Joint effort required to increase funding to tackle TB

Dar es Salaam. Last Thursday, Tanzania joined other countries around the globe to commemorate the World Tuberculosis (TB) day, which is observed every March 24 to raise public awareness and understanding about one of the globe’s deadliest infectious diseases as well as its devastating health, social and economic impacts.

This year’s theme, “Invest to end TB. Save lives”, emphasized the urgent need to invest the resources necessary to ramp up the fight against TB, and realise the commitments to end TB made by global leaders.

In commemoration of this year’s World TB day, a cross section of health stakeholders requested for urgent, huge investment to fight against TB and allocate towards TB research in order to accelerate technological breakthroughs and the uptake of innovations towards ending TB by 2030.

According to the latest data shared by the Minister of Health Ummy Mwalimu, while the world is fighting against Covid-19, a total number of 87,000 people were diagnosed with tuberculosis TB and another 26,800 died in 2021 in the country.

Management and Development for Health (MDH) Program Manager and Community TB Services Mr Hassan Mataka explained to Your Health that in 2020, the World Health Organization (WHO) estimated Tanzania was supposed to have 133,000 TB new cases but up to now only 84,791 TB patients have been identified.

This year’s theme ‘Invest to end TB. Save Lives’ is a call to the government and stakeholders to continue investing in the improvement of TB care and treatment to control infections as well as deaths.

“The theme reminds us that we still need to continue to invest resources to save lives; a lot has been done so far, but yet more investment is crucial,” said Dr Mataka. 

He said, “The country’s geographic position makes it difficult for service providers to reach all the areas and there are limited TB diagnostic facilities (1,600) as compared to over 8,000 health facilities which offer the services,

Dr Mataka urged patients to seek medical proper medication instead of seeking treatment from traditional healers.

Explaining Dr Mataka said a number of achievements have been attained at community levels in TB treatment whereas last year, 23,241 new cases (27 percent) were identified at community level out of the 87,140 new cases countrywide.

In the same year, at facility level, a total of 3,842 HIV positive patients were diagnosed with TB in Kagera, Geita, Tabora and Dar es Salaam.

Dar es Salaam’s Temeke District is leading nationally with the highest number of TB patients due to HIV/Aids prevalence and improved laboratory network.

He said the organization contributed to the increase in case detection in both public and private health facilities and provided training to 1,680 Community Health Workers (CHWs) in seven regions, support transportation of sputum samples from non-diagnostic health facilities to TB diagnostic facilities whereas a total of 128 motorbike riders form 56 district councils are paid allowances each month totransport sputum to testing facilities.

He said that MDH Tanzania has also trained 840 Accredited Drug Officers (ADO)who have been enabled to identify and refer presumptive TB cases to facilities and training to 560 traditional healers who were also equipped with some knowledge on how to identify and refer presumptive TB cases to health facilities.  

To improve access to TB diagnostics, MDH strategically supports activities that improve TB diagnostic technologies through provision of modern machines, provide training on laboratory technologies and support super users to conduct troubleshooting, maintenance and module replacement of testing sites machines, he added.

On challenges, Dr Mataka said the outbreak of COVID-19 affected TB treatment as some patients stopped attending clinic sessions, something that endangered their lives and the people surrounding them. He added that some Tuberculosis patients, especially those from poor households, face catastrophic costs which contribute to their failure to properly follow treatment as sometimes they cannot travel to health facilities due to lack of money.

“The country’s geographic position makes it difficult for service providers to reach all the areas and there are limited TB diagnostic facilities (1,600) compared to over 8,000 health facilities which offer the services,” said Dr Mataka, calling upon patients to seek proper medication instead of seeking treatment from traditional healers.

The government is implementing a number of strategies including the Leprosy Strategic Plan to achieve the goal of reducing Tuberculosis (TB) cases by 50 percent and number of deaths by 75 percent by 2025.  Sustainable Development Goals (SDGS) target 3.3 calls for governments to end epidemics of TB, HIV/Aids, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases by 2030.

Senior TB/HIV Manager for MDH Tanzania, Dr Anna Kiravu said that TB and HIV/Aids have close links whereas recent statistics show that 30 percent of people with TB are living with HIV and it is estimated that between 10 and 15 percent of people living with HIV are infected with TB.

On deaths, she says 2019 data indicates that almost 44 percent of all the deaths of people living with HIV/Aids were caused by TB.

“A single person with TB who has not started medication can infect between 10 and 15 people,” said Dr Kiravu, adding that the organization has been providing education to health workers and in 2021, a total of 150 health practitioners from four regions received the training.

According to her, those vulnerable to TB include cancer and diabetes patients, people living with HIV, children and miners. The list also includes prisoners and boarding school students due to congestion in dormitories.

The minister said, “There is a huge challenge in identifying new patients. Last year we discovered 87,000 new patients yet there is an estimated 133,000 new patients each year of which we can only identify 66 percent.”

According to her, the government was doing its best to strengthen TB and leprosy services across the region.

She said the government recently distributed over six vehicles that will help be coordinate TB-related activities with chief physicians as well as the administrative secretaries of Shinyanga, Singida, Manyara and Morogoro regions.

At the UN High-Level Meeting on TB in 2018, world leaders agreed to mobilize $13 billion per year to finance TB prevention and treatment by 2022 and promised another USD2 billion per year for TB research in the face of growing concerns around drug-resistant TB.

However, funding for TB prevention, diagnosis and treatment services continues to fall far short of estimated global needs and the United Nations global target. In 2020, global spending on TB services fell to $5.3 billion, and funding for research was $901 million.

While national strategic plans and accompanying budgets for tuberculosis have grown in ambition, mobilization of funding has not kept pace. In Africa, governments contribute only 22 percent of the resources required to deliver adequate TB services, with 44 percent going unfunded, seriously impeding efforts to reduce the TB burden.

South Africa and Zambia are the best examples of high TB burden countries that have steadily increased domestic funding specifically allocated for TB. In 2020, South Africa provided 81 percent of domestic funding to support TB activities. Zambia has increased its domestic funding seven-fold since 2015.

Increased funding from domestic sources and international donors is urgently needed if we are to counteract a reversal of the significant gains made against TB in the past decades. At the current rate of progress, the UN Sustainable Development Goals (SDGs) target of ending the TB epidemic by 2030 will not be achievable.

To reach the target, TB incidence would have had to record an annual decline of 4 to 5 percent in 2020, increasing to 10 percent per year by 2025, and then to an average 17 percent annually in the following decade. In fact, the world saw an increase in the number of global TB deaths for the first time in over a decade in 2021. Contributing factors included reduced access to TB diagnosis and treatment, in the face of the COVID-19 pandemic.

With 36 percent of all TB deaths occurring in Africa, failure to invest in the TB response is set to take a formidable toll on African countries. Increased investment can be a game-changer, and alleviate the preventable suffering and death of millions of our people.

Today, I call on governments to mobilize additional domestic financial support for TB control, including contributions to the Global Fund, which last month launched its USD18 billion Seventh Replenishment campaign in a bid to counter the catastrophic impact of COVID-19 on the fight against TB.

I urge all stakeholders to advocate for increased investment, and to ensure that TB services are integrated into the primary health care response. We must all also work more closely with our communities, leveraging their expert local knowledge to tailor response efforts for maximum impact.