Swaziland: Fight against TB in troubled waters

Swaziland has the highest per capita TB burden in the world, and HIV incidence is 26% which is no less alarming. Not surprisingly TB-HIV co-infection rate amongst TB patients in Swaziland is 80%. "The government is creating genocide where we are infecting each other" said Tengetile Hlophe from Swaziland at the 41st Union World Conference on Lung Health in Berlin, Germany. Also rate of drug-resistant TB among new TB cases is worrisome, said Tengetile. Read more

She said so, because there is a range of issues plaguing TB control in Swaziland, particularly if we see from the human rights and ethical lens.

Swaziland constitution has the right to life but it does not explicitly provide for the right to health. This has a negative impact on the control of TB and HIV both.

For instance, early this year, there were not enough anti-TB drugs in the clinics and doctors were handing out a prescription to people who had spent a part of their daily income on transportation to come to these clinics and a number of them didn't had enough money to buy whole course of anti-TB medicines.

When Tengetile highlighted these key impediments to TB control in Swaziland to the Minister, the reply was: the problem is not money – it is procurement procedures that had caused drug stock outs. Swaziland is also a recipient of a grant from the Global Fund to fight AIDS, TB and Malaria (GFATM).

"This year has been a difficult time - early this year there were cases where TB patients were given prescriptions to go to pharmacy and buy drugs" said Tengetile. "As patients had spent money on transportation to clinics, they only had enough money left to buy drugs for 5 days only. In June 2010, we didn’t have caprimicin in the clinic. Then the minister intervened that doctors are not supposed to give prescriptions. So patients had no choice – clinics had no caprimicin for two weeks, and doctors cannot give prescription even if a patient can afford it… what is the point of spending the money to go to the clinics?" said Tengetile.

"Luckily enough, now treatment has arrived for 12 months for those patients who were already on the MDR-TB treatment. What about new patients? We need to advocate as organisations for a buffer stock of drugs" said Tengetile.

One of the other primary obstacles is the lack of information, said Tengetile. There is inadequate access to TB information in Swaziland. TB infection control practices are appalling – with clinics overcrowded with patients – putting everyone who goes to health facilities at a high risk of infectious diseases. Extremely low level of treatment literacy is another impediment to effective TB control. Even the basic information about signs and symptoms for early diagnosis of TB is not available to common people. No wonder information on TB-HIV co-infection and drug-resistant TB is more likely to be missing those who might need to be informed the most, said Tengetile.

Education on TB and HIV is highly needed for patients to make informed decisions on their lives. This is one of the areas where communities have a well-recognized and a vital role to play. Greater and genuine involvement of TB patients in planning programming and implementation at all levels will help bring the difference, said Tengetile.

"If we can take a approach where rights of people are respected, including the right to health, we will see the difference" said Tengetile.

Themba Dlamini, Swaziland's National TB Programme (NTP) manager, who also spoke at a different session at 41st Union World Conference on Lung Health in Berlin, Germany, was presented the concerns raised above by CNS. Themba replied:  "There is increased access to TB services at community level as 9 community-based organizations (CBOs) are supporting delivery of TB services to 3000 patients in Swaziland. CBOs consists of NGOs and faith based organizations, and also former TB patients' organizations like "Women Live Together" which is a network of women living with HIV and half of them are co-infected with TB."

Themba Dlamini further said: "There are no more drug stock outs and procurement issues have been addressed. The drugs from the Global Drug Facility (GDF) have come now for another year and I hope there will be no further stock outs."

The WHO Stop TB Strategy also advocates for engaging affected communities meaningfully – and puts forth the Patients’ Charter for TB Care as a rights and responsibilities based framework to be used as a powerful tool in mobilizing communities as partners with dignity, to advocate for achieving the International Standards for TB Care in their local healthcare centres.

Bobby Ramakant - CNS