South Africa has one of the most serious TB epidemics in the world. It is the leading cause of death with over 60 000 deaths notified in 2010. The World Health Organisation (WHO) estimates that in 2011 there were more than 500 000 cases of active TB in South Africa, of whom an estimated 330 000 cases also had HIV infection. An estimated 80% of South African’s have latent TB.
The incidence of TB among workers in South Africa’s mines is the highest in the world, between 3 000 and 7 000 cases per 100 000 people. As WHO classifies 250 cases per 100 000 people as a “health emergency” it is not surprising that the spread of TB in the mining sector has been described as “the worst public health epidemic that we’re facing today”. In 2011 there were an estimated 760 000 new cases of TB related to South Africa’s mining sector, which was a third of all new cases in Africa that year, and a staggering 9% of all new cases worldwide.

SACBC AIDS Office has been implementing an “Early Detection of TB” program since April 2012 – in 17 places in South Africa (in the Dioceses of Dundee, Aliwal North, Queenstown, Port Elizabeth, Kroonstad, Durban, Rustenburg, Tzaneen and Keimoes/Upington) and two in Swaziland.

The program uses community health workers to screen clients for TB, take sputum samples of those suspected of having TB, have the samples tested, enrol those who test positive on TB treatment, monitor those on TB treatment for adherence, counsel and test clients for HIV, enrol those who test positive on ART and monitor them for adherence.

The program ends in March this year. An independent evaluation by Dr Ruth Stark (former CRS South Africa country director) and Dr Marisa Wilke (University of the Free State Nursing Faculty) have just published an independent evaluation of the program, which confirms its success. Statistics are impressive: last year alone, 161 959 people were screened for TB, 6 789 were initiated on TB treatment, 65 301 were counselled for HIV and 3 360 were initiated on antiretroviral treatment. But statistics tell only part of the story. Interviews with community health workers as well as patients show the lengths health workers go to in order to serve their neighbours. Patients describe health workers as “my friend”, and “somebody with whom I can discuss my problems”.

The report contains anecdotal evidence showing that the program is resulting in a decrease in morbidity due to TB in its implementation sites. The former Priest in Charge at Regina Mundi in Swaziland reports that the number of funerals conducted in the parish decreased to less than a quarter of the normal number since this program was initiated there. He attributes this solely to the fact that people with TB are now accessing treatment in time.

During the program, community health workers were able to improve their skills, by attending training in TB, HIV counselling and testing. The program shows that ordinary people can play a significant role in improving the health and well-being of their communities.


Dr Ruth Stark with community health worker and TB patient in Swaziland during evaluation



Nurse with TB patient at Good Shepherd Hospital, Siteki, Swaziland