Why SA’s reconstituted parliamentary TB Caucus is of critical importance

At the biennial SA TB Conference, in Johannesburg last week, researchers and advocates presented the latest scientific innovations while issuing a stark call to action: South Africa must prioritise a disease that kills 54,000 citizens every year.

The efforts of researchers, doctors, stakeholders and civil society at the conference were critical because tuberculosis — despite being both preventable and curable — remains one of the country’s deadliest public health crises. Yet it rarely receives the political attention or urgency it deserves.

This is exactly why South Africa’s parliamentary TB Caucus, which was reconstituted last year, matters more than ever.

South Africa’s health system is navigating multiple transitions simultaneously. The country faces a donor transition as international health funding becomes increasingly limited. It is experiencing demographic and epidemiological shifts, where infectious diseases continue to burden communities alongside a rising tide of non-communicable diseases, like hypertension, obesity, diabetes and heart disease.

It is also confronting a technological transition, where new diagnostics, digital systems and future TB vaccines offer significant promise but require political leadership and sustainable financing to ensure a comprehensive and equitable roll-out.

At first glance, parliamentary caucuses can appear symbolic — spaces for meetings, declarations and discussion. However, the TB Caucus has the potential to become one of the country’s most important accountability mechanisms for health governance.

Raising the alarm

The caucus has been formed at a time when Parliament itself is increasingly raising the alarm about the state of the health system. The Portfolio Committee on Health’s recent Budget Vote Report highlighted weaknesses in accountability, financial controls, staffing, governance and service delivery despite increased spending.

Concerns were raised about long waiting times, poor infrastructure, shortages of healthcare workers, governance instability and growing risks linked to corruption and audit failures. Serious concerns were also raised about HIV and TB services, emergency medical services, maternal health provision and the sustainability of programmes previously reliant on donor funding.

These concerns mirror many of the issues raised during the recent Global TB Caucus discussions held in Cape Town three weeks ago. Parliamentarians from across the continent acknowledged that constrained fiscal environments, changing donor landscapes and increasing health burdens are forcing governments to re-evaluate how health systems are financed and governed.

Finance committees can no longer afford to view health expenditure as a secondary social cost. Investment in TB prevention, diagnostics and treatment is an investment in societal flourishing, labour productivity, economic resilience and long-term development. Likewise, health committees cannot effectively advocate for improved services without understanding the fiscal and budgetary realities shaping implementation.

South Africa is uniquely positioned in this conversation. We already fund most of our TB response domestically. Yet sustaining and strengthening that response in an era of fiscal challenges will require firmer political commitment, stronger accountability systems and more strategic approaches to financing and service integration. It also presents South Africa with an opportunity to demonstrate how middle-income countries can transition towards more sustainable and resilient health financing models.

One of the most promising developments linked to the work of the TB Caucus has been the growing emphasis on data transparency and accountability. The emergence of South Africa’s public-facing TB dashboard represents an important step towards institutionalising accountability within the health system. Policymakers, legislators, civil society organisations and communities are increasingly able to engage with more detailed TB data to identify gaps, monitor progress and strengthen oversight.

But data alone is not enough.

Political action

Data only becomes meaningful when it is accurate and relevant, and when it drives political action. Parliamentary caucuses should translate statistics into accountability. They can ask why testing targets are being missed in certain districts. They can interrogate whether funding allocations are reaching frontline services. They can investigate why certain populations continue to experience poor outcomes despite national commitments. Most importantly, they can ensure that TB remains politically visible at a time when there is a real danger that it could become a silent casualty of global funding shifts.

This political visibility matters because TB cannot be solved by the health sector alone.

Tuberculosis sits at the intersection of poverty, housing, nutrition, labour conditions and inequality. Every untreated person with TB represents not only a medical failure, but a failure of social protection, governance and public accountability.

The future of TB governance will therefore depend not only on good health policy, scientific innovation and sustainable financing, but on sustained political leadership and prioritisation.

South Africa already has many of the ingredients necessary to lead the fight against TB: world-class researchers, excellent clinicians, strong civil society networks, improving accountability tools and increasing parliamentary engagement. The challenge now is to institutionalise this momentum so that TB remains at the centre of political decision-making long after moments of crisis fade from public attention.

Ultimately, the continued loss of tens of thousands of lives to a preventable and treatable disease is not an inevitable fact of life.

It is a policy choice. DM