Framework & strategy for disability & rehabilitation services in South Africa 2015-2020

Framework & strategy for disability & rehabilitation services in South Africa 2015-2020

Also known as the FDSR. The strategy expired in 2020 without evidence of an NDoH review. It is one of several national disability policies spread across national departments.
Goal 1 is interesting because it speaks to disability and rehabilitation in priority health programmes. The trouble is that the NDoH NCDs sub-programme is not on the list as there are not considered a national priority in the National Development Plan.  Integration is not possible as long as we have policy and funding silos.
The monitoring and evaluation framework was due for implementation in full by March 2020. A recent WHO global report highlights health inequity for people with disabilities.

GOAL 1: Integrate comprehensive disability and rehabilitation services within priority health programmes (including Maternal and Child Health, District Health Services, HIV/AIDS, TB, Health Promotion, Nutrition, Mental Health and Substance Abuse and Human resources) from primary to tertiary and specialised health care levels.

Rehabilitation: is a goal-directed process to reduce the impact of disability and facilitate full participation in society by enabling people with disability (PwD) to reach optimum mental, physical, sensory and/or social functional levels at various times in their lifespan. The rehabilitation process has levels or stages with specific outcomes for participation throughout the lifespan. (see page 22 FDSR)
Impairment: a loss or abnormality in body structure or physiological function, including mental function. It may be temporary or permanent; progressive, regressive or static; intermittent or continuous. The deviation from the norm may be slight to severe and may fluctuate over time. The presence of impairment necessarily implies a cause. However, the cause may not be sufficient to explain the resulting impairment. It may be part of, or an expression of a health condition, but it does not necessarily indicate that a disease is present or that the individual should be regarded as sick. A primary impairment may result (see page 22 FDSR) 2015 - Framework and strategy for disability and rehabilitation services in South Africa 2015-2020-annotated

2015 Rights of persons with disabilities White Paper.

2015 Rights of persons with disabilities White Paper.

The social framing of disability is at the heart of the White Paper and follows similar moves globally at the time it was produced.  However, WHO’s definition of disability is not only focused on social issues, it is not an exclusionary definition of disability.
Only HIV health programmes are mentioned on page 88 as a prime intervention in South Africa. The only clear funding at a national level is for HIV-related programmes via a conditional grant. Disability is framed as a social issue and added as a priority via a revision to chapter 11 of the National Development Plan (NDP).
In effect, this means the prevention and treatment of NCDs is not considered important in relation to disability. For example, preventable sight loss or limb amputation are not considered in this policy as it follows the social model of disability. This kind of dualism is outdated. We need integrated frameworks at a high policy level that deal with social issues and allow for the health causes to be addressed directly through the National Department of Health and the provincial departments that implement care.
None of this will be possible until NCDs are made a priority in chapter 10 of the NDP. And that is just the beginning.
The white paper is the product of the Department of Social Development. It is heartening that this policy is currently (2023) under review by the Department of  Women, Youth and Persons with Disabilities  (DPWYPD).
The policy is dated in that it developed prior to the Sustainable Development Agenda 2030 and contains minimal references to a more inclusive and integrated agenda.  The 2022 WHO Global report on health equity for persons with disabilities. 

“The world is still far from realizing this right for many persons with disabilities who continue to die earlier, have poorer health, and experience more limitations in everyday functioning than others. These poor health outcomes are due to unfair conditions faced by persons with disabilities in all facets of life, including in the health system itself. Countries have an obligation under international human rights law to address the health inequities faced by persons with disabilities. Furthermore, the Sustainable Development Goals and global health priorities will not progress without ensuring health for all.

white paper on disability rights 2019
Policy NCDs National Strategic Plan 2021-2016 final version

Policy NCDs National Strategic Plan 2021-2016 final version

[vc_row][vc_column width=”1/2″][vc_column_text]The final draft of the 3rd NCDs+ National Strategic Plan that was submitted to the South African National Health Council Technical Committee in Nov 2021 for approval by the National Department of Health. This approximate version has been approved.

The version was finalised by an NDoH Technical Committee after a long non-transparent development process. The SA NCDs+ Alliance was the only civil society representative on the TC.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]Annex a sancda ncds timeline policy events 26 Jan word version
[/vc_column_text][vcex_spacing][vcex_button align=”left”]Click Here To Download[/vcex_button][/vc_column][/vc_row]

Draft national youth policy (NYP) 2020-2030

Draft national youth policy (NYP) 2020-2030

NYP objectives 1 and 2 are directly relevant to the NCDs agenda:

  1. Integrate youth development into the mainstream of government policies, programmes and the national budget.
  2. To promote physical, mental, spiritual; and sexual reproductive health and rights

A quick look at sections in the NYP draft directly to health and NCDs are:
6.4 — Poor health, high HIV/AIDS prevalence, and high rates of violence and substance abuse (page 19).
6.7 — Youth with disabilities (page 20).
7.2 — Physical and mental health promotion (page 32).

?A policy wish list ?

The policy is suitably vague interventions using language like “should ensure” and no targets. Critical health issues like substance abuse and youth suicide must be linked with the NCDs strategic plan. tical issues like youth suicide gets one line in a paragraph one

[embeddoc url=”” download=”all” viewer=”google”]

Disability and NCDs

An estimated 1 billion people, or 15% of the world’s population, have a disability 1, and the increase in diabetes, cardiovascular diseases (heart disease and stroke), mental disorders, cancer, and chronic respiratory illnesses, will have a profound affect on this population. According to the World Report on Disability, these diseases are estimated to account for 66.5% of all years lived with a disability in low and medium resource countries.