Message de la Directrice régionale, le Dr Matshidiso Moeti, à l’occasion de la Journée mondiale de lutte contre la tuberculose, le 24 mars 2017

Aujourd’hui, 24 mars 2017, l’Organisation mondiale de la Santé se joint au reste de la communauté internationale pour célébrer la Journée mondiale de lutte contre la tuberculose. Pour la deuxième année consécutive, la campagne aura pour thème « S’unir pour mettre fin à la tuberculose ».Cette année,l’accent sera mis plus spécialement sur les efforts visant à « ne laisser personne de côté », dans le droit fil des objectifs de développement durable.

La tuberculose reste l’une des 10 premières causes de mortalité dans le monde. Si le nombre de cas de cette maladie est en baisse à l’échelle mondiale, on estime qu’un total sidérant de 10,4 millions de personnes ont quand même contracté la tuberculose en 2015. Plus du tiers de ces personnes n’ont pas encore été diagnostiquées, ni traitées, ou ellesont été diagnostiquées sans pour autant être enregistrées par les programmes nationaux de lutte contre la tuberculose.

Un cas de tuberculose sur quatre est notifié en Afrique, qui totalise 16 des 30 pays à plus forte incidence de tuberculose. En outre, un cas sur trois de tuberculose associée au VIH est rapporté dans la Région, et 81 % des patients tuberculeux recensés connaissent leur statut pour le VIH. La situation est aggravée par le fait que sept pays de la Région affichent les taux les plus élevés d’incidence de la tuberculose multirésistante (tuberculose-MR). La tuberculose pharmacorésistante reste un problème sérieux, faute d’une capacité de laboratoire appropriée pour la détecter et à cause de la difficulté d’accès au traitement, de sa longue durée et de son coût prohibitif.

En 2014, les pays de la Région africaine ont convenu de réduire de 75 % la mortalité tuberculeuse et de 50 % le nombre de nouvelles infections par la tuberculose, d’ici à 2025. En vue d’atteindre ces nouvelles cibles, les pays et les partenaires doivent intensifier les efforts pour toucher, traiter et soigner chaque patient tuberculeux. Un accent particulier était mis sur les personnes les plus démunies et les plus vulnérables touchées de façon disproportionnée par cette maladie, mais aussi sur les zones ou localités peu desservies qui n’ont pas accès aux services de santé les plus élémentaires.

Les groupes de population ciblés comprennent les migrants, les réfugiés, les minorités ethniques, les personnes qui travaillent dans les mines et celles qui travaillent et vivent dans un environnement à risque, les personnes âgées, ainsi que les femmes et les enfants marginalisés vivant dans divers milieux. Des facteurs comme la malnutrition, de mauvaises conditions d’hébergement et d’assainissement, et d’autres facteurs de risque tels que le tabagisme, l’usage nocif de l’alcool et le diabète, accentuent notamment la vulnérabilité à la tuberculose. L’accès aux soins est souvent rendu difficile par les coûts catastrophiques induits par la maladie et ceux associés à la recherche du traitement et à la poursuite des soins, le cas échéant, sans oublier le manque de protection sociale, toutes choses qui entretiennent le cercle vicieux de la pauvreté et de la mauvaise santé.

Cela signifie qu’il faudra s’unir pour converger vers la couverture sanitaire universelle, en impliquant d’autres intervenants en dehors des ministères de la Santé. Cela signifie également qu’il faudra créer des opportunités dans toute la société – en faisant intervenir d’autres départements ministériels, la société civile et les communautés, les organisations non gouvernementales et le secteur privé – afin de permettre aux différents acteurs de contribuer à la lutte pour mettre fin à la tuberculose de notre vivant.

En outre, nous devons intensifier la lutte contre la tuberculose en tirant profit de l’innovation. Les experts se penchent désormais sur des approches novatrices telles que le recours à des techniques numériques comme la télémédecine et la santé mobile pour accroître la couverture par une action plus efficace. Par exemple, des radiographies numériques peuvent être envoyées par courriel, permettant un soutien à distance et la notification en temps réel au moment où les cas sont diagnostiqués. Certains pays africains utilisent déjà des téléphones et autres dispositifs mobiles pour enregistrer et rapporter les notifications de cas. Il s’agit là d’une méthode bien plus efficace de traiter en temps opportunles patients, et de suivre à la trace ceux qui ne se sont pas présentés pour les visites médicales.

Pour faire les choses différemment, nous devons faire preuve d’engagement à renforcer les systèmes de santé, nous devons améliorer les communications et renforcer les capacités des prestataires de soins de santé pour espérer atteindre la cible des objectifs de développement durable qui vise à mettre fin à l’épidémie de tuberculose d’ici à 2030. Nous devrons consolider les acquis que nous avons engrangés durant la période des objectifs du Millénaire pour le développement et redéployer les ressources en vue d’obtenir de meilleurs résultats et un meilleur impact.

La communauté mondiale s’attache à relever l’immense défi qui consiste à atteindre cet objectif. Pour y parvenir, la toute première Conférence ministérielle mondiale de l’OMS sur la tuberculose sera organisée en novembre de cette année à Moscou (Russie), dans la perspective de la Réunion de haut niveau des Nations Unies sur la tuberculose qui aura lieu lors de l’Assemblée générale des Nations Unies en 2018.

Au moment où nous célébrons la Journée mondiale de lutte contre la tuberculose, je lance un appel aux gouvernements et aux autres parties prenantes pour qu’ils « s’unissent pour mettre fin à la tuberculose » en œuvrant de concert pour éradiquer ce fléau tout en veillant à ne laisser personne de côté. Cela passe par un investissement accru dans les soins de santé, et l’on devrait particulièrement veiller à ce qu’aucune famille ne s’appauvrisse en supportant le coût du traitement et des soins de maladies infectieuses comme la tuberculose. Pour sa part, l’OMS continuera d’apporter son concours aux pays afin de renforcer les systèmes de santé et de traduire le slogan de cette année en réalité.

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