The Inequality of the Tuberculosis health crisis in South Africa – by Justine Fargher

TB Inequality Image

By Justine Fargher

One weekend, while hiking in the beautiful mountains of Cape Town, an acquaintance asked me what work I did. On hearing that I worked in the field of drug-resistant tuberculosis (TB), he replied “TB? Here? In South Africa?”. His surprise was only matched by my own—how was it that a white, well-educated 50 year old South African could not know about the TB epidemic ravaging the country?

TB is the leading cause of death in South Africa, and the latest stats from the World Health Organisation reinforce the startling reality of this deadly infectious disease. The country is considered to be one of the top high-burden countries globally, with around 438,000 people developing TB disease and 124, 000 dying from it in 2016 alone. Such shocking stats would surely be a fact of which no well-informed individual could be unaware. However, in South Africa, centuries of structural injustices (such as racial segregation and later formalised as ‘apartheid’) has led to health crises being clearly demarcated along racial and socioeconomic lines, perpetuating already drastic inequalities. It is in fact not surprising then that TB, a disease commonly associated with poorer social contexts, also tracks along these divisions leaving a privileged minority unaware of the impact of TB.

Working with Medecins Sans Frontiers (MSF)/Doctors without Borders on the front line of this epidemic in Khayelitsha, a peri-urban township on the outskirts of Cape Town, has highlighted how social inequalities—in this context, informal and often overcrowded housing, unemployment, poor nutrition and others—have led to the burden of the TB epidemic disproportionately impacting those who are already the most vulnerable.  Khayelitsha has been home to an MSF project addressing drug-resistant tuberculosis (DR-TB) for more than 10 years, during which the project has provided new drugs to patients, including delamanid and bedaquiline, the only two new drugs developed for DR-TB in 50 years. The project has also provided intensive patient support services, ensuring our patients receive a holistic package of care. Yet, outcomes for patients with DR-TB remain poor with less than half of patients with multidrug resistant (MDR) TB having a successful treatment outcome, and only 20% for those with extensively drug resistant (XDR) TB.  These poor outcomes highlight the need for interventions to be more than just medically oriented. Vulnerable groups who are living with TB disease require support that directly deals with the inequalities that have placed them at high risk, but further they require support that prevents further deepening inequalities because of the impacts of the disease. This support demands a more nuanced approach built on an awareness of the political, cultural and social context in which the TB crisis.


Dr. Justine Fargher


Justine Fargher, MBBCh (Wits), MA (UCL), DTMH (LSTM), is a medical officer in General Surgery at Port Shepstone Regional Hospital in in rural KZN, prior to which she worked for Medecins Sans Frontieres. She is passionate about social justice, improving healthcare equity, and advocating for patients’ rights.



Image by Robina Weermeijer on Unsplash.