“Too many people are still left out of care”: Health experts call for stronger community TB and HIV outreach in South Africa

By: Aphelele Buqwana

South Africa’s broader economic pressures are increasingly affecting the country’s TB response, with rising costs making it harder for clinics to maintain essential basic services.  

Although the health budget increases each year, rising costs for medicines, laboratory services and salaries are outpacing those increases. As a result, provinces have less to spend, leaving clinics with fewer resources for TB testing, treatment and community outreach services. 

This is according to Rashaad Amra, a researcher of the Public Economy Project at the Southern Centre for Inequality Studies, during the two-day SANAC Civil Society Forum (SANAC CSF) engagement hosted by the TB Accountability Consortium (TBAC). 

The engagement, which looked at the programmatic and financial outlook for South Africa’s TB response, provided an overview of the National Strategic Plan for HIV, TB and STIs, focusing on its four pillars and their relevance for advocates. Discussions also covered health financing, including the recently tabled Medium Term Budget Policy Statement, the department of health’s 1.1-million HIV testing campaign and the End TB Campaign. 

During his presentation on health financing for HIV and TB, Rashaad discussed how the current budget outlook leaves a little room to expand essential TB services. He stated that, “Treasury made it clear that the MTBPS leaves no room for new spending, which is worrying because TB programmes urgently need expansion, from new diagnostics to decentralised care and better treatment literacy.”  

He explained how national economic decisions ultimately shape what happens in clinics, noting that “The macroeconomic choices being made at the Reserve Bank level filter all the way down to the clinic, leaving TB services stretched, underfunded and unable to expand at the pace the disease requires.” 

Expanding on Rashaad’s concerns about limited resources, Dr Musa Manganye, Director of HIV Treatment, Care and Support at the National Department of Health, also stressed that reaching people at community level remains critical. 

Speaking on the Close the Gap Campaign, which aims to initiate 1.1 million people living with HIV who know their status but are not yet on treatment back into care by December 2025, Dr Manganye warned that when clinics lack enough resources, people fall through the cracks.  

“The reality is that people are still being missed and those delays have consequences. Our goal is to make sure those living with HIV are identified, linked to care and able to stay on treatment,” he said, emphasising the need of reaching those still missed in care. 

He further stressed the need of addressing preventable deaths saying that the country cannot continue to have people dying from TB, which is a disease that is preventable.  

“That is why the gap has to be closed so that people can access treatment, stay on treatment and lead better lives,” he said.  

According to research, 54% of people with TB in South Africa are living with HIV, and the World Health Organization estimates that of the 54,000 TB deaths each year in the country, around 31,000 occur in people living with HIV. 

These figures, according to Professor Nobert Ndjeka, Chief Director of TB Control and Management at the health department, underscore the urgent need for coordinated efforts to reach communities where gaps in care still persist. 

Presenting on “TB in Focus: Understanding the Roadmap to the Goal”, Prof Ndjeka highlighted the progress made through the country’s TB recovery plan, including improvements in treatment coverage, which increased from 77% in 2022 to 79% in 2023. He stressed that despite these gains, reaching people who are missed remains critical.  

“The treatment coverage has improved as a result of our recovery plan, but mortality remains high at 54,000,” he said, emphasising the importance of testing, finding missing cases and strengthening community outreach to ensure more people are linked to care and are on treatment. 

Speaking on the country’s TB response, Russell Rensburg, Project Director for TBAC, also emphasised the need to strengthen efforts to reach more people and the importance of targeted testing. 

“The goal is clear. We need to find and treat as many people as possible and the first step is making sure we’re testing the right people,” he said. 

He also noted the persistent challenges facing the response while emphasising the importance of leadership and collaboration. 

“There are still big challenges like inequalities, limited resources and systemic barriers, but collaboration, accountability and innovation are key,” he said, adding that addressing these challenges requires deliberate action and coordinated leadership. 

“As leaders and advocates, we have a responsibility to use the information we have, plan more intentional responses and ensure no one is left behind. That’s how we move toward a South Africa free of TB and HIV,” he added.