SAHR 2007 - Health Systems Trust

Health and Related Indicators 15
Figure 5: Death rates by age and sex per 100 000 from TB, 1997 and 2004
Health Status – Infectious Disease
700
600
Deaths per 100 000
500
400
300
200
100
0
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Male 1997 Male 2004 Female 1997
Female 2004
Source:
StatsSA Adult mortality.
In the light of the MDR- and XDR-TB crises, much has been
made of South Africa’s laboratory capacity, compared
with that in the rest of the continent. Compared with other
middle income countries, South Africa was still lacking key
capacity. Whereas Brazil had 10 laboratories per 10 million
population that are capable of determining drug sensitivity,
and Thailand has 6.2, South Africa had only 3.8. No South
African laboratories were reported to be part of an external
quality assurance system for sputum smear microscopy in
2005. While South Africa reported having 143 laboratories
capable of performing sputum smear microscopy, it had only
18 which could perform a mycobacterial culture and / or
drug sensitivity test. Given the apparent extent of the MDR-
TB problem, it is of great concern that South Africa reported
no data on the 4 indicators relating to management of such
cases. These are:
1. % of new cases notified which receive drug sensitivity
testing at the start of treatment;
2. % of new cases notified which receive drug sensitivity
testing at the start of treatment and are shown to be
MDR-TB;
3. % of retreatment cases notified which receive drug
sensitivity testing at the start of treatment; and
4. % of retreatment cases notified which receive drug
sensitivity testing at the start of treatment and are
shown to be MDR-TB.
XDR-TB (in which the organism is resistant to isoniazid and
rifampicin, a fluoroquinolone and at least one second-line
injectable agent, either amikacin, kanamycin and / or capreomycin)
has been detected in all 9 provinces, but the true
magnitude of the problem can only be determined through
testing of isolates from MDR cases identified in routine drugresistance
surveys. Similar data from at least 10 countries is
expected to become available in 2007.
The latest issue of the WHO report included financial data
for South Africa for the first time, gathered from the provincial
programmes. In contrast to many other high-burden countries,
South Africa reported no funding gap in relation to
TB programmes. The total programme costs for 2007 were
reported to be US $235 million, the second largest among
the high-burden countries after the Russian Federation. This
represented a 53% increase since 2002. Importantly, only
3% was sourced from grants, including from the Global Fund.
On a per patient basis, total programme costs for 2007
were budgeted at US $803, with $61 per patient for first-line
drugs. The total programme costs per patient were reported
to be twice as high in the Russian Federation ($1 698 per
patient), but similar in Brazil ($864 per patient). Most of the
other high-burden countries were budgeting far less, with a
median of $259 per patient, with $26 for first-line drugs.
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