Advocating for a Socially Accountable Package of Care for Adults Hospitalized with Tuberculosis in the Western Cape, South Africa: A Policy Brief

Abstract

South Africa is consistently listed among the 30 high TB-burden countries, with a national incidence estimated at about 615 per 100,000 population, and a provincial variation ranging between 427 and 835 per 100,000 in 2019. Adults hospitalized with TB often face complex biopsychosocial challenges, including poverty, substance use, HIV co-infection, and housing instability, that are inadequately addressed by the current biomedical model of care. This policy brief advocates for the provincial adoption of a socially accountable, interprofessional model of care tailored to the needs of hospitalized TB patients.

Despite progressive national and provincial policy frameworks, implementation at the hospital level remains fragmented, with limited integration of clinical and psychosocial services. The proposed policy framework promotes person-centred, multidisciplinary care through ward-based teams, structured discharge planning, and community-linked follow-up. Grounded in Human- Centred Design (HCD) and the Partnership Pentagram Plus (PPP), it emphasizes co-design with patients, frontline workers, and civil society.

Key implementation steps for the proposed policy include stakeholder engagement, Theory of Change development, patient journey mapping, and pilot testing in provincial TB hospitals. The model aims to improve treatment adherence, reduce hospital stays, and enhance patient dignity while remaining operationally feasible through strategic task-sharing and resource realignment.

This policy brief calls for formal adoption and scale-up of a new standard of care that embeds equity, collaboration, and accountability into routine practice. By closing the implementation gap, we can advance ethical, effective, and socially responsive care for one of South Africa’s most underserved patient populations.