TB Accountability Consortium

TB Accountability Consortium

Why South Africa’s TB recovery programme needs to become a public facing one

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

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

In the health sector, the shadow of the pandemic still lingers. Over the last two years, a
considerable amount of research and studies have quantified the direct and indirect
cost of the COVID-19 pandemic on South Africa’s health care system.

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

To deal with this fall out, there has been a massive push to regain the momentum that
was lost due to the reallocation of resources coupled with people not seeking health
services. In 2020, the National Department of Health proactively spearheaded the
development of the National TB Recovery Plan.

In spite of the challenges brought on by the pandemic, TB remains a significant public
health challenge for South Africa. Our most recent figures show that in 2021, a total of
54 000 people perished from TB in South Africa. About 172 000 people were diagnosed
with the disease. In total , an estimated 304 000 people in South Africa fell ill with this
curable disease.

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

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

And a deeper dive into the processes within the National Department of Health and its
provincial counterparts around its TB response shows equally as dismal results.
We collated a timeline of the health department’s action around its TB response plan.

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

Further to this the KwaZulu-Natal, Eastern Cape and North West provincial health
websites had no TB guidelines available at all. The Free State had listed outdated
guidelines and the Western Cape had the 2018 drug-resistant TB (DR-TB) clinical
guidelines available.

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

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

A lack of transparency

The challenge is that the lack of transparency on the part of the National Department of
Health makes it difficult for anyone to monitor the implementation of the National TB
Programme as well as the recovery plan or to hold the department of health to account.
Publicly available information is critical to maintain transparency and creates an
effective mechanism of accountability, which ultimately improves the governance of a

The lack of transparency speaks to a bigger problem of governance within the TB sector.
Governance is important in the context of South Africa’s TB response given the complex
nature of the disease. While there has been a focus on governance in the health system,
this has been largely missing in the TB sector and has been a longstanding issue
predating COVID. What this means is that there is no clear understanding of the line of command in the
overarching TB response.

Going deeper

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

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

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

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

For South Africa’s National TB Programme to gain momentum and for its TB Recovery
Plan to reach implementation at provincial level, more transparency is needed.
This will help TB stakeholders to see the inadequacies in the system and to ask the
questions that will ensure programme accountability.

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

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

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