Urgent political action to implement TB policies outlined in the new National Strategic Plan for HIV, AIDS, STIs and TB 2023 – 2028.

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Director-General for Health, Dr Sandile SS Buthelezi Acting Deputy Director-General, HIV and AIDS, TB, Maternal & Women’s Health, Mr. Ramphelane Morewane Chief Director, TB Control and Management Cluster, Prof. Norbert Ndjeka Mr. Paul Mashatile, Deputy President of the Republic of South Africa and CoChairperson of SANAC Ms. Steve Letsike, SANAC CSF Chairperson and SANAC Co-Chairperson Dr. Thembisile Xulu, CEO of SANAC

Honourable Minister Dr. Phaahla.

Re: Urgent political action to implement TB policies outlined in the new National Strategic Plan for HIV, AIDS, STIs and TB 2023 – 2028.

TB is the leading cause of death from an infectious disease in South Africa and we have noted that only 4 out of around 70 political parties contesting in the national elections have mentioned TB as an important health priority that needs to be addressed in their manifestos.

As a Minister of Health, your tenure must be remembered for your leadership to turn the health fortunes of South Africans around. We applaud you for driving the NHI to be adopted as an Act of Parliament. However, if the fight against TB to make South Africa a TB Free Society is not realised, your efforts will be forgotten because you would have failed if TB as is the case remains a public health threat that kills more than 50,000 people in South Africa annually and yet TB is curable. #Sikhathele to be preaching the same things and nothing is being done.

As TB advocates and champions, we know that more is needed than improved TB programme outcomes, because there are organisational and institutional barriers to health equity at a macro level. TB is not only the responsibility of the health department, it is in the realm of those who have the political decision-making power. With an estimated 280,000 new infections each year and 54,000 deaths, TB remains a significant public health threat. Policies that improve the social determinants of health must be implemented

We call on the South African government, to make TB a political priority, and a multisectoral departmental responsibility. The Constitution affords everyone equal rights, and access to healthcare. We highlight that the National Health Act states that “the right to health is not fully realisable without other constitutional rights being realised.” As a TB advocacy collective, we have the following key asks for implementation by 1 Dec 2024 from the Minister of Health – as the outgoing Minister, please ensure that your hand-over report for the next Minister includes the following demands that must be met:

1. Targeted Universal Testing for TB (TUTT) must be implemented in all provinces and scaled up to provide routine annual TB disease testing for people living with HIV (PLHIV), as well as testing of all close contacts of people with TB, and people treated for TB in the previous 2 years. Provincial plans to implement TUTT should be released with clear guidance on how training will be provided to all health workers, including community health workers (CHWs). A national public-facing TB dashboard should publish the number of people tested for TB and the proportion testing positive per sub-group, specifically for TB contacts, with data on the number started on TB treatment and TB Preventive Therapy (TPT) compared to TB targets as per the NSP on a monthly basis. Communication campaigns to raise awareness about the new eligibility criteria for TB testing must be implemented in local languages. These must include stigma reduction messages.

2. Expansion of shorter-course, safer TB medication – Short-course treatment for drug-susceptible TB in children and drug-resistant TB must be available at every TB clinic. – Short-course TPT as outlined in the 2023 “National Guidelines on the Treatment of Tuberculosis Infection” should be accessible to all PLHIV, close TB contacts, and other high-risk groups, including people with silicosis, people who previously had TB, health workers, and prisoners in correctional facilities.

3. Each person diagnosed with TB should have access to high-quality TB counselling to strengthen treatment literacy and to help identify those in need of referral for additional psychological and social support, including nutritional support packages, in order to ensure TB patients remain in care and complete their treatment.

4. Increased civil society engagement in policy development and implementation: The DDG: HIV and AIDS, TB, Maternal & Women’s Health should schedule quarterly meetings with the SANAC Civil Society Forum TB Task Team to review progress of Advocacy Letter for a TB Free South Africa Letter to the Minister of Health 4 June 2024 T. 012 748 8000 E. greer@sanaccsf.org.za W. www.sanaccsf.org.za 2ND FLOOR | BLOCK E | HATFIELD GARDENS | | 333 GROSVENOR ST HATFIELD | PRETORIA | 0028 implementation of the NSP and TB Recovery Plan, as well as review of the Global Fund project reports. The outcome of these engagements should be processed through relevant government structures, starting with SANAC Plenary so that we move from TALK TO MEANINGFUL AND LIFE CHANGING ACTION. We are tired of being taken for a ride through boardroom engagements that do not result in action. Failure to do things differently will result in us mobilising society for drastic action to see results from our talk. #Sikhathele to just be talking!

5. Safeguard TB funding within increased District Health Services allocation: Provincial TB budgets must ensure that TB services are protected despite financial constraints, and must be shared with civil society organisations for full transparency regarding budget allocations, to monitor funding for implementing the TB Recovery Plan and NSP.

We hope that the fortunes of the elections result in you coming back to your position so that we can finish with you what we have started. However, if this is not the case, make sure that you provide to the Minister who will take over from you this letter and advice him to act with greater speed than you did.

We appreciate your consideration and look forward to your response, which can be directed to Mabalane Mfundisi from SANAC Civil Society Forum TB Task Team via email mabalane@showmeyournumber.org.za and copy Ingrid Schoeman from TB Proof via email ingrid.tbproof@gmail.com Respectfully.