A retake on the NDP with a summary biased towards NCDs with the following key quotes:
“Evidence suggests multiple system failure across a range of programmes, including maternal and child health, HIV/AIDS, tuberculosis and other, with a devastating combined impact. At the heart of this failure is the inability to get primary health care and the district health system to function effectively” (p. 301).
One of the key issues here is collaboration across sectors p. 303 “the health sector should engage with partners and departments to ensure that the negative impact of other policies on health outcome s is understood and minimised.” Mostly it is a list of government departments and is not outward looking to what broader civil society can offer. One wonders who they mean by partners.
It is a must read document, bit by bit, like the elephant it is. Particularly moving is the vision statement for South African for 2030. p. 40.
Chapter 10: Promoting health: p 295-324
Three main sections: demographics and health, health systems and social determinants of health.
Note the emphasis: The section on health is interesting and includes long bits on the re-engineering of primary health care and what the teams and structure will look like. It is also a vision statement. This makes if like a look and feel statement. It is not policy but just how the thinking goes.
The discussion about NCDs is limited to population (primary prevention) methods: stop smoking, be more active, eat better and probably less, limit alcohol intake.
However, most of the messaging still remains about HIV/AIDS its prevention, treatment and complications. Clearly a great deal has to be done to capture the attention of the national planning commission.
Targets are listed as follows and primarily related to the MDGs p. 36
• Demographics and health:
NCDs (emphasis in the document are on those of relating to lifestyle – the bang for the buck for prevent) are seen as one part of SA’s quadruple burden of disease (others HIV/AIDS , maternal and child mortality, violence and injuries)
Health targets are on page 218 and those relating to NCDs are preventable (depends what is meant by preventable). Reduce by 28% by 2030
o Cardiovascular diseases
o Chronic respiratory diseases
Risk factors linked to these NCDs include the normal list tobacco smoking, physical inactivity, raised BP, raised blood glucose, objesity and raised cholesterol.
When HIV/AIDS is mentioned, so too are related issues like TB, STDs, Perhaps there should be a related list NCD list
• Health systems the introduction is scathing.
“Evidence suggests multiple system failure across a range of programmes, including maternal and child health, hive/aids, tuberculosis and other, with a devastating combined impact. At the heart of this failure is the inability to get primary health care and the district health system to function effectively.” p. 301
Access to health care is the rationale behind the national health insurance.
Health systems include health finance, workforce, infrastructure, technology, information and governance.
• Social determinants and ecology
At last a full recognition of the role of social determinants of health. One of the key issues here is collaboration across sectors p. 303 “the health sector should engage with partners and departments to ensure that the negative impact of other policies on health outcome s is understood and minimised” Mostly it is a list of government department and is not outward looking to what broader society can offer. One wonders who they mean by partners.
Partnerships are highlighted again p.304 in relation to health system strengthening and quotes the DBSA report that calls for those partnerships that can help to leverage funding.
Health lifestyles (diet and exercise) highlighting partners (one assumes) such as schools and employers. (p.303)
Prevent and reduce disease burdens and promote health p. 306
Note emphasis of this report. Prevention and only issues mentioned directly are “treating HIV/AIDS ” and “alcohol abuse” and unspecified other “new epidemics”.This is a clear case for NCDs advocacy. The epidemic of NCDs is hardly mentioned.
Health financing deals with the universal access to health care (NHI) issue takes up a large proportion.