Taking on TB in Southern Africa will need a united effort

Tackling the scourge of TB in southern Africa will require cross-border co-operation because of labour migration patterns, writes Nazira Karimo Vali Abdula

The worldwide battle against tuberculosis reached a turning point in 2015, when the illness became the leading global cause of death from an infectious disease, surpassing HIV/Aids.

Southern Africa is bearing the brunt of this crisis. One-third of the countries worldwide with the highest TB burdens are in southern Africa, and they show few signs of slowing the disease. Furthermore, the emergence of multi-drug-resistant TB is an even bigger threat, as treatment is dramatically more expensive, lengthier and more toxic.

TB is an infectious disease which is fuelled in southern Africa by intraregional activity, including cross-border trade, patterns of migration, and labour from neighbouring countries moving to South Africa, particularly to support its mining industry.

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While such activity is critical for advancing economic opportunities, it has also made efforts to control diseases such as TB more challenging.

It is critical that political leaders, ministries of health, mines and labour and the mining industry itself work across borders in a proactive, strategic manner to address TB as a public health issue - one that threatens to undermine economic gains.

Last month, Maputo hosted delegations from seven countries led by ministers of health and labour, senior representatives of regional organisations and international agencies.

It was the launch of an innovative regional effort that bolsters our collective efforts on this front.

This $122-million (about R1.65-billion) collaboration, called the Southern Africa Tuberculosis and Health System Support Project, brings together Lesotho, Malawi, Mozambique and Zambia to support a regional response to TB and occupational lung diseases, as well as to strengthen health systems and improve the region's capacity to manage TB.

The project, which is supported by the World Bank, will target individuals and families affected by TB in mining communities, in transport corridors and in cross-border areas across the four countries that are particularly vulnerable to the disease.

It will also focus on regions with high rates of both TB and HIV/Aids: between 55% and 70% of those with TB also have HIV/Aids, putting southern Africa at the epicentre of these dual epidemics.

Addressing TB in the mining sector is essential, as this industry has historically attracted large numbers of workers from neighbouring countries to South Africa.

About 40% of the estimated 500,000 workers in South Africa's gold mines originate from Lesotho, Mozambique and Swaziland.

In South Africa alone, TB rates within the workforce are estimated at 2,500 to 3,000 cases per 100,000 individuals - an incidence that is 10 times what the World Health Organisation terms a health emergency.

For Mozambique, the project will have a dual focus, tackling a burden of TB linked to historical cross-border migration - particularly from the southern provinces to South Africa - and building systems and rolling out services to position Mozambique's own rapidly expanding mining sector to better manage TB and other occupational lung diseases.

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Importantly, this project will build upon recent collective efforts among countries in the region to tackle TB.

These include the August 2012 passage of a declaration by the heads of states which are members of the Southern African Development Community to eradicate TB in the mining sector; and the development of a regional framework that harmonises treatment, prevention, diagnosis and referral services across South Africa, Mozambique, Lesotho and Swaziland so that mineworkers who start treatment in one country can receive continued care in the neighbouring country.

This regional effort has taken important lessons from an earlier project involving mineworkers in South Africa and the region, which has helped to introduce innovative ways of finding and managing cases of TB.

While the southern Africa region has seen GDP growth above 4% since 2005, continued high levels of poverty and inequality and the presence of diseases like TB are holding our region back from enjoying truly sustainable and inclusive growth.

It is imperative that nations in the region ramp up working in an integrated manner to build awareness about TB, promote proven interventions and create opportunities for learning.

I look forward to working with my minister of health colleagues across the region on this initiative.

The economic growth of southern Africa depends on it.

• Abdula is Mozambique's minister of health