Health Promotion Levy passed – Where to From Here?

With the first and biggest battle won against NCDs at the end of 2017, the Health Promotion Levy (HPL) comes into effect from April 2018.

The tax works in the following way, the first 4g of sugar per 100ml in a drink is exempt from taxation. Any sugar after this is charged at a rate of 2.1c per gram. If a company does not give the exact sugar content of its drink, it will be taxed at a base rate of 20g per 100ml. This tax would see certain drinks like Coca-Cola being taxed 10% of the can.

The second win is the establishment of an NCDs Commission within the frame work of the National Health Insurance. The Commission’s purpose is to coordinate policy and action across government and society to maximize NCDs prevention and control. Its official name is the South African National Health Commission. Combined with the HPL, this will go a great distance to an NCDs free future for all South Africans.

By calling the sugar tax a “health promotion levy” the intention to use a portion for health promotion work. However, there is no clear outline or understanding of how the collections will be spent or allocated.
The SANCDA along with it civil society partners and stakeholders are lobbying for the money to be used to directly fund the fight against NCDs. It is important to have clear measurable plans with a budget to fund education, civil society action, screening and treatment of people at risk and living with NCDs.

The people of South Africa deserve to have a fighting chance against the scourge of NCDs gripping the nation and civil society is best equipped to take this fight to the most basic of ground level where the government cannot or struggles to reach.

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. 

Review of the Prescribed Minimum Benefits – Open for Comment

The Council for Medial Aid Schemes (CMS) is looking for comment on the prescribed minimum benefits. This links to South Africas National Health Insurance as well as Universal Health Coverage in its outcomes. CMS are calling for comment and it should not be forgotten that patients should be involved in this process. As it affects them the patients in the outcomes of this process.

Section 6 listed below.


Sustainable Development Goals (SDGs): Utopian dream or plausible plan?

Health-e News September 28, 2015

Agenda 2010 SDGs -Sustainable Development Goals

Agenda 2030 SDGs -Sustainable Development Goals

For the next 15 years, the newly  adopted Sustainable Development Goals (SDGs) will guide what donors fund and what countries push – and the world may just take a page from Africa’s playbook as it pursue universal health coverage.

Born in Springs on Johannesburg’s East Rand, Matshidiso Moeti grew up watching her doctor parents tend wounds and set bones in nearby KwaThema. The little girl destined for big things learned early that injustice and inequity were their own sorts of plagues. “My parents were doctors in the township and ran a practice…so one was aware of the struggles of families in the community,” she said. “Even by the time I was 7 or 8 years
old, I remember reading The Post newspaper and being very much aware of the political system in place, aware of what was essentially an unjust society… this influenced me a lot.” When Moeti’s parents moved to Botswana, her father took to the bush conducting small pox eradication campaigns. Her mother took a post at the Botswana Ministry of Health, which led her to what is now Kazakhstan for a work meeting in 1978. When Moeti’s mother returned home, she had been a part of history. Her meeting had adopted the Alma-Ata Declaration, which made the case for universal health coverage. It would also shape her daughter’s destiny.

Universal health coverage is one of the 169 targets and 17 goals comprising the SDGs adopted by the United Nations on Friday 25 September. They take over from the eight Millennium Development Goals adopted 15 years ago. The product of hard Moshidisonegotiations and almost 100 international consultations, the SDGs are sufficiently vague to read like a Utopian laundry list. The real meat likely to guide governments’ and donors’ money is hidden in the SDG’s targets, which include the roll out of universal health coverage (UHC).

But what the world committed to in New York this weekend, Africa has been slowly mulling over for the last decade as more countries including South Africa turn to UHC as a way of improving health outcomes and stamping out deadly inequalities. From Nigeria to Rwanda, African countries are carving out new ways of dolling out – and paying for – healthcare. (more…)