Hansard: JS: Unrevised hansard

House: Joint (NA + NCOP)

Date of Meeting: 13 Mar 2020


No summary available.













Members of the National Assembly and the National Council of Provinces assembled in the Chamber of the National Assembly at 10:03.



The Chairperson took the Chair and requested members to observe a moment of silence for prayer or meditation.






The DEPUTY MINISTER OF HEALTH: Hon Chairperson of the NCOP, hon Ministers and Deputy Ministers present, Chairperson of the Portfolio Committee on Health and also the Chairperson of the Select Committee for Social Services in the NCOP, hon members, thank You very much for this opportunity to participate in this debate on TB in the month of March when we focus on



Tuberculosis — with World TB Day taking place on 24 March every year.



Hon members, I bring you greetings also from my colleague Minister Mkhize who I left in Polokwane last night together with other members of the Executive together with the leadership of Limpopo province, including the premier who was busy putting final touches on the return of South African citizens who are being repatriated from Wuhan City in China.



I just want to report also to the House that in the process of our engagement during the course yesterday, we were able amongst others to have an audience with the leader of the biggest church in Southern Africa, His Holiness Bishop Barnabas Lekganyane who pledged full support for government’s support to curb the spread of Coronavirus and also to work with the government in the coming challenges around a mass gathering, including the Easter gathering in Moria City.



Hon members, I wish to draw your attention to the fact that Tuberculosis and Coronavirus share some similarities but there are also a number of differences. While TB is caused by bacteria called Mycobacterium Tuberculosis, Covid-19 is caused



by a virus as we know Coronavirus. Whilst TB is an ancient disease, Covid-19 was only discovered on 17 January this year, 2020.



While we know a lot about TB, we know very little about Covid-


19. We have the diagnostic tools and drugs to diagnose and treat TB and cure it, including drug resistant TB, but we don’t have a cure for Covid-19. We have a vaccine called BCG which is almost 100 years old to prevent TB, which is effective in at least 60% of those who have been vaccinated. But as of now just to emphasise there is no vaccine for Coronavirus for Covid-19.



But despite these differences, there are also similarities between TB and Covid-19, both are spread by droplets. That means coughing and sneezing; both affect the respiratory system; and both can be prevented by similar public health measures like coughing and sneezing either into your sleeve or into the crook of your arm or into a tissue paper or handkerchief to avoid the spread of the disease.



Social distancing is another method to limit the spread of the disease, standing around a metre away from other people. As we



have seen in Italy and other countries in Europe, unfortunately hon members, this social distance and avoidance, includes unfortunately kissing ... [Laughter.] ... shaking of hands, avoiding kissing and shaking of hands is also recommended.



Proper ventilation in homes, schools, busses, taxis and trains etc, is critical to ensure that when people congregate they don’t infect each other with TB in the same way as Coronavirus. So, we must encourage everyone to ensure that we open windows especially at home and public transport — even in winter. These same interventions will also work to limit both the spread of Coronavirus and Tuberculosis.



Hon Chairperson, I thought that with all the panic around Coronavirus - which is understandable because it is a novel disease - I should point to the similarities between this old disease which we are talking about today which is Tuberculosis and the new one which is only a few months discovered, that’s Covid-19. Returning to TB, hon Chair, South Africa is one of the 22 highest burden TB countries in the world. In our country it’s estimated that about 700 people in every 100 000 have TB. We estimate that more than 320 000 people contract TB



every year — so in fact we have to worry as much, if not more about TB than other diseases. As we have said many times — for as long as one is breathing one can get TB because it is an airborne disease.



As hon members know — TB and HIV are two sides of the same coin. About 60% of people living with HIV also contract TB because HIV as we know weakens the immune system. In fact, most people with HIV who die - die because of the result of TB. Therefore, it is very important for us to deal with these diseases together.



According to Statistics SA in 2016 using the death notification reports, there were 29 513 deaths as a result of TB out of the total death which were over 450 000, that’s 6,5% of the deaths reported in 2016 were related to TB. This is lower than the number of deaths due to TB in two years before which was 2014 which was 39 000. In other words, in 2014 we were 10 000 more deaths from TB which constituted 8,3% compared to 2016. So, the number is going down but is still very high. The good news is that as I said earlier, TB is curable. We have world class diagnostic tools — called GeneXpert — and drugs in South Africa and these are free in



the public health facilities. Our health workers are well trained to diagnose and treat TB. We even have drugs such as isoniazid preventive therapy, in short called IPT to prevent - especially focussing on people living with HIV — from contracting Tuberculosis.



South Africa is a world leader in several areas when it comes to TB. We have top class TB researchers; we were the first country in the world to expand the Genexpert platform to all our laboratories and used our volume of tests to reduce the global costs of this Genexpert; we were the first to use a drug called bedaquiline to treat multiple drug resistant TB and again because of our volumes, we were able to drive the cost of this drug down from a high of US$800 per patient to half of that which is US$400; and we also have the largest number of patients on the IPT, which is the prophylaxis which I mentioned earlier



Despite these achievements, we have many challenges. We should be finding and treating around 320 000 people as I mentioned the infection rate each year. However, at the current moment, we are only able to trace 220 000, which means almost a

100 000 people we are not able to trace. They are unknowingly



spreading the disease. Especially men are missing in terms of coming to the clinics and therefore be tested. We are missing men and young people largely because men and young people do not typically visit our health facilities.



For a number of reasons South Africa also has many patients who are drug resistant or also extremely drug resistant. We used to think that only those who didn’t complete their treatment become resistant to the first line of TB treatment but now we know that what is worrying is that the drug resistant form of TB can also be transmitted from one person to the other. If one person has developed a drug resistant, they can infect the next person with the kind of TB which is resistant to the first line of treatment.



This means that we must do everything possible to stop the transmission, which means we need to focus on prevention, early diagnosis and treatment for six months if is the drug sensitive TB with the fist line. But once you go into the resistant mode of TB then you require nine months to 12 months.



There are a number of interventions to increase our ability for case finding, in other words to find people who are not diagnosed and we are implementing these in our facilities.



However, I wish to encourage hon members — especially as we relaunch this Parliament TB Caucus to spread the message that: Firstly, people with symptoms of TB must get tested and treated as soon as possible - don't wait until the symptoms become unbearable; Secondly, once the diagnosed take the prescribed treatment and ensure that the course of medicines is completed — if not, you will run the risk of spreading the disease.



So, hon members, as I conclude, I want to say to you that indeed TB can be defeated if we work together. Thank you very much. [Time expired.] [Applause.]



Mr S M DHLOMO: Hon Chairperson, Ministers, Deputy Ministers, hon Members of Parliament, my colleague hon Gillion, the Chairperson of the Select Committee on Health and Social Services in the NCOP, we would like to start by commending the interministerial committee tasked by our President Ramaphosa



in conducting repatriation of our citizens from Wuhan in China, who will be landing this afternoon in our shores.



The outline by this committee yesterday showed an excellent military preparation for such an operation. I suppose our Ministers did not have to dig too deep in recollecting their Military Combat Work, MCW, training they had in uMkhonto we Sizwe. Thank you very much for this.



About 25 of our people will be laid to rest in Centane this afternoon in the Eastern Cape as part of the road carnage. The motor vehicle accident claimed more than 11 lives again in Gauteng, including three children from one single family. Many others are still lying in various hospitals. Motor vehicle accident has a huge impact on the health budget. We don’t lose less than 10 people per week on our road accidents in this country.



The heightened awareness and attention that coronavirus is received by many, should be extended to the motor vehicle accident problems in our country and TB as a social problem. There is a saying that says; common things occur commonly.

This is true for TB in South Africa. The information sharing



today in this debate is critical to improve our understanding of TB epidemic by all Members of Parliament such that in all districts where we have constituency offices. There is enough TB for you to assist in actually combating and managing it.



We therefore hope that this awareness is going to assist us in various areas where we are and where we have an impact. If there is one medical condition that is linked to the triple challenges of poverty, unemployment and inequality, it is TB. The Global TB Caucus is a network of parliamentarians that was launched in Barcelona on the 27 October 2014. The caucus has then become recognised as a global entity and has grown from seven Members of Parliament to over 2300 Members of Parliament in over 130 countries.



Regional network has also been established in Africa. Therefore, caucus realised that TB is the world’s biggest killer and the objectives are there to accelerate our progress to ending TB epidemic through targets that are there in global, regional and national programmes. There is a declaration in this regard. We are happy that today we are re- launching the South African chapter of this Global TB Caucus



in Parliament and the STOP TB Partnership, where our former Minister was once part of.



I would like to draw your attention to one of the areas that are critical and want to talk about today. A problem called MDR and XDR. I would like you to understand what this is and indicate how it comes about and what role we can play as Members of Parliament. MDR as the name stands; is the Multiple Drug Resistance to TB where you suddenly cannot be able to have an impact on your TB with rifampicin or isoniazid, which we call the backbone of the treatment of TB.



Suddenly, we also developed what we call XDR; the extreme form of resistance where all first line treatment drugs for TB, including the injectables like amikacin and kanamycin are no more effective. But in a sociological term, for us as members of society if we leave this science behind, MDR and XDR TB is a failed management of TB by the society and, by society, I include you, hon members.



On the 10 April 2011, the former Minister of Health, Dr Motsoaledi, accompanied our former Deputy President, Mr Kgalema Motlanthe to KwaZulu-Natal to open the state of the



art MDR and XDR TB in Catherine Booth Hospital. In KwaZulu- Natal, there are more than 200 beds of this type of TB in Catherine Booth in Manguzi and King Dinuzulu, and many others. This is not a good story to tell.



We spend lot money treating TB but we spend much more to treat MDR and XDR TB. We should reduce TB, but we should eliminate MDR and XDR. This sign I am wearing is saying to us; there must be a cul-de-sac on TB. TB must go and stop at a particular time. It cannot stop if we always think that it is going to be a South African problem only.



How you get XDR is very important. Ordinary symptoms of TB which is loss of weight, loss of appetite, coughing for more than two weeks, night sweats; should be pre-empting us to go and get treatment for TB; including the support that we get from traditional healers and leaders. This means that you must be on TB treatment for six months and it is a real burden on the patient, the society and everybody else.



Now, how does it come about that you get XDR TB? When you to a clinic and they tell you to come back tomorrow because they don’t have medication today, that is the start of XDR. They



never ask the patient if they have money to come back the next day or will they be allowed at work to come back tomorrow or is it the end of it? And suddenly, our patients disappear and never come back and then we call them defaulters, yet it was our own cause.



How many of us are willing and available in our own homes to support a member of the family who has a burden of taking tablets for six months; to remind them and give them support. If we don’t do that we are also adding more to this issue of XDR. We need to actually say to people out there, ordinary health professionals called ... [Inaudible.] ... care workers who go around telling people to take the TB treatment. It is not a very easy issue.



If you do not take treatment for six months, conventional TB treatment, you then go into a stage where you must go for nine months or 12 months for a very expensive treatment for TB, sometimes in hospital. So it is very expensive to treat MDR and XDR. We should not be going that way.



We should all say collectively as Members of Parliament that I have a constituency where I have an office. Go there and just



check how many people in the area where you stay, where you have an office, are on treatment of TB. How many of those are taking treatment of TB regularly? How many of those prefer to take alcohol and forget to take TB treatment? In that way, you will close that space as a leader. And, if we were to be measured as parliamentarians, we should be measured about how many people in the area that I am part of as a constituency office are without TB or completes their treatment.



If we don’t do that then we should think twice about having an impact in stopping TB. We have to work very closely with the religious leaders, traditional leader and traditional healers in various areas in our society because they have an important role to play. Now, I am therefore saying ...





 ... ukulashwa kwesifo sofuba masingayenzi inkinga yoMnyango Wezempilo kuphela, akube yinkinga yethu sonke zingumphakathi. Isiguli asithole ukwesekwa emndenini, sithole ukwesekwa nakubasebenzi bethu bezempilo emitholampilo. Umtholampilo mawube nemithi, ingapheli imithi, abantu bafike kuthiwe imithi ayikho akayobuya kusasa, bengamuphi imali yokuthi abuye



kusasa, angabe sabuya umuntu bese bathi uyena okhethe ukungezi ngosuku olubekiwe.



Umqashi naye akalekelele abantu, umqashi amudedele umuntu uma efuna ukuya emtholampilo eyolanda amaphilisi esifo sofuba ngoba kubaluleke kangaka. Ngakhoke zonke izakhiwo zomphakathi namahhovisi ethu omphakathi mawabe nayo indlela yokuthi sikwazi ukuqeda isifo sofuba emphakathini. Ngakhoke angifisi- ke Malungu ahloniphekile ePhalamende sithi, hhayi, indaba yesifo sofuba yinto nje kaDokotela uZweli Mkhize, yinto yoMnyango Wezempilo, yinto yethu sonke, lokhu sazalwa.

Sesineminyaka esondele engamashumi ayisithupha kunesifo sofuba esingafuni ukuphela eNingizimu Afrika.



Kwenzenjani? Uma sithi eyalaba bantu akuyona eyethu, ngeke sikwazi ukuphumelela. Asiyibambeni sonke singabaholi, singumphakathi, sithi ...





 ... All of us have a role to stop TB. All of us have a role to completely eliminate the MDR and XDR because they are as a result of a management by the society. All of us there included. Thank you very much. [Applause.]



Ms H ISMAIL: Aahh, tuberculosis, the serial killer! It wonders through the cities, towns, communities and homes. Tuberculosis is second only to HIV/Aids as the greatest killer worldwide due to a single infectious agent. It does not care about the victims; it does not care for gender, for religion or for colour. A victim is a victim and a host is a host.



Tuberculosis appears to be particularly fond of the poor and vulnerable, invading shacks where many are gathered around their meagre meals, staving off starvation. It sneaks around the woman gathered at the single tap or watering hole and the lost with hopelessness in their eyes.



Tuberculosis is well known to us and much is spent to track it down. Sometimes we corner it, and it seems to slip through our fingers. Sometimes we contain it, and then like a thief in the night, it slips out and finds more victims.



It is elusive and it appears we cannot arrest it. It ravages its victims; leaves them weak, in pain and exhausted from constant hacking. Tuberculosis found one victim, which became ten, became thousands and overtime it has got to millions and



as our poor South Africans become more despondent, more dependent it takes more control.



The victims are angry, broken and survival every day is a challenge. Some victims are embarrassed, shying away from victimhood, afraid of segregation and persecution and disdain of their communities. Many victims will seek help, tired of being ill and desperate for respite. And so, with their few coins they will go to their clinics, seek help and find the means to shake off this dreaded stalker. But over time, and with no resources, getting aid becomes exhausting as the disease itself.



Without the financial means and weak, lengthy travels and long queues at clinics becomes a burden to great to bear. Some are fighters ensuring that at whatever cost they will release themselves from control of their dreaded stalker, and with time and proper medication they find themselves on the mend.



Sadly though, feeling better and confident that they are no longer under the control of the dreaded stalker, they stop medicating. Many are unaware that the TB stalker, if not eradicated completely will turn from just a stalker to a



serial killer. It mutates and gains back control in every sense of the word. Tuberculosis is unforgiving.



It is quick to take advantage of the sad economic situation in South Africa, of the poor health facilities and the unemployment. It is quick to take advantage of the hungry, of the poor housing and lack of basic facilities. South Africa has the fifth highest burden of TB globally and TB remains one of the leading causes of death in South Africa.



Over 95% of TB deaths occur in low and middle-income countries. As the situation in South Africa deteriorates so does the health of its citizens, the workforce, and for those that are lucky enough to work lose productivity. Education takes a knock.



The time has come to say enough is enough to our vicious stalker. It needs to be arrested and stopped in its tracks. Better health is central to human happiness and well—being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more.



The time has come for change. It is time for those who claim to care for the poor and vulnerable, the sick and the ravaged to put their hands up and prove it. Our current track record shows us a government in denial and out of touch with reality.



We care and say today: If those in control cannot manage this untenable situation, we will! Time and time again we have proved that we can deliver, and we do. It is a testament to an organisation that cares, that puts the needs of South Africans first.



We have planned and delivered strategies to arrest this stalker, to give its victims the opportunity to fight back and arrest it. The means to instil hope, to alleviate the poverty and the abysmal living conditions. Our universal vision is a world free of tuberculosis and that means zero deaths, zero diseases and suffering due to tuberculosis.



We, the DA, stand united with all South Africans and the world in the fight against tuberculosis, and it is a fight we must win. I thank you. [Applause.]



Ms N N CHIRWA: Revolutionary greetings to the commander in chief of the EFF, Julius Sello Malema, the deputy president, Floyd Shivambu, commissars and ground forces of the EFF.



Tuberculosis remains one of the number one killers claiming


68 000 lives lost in South Africa in 2018 alone. As a country we should have exited the phase of stagnant decrease of TB deaths but we unfortunately are burdened with a government that gloats about healing sick people than preventing deaths.



The EFF emphasises, once again, the importance of primary healthcare and prevention. It seems this government is accustomed to panic once too many lives are already lost. This is nothing new under the ANC-led government. We saw what happened during the HIV and Aids denialism during Thabo Mbeki’s occupancy as President. The repercussions of this attitude still reverberate for millions to this day.



This government also has a tendency to hide its inability to deliver services by blaming foreign nationals when we, in fact, are one of the top 11 countries in the world with the highest number of our citizens leaving our country for other countries. This attitude not only creates fertile ground for



xenophobia by South Africans but also exposes South Africans in other countries to xenophobic attacks in the future.



For years civil society has been begging the ANC-led government to give support to those with HIV and TB, and you have thoroughly ignored these cries. This is because they come from the trenches of the poor.



Our people know that TB is preventable and curable. Our people want to take their medication but our people are hungry. The number one cause for defaulting patients is poverty and lack of patient-centred care.



Give our people land so they can farm and feed themselves; jobs so they can nurture themselves; and clean water to stay healthy. Our TB crisis is, in fact, a crisis of landlessness, dispossession, unemployment and poverty.



Mpumalanga is one of the highest air pollution areas globally, and workers, ordinary citizens and pregnant women experience a direct implication by being prone to respiratory diseases like tuberculosis. The Minister has done nothing about this even after our recommendations in the past year.



Exploitation of mine workers, which in majority are black men, by mining companies who steal our minerals, and failure of the ANC to normalise health care for men in the mining industry is a form of gender based violence against men.



The country is sitting at 17 infections of coronavirus which is declared a global concern and yet, in South Africa, research and information dissemination is lacking on how coronavirus will affect people with tuberculosis and HIV, and measures taken in this regard.



In 2014 following the Ebola outbreaks, travel bans against three African countries were instituted when we had zero infections. This has not been done in response to coronavirus global outbreak when we are sitting at 17 infections over a few days.



The EFF proposes the following to the Minister of hospitals since we do not have a health system in this country.



The Sixth Parliament should finalise the National Health Amendment Bill to ensure clinics are open 24 hours.



The overall target in South Africa should be that no citizen should go three months without a medical check-up. Regular checkups should be linked to other social services such as collection of social grants.



Every clinic must provide patients with chronic illnesses with groceries. These services must be linked to auxiliary social worker services.



The department must build and resource science centres in townships and rural areas and do mass programs on normalising healthcare for men in taxi ranks, train stations and popular hangout places for young people.



The department must release funding to creating an environmental and scientific cohort that will highlight high risk areas for easy transmissions and infections.



The Minister must ensure the sustenance of specialised TB facilities instead of leaving vulnerable patients destitute like you have done in Port Elizabeth, Empilweni TB Hospital.



The department must hold mining companies accountable through monetary penalties and strip them of licensing for depriving mine workers of health surety and exposing them to unsafe labour with which is guaranteed to leave them dying from silicosis and prone to contracting and spreading tuberculosis

... Prevention, education, primary Healthcare.



You have demonstrated to South Africa in your 26 years of governance that a respiratory disease has more power over you by failing to conquer tuberculosis which is preventable and curable. If you can’t learn from us, at least learn from your own failures, and for once, be a proactive and not reactive government. I thank you. [Applause.]





Nks N NDONGENI: Sihlalo weNdlu, abaPhathiswa, ooSekela baPhathiswa, amaLungu ePalamente neendwendwe ezikhoyo, molweni. I-ANC isazimisele ukusebenza nzima ngenjongo yokufumanela abemi beli bonke impilo engcono nobomi obungcono.



Urhulumente okhokelwa yi-ANC uhambe umgama obonakalayo ekulweni isifo sephepha neNtsholongwane kaGawulayo. Eli dabi limele ukuqiniswa ingakumbi ukuba eli Iizwe liza kufikelela



kumasikelo ehlabathi nalapho amazwe amele ukuqengqa aqangqulule ezi zifo azoyise nobungozi bazo ungafikanga unyaka wama-2030. Ngelixa abantu bequbisana neendleko ezayanyaniswa nesifo sephepha, abaninzi nangakumbi bayadleka ngokuthi baye kuphuthuma amayeza, ukugcina iintsana, ukuphulukana nomvuzo ngesizathu saso esi sifo.



lyafuna ukunqonqoziswa into ethi, esi sifo sephepha sichaphazela iintsapho namakhaya amaninzi asokolayo. I-ANC iwenzile amatile-tile okuqinisekisa ukuba iindleko ezikumila kunje azinafuthe kwaye ziyahlawuleka. Phofu, ubungqina obuvelayo bubonakalisa ukuba ukhuseleko ekuhlaleni, ingakumbi kwabo basebenzisa unyango, lubonakalisa iziphumo ezingcono nezincomekayo.



Umzila wocalu-calulo ubangele ukuba I-ANC ilandele inkqubo egqibeleleyo yokhuseleko lwasekuhlaleni ngenjongo yokulwa nendlala, intswela-ngqesho nokungalingani, zizinto ezo ezimele ukwayanyanyiswa namaxesha amandulo. Ubungqina bubonakalisa ukuba iinkqubo zikarhulumente ziyaphumelela ekulweni nendlala, phofu ziphucula nokusiwa phantsi kwempumlo, ukuhanjwa kwesikolo nempilo engcono.



lsifo sephepha, njengayo yonke eminye imibulalazwe, ayazani namida. Izizwe namazwe amele ukubambana ngezandla ukulwa nesi sifo. Hayi okokuba sime apha sikhombane ngeminwe sityholana ukuba ubani wathi, ubani wathi. Nanjengoko ke le nyanga yoKwindla ithathwa njengenyanga yesifo sephepha kwihlabathi, umhla wama-24, wama–2020 nophawulwa njengosuku lwesifo sephepha jikelele, uya kuba sisikhumbuzo nesiMongo siya kuba sisithi - “It’s TIME”.



Ingqwalaselo isekukhawuleziseni unyango nogonyo ngelikhawulelana nokusindisa imiphefumlo; ukuphelisa intlupheko nokusa phambili imibono yokuzibophelela kweentloko zamazwe ngowama-2018, kwingqungquthela yabo ngesifo sephepha.



Esi ke sesona sizathu sokuba isifo sephepha soyiswe nkalo zonke eluntwini. Umsebenzi wokwazisa abantu ngale nto umele uqhube, sibafundise sibavundlise abantu ngesi sifo nonyango lwaso, namacebo akhoyo eburhulumenteni.



Mandithathe eli thuba ndibulele; ndidomboze; ndithi huntshuuu kubasebenzi bempilo, oomongikazi bethu nakoogqirha mbombo zonke kweli. La ngamaqhawe nakhokelayo kwidabi lesi sifo; igalelo lenu liyancomeka. [Kwaqhwatywa.] Ukusebenza ngokuthi



uqokolelele ndawonye abantu ibaluleke kakhulu ekukhawulelaneni nefuthe lesifo sephepha kuqoqosho nokuhlala kwabantu.



Ubunkokeli bepolitiki bubalulekile ukuba ihlabathi kwakunye neli lomdibaniso baza kusoyisa esi sifo. Iikomiti zempilo kule Ndlu yoWiso-mthetho yeSizwe, nakwela Bhunga lamaPhondo eSizwe, mazikhokele, zithi ngokuhlangeneyo ziqinisekise ukuba indima yamalungu iyacaca. Bangafonyozi bafede, bathethe kakubi ngalo rhulumente ukhokelwa yi-ANC.



Inkongolo yabantu iyayibethelela indima yamalungu namele ukuba ngamatsha-ntliziyo kweli phulo ingakumbi xa bephumile besebenza kwiingingqi zabo. Funeka ke amalungu azibandakanye nezi okanye kwezi zinto zilandelayo: kwazisa uluntu lokuhlala ngeendlela zokuzikhusela; ukuhlolwa nokuvavanyelwa isifo ingakumbi xa iimpawu zizibonakalisa. Bazibandakanye namaphulo okufumana izigulane ezilahlekayo, nabo bathi bangayi ukuya kuzivavanya, kwanabo bangawatyiyo amayeza. Mabazibandakanye neengxoxo kumaqonga ehlabathi, ngenjongo yokwabelana ngamava nokufunda uhlobo amanye amazwe enza ngalo. Nokudibanisa umsebenzi ngesifo sephepha apho ubani angumthunywa khona – constituency - Incorporate TB in Constituency Work.



Ukuyinqanda le nto yesi sifo kufuneka abantu babenolwazi kuqala ngeempawu, ze kukhuthazwe ukuba abo basulelekileyo bakhangele unyango. Oku kuzaqinisekisa ukuba izigulane ziyawatya amayeza, ixesha lokwenza njalo de liphele.



Izigulane zesifo sephepha ezithatha amayeza zingasebenza ekuhlaleni, yaye ke aba bayayidinga inkxaso yethu ngethuba besendleleni esinge kwimpilo egqibeleleyo.



Mandiqukumbele, ukuzeka mzekweni kumazwi kaMongameli uCyril Matamela Ramaphosa:



“Ukusebenza ngokuhlangeneyo ngolu tshaba lufihlakeleyo iya kubaluloyiso. Yomelelani ukwenzela nabanye babonele kuni nokuba umthwalo uyasinda.



Khumbulani le nto ke, ukuphelisa isifo sephepha nesifo sikagawulayo, kusezandleni zethu. Ndiyabulela. [Kwaqhwatywa.]



Ms M D HLENGWA: Hon Chairperson, hon Deputy Minister of Health, members, Tuberculosis remains one of the leading causes of death in South Africa. In 2018 we lost 63 000 people to this dread disease with estimates of those who contracted



the disease in 2018 ranging from between 215 000 to 400 000 people.



We have one of the highest incidences of TB prevalence of any country in the world; and although we are witnessing a decrease in new infections, these are occurring at far too slow a rate for us to say that we are winning the war against TB.



It is very commendable that the department and ministry continue to play a leading role at the Global Tuberculosis Caucus, but the IFP would like to see greater political commitment and resources being deployed for TB care and prevention at home.





Sihlalo ngaphambili njenge-IFP sishaya ikhwela sithi lesi sifo ngabe asiqhubeki kangaka ukuba abantu bayidla kahle le mithi. Uma beyidla abalambile yini. Bantula ukudla, bantula yonke into. Bantula ngisho amanzi abantu bakithi. Yingakho isifo sofuba siyohlala sinjena ezweni lakithi. Ngiyaphinda futhi ngishaya ikhwela koNgqongqoshe nje abathathu ukuthi baselekelele, oWezempilo, oWezokuthuthukiswa Komphakathi



noWezemfundo. Bonk bahlangane ndawonye babone ngoba kwezemfundo izikole ziyagqekezwa abantu befuna ukudla ngoba balambile. Konke lokhu kusenzela phansi njengohulumeni. Ngakho sidinga uhulumeni noma oNgqongqoshe noma iMinyango ebambene ukulwa nalolu bhubhane lwe-TB. Balambile abantu.





Poor nutrition in vulnerable communities remains one of the most aggravating circumstances for the contracting of this disease and in this regard, we call for greater government support to feeding schemes in these vulnerable communities.



Government should also ensure that high risk communities are adequately educated in terms of proper nutrition and TB awareness and prevention campaigns.





Uma ngikhuluma ngokuqwashisa mhlonishwa wami. Angisho ukuthi asiyothi TB lokuya nalokuya kodwa asibatshele abantu ezifundazweni eziyisishiyagalolunye ngolimi lwabo abalukhulumayo ngoba ziyisishiyagalolunye izilimi abazikhulumayo. Abezwe ngolimi lwabo ukuthi uthini uhulumeni futhi uthi abenze njani.





Initiatives such as those that have been orchestrated in partnership with the private sector to screen for TB and other preventable diseases must be further encouraged to ensure as many South Africans [Time expired.] as possible know their TB health status. I thank you. [Applause.]





Mnu M BARA: Masibulele Sihlalo weBhunga laMaphondo leSizwe.





Hon Chair, hon members and fellow South Africans. According to Statistics SA, Tuberculosis, TB, continues to be the leading cause of natural deaths in South Africa. It is also estimated that about 80% of the population of South Africa is infected with TB bacteria, the vast majority of whom have latent TB rather than active TB disease.



The highest prevalence, estimated at 88% has been found amongst people in the age of 30 to 39 year old living in townships and informal settlements, meaning that, that is prime of any person who is supposed to be at work and cannot take care of themselves in terms poverty lines.



The World Health Organisation gives a figure of 22 000 deaths from TB in South Africa in 2017 but this excludes those who had both TB and HIV infection when they died. These people are internationally considered to have died of HIV. It is estimated that 56 000 people with both HIV and TB died in 2017. It is a huge problem in countries where poverty, overcrowding and malnutrition is rife. Spikes in TB prevalence are catalysed by HIV/Aids and that have remained largely impervious to control efforts.





Enye yeengxaki ezikhoyo ngesifo sephepha kukuba abantu bayayeka ukuya kumaziko empilo ngenxa yokuba ekude kubo. Kwakhona, izigulana ziyayeka ukutya amachiza xa kuphele iimpawu zesifo becinga ukuba banyangekile.



Loo nto inokubangela ukubuya kwesifo sephepha esinenkani ukunyangeka ngamachiza aqhelekileyo. Ukuhambela unyango ixesha elide lethuba lenyanga ezintandathu ukuya kwezilithoba, ngumceli-mngeni onzima kakhulu kuninzi lwabantu.



Kubalulekile ke ukuba abantu bandwendwelwe kumakhaya abo ukuze bafumane uncedo kwiindawo abahlala kuzo. Ukukhuthaza amadoda



ukuba aye kumaziko empilo xa eziva ukuba awaphilanga yenye yezinto ezingundoqo ekufuneka zenzekile.





HIV and Aids provides breeding ground for TB because it finds the immune system compromised. In a country like ours, with millions of people living with HIV, it is important that our people take antiretroviral treatment regularly to avoid opportunistic diseases like TB.



As much as TB treatment is a personal journey full of recovery, a support system is important to reach your destination. No one can be healed if there is no support structure, either at home or within the community.





Kubalulekile ke ukufundisa abantu ngococeko kuba iintsholongwane ziphila ngokuphinda-phindeneyo kwindawo ezingacocekanga. Ngoko ke kumele ukube umcimbi wesifo sephepha ungenzeki ngenyanga yoKwindla nje kuphela kodwa ibe yinto yemihla ngemihla.






The Eastern Cape, KwaZulu-Natal and the Western Cape are the provinces which have the highest incident rates in South Africa with reported rates of 692, 685 and 681 per 100 000 respectively for 2015. The most notable decline has been Kwazulu-Natal where the incidents rate has decreased from 1185 to 685 per 100 000 over last five years.



We want to urge the Minister not to wait until next year to purchase and roll out 3HP medication and take advantage of the 70% price cut. This short course of two in one pill will go a long way to saving lives as opposed to taking 10 tablets a week. There is a need to improve living and working conditions of mine workers as they are vulnerable to the disease. The same must be said about inmates in correctional facilities if we are to curb the catastrophic consequences of TB.



It is worrying then therefore, when we see the spending patterns of our government that we prioritise bailing out state-owned enterprises, SOEs, when we have a catastrophe caused by TB right on our doorsteps. If we mean what we say, it means that we must budget accordingly so that we deal with specific areas that are challenges to our people



Government should intensify advocacy and awareness campaigns about TB. Messaging therefore, to conscientise our people about the realities and the dangers of TB in society let this campaign extend beyond March as a TB awareness month. I thank you so much [Applause.]



Mr S N SWART: Chair, the ACDP welcomes this debate about the TB pandemic, particularly when seen against the Covid-19 outbreak. While there has been an understandable global alarm and concern about the corona virus, with various countries in lockdown, it is important to see this virus in perspective in South Africa, without detracting from its seriousness.



As of yesterday, there were around 4 800 deaths from corona virus worldwide. Compare this to the staggering levels of TB in South Africa. It is the leading cause of death in South Africa with 63 000 people dying in 2018. That is approximately

172 persons today. Why then is there not a similar outcry and even outrage about the soaring levels of TB in our country, particularly as it is fully treatable as a bacterial disease? We can and must do more.



At the forefront of the fight against TB are of course the brave doctors and nurses at both primary and secondary level. The ACDP recently visited the Brooklyn Chest Hospital, a centre of excellence in the treatment of TB. We want to pay tribute to the nursing staff at this facility, and indeed, at other facilities across the country that are committed to treating patients with TB, including of course the extreme drug-resistant, DR, patients.



Poverty clearly contributes to the spread of TB, and that maybe the case with Covid-19. Many of our impoverished living in crowded housing conditions, have to use crowded buses, taxis and trains to commute. Our poor are also less likely to seek care or complete their course of medication. Poor nutrition can also reduce one’s chances of being cured.

However, because TB is largely curable, it is, from the ACDP’s perspective, incomprehensible that so many South Africans are still dying from it.



In addition, those who suffer from TB and/or HIV are higher risk of contracting Covid-19, given their compromised respiratory and immune systems.



What then should our response be? We support the calls to clean our hands, washing them with soap and water, and cover our mouths when coughing or sneezing, try to build up our immune systems, and get quality sleep and exercise. If you feel sick, call the helpline and get aid. This will of course reduce the spread of the corona virus and TB.



Lastly, in addition to these commonsense steps and precautions, we who are believers in this nation need to emulate Jesus, particularly who taught us to love and care for those who are sick and suffering. Let us not allow fear and panic. Remember God’s Word in Psalm 91: “If you place your trust in the Lord, no evil shall befall you; nor shall any plague come near your dwelling.”



Take precautions. Do not be fearful or anxious, “for God has not given us a spirit of fear, but of power and of love and of a sound mind.” I thank you.





Nk S A LUTHULI: Ngibingelela ubuholi be-EFF, ngibingelela amalungu e-EFF emakhaya kanye nomphakathi uwonke, isifo sofuba ingenye yezifo ezihlasela iningi labantu abamnyama eNingizimu



Afrika. Iningi lalaba bantu basebenza ezindaweni ezifana njengezimayini lfuthi akulula ukuthi bathole usizo.



Ngiqhamuka eNdwedwe KwaZulu-Natal. Abantu bayashona futhi ayikho into esiyenzayo njengaleNdlu ukuthi sibafundise ukuthi bangazivikela kanjani beyimiphakathi. Njengoba ngishilo ukuthi ngiqhamuka KwaZulu-Natal, iKwaZulu-Natal yaziwa njengesinye sezifundazwe esinesibalo esikhulu umangabe sikhuluma ngezifo ezifana no-HIV ne-Aids. futhi siyazi ukuthi umangabe unesifo se-HIV ne-Aids uphila usethubeni lokuthi uthole izifo eziyimixhantela ezifana naso isifo sofuba.



Izimo abantu abaphila ngaphansi kwazo zinyantisa igazi kepha lo Hulumeni wabathembisa impilo engcono eminyakeni engamashumi amabili nanhlanu eyadlula. Lo Hulumeni awunalo ulwazi ukuba kumele wenzenjani ngezempilo. Sifundisa ngenhlanzeko kepha abantu bahlala ezimweni abangakwazi ukuthi bahlanzeke kuzona. Abantwana bethu basafunda ezikoleni ezisenezakhiwo za-asbestos and basasebenzisa izindlu zangasese zemigodi, abanawo amanzi. Abakwazi nokugeza izandla uma bephuma ukuyozikhulula ezindlini zangasese.



Imikhukhu yethu indle igijima emigwaqeni and abantu bahogela konke lokhu kungcola Uthi lohulumeni ukulashwa kwesifo sofuba kumahhala, ngiyavuma kumahhala kepha uya kanjani emtholampilo ukuthi uyoyhola imishanguzo yesifo sofuba, imitholampilo ikude, abantu bayagibela zonke izinsuku ukuze baye emitholampilo, imali abanayo, abasebenzi, abantu balambile.

Kungesinye sezizathu ezenza ukuthi abantu bashone.



Ngibona kungenye indlela lo Hulumeni weqembu elibusayo ohlulekayo ukuthi alekelele abantu ukuthi bakwazi ukuphila. Iminyango ayisebenzisani, ngikhuluma ngoMnyango Wezemfundo, uMnyango Wezempilo, Umnyango Wezokuhlaliswa Komphakathi.



Lo Hu|umeni ulinda ukuba abantu baze baye emitholampilo ukuze bathole ukuthi bayagula banesifo sofuba. Ayikho indlela yokuthi lo Hulumeni uye kubantu uyobafundisa uyobaxwayisa ngalezi zifo awunayo indlela yokuya kubantu ubafundise ngezindlela zokuvikela izifo. I-Cuba inenani eliphansi kabi labantu afayo ngenxa yesifo sofuba. Isizathu salokho yingoba uHulumeni wase-Cuba ugxile kakhulu ekusindiseni izimpilo zabantu, awugxilile ekwenzeni imali. Sidinga ukwakha imitholampilo kuwo wonke amawadi ukuze wonke umuntu akwazi ukufinyelela ukuthi aye emtholampilo.



Sidinga ukuba abantu abafundisiwe ukuba baye eMtubatuba, baye e-Vembe, baye -Engcobo, baye e-Nkangala nazo zonke izindawo ezisemakhaya ukuze bakwazi ukufundisa abantu bethu nokuthi babaqwashise ukuthi lesi sifo silekelelwa kanjani, sivinjelwa kanjani ukuthi singene kuwena.



Akumele abantu ukuthi babone izikhangiso ngesifo sofuba ngoba nakhu sebe semitholampilo. Kungani kungabikhona izikhangiso emgwaqeni, ezitobhini zamabhasi, emarenki nayo yonke indawo abantu abahamba kuzona. Ngisho nasezikhungweni la abantu abalanda khona izibonelelo zabo zakwa-SA Social Security Agency, Sassa, yindababa zingekho izincwajana abantu abanikezwa zona ukuze bakwazi ukuthi bafundiswe ngesifo sofuba.



Kungani lo Hulumeni ungenzi njengezinkampani ezinkulu, izinkampani ezidayisa utshwala ngoba utshwala ubuthola yonke indawo, bayakwazi ukubuyisa kuwo wonke amakhona akhona eNingizimu Afrika, nathi sidinga ukwenza njalo. Sidinga ukuba nenndlela yokkuhambisa imiishanguzo yesifo sofuba kubantu bethu ngendlela izinkampani ezenza ngakhona. Angeke siyinqobe lempi yesifo sofuba uma sizolinda abantu kube yibona abeza emitholampilongoba abantu vele abezi emitholampilo. Kumele



thina siye kubantu zinsuku zonke , ngezikhathi zonke uukuze sikwazi ukuvikela lesi sifo esibulala abantu kangaka.

Ngiyabonga. [Ihlombe.]



Mr S N AUGUST: Hon Chairperson, with increasing infections of the corona virus in our country, patients with TB and HIV could be at a higher risk of obtaining the virus, therefore we need to ramp up our efforts for prevention, testing, treating and awareness for all these diseases.



Although we don’t know much about corona virus, we do know that it poses particular risks to people with compromised immune systems.



With this being a worldwide issue and with TB and corona virus targeting the lungs, it does put us in stark contrast to many other countries because, as a disease, TB is more prevalent in South Africa, and more so in the Western Cape, Eastern Cape and in KwaZulu-Natal.



We are one of 30 high-burdened countries, who collectively account for close to 90% of TB cases in the world. It also remains the leading cause of natural deaths in South Africa.



We need to encourage South Africans to get tested for TB and take their prescribed course of medication. It is time to stop being complacent with our health.



If we know that TB is driven by poor living conditions and late presentation to health facilities, our citizens must be encouraged to learn better habits and to see doctors when necessary, even with mild symptoms.



With the national strategic plan of government, we have made great gains on TB infections and treatment, however there is much more to be done.



We need to start seeing the results of rapidly cutting down on new infections and an increase of figures on those cured of TB.

We must also see these rates increase significantly in our poorer communities, where the infection rates are much higher than in our suburbs.



Greater awareness, education and outreach programs should be a priority by the Department of Health, particularly within schools, health facilities and in public areas. Both



Archbishop Tutu and tata Madiba who had TB did a lot to fight this disease. It is no secret that these diseases thrive in environments in which our poor people are forced to live and work.



We need to raise awareness in all languages, across the full media spectrum to keep people informed on practical steps to maintain their health and prevent the spread of Covid-19, HIV and TB.



We need to radically ramp up access to testing, isolation and treatment. This will indicate that we are prioritising the poor and working towards equal health care for all our people.



Every South African deserves additional health care provision over and above the nationally provided health care. The research on TB continues, with existing treatments to control it, but we need citizens to play their role to unite and help us fight TB together. I thank you.



Mr A M SHAIK EMAM: Chairperson, South Africa is one of the countries with the highest burden of tuberculosis. About 1% of our population - which is currently estimates at almost



60 million - develop TB and this end up to be about 600 000.


Sixty percent of those who have TB are also HIV positive. Tuberculosis is the leading cause of death in South, and of course, the most affected areas appear to be the Eastern Cape and Western Cape. It is estimated that over 330 people died of TB everyday in South Africa in 2016, and 1,7 million people died worldwide. Of course, the figures are currently much lower.



A study funded by the Research Council of South Africa was conducted by the Stellenbosch University in the Western Cape. Amongst its findings were risk factors for the Western Cape poor communities of TB where children and rural patients were discharged from hospital without TB medication, poor data systems and poor continuity. This means that processes from the time they came in hospital were not actually followed.

There was no continuously checking on them.



To the DA member who came and spoke here, and it was her maiden speech as I was told, let me advise you that you need to go to areas like Highlands Park because you are agreeing to what the causes are. Look at the conditions that those people are living in - almost on top of each other. They are living



in shacks. That is the reason why TB is one of the highest in the Western Cape. Let me tell you, you cannot compare the Western Cape with other provinces which have minds and thinks. The Western Cape does not have it. It means that TB rate is much higher.




Let me go one step furtherer in terms of that. You have identified the problem; your public representative must ensure it. Let me tell you what I have just picked up. Not a single health care facility in the Western Cape go out and visit children in those poor areas, schools or in their homes to see that you can try and prevent tuberculosis or give them treatment. Not a single one of them! How are you expecting it to come down? [Applause.] You must go out so that them.



Next time when you have a caucus meeting I want to plead with you to discuss these: how you can get your structures work on the ground; how you can get your health facilities improved; how they can go and test people on the ground; and how they can go and test the school. I promise you, one year down your TB rate will be much lower. Thank you very much.



Mr S E MFAYELA: Chairperson, according to the World Health Organisation about one quarter of the world’s population is infected with tuberculosis bacteria. Only a small proportion of those infected will become sick with TB. People with weakened immune systems have a much greater risk of falling ill from TB. A person living with HIV is about 20 times more likely to develop active TB. South Africa ranks as one of the eight countries who have the highest levels of infection rates.



The World Health Organisation estimates that 128 000 people died of TB in South Africa in 2016. That means about 330 people died from this infection daily – “Iyabulala lento!” [This thing kills].



Recently we have been faced with added risks to the health of our population in the form of coronavirus. The potential of this virus being mixed with the high TB infection rates in South Africa could lead to an increased pandemic for South Africa in particular. Government must not wait for reports to plan for the deadly combination of the two but have measures in place to deal with it. South Africa cannot afford to sit back and relax as the infectious rates increase and as a



result, government’s slow response in equipping hospitals is worrying. We must urgently allocate funds to fully equip and refurbish hospitals with strict timelines in order to get a handle on the deadly corona virus. [Time expired.]



Mr L M NTSHAYISA: Hon Chairperson, TB is as old as the mountains. It is one of the challenges facing our country as a killer disease. The poor are the most targets more especially the blacks as they are in the majority. Thus poverty contributes a lot to this disease. Therefore, this means that growing our economy will help us fight TB.



We have to come together and reason together so that we can overcome this curable disease because it is curable. Unlike Hiv and Aids, TB is curable. We should boost our immune system by eating healthy diet and do away with liquor. Liquor cannot cure TB, but makes it worse. Therefore, we encourage people not to take a lot of liquor. Many have died because of TB. It is worse with the diabetic people because it also contributes. The microbacteria that cause TB can also be done away with if we come together.



Chairperson, we should breath fresh air, live in a healthy environment and always be clean because cleanliness is next to Godliness.



Besides the normal TB there are two types of TBs, namely, the multidrug resistant and extensively drug resistant. I am proud to say that in Matatiele we are now in a position to treat the multidrug resistant diseases. The extensively drug resistant must is sent to Port Elizabeth. In Matatiele we are lucky because we have good doctors, the likes of Dr Tshepang Nakin and Dr Peter Hene.



Those with extensively drug resistant, as I said, are sent to Port Elizabeth for treatment. It is also in the Eastern Cape. This means that at least we are trying a lot in the Eastern Cape. We must always make sure that our people are made aware of this disease and we encourage them to go to clinics for treatment. They should not dodge because it is their lives. It means we should always be together with our people.



Again, I would encourage the department to go down to the people and look for those may perhaps be affected so that they can be treated early. [Time expired.]



Mr W M MADISHA: Permit me hon House Chairperson, to remind the House what happened to our late President Mandela when he was released. Only a few months he went to hospital after he had declared that he was not well and had tuberculosis, TB. Indeed he was treated – I do not want to say that he was recognised basically because of his status – inside a period of six weeks and all the problems were dealt with. The question is, is that the case with the majority of the people of our country today? That to me is a major problem. The late President received quality urgent treatment.



Today, the majority of the people who are faced with this illness are the working class and the poor people. What happens to them? They go to hospitals, clinics and there you will find serious problems. Fortunately, I want to emphasise that our Deputy Minister, the Minister, the previous Ministers going back to the late Manto Tshabalala-Msimang were doctors and we therefore know what is happening in our hospitals. Is there any success? I want to say there is no success so that we then can be able to look into that.



In the hospitals we do not have doctors. Remember we have one doctor to 100 patients and then therefore as a result of that



you cannot have proper treatment. We have a problem of lack of medicines and if you go to hospitals because of that there is a major problem. I come from the rural areas and the Deputy Minister comes from there as well. You know that the buildings are collapsing and the hospitals now are becoming shacks and as a result of that we will not have patients treated properly.



Given this, I want to say that we need to come up with a state of emergency. Number one, accept that the majority of our people who have TB and other diseases are the ones who are not working, extremely poor and these would not even want to go to hospitals because should they go there then, they will lose their jobs.



Ms M S KHAWULA: Hon House Chairperson, on a point of order:



The HOUSE CHAIRPERSON (Ms M G Boroto): On what point of order are you rising hon member?





Ms M S KHAWULA: Cha, ngisenkingeni, sengiyesaba manje.





The HOUSE CHAIRPERSON (Ms M G Boroto): Hon member, why are you rising? Which point of order are you rising on?





Ms M S KHAWULA: Hawu cha, angazi la mnumzane useyatatazela; ukhumula nebhantshi angazi udayisa ni la ngaphakathi.



The HOUSE CHAIRPERSON (Ms M G Boroto): I am switching your microphone now; that is not a point of order. Take your seat.



Mr S F DU TOIT: Hon House Chairperson, TB South African’s biggest killer and the Covid-19 virus could be its rival. A total of 63 000 people died of TB in South Africa in 2018 according to the figures released by the World Health Organisation, WHO. Two thirds of those that died were HIV positive. The WHO estimates that about 301 000 people fell ill with TB in South Africa in 2018. These are however significant uncertainty about this since there is a 95% chance that the real number lies between 215 000 and 400 000.



South Africa has more than 880 new infections per day. It is a country’s leading cause of death and has been made worse by



the HIV epidemic by 7,4 million people being infected with HIV. South African public is in a state of panic with the grim reaper called Covid-19 that is looming to take its toll on TB and HIV infected people. Just think of the devastation that the Covid-19 virus could cause in South Africa.



If government was not able to win the fight against TB what will they do to protect South Africans against the dreaded Covid-19? What are they doing? The fight against TB should have been won by now. Deputy President David Mabuza said in December 2019 that South Africa’s target is to put an additional 2 million people on TB medication by the end of December 2020. So what are the issues?



Reports by the Treatment Action Campaign, Tac, indicates that the public healthcare system is so severely dysfunctional that it hinders the implementation of HIV and TB programmes. Hon Chair, I need to stress the fact that our medical personnel, support staff and even dispensary personnel need to be provide with Personal Protective Equipment, PPE with reference to the real corona threat that is out there.






Hou vas aan Psalm 50 vers vyftien: “Roep My aan in die dag van benoudheid. Ek sal jou uithelp en jy moet My eer.” Ek dank u.





Mr M G E HENDRICKS: My apologies Chair, I was at a very important parole meeting and just the House to know that I am very passionate about the rights of parolees. On the issue of TB I would like to record my appreciation for the tremendous efforts especially made in our communities to assist them. I have worked with a lot of NGOs and my family members have been affected by TB. I was really impressed with the regime that they have to follow one case with so much attention to details that one of the people I was working with had to report to the nurse everyday. She wanted to make sure that he takes his tablet and swallows it and not just make as if they use.



So, I think the foundation has delayed for a successful regime of treating South Africans who have TB and all we have left to do is to try and improve and encourage that more and more people come unto this regime. The harmful effects of TB and your immune system is now going to hit us hard when it comes to the Corona Virus because those very people are now in the high risk category. All we can do is to ask the Department of



Health and the other departments involved to continue their good work. Thank you very much.



Ms M N GILLION: Hon House Chair, the Deputy Minister of Health, the Chairperson of the Portfolio Committee, Dr Dhlomo, fellow hon members, in the words of former states man, Nelson Mandela and I quote, “We cannot fight Aids unless we do much more to fight TB as well.”



Thus this ANC-led government has made notable intervention to curb the scourge of TB and related illnesses over the years. More than 6,8 million people living with HIV and Aids get treatment, screening, treatment and preventative methods are intensified and readily available for free in government facilities. The problem of stigmatisation is greatly reduced due to an extent that people living with HIV and TB are now acceptable in society.



A 2018 article published in the PLOS ONE journal found that and quote:



In the preHIV era the Western Cape province had the highest TB prevalence in South Africa, largely through to poor



socioeconomic conditions and failed public health responses before and during apartheid. The provincial TB Incidence of 906 to 100 000 at the time of the study remained one of the highest in the country.



One of the findings of this journal revealed that most discharged TB patients did not continue care or successfully completed TB treatment with potentially serious implications for patients, the community and the health systems. We thus call on the provincial government of the Western Cape to ensure that the hospitals improves the quality of care of TB patients, develop integrated hospital TB surveillance systems linking to the national TB information system and strengthen care pathways for TB patients across levels of care.



Now Chairperson, in the Gauteng province, South Africa has made significant progress in its control of TB. The ANC-led government has put in place many of the key elements of the successful TB control programme including significant resource allocation, a strong policy environment, rapid technology introduction, valuable research outputs and bold political support. The country’s government is heavily invested in its



TB programme, with one of the highest proportions of domestic funding in development countries.



We must commend some of our provincial Departments of Health for heeding to the call for swift responses to the epidemic, in ensuring the country realises the global targets of eliminating the disease by the year 2030.



Gauteng is one such province. Education and screening programmes are done at all levels of service delivery as a package. They are mainly coupled with symptomatic screening of individuals and groups of people in facility waiting areas and during planned campaigns in communities, congregate areas, example correctional services, hotspots like taxi ranks, hostels and in health facilities.





Ope dae word ook in die provinsie van Gauteng gehou, waar stalletjies vir die gemeenskap opgesit word, en waar hulle opleiding oor hul publieke gesondheid rakende TB en MIV ontvang. Hulle het baie sulke ope dae.






Outreach activities are carried out by nongovernmental partners supporting the Gauteng Department of Health in malls and taxi ranks. Comprehensive screening and health education including TB services and linkage to care for those suspected of TB and those that interrupted their treatment.



Community work is done by the Community Health Care Workers on a Ward-Based Outreach Teams during which home visits door-to- door campaigns are done including profiling of TB patients, screening and referring to health facilities for further treatment and care. This list can go on and on and on.



We need to commend the MEC of Education in the Gauteng province on this good wood work.



In closing Chairperson ...





... as ons nie gaan ophou om politiek met die epidemie van TB te speel nie, gaan ons nie Suid-Afrikaners help nie. Ek wil saamstem dat ... In die Wes-Kaap wil ek vir die DA vra om te gaan kyk in ons arm gemeenskappe. Solank as ons nie die sosiale en ekonomiese omstandighede van ons mense verbeter



nie, gaan ons nie die TB-getal in die Wes-Kaap kan verminder nie.





Chairperson, in conclusion the ANC is calling on all South Africans and provincial Departments of Health to be part of a global voices, shaping the future TB direction and for more concerted efforts to make in an effort to realise that our National Development Plan, NDP, target of progressive improving TB prevention and cure. It is indeed, in our hands to end TB in this country. I thank you, Chair. [Applause.]



Ms E R WILSON: Thank you, House Chair. Someone said to me that we are living in interesting times. No, I think we are living in very scary times. Over the last couple of months this House has sat through the President’s state of the nation address and the Budget speech.



President Ramaphosa has spoken on more that one occasion of his dreams and the need to dream. Well, in order to dream you have to sleep and quite frankly with the current state of South Africa, how any member of this Cabinet can sleep is beyond me. They should be lying awake 365 days of the year



asking themselves what have we done? How did we end up in this unholy mess? Can we ever forgive ourselves?



Yes, I am aware that this debate is on Tuberculosis, TB, and the theme is; united in fighting Tuberculosis, TB. Just days before the global conference on this subject hosted right here in South Africa we are having an emergency sitting to get your approval. Really, does this indicate to the rest of the world that we are serious about this issue? 10 years ago we pleaded for a caucus to be established to discuss plan and to address the TB crisis in South Africa. Our plea fell on deaf ears ...



The HOUSE CHAIRPERSON (Ms M G Boroto): ... order! Order!



Ms E R WILSON: At the end of the last term the health portfolio was suddenly advised on very short notice that a meeting was being held in Cape Town to establish a TB caucus. The scramble was on. Is this indicative of a government that really takes the crisis within our borders seriously? I think not. Here we sit another year on to get your approval ...



The HOUSE CHAIRPERSON (Ms M G Boroto): ... hon Wilson, will you, please, take your seat. I see your hand, on what rule are you rising, hon member?



Ms M M RAMADWA: On a point of order, Hon Chairperson.



The HOUSE CHAIRPERSON (Ms M G Boroto): Okay, thank you.



Ms M M RAMADWA: Does the hon member realise that, that is a


... [Interjections.] ...



The HOUSE CHAIRPERSON (Ms M G Boroto): ... hon member, I think you are coming with a point of order, not a question.



Ms M M RAMADWA: No, it is not a question.



The HOUSE CHAIRPERSON (Ms M G Boroto): Okay.



Ms M M RAMADWA: It is a point of order that the hon member should realise that, that is a podium and not a dancing floor.



The HOUSE CHAIRPERSON (Ms M G Boroto): Hon member, that is not a point of order. Continue, hon Wilson.



Ms E R WILSON: [Inaudible.] done.



The HOUSE CHAIRPERSON (Ms M G Boroto): Order, hon members, order.



Ms E R WILSON: An article by the South African Medical Research Council, SAMRC, on HIV-TB pathogenesis and treatment advises that HIV infection is the leading cause of deaths in South Africa. This we know. It also advises that South Africa has the third life highest human immunodeficiency virus, HIV, related TB problem in the world with as many as 60% of HIV patients being coinfected with TB. With 7,7 million people living with HIV in South Africa, this tells us that over 4,6 million people have both HIV and TB.



Added to our woes of vast unemployment, substandard living conditions in many areas, extreme poverty, the lack of decent water supplies and a failing health system we now have to manage the Coronavirus pandemic too. 90% of TB deaths occur in low and middle income countries and right now South Africa is up there high on the list. The most vulnerable of all of our citizens in South Africa in light of the Coronavirus are the



7,7 million poor people with HIV and the 4,6 million who have to deal with both HIV and TB.



We are sitting at the precipice of the biggest crisis South Africa has ever been faced with. How do we sleep at night? The fact is that we must accept this. We are in this together and united we must be to fight and win this battle. But were we prepared for this battle? Judging by the suddenness of this meeting ahead of a global conference ... we must assume, no.



Tick box exercises are a farce and will not help us as a country nor will it inspire confidence in our abilities in the rest of the world. We are in the middle of TB awareness month. However, the entire focus on health in the last couple of weeks has been the Coronavirus and indeed, it is a pandemic of global proportions. However, what actions have been taken on the awareness of TB in this month, particularly in the light of the double jeopardy?



If just 1% of our HIV-TB patients contract Covid-19, which is approximately 46 000 people, will our designated hospitals and quarantine wards cope? Not a chance. The staffing, resources, equipments, laboratories, infrastructure are not there. Our



health system which has systematically declined in recent years is quite honestly not going to manage this.



Join hands we must, united we must be. We will require partnerships of massive proportions, not just within the private sectors within our borders, but those well beyond too. It is accepted that over the years we had considerably reduced the number of TB infections in South Africa, but when, when were conditions were better than they are now? When there was a higher rate of unemployment and before medical centres began a steady decline, when clinics and hospitals were better resourced with less exhausted doctors and nurses, when people had the means to go to the clinic or a hospital and when medicines were available.



I fervently pray that the global conference will take these matters into account that we are able to be honest and transparent about our situation and not merely dream of plans and strategies. I think of this song; don’t cry for me Argentina, written by Sir Andrew Lloyd Webber and Tim Rice.

The words of which goes: Don’t cry for me Argentina, The truth is I never left you, All through my wild days, My mad existence, I kept my promise, Don’t keep your distance ...



I wonder what the hell they would have written if they were writing in the South African context right now. I think it would go like this: Please cry for those in South Africa, The truth is they just don’t love you, You are poor and vulnerable, A sad existence, we’ve made you promises, we’ve got no hope of keeping. Let us tackle this, let us be systematic, let us plan, let us strategise but do not make promises you cannot keep. I thank you. [Applause.]



Mr K L JACOBS: Hon Chairperson, we have heard here today that Tuberculosis, TB, is a leading reported cause of death which is 88.4% of all deaths in South Africa and the leading cause of death by a single infectious agent globally.



The ANC led government has been at the forefront of working towards and ensuring improved outcomes for all South Africans with regard to tuberculosis infection.



We are also the leaders in the world with respect to this and I’m going to showcase it here that we are those leaders. In 2006-2016 the number of deaths due to TB declined from 76 000 to 29 000, in other words more than half from 13% to 6%.



In terms of new cases, South Africa had 322 000 new TB cases in 2017 and 301 000 new TB cases in 2018, showing a significant decline. We understand that an estimated 63 000 people died from TB in 2018 and millions more South Africans have dormant or latent Tb. It is important to note this one.



Two thirds of those who died of the 63 000 were HIV-positive. There has been a change in the profile of people dying from TB with a decreasing proportion of children under the age of 15 years, a decrease in the number of adults over reproductive years which is 15-49 years of age and a decrease in the number of women.



The total reduction in TB incidents between 2015 and 2018 was 6.3% although in South Africa we are falling short of the End TB Strategy milestone of a 20% reduction, we have done fairly well to get the 6.3%.



South Africa’s public sector provides diagnostic and treatment services for TB with no out of pocket cost, that’s very important to note.



It is also important to note that 82% of drug susceptible patients, 55% of Multi-drug-resistant tuberculosis, MDR, patients and 48% Extensively-drug-resistant, XDR, patients are successfully treated.



We know that there is a link between Tuberculosis and HIV and that they are strongly linked and we must please note the following, that people with healthy immune systems may not fall ill from latent TB but people living with HIV a with a low CD4 count are much susceptible to active TB. The number of people with HIV-TB who died during treatment in 2017 was 11%, almost three times higher than the number of people who died on treatment for TB alone which was at 4%.



This decline in TB incidents in South Africa over the past decade is attributed largely to the broad roll out of antiretroviral therapy which is a huge achievement of the ANC led government.



Yes, the progress to ending TB is slow and gaps do exist in prevention diagnosis in treatment of TB and therefore early detection and early effective treatment are essential to preventing TB associated deaths.



The emergence of MDR-TB and XDR-TB created quite a challenge in terms of numbers, 15 986 MDR-TB cases and 747 XDR-TB cases were reported in 2017 and 11 000 fell ill with MDR-TB in South Africa in 20218.



The importance of these numbers is the following that those patients have fewer treatment options with longer treatment durations, more severe treatment side effects and lower treatment success and survival rates. The standard treatment for MDR-TB was only effective in 50% of cases and that injectable had serious toxic side effects.



South Africa is the first country in the world to take the bold step to ensure that no one with drug resistant TB was denied access to better drugs by scaling up access to a new effective drug making MDR-TB treatment more tolerable.



Experience with this drug called bedaquiline in treating drug resistant TB made mainly from South Africa with experience from South Africa demonstrates improved clinical outcomes in people living with MDR-TB that is safer and effective.



So, this progressive move by the National Department of Health of the ANC led government to introduce the bedaquiline for all patients is a historic achievement.



Now, health facilities and primary health care must be supported in developing capacity to use bedaquiline and other new drugs and to access new and repurpose drugs asteriated in Drug-resistant, DR-TB, regiments must be improved in order to ensure treatment initiation and access to drugs and patient support closer to the communities where DR-TB patients live.



In addition, the National Department of Health, NDOH, is hoping to introduce 3HP, which is the once weekly treatment for 12 weeks for latent TB in four districts very soon and is also happy with the results to date with the new drug combination BPaL, which is being trialled in South Africa, which is a three-drug combination currently showing a 90% treatment success rate.



Additionally, South Africa has spear headed the new important health technologies in terms of tuberculosis. It’s one of the first countries to implement the gene expert TB diagnostic following recommendations by the World Health Organisation.



Gene experts significantly reduce the turn around times for diagnosing both drugs susceptible TB and Rifampicin resistant TB.



In addition to pioneering new health technology, South Africa has demonstrated a significant political will and leadership in pushing for global action and investment to address TB.



South Africa committed more to TB Research and Development as a percentage of Gross Domestic Product, GDP, than any other country, making South Africa the largest funder of TB Research and Development as a percentage of government expenditure.



On the TB research front, South Africa substantial clinical trial capacity and trials of TB drugs and TB vaccines received significant funding from foreign donors as well as from our South African government.



Significant basic TB research is conducted in our country particularly in relation to identifying better diagnostic and prognostic bio-markers or sets of bio-markers.



So, work on TB diagnostics in South Africa has led to three diagnostic products being spun off into companies, with one diagnostic product used to collaborate gene expert machines already in wide use.



To speak to the hon members who mentioned here what they can be doing for us, we are the leaders in the world in terms of TB.



To the hon member of the EFF, I cannot see how you can assist us in dealing with TB if we are the world leaders and I have just showcased this to you here.



To hon Wilson and Ismail, I need to reiterate what hon Gillion had said as a medical person and having trained here in the Western Cape, Western Cape was the hub of TB, it was and still is the hub of TB and I find it strange that you will say that you will be able to show us how to treat TB.



The ANC led government is very active in the fight against tuberculosis. In prevention, treatment, use of new drugs, improvement of the co-mobilities like HIV, diagnostics and technology, research and development led by our President



Cyril Ramaphosa as the only head of state from a Brazil, Russia, India, China and South Africa, BRICS, country to attend the 2018 United Nation, UN, high level meeting on TB during which he called for greater TB Research and Development investment, affordable drugs and the adoption of intellectual property laws that promote public health. Thank you Chairperson.



The DEPUTY MINISTER OF HEALTH: Let me first thank the hon presiding Chairperson, let me also thank our presiding officers and the programming committee for having scheduled this debate. I am sure that the hon members will agree with me that indeed this has been a very worthwhile debate and ... [Interjections.]





Nk M S KHAWULA: Uxolo Sihlalo.



The HOUSE CHAIRPERSON (Ms M G Boroto): Hon Deputy Minister, can you take your seat?





Yebo mama.



Nk M S KHAWULA: Ngiyaxolisa sthandwa sami, ngokukhulu ukuhlonipha mntakwethu. Siyashoda ngodokotela kodwa lo dokotela wenzani lapha. [Ubuwelewele.]





USIHLALO WENDLU (Nk M G Boroto): Cha, siyathokoza mama. Akukona ukukhalima ophambukayo.



Nk M S KHAWULA: Akabuyele emuva bakithi. [Ubuwelewele.]





USIHLALO WENDLU (Nk M G Boroto): Thula! Hlala phansi. Ngizocisha umshini. Qhubeka Dokotela.



The DEPUTY MINISTER OF HEALTH: Chairperson, I want to take the opportunity to thank hon members for their contributions to this debate. A number of positive contributions have been made from this podium and we indeed appreciate and welcome those contributions. I also just want to assure even some of those who spent more time on making more noise than facts that we will indeed, nevertheless, we will still look at the facts within that noise, where there are some facts, we will indeed



separate them from the noise and make sure that we can make use of them.



I just want to make some few corrections. The hon Du Toit from the FF Plus misquoted the Deputy President. In terms of the

2 million people, who we are targeting to find, test and treat, is in terms of HIV and Aids, which is the target that has been set through the 1990 programme, to find 90% of those who are HIV positive to be tested, to be put on treatment and also to make sure that they are virally suppressed.



In terms of TB, the shortfall in terms of finding people who have not been tested, it’s only 80 000, that is the target which we are working on. As I have indicated in my speech earlier on, just to correct hon Madisha as well who said a lot of things which actually unfortunately are unfounded including saying that some of our hospitals have become shacks, and he wants to include me in that, saying that we are both coming from rural areas.



The rural area in Sekhukhune where I come from, there are no shacks of hospitals. Many of all the clinics in that area has reached the ideal status, hospitals have been upgraded and it



has been made sure that they have got equipment and they are well staffed. So, I don’t know where actually, hon Madisha, you want to include me because I have no idea about where he comes from. I know him to be coming from Lebowakgomo where its hospital is well upgraded and well equipped with state-of-the- art equipment.



So, I don’t know whether he is including the Zebediela area as well. But also, I don’t know whether it’s because it’s a long time since hon Madisha has left the ANC. He is saying that former President Mandela was diagnosed with TB when he was out of prison, and yet, he was still in prison. He was still a prisoner that was taken from Robben Island who was suffering from chest pains and later diagnosed with TB but was treated during that era.



However, we do appreciate the message that the former President made to make sure that he was one of the champions to inform people about the fact that TB is not a killer disease, but it can kill if it’s not detected and not treated. We appreciate that. We also appreciate the contributions by members in terms of which some are about communication with



education material, I think it was hon Hlengwa, in making sure that they are available in all languages.



As I said earlier on, unfortunately, some of the members spent more time dancing and making noise, without actually making any positive contributions. It’s not surprising that hon Wilson has left after subsequently dancing because she is not very serious about this issue. We want to assure the hon members that indeed through SA National Aids Council, SANAC, which also focuses on TB, on 24 March which is World TB Day, we will be having a national activity in Mpumalanga.



Already SANAC, including the civil society, are on the ground making sure that people are being tested and that mobilisation is being done on those areas. So, we acknowledge that we can do more. I also want to join hon members in appreciating the work done by health workers, our nurses, our doctors and laboratory technicians who are making sure that we can go out there to screen people, put them on treatment and make sure that they can be cured.



Indeed, I agree with the hon members that TB does not discriminate and in regard, I hope that in that spirit, hon



members, as we tackle various challenges ahead of us, the Coronavirus on top of the TB and the HIV, that we will appreciate the fact that it doesn’t matter whether it is TB or Coronavirus, they do not ask which party you belong to, they also don’t ask whether you are somebody from high or low income.



These diseases don’t choose. So, I hope that this will always inform us, and make sure that we can indeed be united in fighting the scourge of TB and other diseases. Thank you. [Applause.] [Time expired.]



Debate concluded.



House Chairperson: Internal Arrangements adjourned the Joint Sitting at 11:52.




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