Tuberculosis (TB) remains a major public health concern in Southern Africa with a huge economic impact in the region. Despite progress made globally in tackling TB, the burden is still unacceptably high in Southern Africa. The region has the highest per capita burden of TB; with countries such as Lesotho and Mozambique bearing the brunt of the disease, with one of the world’s highest TB incidence at 665/100,000 and 551/100,000 population respectively. 

The World Health Organisation (WHO) indicated that in 2017 alone 49,000 and 78,000 deaths occurred due to TB in Mozambique and South Africa respectively. The high burden of TB in the region is compounded by the high HIV/AIDS burden and intra-regional movement of people for labour and other economic activities facilitating cross-border movement of the disease. 

Furthermore, mining which is a major source of economic growth in most of the countries in the region, and a major contributor to intra-regional movement of labour has been associated with high TB incidence accounting for 33 percent of all new TB cases in the region. Tackling TB in Southern Africa therefore requires a regional approach and, in this regard, SADC adopted the Declaration on TB in the mining sector to guide its regional approach to tackling TB.

Besides TB, the region has experienced public health emergences such as the recent cyclone (Idai and Kenneth) that affected Malawi and Mozambique and other neighbouring countries with risks for outbreaks of cholera and other diarrhoeal diseases; and outbreaks of infectious diseases like cholera, anthrax, rabies and leptospirosis that underscored the need to further strengthen emergency preparedness and response to outbreaks and public health events. 

The AUDA-NEPAD Southern Africa Tuberculosis and Health Systems Support project

The AUDA-NEPAD Southern Africa Tuberculosis and Health Systems Support (SATBHSS) project is a collaborative initiative with two partner institutions, ECSA-HC and World Bank.Itis supporting the region to respond to TB and occupational lung diseases among miners and ex-miners, health care workers, mining communities, high TB burden regions, high HIV/AIDS burden regions, transport corridors, cross-border areas, and labour-sending areas. The project is implemented in Lesotho, Malawi, Mozambique and Zambia with regional benefits for the whole SADC region. The project is facilitating innovation and country to country learning as well as joint response to TB and other cross-border outbreaks among the project countries and with other neighbouring countries such as DRC, Tanzania, Zimbabwe, Swaziland and South Africa. 

The latest project results show a number of key achievements as follows:- 

(i) Following the implementation of TB control interventions, there has been over 200% increase in notification of TB among miners including cross-border referrals and enhanced cross-border screening. This is contributing significantly to finding and treating missing TB (and Drug resistant TB) cases in the region;

 (ii) The project enhanced cross-border disease surveillance and response by zoning and enhancing capacities of multi-sectoral teams to effectively respond to outbreaks.  The zones have been involved in surveillance and joint outbreak investigations of diseases such as the cholera, foot and mouth disease, leptospirosis and rabies suspected outbreak between project countries and other countries; 

(iii) Enhanced capacity for diagnostics and quality systems improvement of laboratories by jointly collaborating to implement peer regional assessment and laboratory certification through the Stepwise Laboratory Quality Improvement Process towards Accreditation (SLIPTA) Audits. This has led to ISO15189 accreditation of 2 laboratories in Zambia and significant improvement in SLIPTA performance of laboratories (>60% above 2 stars) under the network in the other project countries; 

(iv) Countries have collaborated to define a regional benchmark for mine Occupational Health and Safety inspection with the view to facilitate strengthening of primary prevention for occupational lung diseases 

Opportunities to bring the SATBHSS interventions to scale 

WHO estimates substantial cases are still being missed and the countries needs to design innovative strategies targeting at-risk populations to capture missing cases.In this regard, the following priorities were identified as key cross-cutting high impact interventions for scale up:

1. intensified case finding to find missing cases through scale up Active Case Finding in the most vulnerable groups (miners, ex miners, diabetic, PLWHA, their families, health care workers) using more sensitive screening tools such as digital CXR, further increasing access to GeneXpert; 
2.  Improving treatment outcomes (and reduce significantly TB mortality) through enhanced quality assurance/quality improvement for TB management and improved patient tracking and patient support;
3. Improving cross-border TB care, including continuum of care; 
4. Expanding cross-border disease preparedness and response interventions; 
5. Implementation of International TB Standards of Care and scaling up primary prevention for occupation lung diseases. The project aims to implementation at scale, decentralize service delivery and adopt more technologies and innovations during the implementation period to realise and surpass the set goals.