South Africa: Reinforcing the Basics to Improve TB Management

Fifty-three year old Vuyisile Makabeni is gaunt and haggard and too ill to work. His cheeks cave in as he describes his various experiences with TB. Each time he has started treatment, he stops as soon as he begins to improve. Like thousands of other South Africans, Vuyisile has yet to complete the six-month course required for a cure and therefore contributes to the country's low cure rates. Beginning in 1997, MSH's EQUITY Project implemented a comprehensive strategy to enable people like Vuyisile to rid themselves of a disease that kills half of HIV-infected South Africans.

To do this, MSH focused on the Eastern Cape Province, the country's poorest, and partnered with its Department of Health to train nurses, supervisors, program managers, and laboratory technicians to improve clinical TB management, while helping to shift its diagnosis and treatment from hospitals to clinic level, where most patients get their care. Emphasis on community-based direct observation treatment short-course (DOTS) paid off; today, 100% of the province's clinics use DOTS, and 85% take TB sputa, compared to 59% in 1998. As one nurse recalls, "We didn't know about DOTS before we underwent training. We saw there was a need for people who cannot visit the clinic to be helped in their community, where they live." MSH also established two innovative projects using taxis and motorbikes to transport TB sputum samples from clinics to laboratories in rural areas, cutting testing-and therefore diagnosis-times from weeks to 24 to 48 hours.

These combined efforts laid the groundwork for effective TB management. Most importantly, TB patients like Vuyisile stand a better chance of being cured than ten years ago. His DOTS supporter, a traditional healer trained by MSH, motivates him to continue: "I am happy with my care. I am not going to stop this time. I am determined to finish my treatment."