THE LOOMING PLIGHT OF SWAZI MDR-TB PATIENTS

PHATHIZWE-CHIEF ZULU

 

The dusty road to Mahlangatja - a remote community in Mankayane, West of Swaziland, kept on winding, and the baking hot summer sun was even hard to bear.

However, after the laborious drive and despite the road condition; our host Benson Maseko (50) was relieved to see us arriving.

Nostalgic about how they used to have plenty harvest in that part of the country, he complained about the weather and the erratic rainfall.

“We’ll die of hunger even this year, Mr Zulu, even this year the sun has hit us” he said, offering a firm hand shake.

“That’s how we live here,” he explained. “We are used to these conditions; the sun, the road, you name it. Hope our MP will do something about it this time around,” he said mischievously.

            Woman Power: Benson Maseko and his wife enjoying the tree shade at Mahlangatsha

Maseko, the ex-miner – married with four children - is amongst thousands of Swazis who left the country to work in the South African mines.

While working in deep level mines in Johannesburg, he contracted the Multi-Drug Resistant Tuberculosis (MDR-TB) in June 2011. The mining company retrenched him back to Swaziland after falling sick.

Tuberculosis is disease that is causing a lot of restlessness in many households in the country to the extent that government declared it an emergency. But advent of MDR-TB is making the suffering for family members even more perilous.

                       Early Bird: Masked Colile Mavuso patiently waiting for treatment at the Health Centre

Even teenagers, some get the MDR-TB strain without getting the normal TB.

Colile Mavuso (15) had to abandon school this year because each morning she goes to Nhlangano Health Centre to get injection. She was supposed to be doing Form 2 this year.

“I’ll stay at home until I finish the treatment because I have to be isolated lest I spread MDR-TB to other pupils”, she explained. “I’ve been on treatment for two months now. I am likely to finish my treatment this year and next year I’ll resume classes,” add Mavuso.

In 2011, World Health Organisation (WHO) reported that Swaziland, Lesotho and South Africa still have the highest TB notification rates with over 600 new and retreatment cases per 100.000 population.

WHO also said Swaziland’s notification rates showed about 1,320 per 100,000 population. When compared to other countries in the region, Mauritius has 21 per 100,000 population and South Africa has 1000 per 100,000 population.

Precisely, Swaziland’s rate - with 1.3 million population - is the highest in the region considering that South Africa has over 50 million population.

       The Defiant Nurse Chief: Bheki Mamba making his point

President of Swaziland Nurses Association (SNA), Bheki Mamba admitted that TB has increased three folds than what it was in the 80’s. And, MDR-TB is rising in countries like Swaziland burdened with HIV/AIDS. And, the serious challenge of the co-infection makes treatment expensive for vulnerable groups adversely affected by the diseases and hunger.

“With our HIV prevalence rate at 26 per cent, we have observed that people die more of MDR-TB than of HIV/AIDS. People just get the first hand the strain of MDR-TB than the general TB. Three out of Five HIV positive patients acquire the MDR-TB strain,” said Mamba.

Mamba said owing to the skewed distribution of wealth and the emergency of the HIV and AIDS epidemic the poor are susceptible to opportunistic diseases like TB.

“More and more of our people are becoming poor and poorer to the point that some families cannot afford three meals a day, while few individuals are getting richer by day,” he said.

Apart from hunger and starvation which face patients living with MDR-TB in Swaziland, the country is embroiled in the subtle skirmish with external donors, the Global Fund in particular, which might affect about 7.7 per cent of patients leaving with MDR-TB in Swaziland.

The situation might have dire consequences for patients like Maseko and Mavuso should Global Fund stop it’s funding to Swaziland.

The country and Global Fund have had good relations since early 2003. But in the past few years, the relationship has been frosty, bordering on issues of financial mismanagement and failure to meet condition precedents.

“The country might not get funding in future from Global Fund because it has not been honest enough to account for the grants received over the years,” said Mamba. “The government even made a commitment to pay back of about E80 million or so to Global Fund.

“Though government might be not forth coming with information, but the truth is that the country is not enjoying good reputation with donors because money is mismanaged and has a high rate of corruption,” he adds.

However, Country Coordinating Mechanism (a stakeholder organ that applies and receive the Global Fund grants) General Secretary, Vulindlela Msibi, disputed that Global Fund is reluctant to fund Swaziland.

He said the old good working spirit still prevails between the country and Global Fund and the latter is introducing a new model of funding not only for Swaziland but for all the countries.

Msibi said Swaziland is listed by Global Fund as one of the countries eligible to apply under the new funding model for the next 3 years, beginning from 2014 and ending in 2016. For that reason, the country is currently preparing a concept note (Application) to be submitted to Global Fund in October 2014.

“This new funding model is expected to make it easy for countries to access the Global Fund grants. This is not a reduction of funding to Swaziland but an end to an agreed grant period which is from 2010 to 2014,” explained Msibi.

“Swaziland will continue to launch a robust response to the TB /HIV response. Presently, the Ministry of Health through the TB programme has a Global Fund grant that comes to an end in September 2014,” he said.

In this external funding furore, Swaziland is yet to meet the requirement by the Abuja Declaration which compelled African countries to commit 15 per cent of their national budget. The country is still cushioned by the assistance it receives from international donors.

The country has managed to allocate about 7 to 8 per cent of its national budget to Health over the years. In the 2014/15 national budget about E28 million has been given to TB Control Programme.

A bit concerned: Themba Dlamini TB Programmes Manager

 

TB Programmes Manager, Themba Dlamini, admitted that the 7 per cent or 8 per cent normally allocated to health is not enough because the money does not go all to the TB response programme. But he insists that government is on track by funding over 50 per cent of the TB programmes.

Dlamini said external funding is helpful but internal funding by government is important because it is reliable unlike the former which comes with a lot of conditions attached to it.

                                                                                

Dlamini is aware of the funding challenges in the TB sector, but according to his knowledge, no partner has indicated to leave the country. Nevertheless, he is equally concerned about sustainability in the event some partners leave.

He is however confident that there can be no disruption of services because there is an exit strategy spelled out in the Memorandum of Understanding between government and the partners, hence their departure cannot be brusquely.

“It will be a great setback. If some partners would leave,” Dlamini said. “It would mean we’ll lose the gains we have made. Take for an instance Global Fund support, it accounts about 35 per cent for our programme imagine if it were to pull out, it would leave a huge void.”

However, Mamba is adamant that if government can prioritise Health the 15 per cent is enough for the government fund all its programmes in the health sector, to benefit patients like Maseko and Mavuso without relying on external partners.

“This country is capable to meet the Abuja declaration,” said Mamba, adding: “But the problem Health is priority number four. Defence tops the list (which in the 2013 it was E1.9 bn) followed by Public Works, then Education because of the Free Primary Education and then it is Health.”

According to Africa Portal (an online knowledge resource for policy-related issues on Africa), Global Fund has invested $76.2 million in supporting HIV/AIDS, Malaria and TB programmes in Swaziland since 2003. And, the programmes have been a tremendous success.

In 2011WHO said the country total expenditure on health per capita was $434. Contrary to Dlamini assertions earlier that bulk of the funding come from government; WHO said the funding of the national TB budget in Swaziland is about $23 million for the estimated 7.7 per cent MDR-TB patients. While 10 per cent is funded domestically, 29 per cent is funded internationally, 62 per cent remains not funded.

Though the country is classified a lower-middle income country and majority of the population live below the poverty line.

Highlighting the state of household poverty, Mavuso said MDR-TB patients need special support because in most cases they cannot work because they have to be isolated.

“Funding for patients should not only for the treatment. Government must provide food parcels for some patients because others live desperate lives, and can’t go to hospitals because they have no money for transport and food,” she said.  

But for Maseko his faith on external donors is unwavering.

“I don’t know what goes on in Mbabane (Swaziland’s administrative capital) and the health organisations. But what I know is that if they can leave the country, we can die like flies, because even the drugs we get in government hospital is not effective like in facilities run be the organisations,” said Maseko.

The fear that Global Fund might stop funding the country or that some donors might leave the country in not a distant future might be played down, as the donor community play it on diplomacy and each stakeholder protects its turf.   

But the certainty in all this health funding roller-coaster is the lives of thousands of Swazi MDR-TB patients at stake.

Global Fund Head of Communications in Switzerland, Ernest Waititu promised to respond but later somersaulted and decided to refer the questions to the Swaziland Portfolio at Global Fund. He later sent an email alleging that the team could not respond to the questions because their schedule was tight and they were preparing for the launch of the new funding model.

University Research CO., LLC, country director, Samson Haumba, could not respond to the list of questions, despite getting assurance from the Communications and Knowledge Management Officer, Babhekile Motsa of getting responses quickly.

The old adage says that each time elephants fight it is the grass that suffers.

One can only hope that Alan Paton words in his book Cry the Beloved Country would not ring true when he said: “Cry, beloved country for the unborn child that is the inheritor of our fear. Let him not love the earth too deeply. Let him not laugh too gladly when water runs through his fingers, nor stand too silent when the setting sun makes red the veld fire…for fear will rob him all if he gives too much.”  

*This story is part of the African Story Challenge; Health Cycle, under the auspices of African Media Initiative (AMI).