NCDs coordinating body for South Africa

Vicki and David Pinkney-Atkinson


The South African NCDs Alliance (SANCDA) and its NCDs partners are celebrating a pivotal win with the creation of a national NCDs coordinating body. In July after four years of consistent advocacy, the South African National Health Commission (SANHC) was created.

It marks an advocacy tipping point with the official acknowledgement of NCDs as the leading class of disease mortality in South Africa. At last, there is parity for NCDs with HIV/AIDS and TB. Well, at least on the co-ordination continuum. More successes along the lines of achieved for the MDG communicable diseases are needed.

The SANHC is one of the institutions created to implement and coordinate the South African version of universal health coverage and access, National Health Insurance (NHI). The NHI is in the second phase of the rollout which will target on vulnerable groups:  mother, child, school health, elderly and disabled.

The revised [i] SANHC objectives are
to address the social determinants of health through a multi-sectoral and development approach involving key government departments and non-state actors. SANHC will co-ordinate key sectors in implementing a health in all policies and an all-inclusive approach to the prevention and control of NCDs, including mental health. Promoting health and preventing illness is central to NHI well as to social and economic growth and development in South Africa.”

Plans for a SANHC were outlined by the National Department of Health in early 2013 with implementation due the following year.  Initially, its scope was to address only “social determinants” and their prevention. From 2014 onward the SANCDA advocated for a wider scope that included NCDs prevention and treatment in a co-ordinated multistakeholder and multisectoral approach.  This whole of government and whole of society context is critical for complex societal and health problems as addressed by the United Nations’s transformational 2030 Sustainable Development Agenda.  The SA National Development Plan (2011) is a visionary precursor.

By the end of the end of 2014 all the activity culminated in a meeting with the Deputy Minister of Health where the SANCDA once more called for the swift formation of this high-level body.

The SANCDA’s 2015 Civil Society Status Report underlined it as a major element necessary to combat NCDs and lamented the lack of action. There was a ray of hope by later in that year with the proposed link to the SANHC to NHI.  The 2015 NHI White Paper (1st version) mentioned the creation of a SANHC but still with a very limited scope which was a key focus area for reform and contestation. The SANCDA in its written comments reiterated its call for a national NCDs co-ordinating body as framed by the Sustainable Development Goals.

In July 2017 a raft of NHI related policy was published including the NHI White Paper (2nd version) plus the formation of seven NHI implementation institutions. There was little change to the SANHC scope and the objectives. However, a swift draft revision was circulated (text box 1) in the SANHC serves as the guardian of NCDs prevention and care. The SANCDA awaits official confirmation of the objectives and structure.

And, as a show of good faith, has nominated SANCDA director, Dr Vicki Pinkney-Atkinson, as a civil society representative. The SANCDA will report on further developments.

Box 1:  SA National Health Commission revised terms of reference [i]
a. Identify the social & economic factors that drive premature illness and death from NCDs.
b. Interrogate the means & mechanisms through which these determinants can be addressed, including the interventions required from different government departments and non-state actors.
c. Utilise scientific evidence on the causes of NCDs and how to prevent these. Based on this information draw up feasible and implementable plans to promote health and prevent diseases through interventions by the relevant stakeholders.
d. Research & utilise international best practice on health promotion and disease prevention interventions across sectors, analyse these for their feasibility and relevance to South Africa and make recommendations on implementation through SANHC to member government departments and non-state actors.
e. Periodically analyse surveillance data on NCDs and adapt strategies to changing patterns.
f.  Analyse cost-effectiveness and cost-benefit of interventions to reduce NCDs and ensure the most effective and efficient use of resources across sectors.
g.  Assist government departments and non-state actors to draw up strategic and operational plans that will positively impact on the social determinants of health.
h.  Consider and provide input into strategic and operational plans drawn up by government departments and other non-state actors vis-à-vis objectives and activities aimed at promoting health and preventing disease.
i.  Monitor the implementation of the plans and activities of all sectors with regards to the plans submitted to redress the social determinants of health.
j.  Evaluate existing interventions aimed at the promotion of health & the prevention of illness as well as programmes and projects that derive from the SANHC and make applicable recommendations to the relevant department or non-state actors.
k.  Ensure collaboration between and across government and non-state actors including non-government organizations, academia, representatives of labour and the private sector, to systematically improve the health status of South Africans and reduce the need for healthcare interventions.
l.  Ensure that all sectors that contribute to health and development outcomes of NCDs are aware of their responsibilities and that they implement relevant policies and interventions as directed by the SANHC;
m.  Where circumstances permit, the SANHC may act as a conduit for channelling funding to relevant sectors dealing with the social determinants of health.
n.  Co-ordinate sectors synergistically & eliminate wasteful duplication.

[i] This draft revision awaits official confirmation. 

Hot off the press WHO Global NCDs Status Report 2014

Global NCDs Status Report 2014

Global NCDs Status Report 2014

A World Health Organization report on NCDs prevention and control (2014) that is framed around the nine voluntary global targets. The report provides data on the current situation, identifying bottlenecks as well as opportunities and priority actions for attaining the targets.
The 2010 baseline estimates on NCD mortality and risk factors are provided so that countries can report on progress, starting in 2015. In addition, the report also provides the latest available estimates on NCD mortality (2012) and risk factors, 2010-2012.

All ministries of health need to set national NCD targets and lead the development and implementation of policies and interventions to attain them. There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the comprehensive response to attaining the voluntary global targets presented in this report.

Click here to download report

Provinces slow to prioritise NCDs

imagesOnly 3 provinces have draft (not officially approved) NCDs plans and none have a budgetary allocation that can be traced to NCDs. Assessing the extent of NCDs roll out is difficult as neither budgets nor monitoring mechanisms are available. The three provinces are Gauteng, KwaZulu-Natal and Mpumalanga (see Table 1).

No province meets the all of the criteria for an operational NCDs plan:

  • NGOs & PLWNCDs engaged in national NCD plan development
  • Provincial budgetary allocation for prevention and treatment
  • Intersectoral NCDs mechanism including NGOs, PLWNCDs and private sector
  • NCDs plan with a ‘whole of government’ approach, i.e. with areas for action beyond the health sector.

NCDs plans could be standardised if a template existed and that could easily be one of the first tasks of the long delayed NCDs Commission / National Health Commission.

Discouraged NCDs personnel in provinces

Dedicated health officials from the provincial heath head offices work on NCDs despite the low priority given by leaders to fight NCDs. One such worker recently said: “I have been told there is no budget for NCDs health promotion in our province for the rest of the financial year. What am I supposed to do for the next 5 months? It is very discouraging.”

Table 1:  NCDs plans available and operational in provinces

Eastern Cape: Unknown No web-based documentation found and no response to request for NCDs plan.
Free State Unknown No web-based documentation found and no response to request for NCDs plan.
Gauteng: Partial Completed draft NCDs operational plan that is combined with geriatrics and eye care. (26) Goals, targeted and with budget request. Intersectoral objectives with meetings and district coordinators already take place. Availability of plan not known.
KwaZulu-Natal Partial Completed draft NCDs plan used to guide activities which presented at the intersectoral KZN–SA NCD Alliance Indaba (workshop) in June 2014.(27). However, support is implied by the attendance of the Member of the Executive Committee (MEC) for Health at the NCDs meeting. (28)
Limpopo: unknown No web-based documentation found and no response to request for NCDs plan.
Mpumalanga partial Completed draft NCDs Operational Plan 2014 (29)
North West unknown No web-based documentation found and no response to request for NCDs plan.
Northern Cape unknown No web-based documentation found and no response to request for NCDs plan.
Western Cape partial Plan under construction. (30)

Source: SA NCD Alliance Benchmarking NCDs for action 2015.  Full list of references in benchmarking document (all are all provincial government documents.)

Latest version of the NCDs benchmarking exercise Jan 2015

The latest version of the 2014 NCDs Benchmarking exercise conducted by the South African NCDs Alliance can be found here.  Click here to download. It is in the process of final modification for publication later this month.

The NCD Benchmarking Exercise assesses the national capacity for responding to NCDs framed by a civil society perspective.

It is framed to complement national reporting processes on NCDs, as well as WHO monitoring on NCDs.
It includes elements of the NCD national response/capacity that are not reflected in official government/WHO reporting, such as elements that relate to civil society organization engagement and capacity.

The benchmarking tool was developed in consultation with an expert working group of the NCD Alliance.
It is piloted as part of the NCD Alliance programme “Strengthening Health Systems, Supporting NCD Action” in Brazil, the Caribbean Community and South Africa.
The programme is funded by a generous grant from Medtronic Philanthropy.

If you have any comments lease return comments to Vicki Pinkney-Atkinson

Feedback on NCDs Action meeting with Deputy Minister Dec 14


The SA NCD Alliance and its NCDs Network met with the Deputy Minister of Health, Dr Joe Phaahla on 11 December 2014.

The most important outcome is the establishment of a 2 monthly intersectoral NCDs forum for communication and consultation. The purpose of the forum is to inform, involve and seek feedback from stakeholders on NCDs related initiatives.  This is seen as the first step towards a national NCDs coordinating mechanism. These functions may, it time be taken over by the National Health/ NCDs Commission (NCDsCom).

The meeting’s objectives were achieved:

  • -To show support for the National Department of Health’s (NDoH’s) NCDs Strategic Plan 2013-2014
  • -To convey the findings of the research into the national response to NCDs.
  • -To ask for NCDs action in terms of resolutions adopted at the SA NCDs Alliance Kopano in November 2014.
  • -To offer the SA NCD Alliance’s assistance with NCDs action


Below is a list of resources relating to the meeting:

Other achievement of the meeting were:

  • Regular 2 monthly NCDs meetings between NDoH and SA NCD Alliance. This includes provincial departments and other stakeholders. The purpose of this meeting is to improve communication about NCDs action and programmes by all stakeholders.
  • Agreement to work together on solutions for NCDs
  • NDoH accepted off to use NCDs networks and expertise.
  • Agreement for SA NCD Alliance and NCDs Network to contribute to the  development NCDsCom documentation.

However, we failed to influence the urgent implementation the long overdue National Health Commission/ NCDs Commission or to have it delinking to the publication of the NHI White Paper. The linkage is seen by the SA NCD Alliance as a mechanism to  postponed the NCDsCom implementation and remove it from the NCDs sphere of activity.