NCDs are a neglected priority in the National Department of Health (NDoH) Annual Performance Plan 2022/23 (APP) which expires at the end of March. Only 4 /18 outcomes in programme 3 are NCD-related.
The bottom 2 rows in the table, require the re-development of national policies for mental health and obesity. Transparency and an inclusive process are problematic.
Our Constitution calls for the meaningfu involvement of civil society and people living with NCDs. Together these conditions impact millions of South Africans and place increasing burden on the health system.
It would also be great to see the reviews of the existing policies which should come before a new policy.
The NCDs+ National Strategic Plan 2022-2027, launched in May 2023, (see the top row in the table) Implying that the provinces will have be close to publishing the impemetion plans for obesity, diabetes and hypertension. I know there is lots hard work getting the plans ready. The Medium-Term Strategic Framework 2019-24 makes it clear that NCDs budgets and implementation must happend in at the sumbnational or provinical level.
Today is the health budget speech at 14:00, and in the interests of transparency and inclusivity, it would be great if we, the people, had a look at it beforehand. The budget speech is a version of the Annual Performance Plan (APP) for the financial year to 31 March 2023.
So we are already into the financial year, and the APP23 s already in progress. Having asked for said APP23 PDF, and scouring government and parliamentary websites, we are still in the dark. The closest we came to is a presentation from the health portfolio committee.
The most positive aspect for NCDs+ is that NCDs+ are still in stream, branch or programme 3 along with communicable diseases. At least it hasn’t be shoved back in Programme 4 Primary Health Care where it languished without food or water.
Mind you it is unlikely to change much since the Medium Term Strategic Framework 2019-2024 (MTSEF24) does not prioritise NCDs+ or allocate funding. Except in the most peripheral way. I call this the legacy of 3M era: MDGs, Motsoaledi and Mkhize. Too bad that we are in SDG times and need different action to achieve universal health coverage (UHC target 3.8) and there is more than the target 3.4to achieve action on NCDs.
The MTSF 2019-2024 – a lasting legacy courtesy of the 3M era, MDGs, Motsoaledi and Mkhize. The absence of national budgets for NCDs+ is not the only issue. At the last count maybe one province had a sort-of-NCDs plan. Clear budget line items are awaited as an evolutionary step like the missing link. It would would great to have progress at the implementation level and within National Health Insurance budgets.
Joy there is a change to the number of outcomes and outputs covering NCDs+ in the APP23. That means a lot without a programme budget and an implementation plan.
Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance says, “People living with NCDs believe it’s a health right to have proper access to care and medicines, especially now during a time of pandemic. Before COVID-19, the NCDs group of conditions killed most South Africans and remained neglected within government policy and budgets. For so long the many millions of people living with NCDs have lamented, ‘it would be better if I had HIV, then I would get access to quality care and medicines.”
NCDs, called underlying conditions during COVID-19, cause most deaths in South Africa. Diabetes kills more women than any other single illness for many years. (1) Government media acknowledge that 90% of those who die following COVID-19 infection had one or more NCD. (2)
Act on NCDs Now – Accountability
The early figures coming out of Wuhan showed that NCDs increased the risk of complications and dying. It was clear that survival depended on well-managed conditions such as diabetes. It immediately exposed the fault lines in NCDs care.
The aim is to get government to implement ongoing care for those living with NCDs by health workers during and beyond COVID-19. This includes ensuring adequate supply of medications that don’t involve travel and visits to facilities and making use of online and tools for consultations to minimise physical interaction and exposure.
The Alliance further proposes performance indicators to assess government’s response to COVID-19 and ongoing NCDs care such as maintenance of food and medicine supply chains, protection and support for vulnerable and neglected people and maintenance of usual health services.
“As South Africans went into lockdown in March, the SA NCDs Alliance initiated online support, counselling and information services to keep people healthy such as the diabetes care line. Those of us living with diabetes soon learned that optimal blood sugar control is the best way to survive a COVID-19 infection. However, getting care and a regular supply of medicines in the public sector involved a stark choice; get your medications or get the virus. Unlike for HIV and TB, a remote non-clinic supply point is a rare option. Insulin, absolutely critical to sustain life in diabetes, is only available at a hospital-level even if there is a clinic next door,” elaborated Pinkney-Atkinson.
Zodwa Sithole, Head of Advocacy for CANSA added, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and physical distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. Part of the response was the launch of our CANSA Tele Counselling service offering free, confidential cancer-related telephonic counselling available in seven languages.”
Nosipho (3) puts the human face on the access issue. In late pregnancy, she always needs insulin and asthma medication. Being a savvy diabetic, she knows she is at risk and tries to avoid the minimum five-hour round trip to get her insulin in central Cape Town during the COVID-19 surge. She knows that the risk of infection is high by using public transport and the long waiting lines at the hospital. When asked, the government sectors were unable to offer a solution.
For other NCDs like cancer, there are implications of delaying any screening that can result in cancers being detected at a later stage and affecting treatment outcomes.
Pinkney-Atkinson concludes, “What works to keep diabetics and other people living with NCDs safe, is not a mystery. There is plenty of evidence, we need action to provide ongoing NCDs care during COVID-19. (4) During the COVID-19 pandemic and beyond, we must go beyond stopping the virus and our right to get our ongoing essential services safely. We need these drugs and supplies (needles and syringes) to stay alive.”
For more information, please contact Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance at email [email protected]
Call 083 38 38-159. Alternate contact is Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected].
Call 011 616 7662 or mobile 082 459 5230.
References:
(1) Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification [Internet]. Pretoria; 2018 [cited 2018 Mar 28]. Available from: http://www.statssa.gov.za/publications/P03093/P030932016.pdf
(2) SA Government News Agency. SA COVID-19 cases rise to 3 034. SANews.gov.za. 2020;2
(3) Not her real name
(4) Young T, Schoonees A, Lachman A, Kalula S, Mabweazara S, Musa E, et al. Taking stock of the evidence. Cape Town: Better Health Programme South Africa; 2020. 50 p
About NCDs+
NCDs are a large group of health conditions that are generally not spread from person to person and used to be called chronic illness until 2000 when the Millennium Develop Goals force a new definition. Often the 5 main NCDs groups of conditions are noted: diabetes, circulatory disorders, mental health, cancer, and chronic respiratory illnesses. However, there are many more conditions that do not get a mention. Globally NCDs conditions are responsible for 41 million deaths annually and they are leading cause of death in South Africa since 2013. Diabetes is the leading cause of death of South African women.
However, the NCDs agenda is not just about illness it goes to a whole of society and whole of government response and for this we need an expanded understanding, meaning, NCDs+. The expanded NCDs+ advocacy agenda includes prevention, vulnerable populations, stigma control and disability. NCDs+ has many determinants (social, economic, and commercial) that disproportionately impact poor people. The Sustainable Development Goals (SDGs) address NCDs+ and its inclusion as an equal part of universal health coverage. (National Health Insurance in South Africa).
About the SA NCDs Alliance
The SA NCDs Alliance, established in 7 years ago, is a civil society partnership between three trusted NCDs advocacy organisations: CANSA, Diabetes SA and the Heart & Stroke Foundation SA.
Its mission is for the people of South Africa have equitable access to quality NCDs+ prevention and management within universal health coverage/ NHI.
For this important COVID-19 and NCDs+ advocacy project nearly 90 civil society organisations are collaborating:
The SA NCDs Alliance’s goal in this programme it to ensure that the policy window of opportunity opened by the COVID-19 pandemic is used to make NCDs a priority in government policy through collaboration with NCDs civil society to put it on a par with HIV & TB. www.sancda.org.za
24 June 2020 – This Nelson Mandela Day CANSA gives back to cancer patients, those affected by cancer and caregivers by launching its CANSA Tele Counselling service. This is confidential, professional, cancer-related telephonic counselling to cancer patients, caregivers and their families and parents or guardians of children living with cancer. Counselling is available in seven languages (English, Afrikaans, isiXhosa, isiZulu, siSwati, Sesotho and Setswana) and is free of charge. #CANSATeleCounselling #ConnectWithHope #MandelaDay
Gerda Strauss, CANSA’s Head of Service Delivery says, “We challenge all to take action and to inspire change this Mandela Day, by donating and sponsoring 67 minutes of counselling. Help us with the costs and expenses to run the service and provide continued in-service training and debriefing sessions to counsellors. We don’t want to add the burden of payment for these sessions to those who are already battling, so we need your help. Even Madiba, when he was first diagnosed with prostate cancer in 2001, reached out to CANSA and benefitted from our support and we’d like to be there for more patients and loved ones and connect with hope. Our launch includes a webinar in mid-August to health professionals to celebrate this Tele Counselling, in addition to our face-to-face counselling services since 1931.”
CANSA has been developing an in-house telephonic counselling service for some time as cancer takes a psychological, emotional and physical toll on cancer patients. This service has just been accelerated due to the limited specialised support available to cancer patients, their caregivers and families during the lockdown period, when face-to-face contact and limited virtual support is not always possible as a result of the COVID-19 pandemic.
Strauss adds, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and social distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. So, this is the perfect time to launch the telephonic counselling. The establishment of this service will not only serve patients during this difficult period, but will become a permanent care and support offering, enabling patients who live far from our Care Centres to also access support and in a language of choice. It’s available during normal business hours.”
“We’re thrilled and thankful that we can partner with Novartis and Roche who made it possible for CANSA to establish and set up this specialised support system in place for cancer patients and loved ones,” concluded Strauss.
CANSA Tele Counselling can be accessed via the CANSA Help Desk on 0800 22 66 22 toll-free to make an appointment with a CANSA counsellor. Or send an email to [email protected].
(For more information, please contact Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected]. Call 011 616 7662 or mobile 082 459 5230.)
About CANSA
CANSA offers a unique integrated service to the public and to all people affected by cancer. CANSA is a leading role-player in cancer research and the scientific findings and knowledge gained from our research are used to realign our health programmes, as well as strengthen our watchdog role to the greater benefit of the public. Our health programmes comprise health and education campaigns; CANSA Care Centres that offer a wide range of care and support services to those affected by cancer; stoma and other clinical support; medical equipment hire, as well as a toll-free line to offer information and support. We also supply patient care and support in the form of 11 CANSA Care Homes in the main metropolitan areas for out-of-town cancer patients and CANSA-TLC lodging for parents and guardians of children undergoing cancer treatment.
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]
