Draft Resolutions for NCDs action from November Kopano

Comment no later than 28 November at 5pm.  Please see attached PDF for full references.
The SA NCD Alliance met on November 17 and 18, 2014 in Gauteng to consider health systems solutions to the epidemic of NCDs in South Africa.
Over 90 stakeholders from five key sectors joined the SA NCD Alliance: patient-related NGOs, healthcare workers, research, industry and government. This group includes representatives from seven provincial and the national departments of health who deal with NCDs.
The delegates resolved to seek an urgent meeting with the Deputy Minister of Health, Dr Joe Phaahla, before the end of 2014 to convey the resolutions adopted.

The SA NCD Alliance is a multisectoral civil society advocacy organisation that seeks action to stop the epidemic of NCDs by:

• United multisector networking to improve NCDs care from the beginning to the end of life;
• Collaboration with and participation across government sectors from the national to the local level;
• Comprehensive NCDs action: including prevention, screening, treatment, rehabilitation and palliative care;
• Person-centred care which puts People Living With NCDs (PLWNCDs) at the heart of NCDs action.

The SA NCD Alliance supports universal health coverage (UHC) with the goal of ensuring that “all people obtain the health services they need without suffering financial hardship when paying for them”. The list below has been adapted for emphasis on NCDs. It is essential for South Africa that the major aspects of UHC need to be in place:

• A strong, efficient, well-run health system that meets priority health needs through people-centred integrated NCDs care by:

o informing and encouraging people to stay healthy and prevent illness;
o detecting NCDs and the risk factors early;
o having the capacity to treat NCDs, and
o supporting PLWNCDs toward self-care including rehabilitation and when needed, palliative care.

• An affordable system for financing health services so PLWNCDs do not suffer financial hardship;
• Access to essential medicines and technologies with which to diagnose and treat NCDs and related risk factors;
• Sufficient capacity of well-trained, motivated health workers to provide the services to meet the needs of PLWNCDs based on the best available evidence;
• Recognition of the critical role played by all sectors in assuring human health, including civil society transport, education, and urban planning;
• An environment supportive of a life free from NCDs.

Resolutions

Resolution 1: An urgent meeting is sought with the Deputy Minister of Health, to discuss the remaining resolutions of this meeting before the end of 2014.

The purpose of the meeting is to discuss the outcomes of the Kopano and to express the concern of the SA NCD Alliance about apparent delays in action around NCDs.

Resolution 2: The SA NCD Alliance supports the National Department of Health’s Strategic Plan for the prevention and control of NCDs 2013-17 in principle.

• All sectors want involvement to achieve national targets and outcomes.
• There is an urgent need for NCD plans in each province.

Resolution 3: The urgent allocation of dedicated funding for critical areas is requested to ensure action on NCDs at both national and provincial levels:

• Community-based education and information programmes dedicated to NCDs prevention;
• Surveillance and research;
• Monitoring and evaluation;
• Multistakeholder NCDs / National Health Commission;
• Training / capacity building for healthcare professionals and community health workers to enable efficient and effective person-centred self-care for PLWNCDs;
• Multistakeholder provincial co-ordination mechanism to enable regular and ongoing communication.

Resolution 4: Ongoing involvement of and communication with PLWNCDs and other key stakeholders in all NCDs-related initiatives.

• The urgent development of a communication and consultation mechanism to inform, involve and seek feedback on initiatives.
• Sufficient transparency and communication at all levels on developments and progress including:

o The Integrated Chronic Disease Management (ICDM) and its iterations ;
o The “Ideal Clinic initiative” at a primary health care level;
o Educational material including implied national clinical standards such as Primary Care 101;
o Referral systems between different levels of care for patients.

Resolution 5: The urgent establishment of a high level multisectoral NCD / National Health Commission to be operational in the first half of 2015.

• The urgent implementation of a high level broad-based national body that is representative of all of society and all of government.
• Its purpose is to ensure co-ordinated, consultative and critical action for NCDs prevention (including the social determinants) and treatment.
• It requires the input and collaboration of NGOs and other stakeholders.
• Draft terms of reference to be published by February 2015 that will include mission, membership, action plan, budget and resources to ensure effectiveness.
• The first meeting of the NCDs/Health Commission is to be held in the first half of 2015 and is to be chaired by the Deputy President.

Resolution 6: Human resources equipped and legally enabled to provide patient-centred care for the prevention of NCDs and the treatment of PLWNCDs.

• A commitment to adopting a multidisciplinary approach at district level with the necessary amendments to the scopes of practice via professional councils where necessary to enable quality patient-centred care.
• Engagement on the personnel policy relating to the use, job descriptions and contraction of health care workers (professionals and community health workers) providing NCDs care at a clinics, out-reach and district teams.
• Aligning training and education with the national National Qualification Framework (NQF) and consideration of the recognition of prior learning.
• Enabling the power to prescribe and treat PLWNCDs according revised scopes of practice and not according to terms of employment.
• Available resources should be used including retired personnel which may require revision of employment contracts.
• Sufficiently certified human resources qualified in NCDs should be incorporated into district specialist teams and be able to contract for National Health Insurance system and in the private sector.

Resolution 7: Standards, practice guidelines and processes for NCD prevention and treatment must be managed at a national level and updated regularly according to international norms.

• The process should be linked to a national structure like the Office of Health Standards Compliance;
• It should follow internationally agreed standards for evidence, consultation. For example, the AGREE domain used by the South African Medical Journal :

o scope and purpose;
o stakeholder involvement;
o rigour of development including evidence;
o clarity of presentation;
o applicability, and
o editorial independence.

• A system for the routine review and updating of evidence based NCDs guidelines and protocol. For example the prevention of rheumatic heart disease guideline, last revised in 1999, which is integral to the prevention of long term disability and heart disease.

The SA NCDs Alliance

Established in July 2013 with founding members CANSA, Heart and Stroke Foundation South Africa, Diabetes SA & Patient Health Alliance of Non-Governmental Organisations (PHANGO): www.sancda.org.za
The founding members have over 160 years of civil society NCDs support and advocacy experience.
Affiliated to and supported by the NCD Alliance, which unites a network of over 2,000 civil society organizations in more than 170 countries.
Awarded a grant by Medtronic Philanthropy to strengthen health systems, support NCD action in September 2013 which funded this report and other activities.
One of only 7 national NCDs alliances in Africa.
Access to national network of civil society and community-based support groups throughout South Africa involving many millions of PLWNCDs.