More than a disease, TB is a symptom of underinvestment

By Dr Allan Pamba, Executive Vice President, Diagnostics, Africa, at Roche Diagnostics

Did you know there is up to a one in four chance that you could be infected with the tuberculosis (TB) bacteria? Luckily, of the quarter of our world’s infected population, only a portion will develop active TB. HIV co-infection increases that probability by 20 to 30 times. And did you know that TB spreads through the air when someone with active TB of the lungs or throat coughs, sneezes, speaks or sings, releasing TB germs that others can inhale?

Active TB is fatal and mostly affects adults in their economically productive years. More than a million people died from TB last year, according to the World Health Organization (WHO). That number is expected to rise rapidly as public health systems face new funding challenges, jeopardising established treatment programmes. The good news, however, is that TB can be diagnosed early and cured with prompt treatment. 

As we mark World TB (Tuberculosis) Day this month, Africa faces a unique set of challenges. Having made significant gains in the fight against TB over the past 20 years, funding cuts are disrupting essential prevention, screening and treatment access for people with TB. 

These unprecedented disruptions have prompted the WHO to urgently call on governments, communities, civil society, healthcare providers, the private sector and the world to advocate, discuss and plan further collaboration to reach all people with quality TB prevention and care services1.

Beyond external funding – which is no longer guaranteed – the statistics indicate domestic underinvestment, particularly in early diagnosis. With early diagnosis, timely treatment can stop this age-old bacterial infection in its tracks 2.

What we don’t test, we can’t treat

Investments in diagnostic services in Africa can – and indeed have – demonstrated substantial returns. Early detection means fewer hospital stays, reduced infection rates and lower long-term treatment costs4.

This is evident in information released by South Africa’s molecular diagnostics programme. A comprehensive study covering 2013 to 2022 revealed excellent return on investment (ROI) values for specific diagnostic tests, with TB leading the pack:

• Tuberculosis (TB) Testing: ROI of 19.0, meaning each dollar invested yielded $19 in health & economic benefits.
• HIV Viral Load Testing: ROI of 1.4.
• Early Infant Diagnosis of HIV: ROI of 64.8.
• SARS-CoV-2 Testing: ROI of 2.5. ⁵. 

Standing strong: a future funded from within

Historically, Africa’s health systems have been shaped by external donors. But global priorities are shifting⁶. Africa needs to shift ahead of this curve. Strong economies invest in their own health, and expanding domestic funding for health and diagnostics in particular, isn’t just about disease control – it’s about building resilience for our people and, by association, economies. Of course, we know domestic funding is limited, which is why it should be allocated smartly.

An Africa that funds its own healthcare is one that will thrive in health, economic growth, stability and innovation. With any treatable disease, the earlier you diagnose, the more affordable it is to intervene. Governments that integrate comprehensive diagnostics programmes into their national health budgets reduce overall healthcare costs and can ultimately deliver more healthcare with today’s budgets⁷. 

A practical fix: making testing work harder

Most African countries already have diagnostic platforms for HIV testing that can also test many other diseases. Due to vertically funded programs, TB and other diseases are often tested separately resulting in laboratories cluttered with many of the same machines. Running parallel systems increases costs and slows results⁸. Integrated testing is the smarter approach – one machine, many tests. The WHO has called for integrated diagnostics to strengthen healthcare systems and improve outcomes¹⁰.

Strategic partnerships ensure that existing infrastructure works harder, reducing costs while improving patient outcomes. By working in partnership with industry, governments can scale up diagnostic capacity, integrate cost-saving innovations like multi-disease testing and train healthcare professionals to deliver faster, more accurate care. 

The challenge is real, but so is the opportunity. A well-funded, well-integrated diagnostic system doesn’t just control TB—it strengthens entire health systems seamlessly. The right decisions today can create a healthier, more self-reliant Africa forever.

An ending we can rewrite

TB has remained a part of Africa’s story for too long. But stories aren’t set in stone. The tools exist to reduce its impact, improve access to testing and create health systems that serve people better. The real question isn’t whether we can do it but whether we will.

A future where Africa funds its own healthcare, invests in the right solutions and builds a healthier, more resilient continent is within reach. The path is clear. It just takes strong political will to walk it!

References

1. WHO TB 2025 Call to ActionBMJ – Tuberculosis: WHO warns of “crippling breakdowns” in response after funding cuts
2. WHO, Global TB Report, 2023
3. WHO African Region Report: Regional Strategy on Diagnostics and Laboratory Services 2023-2032
4. WHO, Strengthening Diagnostics Capacity, 2023
5. MedRxiv: South Africa Molecular Diagnostics ROI Study 2024
6. UNAIDS, HIV/AIDS Global Report 2021
7. WHO: Maputo Declaration on Strengthening Laboratory Systems
8. Africa CDC: Skills to Plug Gaps in Diagnostic Capacity and Disease Surveillance
9. WHO, 2023, Integration of Diagnostics Across Disease Programmes
10. WHA76.5 Resolution, World Health Assembly, 2023