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
Obestity prevention and control strategy South Africa 2015-2020
NDOH Obesity strategy
1st meeting of the National Consultative Health Forum NDoH 2006
This is a special kind of health stakeholder consultation in terms of the National Health Act. It set the standard for the future and not a high one. The national Department of Health s
pecial. Short notice with little choice of topic Since then the notice is much shorter. Inclusion is still a mystery. In 2006 it was based on which organisations the Minster liked. Mostly anything but HIV.
The attached programme is illustrative of the era. These were tough times. Getting an invitation was like a poison chalice. It showed the rift between the Mbeki administration and the people. AGISA was incomprehensible and deliver at great length.
Disability access was laughable. The minister injured a foot and arrived late in a wheelchair. The usually constructed stage had no disabled access certainly not for a wheelchair. So it took great deliberation to find 4 strong people to lift the wheelchair and minister onto the stage. The rest is a bit of a blur until lunch.
I chose a table near the door and went to get lunch. When I came back the minister and health MECs filled the table it was a conventient spot for a wheelchair bound person. The minster ordered wine, the only person in the room to do so. I had a diet cold drink. The minister stated how poor my choice refreshement was, all the artifical sweetners were terribly bad for me. The MEC ssat sicophantically by and one even pretended to drink wine.
Memories of a survivor
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.
white paper on disability rights 2019“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.