Reading the Auditor General’s report 2018-19 is not the way to finish off a week. It is a dismal tale of woe which adds another distressing layer to the state capture saga. What is truly distressing is that this information is in plain sight and very little is done from one year to the next. The Citizens version candidly spells it out: “overall audit outcomes take a turn for the worse over five years.” For me, it is much clearer that the boffins’ version of the report which sugar coats the message as “audit outcomes regressed since 2014/15.”
Provincial departments of health are in a bad state and need urgent intervention to prevent collapse. An exception is the Western Cape.
Serious weaknesses in the financial management of national & provincial government unaddressed in the last five years. (Section 4)
The quality of the performance reports slightly regressed since 2014/15 from 66% to 62% (auditees publishing credible reports).
Little improvement on key government programmes according to the National Development Plan Section 6 district health services (HIV/AIDS, TB &maternal & child health) box below water infrastructure development, housing development finance, school infrastructure delivery expanded public works programme.
72% of the auditees materially did not comply with legislation similar to the previous year & slightly higher than the 70% in 2014/15.
What does this mean for National Health Insurance Bill and sweeping changes needed for the financing of health care? The National Department of Health is not among those that received a clean (unqualified) audit.
Whoopee! Next month it’s my 67th birthday and this blog, #VixView, is my celebration of life. The goal is to stay alive for three more years. Why three years, I hear you ask?
Dying early -the magic of 70
Let’s blame it on the United Nations and the Sustainable Development Goal number 3 target 3.4:
By 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing
So if I die between the ages of 30 and 70 years, it is too soon. Well not me specifically, but people who live with non-communicable diseases (NCDs). You get the drift – so I am hanging in for 3 more years. It sounds a bit like an electioneering slogan. But it isn’t. It’s deadly serious. Really.
An activist – why me?
Today I coexist with over 20 health conditions, all NCDs, with the first illness, psoriasis, starting in my first 500 days. I have a most productive and interesting life despite this seemingly woeful state of my health.
Being an NCDs activist gripped me tighter each time I survived another near-death experience (NDEs). Trust me, NDEs change one’s perspective, one’s way of being. I found that to live, I had to fight for my life. So that’s what I do and along the way, I do it for and with those who living with NCDs. I learned radical self-care.
Note: Don’t scoff too much about NDEs. Remember Angelo Agrizzi and what he did after his NDE?
50 years on
If that isn’t enough, this is my 50th year as a health professional working in the health sector. It feels like an alien place. I have a 360º view through all the learning and experience. My beacon remains the Alma Ata vision of primary health care.
Today, with profound sadness, I see us facing many of the challenges from when I first began back in 1970. I recognise that the health system in our noble land often fails us, its people, irrespective of where we get care: public or private. Evidence is all around.
The leading cause of disablity in South Africa is hardly a surprise, HIV/AIDS. And, the good news is that there is a 10% reduction compared to 2007. But what this image shows is that NCDs (the blue dots) remain the largest group illnesses to cause disability irrespective of age. What is alarming is the for 6/8 NCDs listed, the increases are in double digits.
Disability measure =YLD
Disability is measured as by the amount of time, in years,that people lose to diseases and injuries = years of life lost to disability (YLD). A disabling condition does kill you but takes its personal and societal toll.
Calculating YLD
Mulitipy a disability’s severity by the time it lasts. This means that a short-term, severe health problem and a long-term, relatively mild health problem could both result in the same number of YLDs. For example, someone who needs two months to recover from a car accident but then regains their full health and someone who experiences relatively mild but lifelong back pain could end up losing the same number of years of their lives to disability. YLDs take into account all disabilities, including lower-visibility ones that result in daily pain, lost work time, or an inability for someone to thrive as they otherwise might.
An NCDs concept note, that is set to inform the expired national NCDs policy, is up for comment following a stakeholder consultation in April 2019.
Its purpose is to frame and inform South African NCDs policy for the next 5 years. It is the first policy developed in the Sustainable Development era (2015-2030).
Sustainable development goal (SDG) 3 = health. Target SDG3.t is to reduce early NCDs deaths by 1/3 by 2030
At the stakeholder meeting, NCDs civil society participation was limited at the stakeholder consultation due to 5 days notice. A Zoom connection was supplied but not audible. The link of an audio recording of the meeting is available here. Duration 2 hours.
WHO consultant Melvyn Freeman developed and presented concept noted. He the former Chief Director, NCDs at the South Africa National Department of Health.
The South African elections are over, and it is back to business. It needs to be business as unusual in the case of NCDs prevention and management. Business as unusual? Einstein characterised insanity as doing the same thing over and over again and expecting different results.
When advocates argue, politicians vote, and organizations campaign, they say they are trying to shape or respond to political will. Political will is the ghost in the machine of politics, the motive force that generates political action. Charney Research
Business unusual
NCDs policy is a case in point with the now expired South African NCDs strategic plan (2013-2017) failing dismally even to scratch the surface of the epidemic. Similar to much of SA health policy, it was purely window dressing, with implementation and budgets unmeasurable. For the last decade, communicable disease (like HIV and TB) is the only health concern of politicians. Jacob Zuma and his ilk came to power on that ticket with a policy emphasising “universal access” for people living with HIV. And so national health insurance (NHI) and its identical twin, HIV treatment access, were born. Politicians and deployed officials don’t differentiate between the two. When you add “health systems strengthening” and the “Ideal Clinic” to the HIV/NHI package, it equals the current broken and siloed healthcare system.
Policy consistency as art
Let us not pretend otherwise as we head for the 2nd State of the Nation Address in 2019 with a raft of fledgeling MPs for 6th Parliament. There is zero political will deal with NCDs. Oops, there are two exceptions: fiscal measures and cancers linked to HIV (cervix and breast at a stretch). In the health bit of the 2019 ANC election manifesto, NHI and HIV remain the only priority. The same goes for the 2019 health budget. Policy consistency as an art form, only Einstein says it is insanity
So, business as unusual for people living with NCDs means acknowledging that NCDs like diabetes, stroke, heart disease and chronic lung problems are the biggest killers in South Africa. It means giving NCDs an equivalent priority alongside HIV and TB and putting the missing money where its collective mouth is.
Political will is the missing ingredient in the SDG era. It is going to take more than cheap words and a dawn walk in the name of NCDs prevention.
Youth Leaders for the Lancet Commission on Global Mental Health will present key mental health recommendations for young people this week at the World Health Assembly. The young people initiated and developed the policy brief to global policymakers.
Chantelle Booysen
I am excited to use this platform as part of the #mymindourhumanity campaign which promotes global mental health for young people. We want to by:
Elevate the voices of youth in health in particular mental health;
Address a high-level plenary that includes policymakers and public officials to get a response to the policy brief;
Collaborate with NCD Child and NCD Alliance so that mental health continues as an active priority.
We call on global mental health advocates to amplify young voices so that we reach the heads of state.
The policy brief is to be launched at the NCD Child and NCD Alliance side event at the WHA72 on 23 May 2019.
If you are attending the WHA72 in Geneva and are interested in attending contact [email protected]
If that isn’t enough, this is my 50th year as a health professional working in the health sector. It feels like an alien place. I have a 360º view through all the learning and experience. My beacon remains the 
The South African elections are over, and it is back to business. It needs to be business as unusual in the case of NCDs prevention and management. Business as unusual? Einstein characterised insanity as doing the same thing over and over again and expecting different results.