COVID-19 and NCDs – a Newly Acknowledged Vulnerability

20 August 2020The South Africa Non-Communicable Diseases Alliance (SA NCDs Alliance) is raising concern over the systemic neglect of non-communicable conditions (NCDs) like obesity, diabetes, high blood pressure, cancer, asthma and mental health problems due to neglected NCDs prevention and treatment. Download infographics

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:

Cancer Alliance South Africa
Dementia South Africa
Epilepsy South Africa
Global Mental Health Peer Network
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) SA
National Kidney Foundation SA
Palliative Treatment for Children SA (PatchSA)
South African Disability Alliance
South African Federation for Mental Health

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

Diabetes helpline +27-81-578-6636

NW Health notes verdict on suspended HOD

Wednesday 14 November, 2018
The North West Department of Health has noted the arbitration court’s decision for Head of Department, Dr Thabo Lekalakala, to be reinstated.

“The department has noted the arbitration verdict concerning the suspension of Dr Thabo Lekalakala. It is important to remind the public that Dr Lekalakala was suspended following allegations of procurement irregularities, which affected a number of contracts,” said the provincial department on Tuesday.

Lekalakala, who was placed on suspension in April, is expected to be back in the office on Monday.

On Tuesday, the department said the contracts in question have since become a matter of forensic investigation.

“There are two issues which are to be considered in this matter. Firstly, the suspension of Dr Lekalakala and secondly, the disciplinary actions which the department has already instituted against Dr Lekalakala.

“Dr Lekalakala was placed on special leave owing to the fact that allegations against him were being investigated. The arbitration verdict, which instructs the department to reinstate Dr Lekalakala, is only concerned with the merits of this special leave,” said departmental spokesperson Tebogo Lekgethwane.

Lekgethwane said the verdict does not deal with the investigations and disciplinary actions.

Meanwhile, the department confirmed that disciplinary action against Dr Lekalakala is continuing, with a disciplinary committee already pursing the matter.

“Specifically on the special leave matter, the department is still studying the verdict and applying its mind on the way-forward. The department appeals to members of the public and public servants to allow the law to take its course,” Lekgethwane said.

NW Health notes verdict on suspended HOD

Wednesday 14 November, 2018
The North West Department of Health has noted the arbitration court’s decision for Head of Department, Dr Thabo Lekalakala, to be reinstated.

“The department has noted the arbitration verdict concerning the suspension of Dr Thabo Lekalakala. It is important to remind the public that Dr Lekalakala was suspended following allegations of procurement irregularities, which affected a number of contracts,” said the provincial department on Tuesday.

Lekalakala, who was placed on suspension in April, is expected to be back in the office on Monday.

On Tuesday, the department said the contracts in question have since become a matter of forensic investigation.

“There are two issues which are to be considered in this matter. Firstly, the suspension of Dr Lekalakala and secondly, the disciplinary actions which the department has already instituted against Dr Lekalakala.

“Dr Lekalakala was placed on special leave owing to the fact that allegations against him were being investigated. The arbitration verdict, which instructs the department to reinstate Dr Lekalakala, is only concerned with the merits of this special leave,” said departmental spokesperson Tebogo Lekgethwane.

Lekgethwane said the verdict does not deal with the investigations and disciplinary actions.

Meanwhile, the department confirmed that disciplinary action against Dr Lekalakala is continuing, with a disciplinary committee already pursing the matter.

“Specifically on the special leave matter, the department is still studying the verdict and applying its mind on the way-forward. The department appeals to members of the public and public servants to allow the law to take its course,” Lekgethwane said.

Systemic reform necessary to cure SA health system

Friday, October 19, 2018

Deputy President David Mabuza says nothing short of a systemic overhaul is required to pull the country’s ailing health system out of the status quo.

“We all agree that our health system is in crisis and needs urgent attention,” Mabuza said on Friday at the inaugural Presidential Health Summit.

Delegates ranging from government officials, academics, labour to social activists are gathering in Ekurhuleni, Gauteng, over the next two days to thrash out pressing matters beleaguering the country’s strained health system.

Where does it hurt?

Before any steps can be taken, Deputy President Mabuza said, the country must collectively get to the root cause of the crisis.

“According to the World Health Organisation (WHO), one of the six building blocks of a healthy and resilient healthcare system is the health workforce or human resources for health.

“Over the past few months, there has been a serious outcry from all corners of our country about the shortages of the workforce in the public sector. Whereas the President has agreed to inject a certain number of the health workforce as part of his stimulus package, this is just but a temporary measure for immediate relief,” he said.

As part of the stimulus package, President Ramaphosa announced in September that Minister of Health and the National Health Council would immediately fill 2 200 critical medical posts, including nurses and interns. Funding would also be made available immediately to buy beds and linen.

On Friday, Mabuza said the summit had to come up with lasting solutions.

“The gross inequalities that have developed in the provision of human resources between the public and the private health sectors need to be faced head-on and resolved speedily,” he said.

The Deputy President said the country needed to urgently produce a national human resource operational plan that each level of health care can use in planning service provision.

The second major cause of problems in the provision of good quality healthcare, Mabuza said, is poor procurement or supply chain management systems that make it impossible to have adequate pharmaceuticals and other vital health commodities.

Although the country has essential medical equipment and medicine lists, which were accompanied by the delivery of chronic medicines distribution programme, challenges emanating from inadequate maintenance of equipment and stock-outs of medicines are still experienced.

“To ensure quality, safe and relevant technologies, we need to involve the end-users, primarily the health workers, in the procurement of equipment to ensure they can be used effectively and efficiently,” Mabuza said.

The Deputy President said the State needs to work with civil society groups to monitor the availability of medicines and other commodities in the healthcare system.

“The public needs to keep us on our toes to ensure that the population gets what is due to them.”

Health services provision is another area that requires urgent attention, Mabuza said, as this would ensure that every South African has access to care that is affordable.

“It must also be comprehensive and include preventive, curative, palliative, rehabilitative and health promotion services. At the moment, the primary health care component of our healthcare system is very weak and is found wanting.

“Our healthcare system is by and large curative, hospicentric and unable to provide comprehensive healthcare.”

Mabuza conceded that public facilities were congested, inappropriately staffed and plagued by long queues of patients, among them too many repeat visits.

NHI

With regards to the National Health Insurance (NHI) scheme, which is set to be phased in from 2019, the Deputy President said health facilities had to meet the set standards in order to be accredited.

Government is in the process of establishing learning centres to implement these standards.

“At facility level, we need to ensure that agreed quality standards are met in the provision of health care services. This must be supported by the recruitment and deployment of appropriately skilled personnel to ensure quality service delivery,” he said.

There is an urgent need to prioritise the development of new infrastructure in previously underserviced areas, and ensure that existing infrastructure is properly maintained to meet the required standards.

“The drastic shortage of appropriate infrastructure means that people with a mental health condition are often hospitalised in non-mental patient wards, and male and female patients are hospitalised in the same ward,” Mabuza lamented.

Funding and meeting infrastructure needs

In response to these challenges, the Deputy President said government must develop a consistent 10-year infrastructure plan, using identified and ring-fenced infrastructure resources that might benefit from the President Cyril Ramaphosa’s R400 billion infrastructure stimulus package.

“Our response to the health sector challenges will be incomplete if this summit does not provide targeted solutions to inadequate health systems financing and management,” he said.

The Deputy President said the financing of South Africa’s healthcare was inequitable across the board.

The private sector, he said, uses a higher proportion of the GDP but only serves only 16% of the population, when the public sector uses a lower proportion of the GDP, while it services 84% of South Africans.

“These inequities need to be identified and corrected in budget allocations.”

In an effort to address some of the challenges, the Office of the President will be re-costing health system funding “to provide more realistic figures on the cost of this health system and estimate a better model of allocation depending on the burden of disease per district”.

“The challenges in healthcare are also found in the private sector, although they vary in nature,” said Mabuza.

The private sector provision costs are unacceptably high and affordable only to a few, as proved by the Health Market Inquiry headed by former Chief Justice Sandile Ngcobo.

Mabuza bemoaned how most medical schemes were unsustainable, as they had high premiums that often increase faster than inflation.

“Medical scheme benefits are often exhausted before year-end, which forces patients to have no cover and many end up using the public health sector.”

He said challenges in both the public and private health sectors require a new approach to serve all South Africans.

“We need a publicly financed health system where services are provided by both the public and private facilities delivered according to improved standards of care. An integrated unitary health system under NHI does not negate the existence of medical schemes for those who desire additional care that complements services provided under NHI.”

He urged both the public and private arms of the sector to address the challenges in commissions over the next two days.

“We must work on a system based on solidarity to give all of our people the best that we can offer as a nation. It is within our power to make quality health care accessible to all.

“As we enhance collaboration in our entire health system, we need to build coordinated, integrated and shared health information systems.”

Checka Impilo

Mabuza used the summit to launch Checka Impilo, a national wellness campaign that focuses on testing and treating people who have HIV, TB, sexually transmitted infections and non-communicable diseases (NCDs) such as diabetes and hypertension.

The campaign will focus on the provision of comprehensive health and wellness services targeted at men, adolescent girls and young women, as well as key and vulnerable population groups.

The success of the campaign, Mabuza said, depends on coordinated collaboration among all social partners in respect to planning, implementation and monitoring.

Checka Impilo is a call to action for South Africans to move from a curative response to health to preventative approaches and the adoption of healthy lifestyles.

The campaign will focus on increased information, education and communication activities, promotion of HIV testing, widespread distribution of condoms, and provision of pre- and post-exposure prophylaxis against HIV.

“All of us must, therefore, go out in great numbers to test for HIV and screen for STIs, TB and NCDs such as diabetes and hypertension.

“Within 24 months of this campaign, we must have found and put two million more people on ARVs. We must also have found and put at least 80 000 more people with TB on anti-TB treatment. We must also have identified thousands more with diabetes, high blood pressure and cancer, and put them on treatment,” Mabuza said. – SAnews.gov.za