The Southern Africa Tuberculosis and Health Systems Support Project (SATBHSSP) is a 5-year project that started in 2017. The WHO End Tuberculosis (TB) Strategy has set a target date of 2035 for the virtual elimination of TB worldwide. It was noted that as TB rates have been dropping, it is necessary to identify key groups and areas that are especially vulnerable.

The project was thus conceptualised following studies in South Africa, as well as other countries, that indicated that miners/mineworkers were more burdened by TB.

• Miners are more than 2x more likely to develop TB than the general population
• Mineworkers with HIV have 3x the risk
• Mineworkers with Silicosis have 6x the risk
• Mineworkers with HIV and Silicosis have 18x the risk

The causes of this increased vulnerability include dangerous working conditions (such as dust which can cause silicosis), risky behaviours leading to higher HIV incidence and confined living and working conditions in some mines.

Regional level

The project is led at the regional level by the Regional Advisory Committee which is composed of Principal Secretaries of key Ministries, namely, Ministry of Health as the lead, Ministry of Mining and Ministry of Labour. Coordination at the regional level is done by East, Central and Southern Africa Health Community (ECSA-HC) (mainly components 1 and 3) and African Union Development Agency (AUDA-NEPAD) (mainly component 2). Centres of Excellency are a key component of the project and as such, each country was given a lead in one area as follows:

1. Zambia         -  Mining, regulations and occupational health
2. Malawi           -  Continuum of Care

• Mozambique - (i) Economics of TB/sustainable financing

- (2) Laboratory and surveillance

1. Lesotho           - Monitoring and Evaluation and Research

Status of the Project
The project in Malawi has been very successful and Malawi has been in the lead in terms of implementations in terms of usage of funds, activities and indicators. However, the funds that were initially allocated to Malawi were smaller than in other countries at $17M compared to around $40 for Zambia and Mozambique. As such, the initial funds were near exhaustion by year 3 (2019) and by 2020, the project was scaled down. A request for addition funds was made and has been approved although the actual sum has not been confirmed. The project has been extended by 3 years from 2021 to 2023.