Swaziland has the highest per capita TB burden in the world.Its 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.
Tengetile stressed that the rate of drug-resistant TB among new TB cases is worrisome. The plague of TB and HIV alarms the authority of Swaziland nowadays.
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 both TB and HIV. Early this year, there were not enough anti-TB drugs in the clinics. The doctors were handing out a prescription to people who had spent a part of their daily income on transportation to come to these clinics. But sadly most of them have no enough money to buy whole course of anti-TB medicines.
When Tengetile highlighted these key impediments to TB control in Swaziland to the Minister. But the reply of the Minister undersored that the problem is not money. It is in the 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.
“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.
According to Tengetile patients had spent all thier money on transportation expense to clinics. They only had enough money left to buy drugs for 5 days only.
“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 organization for a buffer stock of drugs,” said Tengetile.
Tengetile said that one of the other primary obstacles is the lack of information. There is inadequate access to TB information in Swaziland. TB infection control practices are appalling. The clinics are overcrowded with patients which put 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.
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 vital role to play. Greater and genuine involvement of TB patients in planning programming and implementation at all levels will help bring the difference.
“If we can take a approach where rights of people are respected, including the right to health, we will see the difference,” said Tengetile.
The WHO Stop TB Strategy also advocates for engaging affected communities meaningfully. They bring forth the Patients’ Charter for TB Care as rights and responsibilities based framework. This is a powerful tool in mobilizing communities as partners with dignity and to advocate for achieving the International Standards for TB Care in their local healthcare centres.