As World Tuberculosis (TB) Day draws near, it's essential to reflect not only on the progress made but also on the challenges that persist, particularly in Africa, where TB continues to claim millions of lives each year. The latest data from the WHO Africa Region paints a hopeful picture, showing a decrease in TB mortality rates from 2012 to 2021, indicating the impact of concerted efforts by organizations and countries. However, this progress is marred by concerning trends, particularly in the realm of drug-resistant TB (DR TB), Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. The WHO estimated that 424,000 people died from the disease in the African region (1.267 million globally) in 2022. Over 33% of TB deaths occur in the African Region.

In Southern Africa, particularly in Lesotho, Malawi, Mozambique and Zambia, The African Union Development Agency – New Partnerships for Africa’s Development (AUDA-NEPAD) implemented the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) Project , funded by the World bank, marking a significant turning point in the fight against TB. Through this initiative, governments within the selected countries provided essential support, including psychosocial, nutritional, and home-based assistance, leading to a reduction in DR TB mortality rates. The project's ambitious aim in Zambia was to detect and treat 175,749 TB patients between 2017 and 2023. Remarkably, by the project's conclusion, a total of 198,201 patients had received treatment, surpassing the target by an impressive 13%. Moreover, during this period, nationwide efforts led to the diagnosis and treatment of 311,308 individuals with TB, with the project alone accounting for 64% of all national TB notifications.

The significant investments poured into this project, along with collaborative partnerships, have yielded tangible results in Zambia's fight against TB. From 2017 to 2022, the TB incidence rate witnessed a substantial decline from 391 cases per 100,000 population to 295 cases per 100,000 population, marking a notable 26% reduction. Such progress underscores Zambia's successful strides towards achieving the milestones set forth in the 2020 End TB Strategy. These achievements not only demonstrate the effectiveness of targeted interventions but also highlight the importance of sustained commitment and collaboration in combating infectious diseases like TB.

The project significantly adheres to regional, continental, and global initiatives on tuberculosis (TB), including the SADC TB Declaration on Tuberculosis in the Mines, SADC Harmonised Minimum Standards for the Prevention, Treatment, and Management of Tuberculosis in the SADC Region, and the WHO End TB Strategy. By focusing on the most impacted communities and providing direct support to vulnerable groups, notably women in the small-scale mining sector, the project underscored a dedication to fairness and inclusivity in TB control endeavors.

However, the onset of the COVID-19 pandemic in 2020 exacerbated existing challenges, further straining healthcare systems and disrupting essential services, including those provided by the SATBHSS Project. During the period of 2020-2021, the limitation of the projects support coincided with a resurgence in DR TB mortality rates, underscoring the critical role that sustained support plays in combating TB effectively. This sobering reality not only emphasizes the importance of ongoing interventions but also serves as a stark reminder of the fragility of progress in the face of external crises.

Several recommendations emerge as we reflect on the lessons learned from Zambia's experience. First and foremost, there is an urgent need for sustained investment in TB prevention, treatment, and support initiatives. Governments, international organizations, and donors must prioritize long-term funding commitments to ensure the continuity of essential services, even in the face of external crises such as pandemics.

Secondly, efforts to combat TB must be integrated into broader health systems strengthening initiatives. By investing in healthcare infrastructure, training healthcare workers, and improving access to diagnostic tools and treatments, countries can build more resilient health systems capable of effectively responding to TB and other infectious diseases.

Furthermore, community engagement and empowerment must lie at the heart of TB control efforts. Empowering communities to take ownership of their health, raising awareness about TB prevention and treatment, and addressing social determinants of health are essential components of a comprehensive approach to TB control.

Regional collaboration and coordination are paramount in the fight against TB. Initiatives like the SATBHSS Project demonstrate the value of cross-border partnerships in addressing the transnational nature of TB transmission.  Countries can maximize their impact by sharing best practices, pooling resources, and coordinating responses and achieve greater success in TB control efforts.

As we commemorate World TB Day, it is imperative to recognize the impending impact of TB on low-income communities and its devastating effects on household income. The economic burden of TB extends far beyond individual health, exacerbating poverty and perpetuating cycles of deprivation.

With the extension of the SATBHSS project until June 2024, let us heed the lessons learned from Zambia and redouble our efforts to eliminate this ancient scourge once and for all. By investing in sustained support, integrating TB control into broader health systems, strengthening efforts, empowering communities, and strengthening regional collaboration, we can build a future where TB is no longer a threat to public health and prosperity.