President Cyril Ramaphosa, accompanied by Deputy President David Mabuza and Cabinet Ministers and the President’s Coordinating Council (PCC) met on Friday, 28 February 2020.
The extended PCC meeting included premiers of the 9 provinces, mayors of 44 district and 8 metropolitan municipalities. It convened to assess progress on the District Development Model (DDM) implementation. It resolved that all spheres of government must work together for efficient service delivery at a local level.
Definition – joining the dots in districts for integration
The DDM approach aims to improve integrated planning across government with the creation and implementation of ‘One Plan’ per district or metro. It brings together all partners to stop dysfunctional silos and to make a joint plan across departments with relevant stakeholders. Local partners include business, civil society, faith based communities and traditional leaders in a compact for development.
Piloted in 3 district municipalities (OR Tambo, Waterberg and Ethekwini) the DDM represents a paradigm shift in government’s efforts to build a coherent and coordinated state.
More than R70 billion of public sector investments have been made in the in the three pilot sites since August 2019. A further 20 districts are to be included by the end of 2020 with all districts covered by 2021.
An analysis of the lessons learnt so far confirms the enormity of the socio-economic challenges faced by districts. It also assisted government to direct spending to the areas of greatest need in a more informed and integrated way. Transparency and accountability at a local government level is a much anticipated outcome.
The pilot of the DDM at the three sites assisted to uncover potential sectors for growth which can be tapped into to improve the living conditions of the most vulnerable. When the DDM is fully operational it will ensure greater inclusivity through gender budgeting.
The PCC has thoroughgoing discussions on the implementation of economic reforms to drive inclusive growth and job creation, infrastructure investment and development, efforts being made to bolster youth employment through the Presidential Youth Employment Intervention and as a progress report on the provision of water services and human settlements.
The President called the PCC an historical meeting of leaders from all spheres of government to support a “joined up approach” that when it comes to development no district gets left behind in development.
The President called on all social partners take the lessons learnt into account and use further impetus to the DDM vision. This vision of capable unitary developmental state with a strong neutral bureaucracy and solid societal relations.
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?
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
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
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.