By Candy Jacobs, Khayelitsha Health Forum Executive
Every day, 148 people in South Africa die from tuberculosis (TB). TB is a preventable and curable disease, yet it continues to disproportionately affect vulnerable communities. Beyond the appalling mortality statistics, TB poses a variety of challenges – lack of awareness, stigma, competing health worker demands and difficulties in accessing health care, with the result that many people infected with TB do not get diagnosed or treated.
Tackling these issues requires a “whole-of-society” approach, where every South African has a role to play – we all know someone affected by TB. Therefore, we must look beyond health facilities and prioritise community-based strategies that complement person-centred TB care.
In high-burden TB areas of the Western Cape, such as Delft and Elsies River, local leaders and health committees are already playing a vital role in raising TB awareness and improving access to services.
In partnership with TB Proof, individuals with lived experience of TB – or a passion for health justice – are working to strengthen the implementation of national TB policies.
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The National Strategic Plan for HIV, TB and STIs (2023–2028) and the National TB Recovery Plan prioritise testing for all close contacts of people with TB, people living with HIV, and those previously treated for TB, regardless of whether they show symptoms. These guidelines are informed by the National TB Prevalence Survey and the Targeted Universal TB Testing (TUTT) trial.
But as with many policies, successful implementation depends on local leadership and accountability.
Community leadership and TB champions
Health workers remain central to testing and treatment. But trusted community members are uniquely positioned to raise awareness, encourage testing, support prevention, and reduce stigma where they live and work. To strengthen these efforts, TB Proof launched the TB Champions initiative in August 2023, equipping local leaders with TB knowledge, communication skills, and advocacy tools.
The TB Champions attended a series of workshops over six months, covering content related to TB and national TB policies. With ongoing mentorship and support from TB Proof, they began putting their knowledge into practice in January 2025. Since then, they have led education campaigns across clinics, schools, workplaces, and faith-based settings.
They hosted 12 events and partnered with local organisations to offer on-site TB testing, while raising awareness about TB’s airborne transmission and the importance of testing close contacts. Their work has led to earlier diagnosis and reduced community transmission.
As of July 2025, the Champions remain active, with TB Proof continuing to provide support as they lead monthly TB testing campaigns in partnership with Delft CHC, alongside other ongoing community engagement activities.
For many TB Champions, this work is deeply personal. They are making a difference in their communities, driven by their own experiences or the experiences of those close to them. Each Champion brings unique strengths to the fight against TB, using their skills and voices to educate, advocate, and inspire action.
Tracey Visagie from Delft works to ensure that people living with HIV are tested for TB and re-linked to HIV care. “I got them a referral, and they got tested and back onto their meds,” she says. “Now I speak about TB wherever I go – at schools, church, even court.”
Daniel du Plessis from Elsies River uses his powerful voice to advocate for testing. “When I speak – even preach – people hear me. Many come back with questions. That’s how I know they’re thinking and talking about TB.”
Bravo Thompson from Delft is a TB survivor who addresses stigma directly. “TB is often seen as a death sentence. But the more we talk, the more we break down the shame.” His openness has helped others seek care.
These stories highlight how TB Champions are driving change, from improving access to care to breaking down stigma and encouraging open conversations about TB in a variety of settings. Their efforts are a testament to the power of community leadership in the fight against tuberculosis.
The untapped potential of health committees
Clinic and health committees are trusted, representative community bodies uniquely placed to advocate for improved services and educate the public on TB and other health issues. These groups organise door-to-door campaigns, host dialogues, and advocate for better care by voicing community concerns to facility management.
But their potential is constrained. Many members are unpaid volunteers, working without structured support. Yet they remain committed health activists, often the first to see gaps in care and the last to give up.
To unlock their potential, provincial governments must prioritise training, formal recognition, and sustainable funding. Strengthening these committees will bridge the gap between facilities and communities, ensuring services are not only available but also responsive and trusted.
Why community involvement matters
Critics may question whether community-led efforts can truly address South Africa’s TB epidemic. Global evidence says otherwise. A systematic review found that health committees in low- and middle-income countries improve outcomes by enhancing service access, boosting patient satisfaction, and supporting health workers. Locally, research has shown that community engagement enhances awareness and strengthens monitoring of TB policy implementation.
While funding remains a constraint, investing in people – particularly those embedded in their communities – is a cost-effective and impactful strategy for improving TB prevention, testing, and treatment outcomes.
TB cannot be beaten with clinical tools alone. South Africa’s response must embrace a whole-of-society approach that includes and values community-driven efforts. By supporting TB Champions and investing in clinic committees, we can reach more people, earlier – delivering quality care, reducing stigma, and ultimately saving lives
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Candy Jacobs is also a member of TB Proof. The author acknowledges Renier Coetzee (TB Proof / University of the Western Cape) for leading the TB Champions Programme, and the TB Proof team—Janet Giddy, Ingrid Schoeman, and Michelle Galloway—for their contributions.
The views expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
