By Michael Gwarisa
Tuberculosis (TB) is by far one of the world’s most ancient diseases, dating back to about 9000 years ago when TB was first detected in humans in Atlit Yam, a city now under the Mediterranean Sea, off the coast of Israel. History has it that Archaeologists found TB in the remains of a mother and child buried together.
Despite being a disease from medieval times, Tuberculosis is one of the world’s second-leading infectious killers after COVID-19 (above HIV and AIDS). According to the World Health Organisation (WHO) data, in 2022, a total of 1.3 million people died from TB, and this includes 167,000 people with HIV. An estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, including 5.8 million men, 3.5 million women and 1.3 million children in the same period. TB is present in all countries and age groups. TB is curable and preventable.
However, TB remains one of the most underfunded diseases on mother earth, with indications that in Low-and Middle Income Countries (LMICs) such as Zimbabwe, international donors contribute majority of funds to TB programs. In most instances donor fatigue has been noted and should the current trajectory continue, low- and middle-income countries will bear the brunt of the TB burden in the foreseeable future.
The Stop TB Partnership’s Global Plan to End TB, 2018–2022 (the Global Plan) estimated that US$ 8.6 billion was required for TB prevention, diagnostic and treatment services in 128 low- and middle-income countries (LMICs) in 2018, rising to US$ 15 billion in 2022. It was estimated that an additional US$ 2 billion per year was needed for TB research
At the 2018 UN high-level meeting on TB, it was agreed that annually, USS$13 billion was needed for TB prevention, diagnosis, treatment and care.
However, the Global TB Report of 2022 revealed that there has been increased political commitment toward TB in other parts of the world, with indications that 60% of TB funding came from domestic resources in 2022. While this exhibits commitment by the governments and is a great step towards sustainability, Low Middle-Income Countries (LMICs) like Zimbabwe have been lagging behind in TB financing.
Zimbabwe is currently skating on thin ice, amid indications that 95% of TB funding is coming from donors, and only a small fraction from government coffers.
In Zimbabwe, less than 5% comes from domestic sources,” said Dr Donald Tobaiwa, the Jointed Hands Welfare Organisation (JHWO) Executive Director in one of the sessions during countrywide UNHLM Feedback meetings.
“This funding gap shows that TB programs are heavily donor-dependent and not sustainable since 95% of TB funding comes from international donors.”
Worldwide, the amount of TB funding has been decreasing since 2018 and it decreased by about 1.2% between 2020 and 2021 from 5 482 in 2020 to 5 418 in 2021.
He said the trend poses a major threat to the sustainability of Tuberculosis control programs that are heavily donor-dependent.
“There is a need for Low Middle-Income Countries such as Zimbabwe to build local capacity to mobilise more domestic funds for TB programs.”
In the WHO African region, about 50% of TB funding has come from domestic funding sources every year since 2017.
“This indicates good political commitment with regard to ending TB in the region. Consequently, Zimbabwe’s Ministry of Health and Child Care (MoHCC) and the government of Zimbabwe should work towards reaching Afro region average TB funding levels where about 50% of TB funds comes from domestic resources,” added Dr Tobaiwa.
Zimbabwe’s Per Capita Health expenditure or the amount the government spends on an individual’s healthcare annually falls short of World Health Organisation recommended standards. Currently, Per Capita Public Health Expenditure (US$) ranges between US$7 and US$45, which is below the recommended US$86 per Capita. The African scorecard for domestic financing for health shows that Zimbabwe is among the list of countries spedni9ng less than the recommended US$86.3. African countries that have met the Africa Scorecard for Domestic Financing for Health Include South Africa, Mozambique, Botswana, Tunisia, Gabon and Algeria.
“Basing on information in the World Tuberculosis Report (2022) on Zimbabwe and information supplied by USAID 2023, the total amount of TB funding was less than US$22 Million in the period 2018-2022.”
Meanwhile, TB funding gaps in Zimbabwe are more pronounced for the TB programme than for Drug-Resistant TB and TB/HIV. Funding Gaps were much higher in 2019 and 2020 than in other years and have been narrowing since 2019.
Dr Mkhokheli Ngwenya, National Professional Officer - Tuberculosis and LeprosyWorld
Health Organisation (Zimbabwe) said increased domestic funding was the cornerstone to
attaining Universal Health Coverage (UHC).
“Under UHC, a health financing policy must address the following: People, revenue raising, pooling, purchasing, service provision and people. It must also address reforms to improve how health financing systems perform. It must also address priorities and trade-offs with regards to population, services and cost coverage,” said Dr Ngwenya.
He added UHC strategies should aim at removing financial risks and barriers to access through pre-payment and pooling mechanisms.
“There is a need to mobilise resources both locally and internationally. There is also a need to promote the efficient use of available resources and ensure resources are used efficiently. There is also a need to promote solidarity of the whole population. The rich must subsidise the poor and the healthy to subsidise the sick.”
Dr Ngwenya also highlighted the need to increase the quality and availability of health services through investing and using modern technologies.
Zimbabwe has to date fared well in terms of revamping its health services infrastructure and TB diagnostic tools. According to the Ministry of Health and Child Care (MoHCC), the total number of Gene Xpert machines in the network in the country’s health facilities is 180. 18 are Gene Xpert XDR machines, 3 LPA sites. The total number of Truenat machines in the public sector is 20 while that of digital X-ray machines in the public sector is 50. 45 new machines awaiting installation.
Zimbabwe was removed from the top 8 countries in Africa on world’s top 30 list of countries with triple burden of TB, TB/HIV and MDR-TB. Zimbabwe is now double burdened with MDR-TB and TB/HIV.
Dr Fungai Kavenga, the acting Deputy Director AIDS & TB Programs (TB Control) in the Ministry of Health and Child Care (MoHCC) said even though Zimbabwe has made remarkable progress regarding TB, the increase in TB in artisanal mining communities was cause for concern.
“In 2023, 15% of notifications were contributed by miners, ex-miners and their families. We are noting a huge exposure to TB through economic activities, especially artisanal mining, and we are seeing an increase in TB in those communities. We are also noting exposure to TB in other sectors such as Agriculture where you see that there is overcrowding in those compounds,” said Dr Kavhenga.
Zimbabwe has a TB in the Mining Sector program as part of efforts by the government and partners to try to collaborate with that sector.
Zimbabwe has a double burden of TB/HIV and MDR-TB. HIV Prevalence: 11.8% (15-49 age group) with Females accounting for the biggest number of infections at 14.8% and Males 8.6%. The country has aTB estimated incidence of 204 /100,000 population in 2022 (Global TB Report, 2023). Treatment coverage was 55% in 2022, increasing from 54% in 2021. (Global TB Report, 2023). An estimated 11,778 cases were missed in 2022. TB/HIV co- infection rate of 51% in 2022.(Global TB Report, 2023), a drop from 54% in 2021.
