World TB Day Commemoration and Indaba - 27 March 2017

Chairperson of Civil Forum and co-chair of the Northern Cape AIDS council Mr Beua Nkaeleng….
Members of the Executive Council
The Executive Mayor of Z .F Mgcawu District Municipality, Mr Abram Vos
Members of the Mayoral committee
Members of Civil of society
The TB-HIV fraternity
Ladies and Gentlemen

It is my distinct pleasure and honour that I am part of this auspicious occasion today. Today as the province we mark the commemoration of the World TB day. As we mark this day, it is important to note that we are doing so as part of the broader South African community. The National World TB day 2017 will be hosted in Mangaung at Free State Province on the 31st of March 2017.  This year, the event will be used among other things as a platform to launch the National Strategic Plan for HIV, TB and STI’s 2017-2022. This is a fourth successive strategic plan that our country has developed to deal with the HIV/AIDS epidemic.
We are therefore hosting this event as part of the national campaign to celebrate this significant milestone of our country. This strategy has come as a result of a broad consultative process between government, private sector and civil society proving once again that the HIV/AIDS compact is alive and functional in South Africa. This is something that we need to be proud off. In 2012 as the country we took a strategic decision to integrate HIV and TB in one strategic plan. We applaud the foresight shown by the ANC government and HIV/AIDS fraternity for taking such a bold decision.
Today we are reaping the fruits of that decision. In the past few years we have been able to increase life expectancy from 51 years to 61 years. We have the largest treatment programme in the world with 2 million people on Anti-retroviral treatment and have conducted the largest HIV testing campaign in the world that has reached more than 20 million South Africans.
We are however commemorating this event fully aware to numerous challenges posed by the TB epidemic in our country. According to the World Health Organisation (WHO) Tb incidence has increased by 400% in South Africa in the past fifteen years. This is mainly attributed to the increase of HIV incidence. WHO estimates that 60% of TB patients are co-infected with HIV. According to a number of sources in South Africa this number is estimated to be more than 70%. TB is now the number one killer disease in South Africa.
In die Noordkaap is die voorkoms van Tubekulosis kommerwekkend en word dit beskou as die primere gevolg van sterftes onder ons mense. En hierdie toestand is meer kommerwekkend omdat ons weet dat Tuberkulosis geneesbaar is. Dit is weens nalatigheid dat mense hul lewens verloor aan hierdie geneesbare en beheerbare siekte. Dit is vandag onder die vaandel van “UNITE TO END TB AND HIV: South African leaders taking action” dat ons bymekaar kom om maniere te vind om hierdie pandemie te stuit en om werkbare oplossings te vind wat bewusmaking sal bevorder. 
Dit is om hierdie rede dat ons U, as leiers van verskeie sektore bymekaar gebring het om saam hierdie pandemie te beveg. Die primere doel van hierdie Indaba is om maniere te vind om die verskeie uitdagings wat Tuberkulosis en HIV bied, te verstaan en om dit suksesvol te bestry. Ons werksaamhede en besluite sal ook Nasionale beleid beinvloed sodat ons tesame die oplossings kan vind vir die uitdagings vorentoe.  
Die algemene doelwit met hierdie byeenkoms is ook om die spesifieke problem rakende TB en HIV onder die vergrootglas te plaas en ook ‘n beter verstandhouding kan kweek oor die negevolge van die uitermatige groot TB syfers waarmee ons in die Noordkaap mee worstel. Dit is skrikwekkend om te verneem dat die insidende of TB verwante gevalle tans meer as vyf honderd mense per een honderd duisend is. Die Nasionale standard is tans twee honderd per een honderd duisend mense.
Wat ook van kommer is dames en here, is nie net dat ons die nasionale norm van twee honderd gevalle per een honderd duisend mense met meer as twee maal oortref nie, maar dat dit vir etlike jare die geval is. En ons moet ons dan vra wat ons nie reg doen nie. Waar kom ons tekort? Wat is die strydblokke wat ons verhoed om die siekte te beheer? Hoe kan ons die verspreiding daarvan stuit? Ons moet ernstig ondersoek oor wat ons as vennote in die stryd teen TB verspreiding kan doen om genesing te bring? Ons sal in erns moet werk en nou hande moet neem om verdere sterftes te voorkom. Harde vrae moet gevra word en oplossings moet gevind word. 
Programme Director without pre-empting the outcome of the discussions I would like to make the following few points as a prelude to the discussions.  The question of leadership is of outmost importance in dealing with these epidemics. During the late 1990’s and early 2000’s when the scourge of HIV/AIDS really started to ravage our communities leaders from all fronts of society raised their hands to take responsibility of leading the response to HIV/AIDS.
Today that kind of vigour and urgency has subsided. This symposium must discuss how we reinvigorate the response again. This is the reason why the new National Strategic Plan has a dedicated goal on leadership, and by leadership we don’t only mean political leadership. We need the church leadership, labour, private sector, traditional leadership, the youth, women etc. I must say that as government we are indeed concerned about the seeming lack of appetite from the leadership to deal with the HIV and TB epidemics.
I know that in certain quarters there is talk of HIV and TB fatigue. Colleagues I want to urge you and remind you that this is not the time for us to lose focus or we will lose the very gains that we have already made. By leadership we also don’t only merely mean representation but programme leadership and accountability. Each sector must be able to direct a programme peculiar to its mandate and reach. For example the religious sector must be able to direct a health programme focusing on TB and HIV as part of their Sunday school education and this must be accounted for in terms of a comprehensive report. The symposium should and must discuss how we make this a reality.
The second point is that we need to deal with the epidemics from the point of view of knowledge or science. In the past twenty years there has been a lot of work that has gone in researching the drivers and the main vulnerable groups for both epidemics. The time for blanket approaches for all areas and for everyone is simply not sustainable.  We live in the times of budget and time constraints, we need more targeted approaches. We need to move from just mere information to strategic information. This means information that enable us to make strategic decisions about priorities and budgets. We need to maximise the impact of our interventions in a short space of time if we are to reach the NDP goals of 70 years life expectancy by 2030.
The NSP introduces the concept of focus for impact. In applying this concept we must make a decision about where should we put our focus and resources as a province. This will require decisive leadership but we must be guided by strategic information in making such decisions. By the end of this symposium and through the information provided here we must already know which direction is the province is inclining. 
Thirdly, there are those problems that I would like to call low hanging fruits. They are seemingly complex but I want to say they are doable if we put our heads together. These are:
• Improving the cure rate
• Reducing the TB mortality rate
• Reducing HIV-TB co-infection
• Reducing loss to follow-up
• Reducing the defaulter rate
Colleagues, I want to say that we must emerge with concrete plans around these outcomes. Remember what President Mandela said “it always look impossible until it’s done”. I believe that the answers to these problems are here with all of us. I have instructed the secretariat that this symposium must not just be a talk show but I want concrete proposals with a concrete plan that will be implemented to improve these outcomes in our province. As a result tomorrow we have a provincial AIDS council meeting to adopt the proposals from this symposium.
Fourthly, I think we must discuss the question of community based models to deal with these two epidemics. The new strains of TB such as MDR and XDR require us to think differently. As the province we have had a high rise of these strains in the past few years. The stigma related to these strains of TB has led to the resurgence of stigma against people living with TB. This is a problem because as you know with HIV problems such as defaulting and loss to follow-up are related to stigma. We need better forms of family and community support so that people who have started treatment can complete the whole duration of treatment.
As a province we have started programmes such as 100 families’ projects. Perhaps these initiatives must also be utilised as vehicles to support people on treatment and their families, particularly children. Our war rooms also as our own community based model to deal with issues of poverty and diseases should be utilised as centres of support for people suffering from TB and HIV.
Lastly and more importantly to underscore the reason why all of us are here today. I would like to remind you that both the TB and HIV epidemics cannot be confined to the department of health or government. It requires partnerships from a wide variety of stakeholders. This is the reason why in South Africa we talk of the multi-sector approach. This multi-sector approach must be truly multi-sector and not only government. We want to make a call to all of you to identify and forge new kinds of partnership particularly to end TB.
Each and every sector has a specific and peculiar role to play. Let us go back to the basics of health and hygiene that all of us grew up with. We have seen for example that we have lost grasp of simple but important things such as opening windows. We have seen for example that in certain areas of our province there are shacks that are built without windows. How is possible for such a family to adhere to basic hygiene standard of opening windows in the morning without windows. We need to teach children in school to wash hands before they eat. I am trying say colleagues the discussions here must not only be 40 feet high but they must also be on the ground.
I wish you a fruitful engagement and I am confident that we, as a collective will emerge from this Indaba with a greater understanding of what we face. I am equally confident that we will rise to these challenges and find lasting solutions to the pandemic we face. We are known as a nation that stand together and fight together. This is a fight for all of us to win. This is another challenge we accept and this too we shall overcome.

Thank you. 


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