South Africa: MSF calls for decentralisation of life-saving DR-TB services in rural setting

An evaluation report released today by Doctors Without Borders (MSF) charts progress towards decentralising services for patients with drug-resistant tuberculosis (DR-TB) in South Africa’s KwaZulu-Natal’s King Cetshwayo District (KCD), in line with the country’s 2011 DR-TB decentralisation policy.

The report finds that the KwaZulu-Natal Department of Health (KZNDoH) has established some level of DR-TB services in six district hospitals, three district clinics, and one district community health centre but that progress towards the full implementation of the DR-TB decentralisation policy is slow.

Health promotion activities in a park in Eshowe. Photographer: Tadeu Andre | Date: 14/02/2020 | Location: Eshowe, South Africa
Health promotion activities in a park in Eshowe. Photographer: Tadeu Andre | Date: 14/02/2020 | Location: Eshowe, South Africa

For example, the report highlights an absence of services for children with DR-TB and patients with extensively drug-resistant TB (XDR-TB) and pre-XDR TB. MSF, which supported the decentralisation of DR-TB services in KCD from 2015 – 2023, calls for the decentralisation of these services as a priority. ​

“The department of health has made enormous strides in implementing the decentralisation policy, yet the most vulnerable DR-TB patients in the district are still having to travel several hours to the province’s central TB hospital in Durban to get treatment and care, at a cost that is often catastrophic,” said Dr Liesbet Ohler, the long-standing medical coordinator of MSF’s HIV/TB project in KCD, which closed in 2023.

According to the report, issues preventing or slowing the decentralisation of DR-TB services in KCD include

  • A lack of medical resources such as Electrocardiogram (ECG) and vital-sign monitors, and a lack of funding for equipment maintenance and repair
  • A lack of human resources in facilities
  • Absence of knowledge regarding DR-TB and its management principles, and no government training

MSF provided considerable support, including structures, equipment, and staff, for implementing the decentralisation policy in KCD.

“In order to fully decentralise DR-TB services in the District, this support will need to be replaced, perhaps with strategic partnerships with non-governmental actors,” said Ohler. He added that MSF’s intention in producing the evaluation report “is not to criticise or apportion blame, but to highlight where the work of decentralisation is incomplete so that it can be taken up with renewed energy.”

South Africa’s DR-TB decentralisation policy was largely based on a successful decentralisation model of care piloted by MSF and the Western Cape Department of Health in Khayelitsha between 2007 and 2011. Although the MSF project in KCD has closed, MSF is currently applying many of the lessons it learned in the district in terms of making treatment and care easier for patients to access in a newly opened non-communicable diseases project in the Eastern Cape.

WTBD_Decentralisation Scorechartreport_final.pdf 4 MB

About Doctors Without Borders (MSF)

Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.

In South Africa, the organisation is recognised as one of the pioneers in providing antiretroviral treatment (ART) in the public sector. It started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).

In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers who struggle to access public health services under South Africa’s increasingly restrictive.

Previously, we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.

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Seipati Moloi
Seipati Moloi Head of Media and Digital Relations, Doctors Without Borders (MSF)
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