As the AIDS Healthcare Foundation, we call on stakeholders to increase funding for TB prevention and treatment programmes in Africa. Partnerships between the government, private sector organisations, civil society groups, and international organisations are critical.
Increased funding is vital to boost awareness of the importance of testing and early diagnosis of TB. Advocacy and community engagement efforts must be intensified to increase awareness and understanding of the disease. We must all do our part to curb TB infections in the region, not just on World TB Day, but every day.
The upcoming second UN High-Level Meeting on TB, mandated for 2023, presents a unique opportunity for stakeholders to renew their commitments to ending TB on the continent.
Although there has been progress in combating TB, Africa experiences challenges accessing essential TB services. This opinion piece explores the current state of TB in Africa, highlights the key obstacles, and emphasises the urgent need for all stakeholders to get involved and increase funding to address this pressing public health issue.
Looking at the statistics and classifications pertaining to TB, one can say that Africa carries a significant disease burden. Seventeen of the 30 high-burden TB countries globally are in Africa, while five of the 10 focus countries for multi-drug-resistant (MDR) TB/HIV co-infection are also in Africa. Globally and in Africa, there were observed gains in focused TB control as evidenced by the declining prevalence, new cases, and deaths attributed to TB. Reductions in new cases and deaths are slower than expected/desired, and this can be attributed to disruptions in funding and services due to competition from COVID-19 as a new global public health priority. Below, we highlight some illustrative examples of trends.
The reported decline in global spending on essential TB services from US$6 billion in 2019 to US$5.4 billion in 2021 is a significant concern and is a major shortfall to the projected need of US$13 billion annually for the past eight years. This mirrors the decline in global TB funding, and there is also a reported decrease in domestic financing for TB services across the 136 selected priority lower-middle-income countries, including almost the entire African continent. Africa is among the regions with a high TB burden globally, struggling simultaneously with weak health systems, poverty, inadequate nutritional support, and limited access to new drugs and diagnostic tools.
These challenges hinder effective TB control and demand urgent attention. TB has a significant socio-economic impact on society, affecting individuals' health and limiting their ability to work and participate in social and economic activities. TB treatment can also be expensive, placing a financial burden on affected individuals and their families, especially those living in poverty. The lack of investment in healthcare systems leaves communities even more vulnerable to TB diseases. Severe shortages of human resources for health, worsened by high turnover, contribute to missed opportunities to identify cases and accurately diagnose TB in patients attending available health facilities.
These missed opportunities translate into delayed treatment and continued sources of TB transmission. Stakeholders must also avail newer treatment regimens and increase access to up-to-date diagnostic technologies to increase health worker capacity to detect, diagnose, and treat TB cases. The Stop TB Partnership has set and published a global plan to end TB as a public health threat by 2030 – a seven-year plan with several objectives, among which are to: find and diagnose at least 95% of people with TB, including adults, children, and those with drug-resistant strains, deliver treatment to 50 million people within the next seven years, with 4.7 million being children, achieve at least 90% treatment success for all forms of TB and provide TB preventive therapy (TPT) to 100% of eligible people with TB.
To achieve these and several other priorities in this TB eradication plan, the TB community calls for renewed efforts to strengthen health systems, including devising innovative technologies, community outreach, and case management approaches, along with increasing funding.
Therefore, this requires a multi-sectoral response to the TB epidemic to ensure these required interventions are implemented immediately to address the TB epidemic in Africa. Addressing these factors requires collaboration across various sectors, including health, education, nutrition, and social welfare. By integrating TB control strategies into broader development agendas, African countries can tackle the underlying issues contributing to the high TB burden and persistent low funding. Reducing stigma, increasing gender mainstreaming, and promoting human rights-based approaches, are crucial for achieving equitable and effective TB responses. Below, we elaborate on specific steps to progress toward achieving some of the objectives to end TB by 2030.
Mobilising additional funding
Despite the devastating toll of TB, it often lacks prioritisation in health agendas and faces inadequate funding. In Africa, governments contribute only 22% of the required resources, leaving 44% of needs unfunded. To make substantial progress in TB control, efforts must be intensified to mobilise additional funds from both domestic sources and international donors. This requires advocacy, networking, and strong leadership to ensure TB receives the attention and resources it deserves.
Learning from COVID-19
The COVID-19 pandemic has overshadowed the progress made in TB control, leading to a decrease in the number of people receiving TB treatment. However, the lessons learned from the pandemic, including solidarity, determination, innovation, and equitable use of tools, can and should be applied to TB. By leveraging the experiences gained during the COVID-19 response, African countries can strengthen their healthcare systems, improve diagnostic capabilities, and enhance TB treatment access. We urge stakeholders to enhance funding for the African TB response, which is essential for promoting awareness, early detection, and treatment. Collective and immediate actions are required to reduce TB infections in the region. The upcoming second UN High-Level Meeting on TB in 2023 offers a distinctive chance for stakeholders to reaffirm their dedication to eradicating TB in Africa.
LYDIA BUZAALIRWA* is the AIDS Healthcare Foundation (AHF) Africa Bureau, Director Quality Management.
