In 2011 President Jacob Zuma and the South African government committed to NCDs prevention and control in line with global conventions. Since then many more commitments have been undertaken. As part of civil society’s watchdog role the SA NCD Alliance monitors how the government is doing. Today we release our report card covering the years from 2010 to March 2015. Click here to download the report.
March 2005 marks halfway through the national NCDs plan. There is still a lot to be done.
SA is doing fairly well at “population”
measures to prevent NCDs like legislation on smoking, salt reduction and food labeling. The relatively cost effective measures mean a bigger bang for each rand spent. We are all for that. However, there is much more to NCDs prevention and treatment (control.)
There are 6 main areas in the WHO’s NCDs Global Action Plan 2013-2020 are used to benchmark the governments progress. Out of over 25 indicators (see table below):
♦ Less than 1/4 were met:
♦ At least 3/25 critical items were not achieved; and
♦ the bulk (64%) were partially achieved or implemented.
This report was compiled by using official government reports, budgets and transparent interaction with stakeholders. It is a first of its kind in South Africa. Over 600 data sources were used. The Parliamentary Monitoring Group was the major source of government meetings.
None of this is a surprised to the National Department of Health because a year ago, armed with the preliminary findings, a NCDs Network delegation discussed our concerns with the Deputy Minister of Health, Dr Joe Phaahla. Sadly not much has changed since then.
Issues of concern include:
♦ A continuing and alarming trend to make policy and plans without any budgetary allocation;
♦ Minuscule budgetary allocation for NCDs within the Primary Health Care programme budget;
♦ Lack of provincial NCDs plans and budgets – the provinces provided the care but can’t do it without dedicated resources;
♦ Failure to include people living with NCDs in the roll out of “ideal clinics” (also known as Operation Phakisa and “integrated chronic care model”);
♦ Lack of patient-centredness including consultation with patients and those living with the illnesses (nothing for us, without us);
♦ Poor or non-existent monitoring and evaluation.
There is more but we would like you to take look. You be the judge, you use the services.
Below see the 6 areas of the WHO Global Action Plan. Green indicates achievement. Red no progress. Blue no evidence. All the rest partial progress/ implementation.
Download here
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?
Figure 1:
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
Our information comes from the draft Annual Performance Plan (APP) and its accompanying budget. – see pages 61-63. Click here to download the draft APP 2015/2016-2017/8
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
employed |
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.
Gauteng leads the way by holding regular intersectoral NCD prevention and control co-ordination meetings. Its goal is to co-ordinate and facilitate action and planning for NCDs in the province.
At the second meeting at Helen Joseph Hospital on August 28 2015. Holding the first provincial NCD prevention and control committee meeting.
The Gauteng DoH is the first province to bring together members from multiple government sectors (all of government) – Education, Social Development, Sports and Recreation, Rural Development, and NCD stakeholders (all of society.) These include NCDs NGOs including SA NCD Alliance, CANSA and Love Your Nuts and the industry. The aim is to create and focused inclusive plan to combat NCDs.
Gauteng DoH is applauded for bringing together all relevant members to discuss and formulate a plan to make a positive change in the approach to fighting NCDs. This is a great example for us all to follow especially at the critical provincial level.
The next meeting is on 23 September 9:00 to 13:00 at Ann Latsky College. RSVP to Ms Dudu Mthombeni
Gauteng leads the way by holding regular intersectoral NCD prevention and control co-ordination meetings. Its goal is to co-ordinate and facilitate action and planning for NCDs in the province.
At the second meeting at Helen Joseph Hospital on August 28 2015. Holding the first provincial NCD prevention and control committee meeting.
The Gauteng DoH is the first province to bring together members from multiple government sectors (all of government) – Education, Social Development, Sports and Recreation, Rural Development, and NCD stakeholders (all of society.) These include NCDs NGOs including SA NCD Alliance, CANSA and Love Your Nuts and the industry. The aim is to create and focused inclusive plan to combat NCDs.
Gauteng DoH is applauded for bringing together all relevant members to discuss and formulate a plan to make a positive change in the approach to fighting NCDs. This is a great example for us all to follow especially at the critical provincial level.
The next meeting is on 23 September 9:00 to 13:00 at Ann Latsky College. RSVP to Ms Dudu Mthombeni
Click here to download the SA Health Promotion Policy & Strategy 2015-19 (HPP&S 15-19)
46 pages. Date of publication: unknown
Purposes
1.To enable South African to increase control over and improve its own health using the PHC approach, which is multidisciplinary in nature;
2.To provide guidelines to support actions at appropriate levels that will advance the aims and objectives of the health promotion policy;
3.To promote a holistic approach to health by:
- Focus on the link between health promotion and the determinants of health
- Emphasise inter-sectoral and multi-disciplinary approaches in planning, implementing and evaluating health promotion interventions;
- Outline health promotion activities in various settings; and
- Specifying strategic indicators to be monitored
Target audiences
The HPP&S 15-19 identifies key target audiences across the life cycle for health promotion interventions (→ focus on)
- Children < 5 years → promoting better health;
- Women of child bearing age → creating awareness on services available;
- Men → promoting a change in gender norms and values by encouraging broader involvement in health issues;
- Youth → addressing risky behaviour and promoting healthy lifestyle practices;
- Older people → community-based programmes and support groups to promote regular health and self-management of NCDs;
- Marginalised populations → specific health needs.
Snippets
12.2 Financial Resources (page 26)
The successful implementation of the health promotion programme requires sustained and dedicated financial resources. The allocation of resources should be based on the principles of redress and equity. The current financial resources limits the implementation of health promotion strategies that are known to increase awareness on critical health issues and impact upon on social and behavioural changes that promote health and well being.
Civil society role – key partners (page 29-30)
- Developing and promoting frameworks for health promotion interventions
- Strengthening partnerships with community structures and civil society for health campaigns
- Supporting PHC Ward-Based Outreach Teams to implement health promotion programmes with activities to develop:
-a package of service delivery of health promotion services
-tools to assess and promote community mobilisation.
- Improving health literacy.
