Government’s transparency gap hampers TB program monitoring

Published on News24

For the ordinary person living in South Africa right now, Covid-19 is a non-event: no one checks caseloads, thinks about new variants, worries about symptoms, or thinks about vaccines.

The pandemic that shook the world for two years has been reduced to a dangerous past inconvenience – a ghost of previous public health emergencies past, that stole many peoples’ loved ones. 

In the health sector, the shadow of the pandemic still lingers. 

Over the last two years, a considerable amount of research and studies have quantified the direct and indirect cost of the Covid-19 pandemic on South Africa’s healthcare system. 

The TB sector, for one, is still dealing with fallout – a reduction in testing and diagnosis as well as an increase in the number of deaths.

To deal with this fallout, there has been a massive push to regain the momentum that was lost due to the reallocation of resources coupled with people not seeking health services.

In 2020, the national Department of Health proactively spearheaded the development of the National TB Recovery Plan.

Despite the challenges brought on by the pandemic, TB remains a significant public health challenge for South Africa. 

Our most recent figures show that in 2021, 54 000 people perished from TB in South Africa. About 172 000 were diagnosed with the disease. In total, an estimated 304 000 in South Africa fell ill with this curable disease.

The plan – which would supplement the five-year National Strategic Plan on HIV, TB and STIs which the TB response is managed under – centres on increased testing for everyone who is considered high risk of contracting TB, irrespective of whether they have symptoms or not.

The intention of the recovery plan was to be implemented from May 2021. Yet, the plan has been beleaguered with delays for more than two years since its inception, with no clarity. 

And a deeper dive into the processes within the national Department of Health and its provincial counterparts around its TB response shows equally as dismal results. 

We collated a timeline of the department’s action around its TB response plan. 

We found more than 18 months after the plan was first conceptualised, there still appears to be inconsistencies in terms of its finalisation and implementation. It has undergone six iterations – and by February 2023, the plan was not available on either of the department’s website. 

Further to this, the KwaZulu-Natal, Eastern Cape and North West health departments’ websites had no TB guidelines available at all. 

The Free State had listed outdated guidelines and the Western Cape had the 2018 drug-resistant TB (DR-TB) clinical guidelines available. 

In addition, standard operating procedures (SOPs) outlined in the TB Recovery Plan are also unavailable on the national and provincial websites.

Although the non-availability of the guidelines on the department’s website and its provincial counterparts’ sites is not an indication as to whether or not the programmes are being implemented effectively, it creates a gap in accountability.

Lack of transparency 

The challenge is the lack of transparency on the part of the national Department of Health makes it difficult for anyone to monitor the implementation of the National TB Programme as well as the recovery plan or to hold the department to account. 

Publicly available information is critical to maintain transparency and creates an effective mechanism of accountability, which ultimately improves a project’s governance. 

The lack of transparency speaks to a bigger problem of governance within the TB sector. 

Governance is important in the context of South Africa’s TB response, given the complex nature of the disease. While there has been a focus on governance in the health system, this has been largely missing in the TB sector and has been a longstanding issue predating Covid-19.

What this means is there is no clear understanding of the line of command in the overarching TB response. 

Going deeper 

For the past two years, the TB Accountability Consortium (TBAC) has been trying to develop stronger accountability networks in the TB landscape – to help egg on the implementation of the recovery plan, by asking hard-hitting questions on the implementation of the programme.

In our latest attempt to hold the government to account, we’ve focused on the issue of governance. We assessed and looked at the effectiveness of governance and what this means for accountability, and ultimately service delivery.

The lack of transparency on the part of the health department highlights the need for availability of data for monitoring of both the success of TB programmes and the effectiveness of their governance as well as the need to disseminate the guidelines on provincial and district level where implementation occurs. 

And their shortcomings in providing up-to-date data showcases their inability to assemble effective data dashboards. If this was available, it would help to strengthen surveillance which could improve transparency and accountability. 

For South Africa’s National TB Programme to gain momentum and for its TB Recovery Plan to reach implementation at provincial level, more transparency is needed. 

This will help TB stakeholders see the inadequacies in the system and to ask the questions that will ensure programme accountability. 

And at the end of the day, it will mean those who need the treatment most, will get what they need. 

If, like Covid-19, TB is one day to become a distant problem that has no impact on our societies, we need to be able to make sure that the government’s response to the TB problem is adequate and effectively implemented today. 

– Sihle Mahonga is the project co-officer for the newly established TB Accountability Consortium, which aims to strengthen TB care in South Africa by consolidating the implementation of policies, technical solutions, and advocacy efforts on a national and provincial level.