theme, according to the World Health Organization (WHO), is that there is an urgent need to invest resources to ramp up the fight against TB so that all countries can reach their TB elimination goals. Considering the negative impact of the COVID-19 pandemic, which has stymied the progress of the TB response across the world, the call for investment is important. In a statement released this week, the WHO notes, “More investment will save millions more lives, accelerating the end of the TB epidemic.”

South Africa has already started to heed the call for this increased investment. The National Department of Health has embarked on an ambitious National TB Recovery Plan. The plan has been developed to help the country regain the losses that the TB response has experienced as a result of the COVID-19 pandemic.

At the core of this recovery plan are five strategies. It will start by finding undiagnosed people with TB through interventions that scale up community screening, introduce Targeted Universal TB Testing, and the use of other technologies. But the plan will also look at how to strengthen the systems that link people to care, strengthen the systems that keep them in care, and scale up initiatives that encourage the use of TB prevention therapy. (Targeted Universal TB Testing involves offering TB tests to people at high risk of TB whether or not they have symptoms.)

While one might think this would require more funding, this is not necessarily the case. It is true that all programmatic work could benefit from additional financial assistance, but the focus right now should be on the strategic use of existing resources to help put the country on the right path.

How health is funded in SA

To understand how we can make better use of existing resources it helps to first set out how health funding works in South Africa.

As a start, the National Treasury allocates financing for the health budget. Nationally collected revenue after debt servicing costs is divided across the different spheres of government –National, Provincial, and Local. The responsibility for health is shared between the National Department of Health and provincial health departments–the latter being the main implementers of healthcare services.

In the case of priority disease programmes such as the response to HIV and Tuberculosis additional funding is provided through a conditional grant. This grant was recently renamed the district health programme grant. The current allocation for this financial year is around R29 billion of which just over R4.8 billion is allocated to the district health programme. The remaining R23 billion supports the national response to HIV.

The district health component allows provinces greater flexibility as to how funds are allocated. So, in theory, this funding could be used to prioritise the implementation of targeted universal TB testing in high-burden TB districts. This has the potential to increase the number of people with TB who are initiated on TB treatment. The district health component also includes funding for community outreach services, notably community healthcare workers.

Improving TB data systems

Access to reliable health management information systems is also critical to the success of the TB recovery plan.

Currently, the National Institute of Communicable Disease (NICD) is able to track the number of TB tests which includes the number of positive cases. Treatment data, as opposed to testing data, is however collected through the TIER.NET system which consolidates TB and HIV treatment data to facility level. There have, however, been some reported challenges with linking the two systems. This makes it difficult to assess how many people diagnosed with TB actually access the treatment needed to cure TB.

Included in the R1.9 billion non-personal services component of the National Health Insurance programme is funding to strengthen patient information systems. Given TB’s status as a leading cause of death in South Africa, some of this funding should be used to prioritise addressing these gaps.

This article was originally posted on Spotlight. Access the full article here.