About

The TB Landscape & the origin of TBAC

In South Africa TB remains a significant threat and a serious public health issue. It is the leading cause of death in the country, claiming the lives of more than 60 000 people each year. Prevalence studies on TB show that South Africa has higher numbers of people with TB than has been estimated in the past – and that many people who are living with TB remain undiagnosed and untreated.

The country has robust policy frameworks for tackling TB, including the National TB Programme Strategic Plan 2017-2021, National Strategic Plan (NSP) on HIV, TB and STIs 2017–2022, National TB Management Guidelines, and international donor guidelines. These articulate a clear intent and could enable and promote accountability in the delivery of TB care.

However, despite strong policy frameworks, accountability for TB care is hard to define and operationalise in the country’s health system, which is plagued by systemic challenges such as disparities in quality service delivery in urban and rural areas, shortages of trained healthcare workers particularly at primary healthcare facilities, medicine stock-outs and corruption.

Origin of TBAC

In 2021, Global Health Strategies (GHS), in partnership with the Rural Health Advocacy Project (RHAP) at the Witwatersrand University, conducted a rapid assessment of the TB accountability mechanisms at the national level and in two provinces that carry the highest burden of TB cases in the country – KwaZulu-Natal (KZN) and the Western Cape (WC).

This looked to advance the Bill and Melinda Gates Foundation’s (BMGF) aims of consolidating advocacy efforts to improve TB accountability at the national and provincial levels. The results from this study (which can be found here) laid the grounds for the TB Accountability Consortium (TBAC).

As a leading figure in advocacy efforts surrounding challenges facing rural healthcare, RHAP was approached to act as the incubator and initial Secretariat for this consortium.

TBAC’s role

TBAC wants to strengthen South Africa’s TB response by filling in these gaps:

Identifying areas in the TB response where government should be held accountable.
Helping policy-makers, civil society organisations and stakeholders to use evidence to ask questions about how money is spent on TB and how programmes are implemented.
Enhancing the existing monitoring tools to ensure that there are links between how budgets are spent and how programme rolled out.
Document and share best practices that can help TB actors scale up their ability to hold government to account.
Driving advocacy that use evidence-based TB accountability advocacy and communication.
Creating a platform to engage with policymakers and tell people affected by TB.

The TBAC Charter

Tuberculosis (TB) is a treatable and preventable infectious disease, yet it is the single greatest cause of death in the South African population. The significance of TB in South Africa’s health landscape is often obscured by the disease being bundled together with HIV and Malaria in the health budget, and in the policy and implementation plans of the health authorities. The campaign against TB was set back by the COVID 19 Pandemic and the emergency response to the pandemic. Despite a TB implementation plan and a TB recovery plan, fiscal restraints and deficiencies in the health service mean that there is much that needs to be done to achieve the goal of eradicating TB. Primary responsibility for funding and implementing these plans lies with the national, provincial and district health services.

Numerous civil society organisations, NPOs and academic formations are involved in research, advocacy, policy formulation and service delivery in relation to TB. While each organisation has its own sphere of operations, there is a need for all organisations to work together to hold the three levels of government accountable for developing, funding and implementing adequate programmes to combat TB in South Africa. A decision was taken at the TB conference in 2022 to create the TB Accountability Consortium (TBAC) for this purpose, and RHAP was mandated to implement this decision, and to act as the secretariat for TBAC.

This charter has been drafted through a consultative process, and sets out the purpose, scope and functioning of TBAC and the role of the secretariat.

STATEMENT OF PURPOSE

TBAC will create a platform to co-ordinate and consolidate advocacy for improved TB services at all levels of government. It will work with all role players who share its values to hold government and non-governmental organisations to account to ensure adequate budgets, comprehensive plans and the effective implementation of such plans.

It will serve as the voice of those not in the room when budgets are considered and reports on TB care presented – in particular for communities, health workers and TB patients and survivors.

It will work to ensure that comprehensive national and provincial plans are implemented flexibly to accommodate local conditions.

THE WORK OF ACCOUNTABILITY INVOLVES

Ensuring that plans and budgets for TB treatment and prevention are transparent and reflect the priority that should be given to this infectious disease
Ensuring that politicians are sufficiently knowledgeable to be able to make good decisions about TB policy and budgets
Building an alliance of civil society organisations and other actors to hold the government at all levels to account in respect of TB policy, funding and implementation
Supporting local organisations to hold the health service to account at clinic and district level, where much of the care and preventive work is located
Educating the country’s citizens about the importance of TB and the extent to which government is (or is not) making headway in the implementation of its plans
Shining the spotlight on egregious failures of implementation including stock outs, TB services being unavailable at the advertised time and failure to translate policy into effective local implementation plans.

STRUCTURE

TBAC will function as a coalition of partners – an alliance of likeminded organisations convened by a secretariat located inside RHAP.

ORGANISATIONAL PRINCIPLES

TBAC will not duplicate existing structures and commits itself to working with and strengthening existing initiatives.

Participants in TBAC commit themselves to:

A spirit of partnership and respect for the work and representatives of other organisations participating in the partnership
Ensuring that all voices are heard
Encouraging a contestation of ideas within a shared framework
Seeking consensus on key points of advocacy to be undertaken by TBAC and its constituent partners
Representing the interests of the most marginalized

The role of the secretariat

The secretariat will:

1. Convene at least four partner meetings a year at strategic moments in the calendar. These meetings will be used to:

Develop consensus positions to be taken by TBAC and its partners on key issues such as the budget or government’s efficacy in implementing its plans
Agree on work to be done by the partners and the secretariat over the next period
Review work done since the previous meeting
Discuss how TBAC’s work can be continually improved

2. Issue statements on important matters relating to TB and seek the endorsement of partners to the extent necessary and possible. Where appropriate statements may carry a disclaimer indicating that the views expressed re those of the secretariat, and not necessarily endorsed by all the partner organisations.

3. Produce an annual publication on the State of TB in South Africa, with invited contributions and comments by TBAC partners.

4. Translate existing knowledge in relation to TB prevention, treatment, budgets and implementation and making it available and accessible to TBAC partners.

5. Create channels of communication between members

ACTIVITIES

Key areas of work to be undertaken by TBAC partners and the secretariat include:

Networking and movement building

This will include but not be limited to:

Acting as a link between members of the consortium at a national and regional level
Creating a forum for members to share ideas and best practices, in relation to both TB and their work on the ground
Developing consensus on key advocacy issues
Convening meetings which allows members to share experiences, strategies and insights.

Strengthen local capacity

Wherever possible work through and strengthen existing local organisations
Encourage linkages between organisations doing similar work within provinces, including organizing local TBAC meetings in co-operation with local members
Improve local actors’ access to Provincial and National Departments of Health
Create pressure for implementation of district health information systems which make data publicly available
Channel information, policy issues and research needs from the district level to national policy makers, researchers and academics, and ensure that responses flow back to community level organisations.
Enhance local level understanding of budgets
Share best practice in holding health service accountable at the clinic and district level

Provision of resources to members

Making useful local and international research, policies and practices available in easily accessible format and language
Publishing an annual review of the state of TB in South Africa
Provide user friendly guides to annual budgets and reports from Departments of Health at all levels of government
Acting as a conduit for highlighting particular local problems that can be shared and discussed with others

SELF REFLECTION AND CHANGE

TBAC is a new initiative. It is intended to review its work and priorities from tim

TB Accountability Consortium