TB programmes & establishment of TB AdHoc Committee in the Western Cape: Department briefing

Meeting report

The Chairperson welcomed the Members of the Committee and the delegation from the Western Cape Department of Health (WCDH) to the meeting, and allowed the Department to proceed with its presentation.

WCDH briefing

Ms Nicky van der Walt, Deputy Director: Secretariat for the Provincial Council on AIDS and TB, WCDH, briefed the Committee on the Western Cape TB programme and the establishment of a TB ad hoc committee in the province.

Giving an overview of TB in the province, she commented that TB was not evenly spread, as some districts in the province were affected more than others, especially in areas with a higher population density where there were more infections. In the last 12 months, there were 46 119 diagnosed cases of TB in the province, with 3 683 cases diagnosed in the month of June 2022. During the same 12-month period, there were 4 156 TB-associated deaths in the province.

In the City of Cape Town metro, there were 25 655 diagnosed TB cases in the last 12 months, with three sub-districts -- Tygerberg, and the Eastern, and Western sub-districts -- accounting for almost half (48%) of all the diagnosed cases. Tygerberg included Elsies River, Delft, Bellville and the Belhar communities. The Eastern sub-metro included the Mfuleni, Macassar, Strand and Somerset West communities, while the Western sub-district included the Langa, Atlantis and Milnerton communities. The City of Cape Town metro had 2 220 TB-associated deaths during the period.

In the rural districts of the province, there were also higher numbers of infections in sub-districts that had higher population numbers and density, especially in the Cape Winelands and the Garden Route. Six sub-districts accounted to almost half (49%) of all diagnosed TB cases. These included Drakenstein, Breede Valley, George, Langeberg, Witzenberg and Theewaterskloof. 1 936 TB-associated deaths were recorded in the rural districts in the last 12 months.

She said 1 820 drug resistant TB cases were diagnosed in the last 12 months. The drug resistant TB case load mirrored the drug sensitive TB caseload in terms of the burden, with a higher number of diagnosed cases in the Cape Winelands and the Garden Route.

There were also higher numbers of drug resistant TB in the City of Cape Town metro, especially in the Tygerberg and Eastern sub-metros in Khayelitsha and Mitchells Plain. There was a higher risk of death among patients with drug resistant TB compared to drug sensitive TB, and in the last 12 months, there were 413 drug resistant TB=associated deaths out of the 1 820 overall cases.

Referring to the impact of COVID-19 on the TB programme, she said that during the COVID lockdowns and reduced mobility of people, people delayed testing for TB, which resulted in patients reporting to testing facilities at more advanced stages of TB and in a much more sickly condition. In 2020, the TB positivity rate climbed steadily to a high of about 20%, and remained there after March 2021. It dropped to 18% from April to September, and was at about 16% at the end of 2021. Whilst the decline was welcomed by the Department, it was still significantly high compared to the single digit percentage target of the Department.

On the establishment of the Western Cape TB ad hoc committee/ TB caucus, she said the Chairperson of the Standing Committee on Health had submitted a proposal to have an ad hoc committee on TB established and the proposal was duly accepted in June this year. Thus far, Gauteng, Limpopo, Mpumalanga and the Northwest provinces had already launched their TB caucuses.

She said the TB Caucus was a unique network of political representatives who would work collectively and individually to increase progress against the TB epidemic at sub-national, national, regional and global levels. Caucus members would play an important role in holding governments accountable and ensuring that commitments were delivered so the TB epidemic could be eliminated.

She said there were four recommended domains in which the TB Caucus could make a difference. It would advocate for the allocation of budgets ring-fenced for TB and report on current spending on TB by relevant public institutions. It would advocate for public institutions to account for the implementation of the TB programme. It would also call for the review of legislation that inhibited access to TB services, or pass legislation that promoted access to TB services. Lastly, it would speak to the relevant constituencies and the media about TB awareness, stigma, prevention and treatment.

Discussion

Ms A Bans (ANC) asked for a monthly breakdown of the TB-associated deaths and a description of where the deaths occurred, because she understood TB to be more prevalent in high poverty areas. She also wanted to know how non-governmental organisations (NGOs) and high poverty areas would be involved in the TB caucus, as well as the role of the TB Caucus in the Western Cape.

The Chairperson asked if issues with commuting to treatment centres contributed to the fatality rate, and what actions had been taken by the Department to address the issues.

Mr D Plato (DA) said he supported the Caucus because it was needed, but the discussions in the Caucus must not be political and should deal with the issues.

Responses

Ms Van der Walt said the death rate numbers she had presented were annual numbers from the last 12-month period (July 2021- June 2022). She added that the Department could provide a detailed monthly breakdown to the Committee, and it was also available on the Western Cape Government website via the dashboard displayed in the presentation.

Regarding the alignment of NGOs and high poverty areas in the TB caucuses, she said the recommendation was that the Caucus members would be Parliamentarians, and platforms for engagement with civil society and NGOs would be created to build consensus and have a coherent response to TB within the province.

On the role of the TB caucus, she said it would advocate for the allocation of budgets ring-fenced for TB, and report on current spending on TB by relevant public institutions. It would advocate for public institutions to account for the implementation of the TB programme. It would also call for the review of legislation that inhibited access to TB services or pass legislation that promoted access to TB services. Lastly, it would speak to the relevant constituencies and the media about TB awareness, stigma, prevention and treatment.

Regarding access to treatment, she said approximately 10% of clients who were diagnosed with TB never went back to collect their results and were never initiated treatment. The current treatment success rate was at 80%, and 20% of the clients were not completing their treatments, especially when they started feeling better, because it was a long treatment process that could last for up to six months. She said the Department was looking at strengthening measures to address that, and one of the innovations was the use of telehouse and telemedicine to follow up on clients that were defaulting.

The Chairperson thanked Ms Van der Walt for her presentation, and said she was very excited about how Parliamentarians would play their part in combatting TB in the province. She said the focus would now be on establishing and launching the Western Cape TB Caucus.

She allowed Ms Van der Walt and the delegation from the Department to exit the meeting.

Committee resolutions/actions

Ms Bans requested information on when the TB Caucus was expected to be established and launched.

The Chairperson said there had been engagement with the Provincial Council which had filtered down to the Office of the Speaker and to the Standing Committee, and it had engaged on the matter. She asked the Committee Secretary to draft a timeline of events that took place from the inception of the discussions of the TB Caucus so that Members could be aware and have an idea of when the launch of the Caucus could happen.

Mr Plato said he was in support of the establishment of the ad hoc TB Committee/ TB Caucus.

The Committee also looked at its draft programme for the third term, and made no changes.

The meeting was adjourned.