Tuberculosis (TB) remains a pressing global health concern, affecting millions of people around the world. In Ghana, the escalating number of TB cases poses a significant challenge to the country's healthcare system and its progress towards achieving the Sustainable Development Goal (SDG) target of ending the TB epidemic by 2030. This article sheds light on the increasing cases of TB in Ghana and explores the critical issue of insufficient financing, which severely hampers advocacy efforts and the overall fight against TB.

THE DISEASE.

According to the WHO, Tuberculosis is a contagious bacterial disease which is caused by Mycobacterium Tuberculosis. Tuberculosis mostly attacks the lungs (Pulmonary Tuberculosis) but can affect any other part of the body (Extra Pulmonary Tuberculosis).

TB is transmitted from a sick TB patient as a droplet infection through coughing, singing and sneezing. Inhalation of these droplets by an uninfected person may cause infection.

TB mostly affects the lungs, but can also affect other organs in the body such as the pleural cavity, liver, scrotum, kidney, intestine and womb. This is known as extrapulmonary tuberculosis.

In addition, tuberculosis may also occur in animals such as cattle and this is referred to as bovine TB. 

Symptoms of TB include cough, weight loss (poor weight gain in children), fever, tiredness, night sweats, chest pain and cough with blood-stained sputum.

Risk Group

According to the National TB Control programme, Adults in most parts of the developing world including Ghana have been exposed to TB bacteria without knowing.

The progression from infection (latent TB) to active TB disease depends on the immunity of the individual. Those at higher risk of progressing to disease are: smokers, alcoholics, prisoners, people living in over-crowded and poorly ventilated rooms, mine workers or persons exposed to silica, and persons with lowered immunity due to medical conditions such as HIV, Diabetes, cancers, kidney failure and malnutrition.

The Burden of Tuberculosis in Ghana

Ghana, with a population of approximately 32 million people, grapples with a considerable burden of tuberculosis. According to the World Health Organisation (WHO), it was estimated that 45,000 people in Ghana fell ill with TB in 2021 and 15,700 people died from the disease in that same year.

In 2022, Ghana recorded 12,000 TB mortality, with childhood TB recording 6,500 cases. There are fears the figures may soar in 2023.

According to the Programme Manager of the National Tuberculosis Programme, Dr. Yaw Adusi-Poku, a total of 16,650 cases of (TB) were detected in Ghana last year. This is an increase of 20 per cent over the 13,278 cases detected in 2021.

“So we’re saying that everyday about 30 people die from TB. 125 persons fall ill with TB. So why are we where we are? Last year For instance we got 20% more of our cases that is 16, 650. It is possible that due to a lot of strategies we have put into place there'll be more cases coming.’’

He further noted;

“So the issue is why we are where we are? Awareness. We need to create a lot of awareness that comes with resources. So it's all about making sure that we have a lot of gene experts which is now the current state-of-the-art machine for diagnosing tuberculosis. We need to have more of the X-rays in all district hospitals that will create access.’’

These numbers are worrisome, as they reveal a trend of rising TB cases, making it crucial to address the underlying factors contributing to this surge.

Contributing Factors to the Increase

Several factors contribute to the increase in TB cases in Ghana. Firstly, the high prevalence of HIV/AIDS exacerbates the risk of TB infection. Individuals with compromised immune systems due to HIV/AIDS are more susceptible to contracting TB and developing the more severe form of the disease, known as TB-HIV co-infection.

Furthermore, urbanization, population growth, and overcrowding in cities lead to the rapid spread of TB. The movement of people from rural areas to urban centers, often driven by economic opportunities, strains urban infrastructures, resulting in substandard living conditions that foster the transmission of the disease.

Covid-19 and TB

According to the Programs Manager of the National Tuberculosis Programme, Dr. Yaw Adusi-Poku, the COVID 19 pandemic set the campaign back by 15 percent, eroding all the gains made, affecting testing, treatment and the advocacy of TB. He however noted that due to the persistence of his office, a lot more of TB cases were diagnosed during that period, capitalizing on samples taken of suspected COVID cases due to the similarity in symptoms presented.

Treatment

Ghana has made significant progress in the treatment of TB. All treatment for TB is free under the National health insurance scheme. The NTP says the success rate for cases under treatment has soared from 85 per cent in 2020 to 88 per cent in 2021.

According to the WHO,

“Through technical support, leading advocacy and effective partnerships, enormous progress had been made over the past decade with high-burden countries such as Ethiopia, Kenya, Lesotho, Namibia, South Africa, Tanzania and Zambia, having surpassed or reached the 20 per cent target of reducing new TB cases.”

WHO Representative to Ghana, Dr Francis Kasolo, said this in an interview with the Graphic. However, he noted, despite the progress, challenges in TB prevention and control remained, adding that there were still delays in TB diagnosis and testing.

Prevention.

TB is a preventable. Tuberculosis Preventive Therapy (TPT) can significantly reduce the development of active TB among clients exposed to TB or who already have an inactive form of the infection.

Challenges in TB Advocacy and Financing

While the rising TB burden demands immediate attention, one of the major hurdles in addressing the crisis is the insufficient financing allocated to TB prevention, treatment, and control programs in Ghana. The limited financial resources impede the efforts to raise awareness, improve diagnostic capabilities, provide effective treatment, and conduct research on innovative solutions.

The government's budgetary constraints limit its ability to invest in strengthening healthcare systems, training healthcare professionals, and enhancing diagnostic infrastructure. Insufficient funds also hinder the availability of high-quality medications and vital resources needed for effective treatment.

The lack of financial resources directly affects advocacy initiatives aimed at raising awareness about TB, educating communities, and reducing the stigma associated with the disease. Without adequate funding, advocacy campaigns struggle to reach remote areas and vulnerable populations, leaving them uninformed and less likely to seek early diagnosis and treatment.

The scarcity of funds inhibits the research and development of new tools, technologies, and treatment regimens to combat TB effectively. Innovations in diagnostics, drugs, and vaccines are crucial for addressing the evolving nature of the disease, especially concerning drug-resistant TB strains. However, without adequate financing, research efforts remain stagnant, impeding progress in the fight against TB.

Impact on SDG Goal Achievement

The inadequate financing situation in Ghana severely undermines the country's ability to achieve the SDG target of ending the TB epidemic by 2030. Insufficient funds hinder the scaling up of TB prevention, diagnosis, and treatment efforts, resulting in delayed case detection, inadequate patient care, and increased rates of TB transmission. Without sustained and increased investments, Ghana risks falling behind in its commitments to the SDGs, jeopardizing the lives and well-being of its citizens.

At the 2018 UN High-Level Meeting (HLM) on TB, world leaders committed to hold a 'comprehensive review by Heads of State and Government at a high-level meeting in 2023' in the Political Declaration on TB agreed at the meeting. The 2023 UNHLM on TB will take place during the United Nations General Assembly High-Level Week in September 2023. Civil Society Groups are concerned that government may be lagging behind in the indicators.

The Push by Civil Society

Many Civil society groups including the Stop TB partnership and the Hope for Future Generations have steped up their advocacy to create awareness about the disease and ensure that government steps up its commitment by providing resources to end the epidemic.

Speaking to JoyNews, the executive director of Hope for the Future Foundation Cecilia Senoo said;

“There are a number of things happening and we want to get the president to participate in that UN level meeting on TB and also sign and commitment to invest in TB. We have the six ask and we want all Ghanaians to join us in advocating for our president not just to sign or not just come in, but to invest money into TB, HIV and malaria. We need to end all these diseases by 2030.”

She added; “Also, the government has pledged $2 million to support the Global Fund to end TB, HIV and malaria during the seven replenishment. We are so grateful because society is happy. Everybody's happy that our president and our government pledged $2 million to global fund to support TB, HIV and malaria. We want to see that this is actually turning into cash to the Global Fund to HIV and malaria in developing countries including Ghana.”

Chairman of the stop TB partnership David Kwesi Afreh said;

"The time for action is now. As Chairman of the Stop TB Partnership, I urge the government of Ghana to prioritize increased funding to effectively combat and eliminate TB.”

Mr Afreh Cautioned;

“Failure to invest in comprehensive TB control measures will have dire consequences for our nation. We risk prolonging the suffering of our citizens, hindering progress towards our health targets, and jeopardizing our collective future. Let us not falter in our commitment to ending TB. With adequate funding, we can save lives, alleviate suffering, and build a healthier and more resilient Ghana for generations to come."

Conclusion

In the labyrinth of Ghana's battle against tuberculosis, the urgency of the times calls for not just scientific strategies but financial investments and an unwavering commitment from every corner of society.

Let us be the architects of change, demolishing the walls of stigma and ignorance that encloses this silent epidemic. For every life lost to TB is a voice silenced, a story left untold, and a dream unfulfilled.

In this fight against TB, we must not be swayed by the specter of limited resources.  For in the end, it is not just the disease we strive to overcome; it is the power of humanity, resilience, and unity that will guide us towards a future where TB is nothing more than a distant memory, etched in the annals of history.