NCDs report card 2010-2015: slow progress & help needed

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

summary of findings csr1

Thumbs up on national cancer control plan inclusivity

Thumbs up to the NCDs cluster of the National Department of Health (NDoH) for its responsiveness to stakeholder recommendations. The draft cancer plan, National Plan for the Prevention and Control of Cancer 2015 – 2020 (NCCP) is being reviewed by multisector – all of society stakeholder meeting early next month. Click here to review this draft.

Feedback from stakeholders on the 2014 a draft NCCP made it clear that more consultation was needed. The initial stakeholder meeting to its content (organisational structure) and process of development (planning process) in Pretoria on 6 February 2015.

The aims of the meeting include:

  • Identifying priorities in cancer prevention and control;
  • Setting goals and objectives;
  • Setting strategies for intervention;
  • Setting processes and timelines to achieve a final draft.


Professor Melvyn Freeman and the cluster team are to be congratulated on the transparent and inclusive step. The 1999 NCCP needs urgent revision to provide an integrated, comprehensive people-centered plan for South Africa. The new plan must take into account:

  • changing demographic and epidemiological trends
  • global and national targets
  • the health and developmental agendas.

For more information contact Elmie Engelbrecht at [email protected]

Click here to download the revised draft outline for consideration.

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

Presentations From Health Systems Strengthening Kopano 17-18th November

Slide presentations from the Health Systems Strengthening Kopano 17-18th November 2014


Introduction to ICDM for PHC NCDs service delivery including & patient centeredness – Dr Margo Uys 

Introducing the concept of multisectoral collaboration for action and accountability using HIV/AIDS context. Application to NCDs – Dr Sue Goldstein

Human resource issues. Training training and mobilisation: focus on nurses, other professions and health care workers – Lindsay van der Linden and Razana Allie

Ring fencing Budgets – Prof Mel Freeman