Numbers don’t lie, especially if you take a look at the place of NCDs in the draft health budget. The words about NCDs imply commitment to solving a huge health problem. That is superficial though when it comes to NCDs. There a heaps of great sounding words (policies and plans) but a clear lack of money. Especially for screening and treatment. Words, even printed ones, are cheap. Little has changed:
Whilst the Minister in the preamble of the Annual Performance Plan highlights importance of tackling non-communicable diseases (NCDs) there doesn’t appear to be any dramatic shift in budget allocation over the Medium Term. Can the department provide reasons for this?
Issues for consideration Parliament Research Unit. Vote15: Health Budget 2014/15 p.6
Health is allocated less than 5% of the proposed national budget (Figure 1). Defense get more yet SA loses more people to NCDs each day than in armed conflicts. Where are our national priorities?
Figure 1:
Looking at the details of the health budget
The smallest by far is Programme 4 for Primary Health Care (PHC) services (R 225 -million)
Most People Living With NCDs get care at primary health care (PHC) clinics and this appears to be the reasoning why NCDs are placed within Prog 4 . People living with HIV/AIDS
Our information comes from the draft Annual Performance Plan (APP) and its accompanying budget. – see pages 61-63. Click here to download the draft APP 2015/2016-2017/8
Fast facts stacking up Programme 4 vs other NDoH Programmes 2015/16
Smallest programme
budget by far |
See Figure 2 |
| 1st place people costs |
Programme 4 cost of PEOPLE EMPLOYED R186.2 million = ↓ money available for implementation |
2nd largest # people
employed |
458 by only 10 people short of no 1 placed Programme 1 (p. 27) |
| Only programme to increase personnel costs |
Leaving less to spend on implementing programmes/ plans |
3 NCDs issues related to HIV/AIDS and Maternal Child health appear in Prog 3 budget (cancer cervix, breast cancer policy, immunizations.) Cancer of the prostate does not warrant a mention in the APP.
The key to the APP is words not allocation of funds. Again NCDs screening and treatment is left high and dry.
Fast facts about NCDs Prog 4 budget
Where is the money for implementation of the NCDs plan in this budget?
| 89.37% for people working on projects – personnel, contractors and consultants |
0 for screening of target of 8 million people for high BP and blood glucose OR
NCDs Commission/ Health Commission (more next week on this) |
1.3 % NGOs or non-profits (< R 3-million) > 50% goes to 2 of 6 NGOs
National Council Against Smoking & SA National Council for the Blind. |
NCDs prevention and treatment cross cuts all Programmes especially at the PHC level. So we need to look at inside other programmes. However, without exception there is no separate financial allocation for stated NCDs targets like for example breast cancer policy development and cancer of the cervix screening in Programme 3 (HIV/AIDS & TB.) Innovations like “ideal clinics” which are supposed to include NCDs take place without consulting NCDs civil society organisations.
Examples from Programme 2: NHI
- Drug procurement and stock out management (all drugs including ARVs)
- National Cancer Registry (words no money)
Programme 3: HIV/AIDS & TB
- Cervical cancer screening
- Breast cancer policy (more words no money)
- Vaccinations against hepatitis & human papilloma virus
- Obesity policy (more words no money)
Watchdogs must bark. An NCDs advocacy series. This is the first in a series on NCDs in policy documents.
Health Minister Dr Aaron Motsoaledi has blamed manufacturers for shortages of medicines including HIV and tuberculosis drugs, but a civil society coalition has alleged 80%of stock outs are due to poor management.
Community members have also complained about medicine stock outs.
In the Stop the Stock Outs Project’s latest survey, more than 40 percent of health facilities reported having experienced a HIV, TB drug stock out: Joe Gqabi and Alfred Nzo districts, Eastern Cape; Bojanala District, North West; Nkangala and Gert Sibande districts, Mpumalanga; and Lejweleputswa and Fezile Dabi districts, Free State.
According to Motsoaledi, recent reports by Times Live and eNCA regarding alleged widespread drug shortages promoted the minister’s early return last week from the World Health Organisation’s on-going, annual World Health Assembly in Geneva.
At a Pretoria press conference yesterday, Motsoaledi widespread shortages of drugs including the country’s three-in-one antiretroviral (ARVs) fixed-dose combination (FDC).
“The FDC is our flagship programme and we do everything in our power to protect it,” Motsoaledi said in a statement. “To make sure that there are not problems in this very important programme, we even implemented the practice of a national buffer stock whereby 10 percent of all the FDCs we provide are strategically stockpiled with a service provider in a warehouse.”
Motsoaledi also added that the county source the combination ARV from three different suppliers to guard against supplier problems affecting supply.
“At no stage did we have a shortage of FDC in the country,” he added.
As of September 2015, about 119,000 patients had been started on the FDC.
One in five facilities have experienced stock outs
The department recently released a list of at least 40 medications -(comment by Vicki Pinkney-Atkinson many of these critical for the treatment of NCDs, morphine and mental health medication)– that were running short at provincial depots nationwide. The department attributed the bulk of shortages to supplier constrained and shortages of the pharmaceutical ingredients used to make the drugs.
Stock outs of medicines are indicative of a bigger problem related to the management and accountability in a health system”
Comprised of civil groups including Medicines Sans Frontières, the Treatment Action Campaign and the Southern African HIV Clinicians Society, the Stop Stock Outs Project (SSP) collects stock out reports from health workers and clinics nationwide.
The group recently surveyed more than 2,500 of the country’s 3,732 health facilities. According to the research to be presented at the upcoming SA AIDS Conference, one in five facilities reported experiencing an ARV or TB medication stock out.
According to a SSP statement released yesterday, management or logistical challenges between medicine depots and clinics caused 80% of stock outs.
However, the group noted that patients were turned away without any medication in only 20 percent of cases.
“Supply of medicine to clinics and hospitals is the basic pillar to any public health system and stock outs of medicines are indicative of a bigger problem related to the management and accountability in a health system,” said SSP’s Dr Karl Le Roux in the statement.
The findings show an improvement over the group’s previous survey in which about one in four facilities reported stock outs.
However, >40% of health facilities in seven districts reported at least one HIV and TB drug stock outs. These districts include the Eastern Cape’s Joe Gqabi and Alfred Nzo as well as the Free State’s Lejweleputswa and Fezile Dabi districts. – Health-e News
Do you know of a stock out?
Email the Department of Health
or Stop Stock Outs sms or What’s App 084.855.7867 or email
© 2015 Health-e. All Rights Reserved.
Source SAnew.gov.za 20 November 2014
Cabinet has welcomed the launch of Operation Phakisa 2 which aims to transform all public sector clinics into “ideal clinics” that will provide good quality care to all communities.
President Jacob Zuma launched Operation Phakisa 2: Scaling up Ideal Clinic Realisation and Maintenance Programme on Tuesday.
Speaking at a post-Cabinet briefing in Cape Town on Thursday, Minister in the Presidency responsible for Planning, Performance, Monitoring, Evaluation and Administration, Jeff Radebe, said Operation Phakisa 2 seeks to improve the quality of care provided in 3 500 primary health care facilities, consisting of government clinics and community health centres.
“The expected outcomes entails transformation of the existing clinics and community health centres into centres of excellence, which will be used by all South Africans, due to the enhanced quality of services they will provide,” said Minister Radebe
Over the last five weeks, a team of 164 senior managers from the national, provincial and local government spheres of government, together with their counterparts from the private sector, organised labour, academia, civil society and public entities, participated in an Operation Phakisa laboratory to devise ways and means of making the ideal clinic concept a reality.
They were supported in this process by officials from the Performance Management and Development Unit in Malaysia, where they learned about the Big Fast Results delivery model.
Operation Phakisa: Ideal Clinic Initiative was organised into eight work streams, focusing on the different building blocks of an Ideal Clinic capable of delivering good quality health services.
The work streams include service delivery, waiting times, human resources, infrastructure, financial management, supply chain management, scaling up and sustainability and institutional arrangements.
Background
In July, the President launched the first phase of Operation Phakisa which focuses on unlocking the economic potential of South Africa’s oceans.
Operation Phakisa is an adaptation of the Big Fast Results methodology that was first applied by the Malaysian Government, successfully, in the delivery of its economic transformation programme.
The operation addressed their national key priority areas such as, poverty, crime and unemployment.
It involves setting up clear targets and follows up with on-going monitoring process which makes the results public.
Through this initiative, the Malaysian government was able to register impressive results within a short period.
President Zuma said South Africa has renamed the Malaysian Big Fast Results approach as Operation Phakisa – from a Sesotho word, which means “Hurry Up”, to highlight the urgency with which government wants to deliver on some of the priorities encompassed in the NDP.
The initiative will initially be implemented in two sectors, the ocean economy and health sector, especially clinics. –SAnews.gov.za
Source SAnew.gov.za 20 November 2014
Cabinet has welcomed the launch of Operation Phakisa 2 which aims to transform all public sector clinics into “ideal clinics” that will provide good quality care to all communities.
President Jacob Zuma launched Operation Phakisa 2: Scaling up Ideal Clinic Realisation and Maintenance Programme on Tuesday.
Speaking at a post-Cabinet briefing in Cape Town on Thursday, Minister in the Presidency responsible for Planning, Performance, Monitoring, Evaluation and Administration, Jeff Radebe, said Operation Phakisa 2 seeks to improve the quality of care provided in 3 500 primary health care facilities, consisting of government clinics and community health centres.
“The expected outcomes entails transformation of the existing clinics and community health centres into centres of excellence, which will be used by all South Africans, due to the enhanced quality of services they will provide,” said Minister Radebe
Over the last five weeks, a team of 164 senior managers from the national, provincial and local government spheres of government, together with their counterparts from the private sector, organised labour, academia, civil society and public entities, participated in an Operation Phakisa laboratory to devise ways and means of making the ideal clinic concept a reality.
They were supported in this process by officials from the Performance Management and Development Unit in Malaysia, where they learned about the Big Fast Results delivery model.
Operation Phakisa: Ideal Clinic Initiative was organised into eight work streams, focusing on the different building blocks of an Ideal Clinic capable of delivering good quality health services.
The work streams include service delivery, waiting times, human resources, infrastructure, financial management, supply chain management, scaling up and sustainability and institutional arrangements.
Background
In July, the President launched the first phase of Operation Phakisa which focuses on unlocking the economic potential of South Africa’s oceans.
Operation Phakisa is an adaptation of the Big Fast Results methodology that was first applied by the Malaysian Government, successfully, in the delivery of its economic transformation programme.
The operation addressed their national key priority areas such as, poverty, crime and unemployment.
It involves setting up clear targets and follows up with on-going monitoring process which makes the results public.
Through this initiative, the Malaysian government was able to register impressive results within a short period.
President Zuma said South Africa has renamed the Malaysian Big Fast Results approach as Operation Phakisa – from a Sesotho word, which means “Hurry Up”, to highlight the urgency with which government wants to deliver on some of the priorities encompassed in the NDP.
The initiative will initially be implemented in two sectors, the ocean economy and health sector, especially clinics. –SAnews.gov.za
