Acting Premier Of The Northern Cape Ms Grizelda Cjiekella On The Occasion Of The Northen Cape World Tb Day

Acting Premier Of The Northern Cape Ms Grizelda Cjiekella On The Occasion Of World Tb Day commemoration
kai! gariep sub-district-kakamas
24 march 2013, 10h00 am



Programme Director
Members of the Provincial Legislature
Members of the Executive Council
Chairperson and Members of the Portfolio Committee on Health
Executive Mayor of the Siyanda District
All Mayors and Councillors Present
All NGO’s and Strategic Partners
Religious leaders
Senior Managers, Municipal Managers, District Managers and Department Officials from all Government Department Present
Members of the Media
Ladies and Gentlemen
Our beautiful Community of Kakamas, Siyanda District and Northern Cape Province

It is on this day, every year, that advocates for the eradication of TB gather across the globe in an effort to spread the messages on TB prevention and to create awareness on the scourge of TB. It is a day on which we will not only reflect on challenges caused by TB and HIV infection, but we will also report progress made and reaffirm our plan of action going forward towards our vision of the elimination of TB in our lifetime.

The World Health Organization (WHO, 2012) estimates the global burden of TB to be at 8.7 million during 2011 and 13% of those people are co-infected with HIV. South Africa ranks third highest amongst the top 22 high burden countries globally with regard to the TB incidence rate that contribute to about 80% of the total global burden of all TB cases.

The Northern Cape Province is in a similar position and it is rated the 3rd highest in the country with regard to the incidence of TB. The incidence rate of TB (new cases) increased from 713 per 100 000 to 734 per 100 000 population. A total of 10 319 (All including new and retreated) TB cases were diagnosed in the province in 2011, an increase from 10 227 diagnosed during 2010. Although this number is low in comparison to other provinces, this burden is a source of concern based on the small population of the province.

Geographically, the burden of TB is highest in the Frances Baard and Siyanda Districts. The districts reported 3503 and 2396 TB cases diagnosed during 2011 respectively.

Despite the availability of free diagnosis and treatment, improved access to TB care, the Northern Cape Province still reports a high proportion of death rate amongst patients whilst on TB treatment. 6% (196 of the 3348) of TB patients diagnosed in 2010 died whilst on treatment whilst an increase of 1% was reported during 2011. Goal 6 of the Millennium Development Goals seeks to combat HIV and AIDS, Malaria and other disease. The world has less than 1000 days to the attainment of the Goal and we would like to call upon all the citizens of the Northern Cape to increase all efforts to the realization of this target.

Similar trends to primary TB are reported in the number of Multi Drug Resistant (MDR) TB cases in the province. 282 MDR TB cases were diagnosed during 2009 and this number increased to 320 in 2011, whilst an increase of Extensive Drug Resistant (XDR) TB was marked from 16 to 54 during the same period.

Ladies and Gentlemen, it has become imperative for the country and the province to determine the magnitude of drug resistant TB and the different strains of M(X) DR TB present. The National Drug Resistant (DR) TB Survey, commissioned by National Department of Health commenced in the province on the 1st August 2012 and expected completion date is 30th September 2013. The outcomes of the survey will inform provincial and national strategies and policies.

Individuals reporting to our health facilities and suspecting that they have TB by displaying the following symptoms, coughing, loss of weight, night sweats, loss of appetite, fever and general body weakness are encouraged to enroll for this study at their nearest clinic. The health professionals will explain the importance of being part of the study and having as many patients registered as possible.

A common and standard message should be shared with those diagnosed with TB. TB is both treatable and preventable, even if you are HIV positive. It is important for patients diagnosed with TB to:

Prevent the spread of TB by ensuring that they practice cough etiquette, It is important to cover your mouth when coughing.
An old practice of keeping windows open throughout the day has to be emphasized.
Practice of hand washing after coughing or sneezing
It is important to avoid close contact with other people during the initial phase of treatment and health professional will advise on how long this period is.
Complete your treatment as directed by the health professional even though you might feel better. TB treatment takes a longer duration to work effectively.
If you know of a child under 5 years old and is a contact of a TB patient, they should receive preventative therapy for TB
People who are HIV positive, should also receive preventive therapy for TB.

What will happen if I don’t complete my TB treatment?
You will spread the disease to others if you have TB and don’t get treated
Many people die from TB when it is not treated
You will develop an advanced form of TB which we call Multi-Drug Resistant (MDR) TB [Definition: Resistance to Rifampicin and Isoniazid] and Extensive Drug Resistant (XDR) TB [MDR TB with further resistance for Fluoroquinolenes and any second line injectable]

What do I have to do: TB PATIENTS’ RESPONSIBILITIES
Provide as much information as possible to health-care providers about present health, past illnesses, any allergies, contacts with immediate family, friends and others who may be vulnerable to TB or who may have been infected and any other relevant details.

Follow the prescribed and agreed treatment regimen and conscientiously comply with instructions given to protect the patient’s health and that of others. Inform health-care providers of any difficulties or problems in following treatment, or if any part of the treatment is not clearly understood.

Eat a healthy diet and exercise regularly

Inform the health care worker when you have to move to another town or farm to ensure that you continue with treatment.

Contribute to community well-being by encouraging others to seek medical advice if they exhibit symptoms of TB. Show consideration for the rights of other patients and health-care providers, understanding that this is the dignified basis and respectful foundation of the TB community.

Show solidarity with other patients. Share information, expertise and knowledge gained during treatment with others in the community. Join in efforts to make the South Africa free of TB!

Additional efforts have been implemented to curb the scourge of TB and manage TB.

Programme Director;

In our intensified case-finding, we have in partnership with Mining Sector, Department of Education and farming community improved access to screening and treatment of those diagnosed with TB. Health Care Workers do not wait for patients to visit the clinic, but outreach services are provided to seek and diagnose those with TB symptoms.

Over 8000 people have been reached through this programme over the past year. Partnerships are strengthened with Department of Correctional Services and the Judiciary which is this year’s focus.

On World TB Day 2011, the MEC for Health in the Province, Hon MS Sokatsha launched a rapid effective diagnostic technique, the GeneXpert which received WHO endorsement. This method allows for early and fast-tracked diagnosis of TB and Drug Resistant TB (within 2 hours of laboratory receiving the specimen). The patient therefore knows from the beginning whether they have TB and whether it is Drug Resistant TB or not. This method saves on time, treatment period and on drug cost as the patient is placed on the appropriate treatment from the beginning. This method of diagnosis has over the past year been rolled to all 5 districts in the province and yielded dividends.

Decentralization of Multi-Drug Resistant (MDR) TB Care

An increase in the number of patients diagnosed with Drug Resistant TB and a shortage of beds has highlighted the need for decentralization of MDR TB care. The policy framework allows for improved access to TB care as some patients are treated in the community without first being admitted to a hospital. Non- Government Organizations and Community Health Care Workers are commended for the sterling work performed in ensuring access to TB and HIV care.

The province has in addition made great strides in commencing Drug Resistant TB services at additional 3 level 1 hospitals in the province, namely Tshwaragano, De Aar and Nababeep Hospital. Patients from these districts do not have to travel long distances to Kimberley or Upington to access Drug Resistant TB care. The implementation of this policy epitomizes the strategy of “bringing services to the people”. In addition, Medical officers conduct outreach DR-TB care to clinics in the districts.

Plans are underway to commission for the refurbishment of Nababeep Hospital and this work is expected to commence in the new financial year, 2013/14.

In addition, the process to build a new 40-bed and a 60- bed Drug Resistant Units at De Aar Hospital and Gordonia Hospital respectively is reaching completion. Gordonia Hospital is expected to be opened in August whilst occupation of De Aar is expected during 2014.

Despite efforts to combat the scourge of TB, Social factors have been cited as major contributory factors common but not peculiar to the Northern Cape:
Substance abuse
Extreme poverty, poor support networks, unstable living circumstances, alcohol and substance abuse are cited as factors that can adversely influence TB treatment outcomes. It has been established that substance abuse is the single major factor associated most strongly with non-adherence to TB drugs and defaulting.

The abuse of alcohol in the Northern Cape especially amongst farmworkers and pregnant women is evident in the number of children born with Foetal Alcohol Syndrome. It remains our responsibility as partners in this province to develop strategies to address the abuse of alcohol and other drugs, the spin-off of which will ensure better treatment outcomes not only for TB but for other conditions. As we screen individuals for TB and HIV, it becomes important to include alcohol abuse and support those patients that are found to abuse alcohol.



Programme Director,
Another factor that contributes to poor adherence of treatment and to primary defaulters, where patients diagnosed with TB have not been commenced on treatment is the migration of seasonal farmworkers.
Within the Northern Cape Province, similar to other parts of the country where there is commercial farming, the movement of individuals has become more frequent during harvesting time. These movements are noted mainly in John Taolo Gaetsewe, Siyanda District-Kei Gariep Local Municipality, Pixley Ka Seme- Siyacuma Local Municipality and between the Northern Cape and Western Cape grape farming communities.
Unemployed people and those with no stable jobs are at a greater risk of defaulting on TB treatment as they often have to migrate to areas where they can find employment. These workers are often not planning to stay permanently and not long enough on one farm to complete treatment. It is incumbent upon government and partners to ensure access to health services for these migrant populations. The Stop TB strategy and the National Strategic Plan for TB and HIV, 2012-2016 clearly recommends that it is essential to put in place intervention strategies to address the plight of the groups that are at risk and they include the migrant workers. The Department in partnership with other stakeholders will during the next financial year develop interventions to address access to TB services for these migrant seasonal farm workers.
Ladies and Gentlemen,
People with TB often suffer from stigma, stereotyping social isolation, rejection and discrimination imposed by family members and the community. Stigma associated to TB and HIV has been reported to impact negatively on patients’ health seeking behavior, disclosure and adhering to TB treatment. The disease stigma has become more prevalent in communities with high TB and HIV prevalence. Fear of being labeled as being HIV positive may be a decisive factor by TB patients not to inform family members that they have TB. In addition, it has been reported that TB patients and their families are often rejected by their communities.

Family support is one of the key factors in ensuring that a TB patient adheres to their treatment. It is important for TB and HIV positive patients to be supported by the Direct Observation of Treatment (DOT) supporters during the duration of treatment to ensure that good treatment outcomes are achieved. Family members and the community have a major role to play in supporting those affected and infected by TB and HIV.

In closing Programme Director;
The prevention and control of TB is still a challenge and thus warrants the continuous engagement of politicians, government, business, private sector as well as civil society to address the impact of TB in the communities. Working together we can certainly do more

The new Provincial Strategic Plan seeks to address this problem within the context of a multi-sectoral approach to combat both HIV and TB as both diseases continue to ravage through our province. The role of partnerships and a multi-sectoral approach in the realization of the Provincial Strategic Plan 2012-2016 cannot be over-emphasized because, it is through combining the resources, skills and experiences of all sectors of society that the PSP goals and objectives can be achieved.

This multi-sectoral approach is based on the commitment of the entire political leadership and support at all levels and all provincial stakeholders, in order to carry out a well structured and effective response to HIV, STI’s and TB. The Department of Health (DOH) and World Health organisation (WHO) TB joint Review conducted in July 2009 emphasised that it is important to consider the impact and severity of the Tuberculosis epidemic in the Northern Cape.

Thank You
Baie Dankie
Siyabulela
Realeboga

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