NCDs in the South African National Development Plan – a change of heart?

NCDs in the South African National Development Plan – a change of heart?

Non-communicable diseases (NCDs) appear to be rising in priority for the first time in more than two decades since the publication of the South African National Development Plan (NDP). The recent NDP 10-year review seems to frame NCDs in a different light by making this recommendation:O

Department of Health should implement the legislative and regulatory interventions recommended by the Strategic Plan for the Prevention and Control of Non-Communicable Diseases.” page 39

The recommendation appears to open the way for a national policy shift, moving NCDs out of the rut that considers them solely lifestyle conditions managed by a mixture of behaviour changes with a mix of policy and fiscal measures. This NDP framing institutionalised the limited allocation of national budget resources for NCDs interventions officially sanctioned as primordial and primary prevention. In reality, it resulted in NCD denialism despite them being the leading cause of death in South Africa since 2009, once ARVs impacted the tragic and callous loss of life due to HIV.

 

The use of the term lifestyle conditions is unacceptable for the HIV and TB community. People living with NCDs+ find it equally demeaning as it places the responsibility mainly on the person to live a better life.This bogus notion disregards the wider or social determinants of health and a public health system that fails to prevent and treat NCDs in a comprehensive way in all primary care facilities.

Very little changed for 20 years with subsequent NDP iterations of health priorties which continue to feature the Millennium Development Agenda identified conditions and South Africa’s much delayed and controversial version of universal health coverage. National Health Insurance (NHI) draft legislation focuses only finacial mechanism and fails to deal with quality and equity for NCDs and mental health.

Be still my heart NCDs equity indicator

Being a cynic in NCDs matters, when I look at policies I look first at the list of acronyms which usually feature up front. Very quickly I notice that the acronym NCDs does not appear in this standard feature South African policy documents. In most health-related policies, NCDs, the acronym, is missing with little or no mention within the policy and, unsurprisingly, even less action.

I made my first indicator of NCDs policy equity to be the inclusion of NCDs in the list of acronyms. Why? It give a snapshot of the framing from the perspective of the policymakers. So it is a huge milestone to have NCDs finally made the acronym indicator cut. NCDs has appear in this review and, be still my heart, in the recently update HIV/TB & STIs national strategic plan. Using the criterion in reverse, it is intriguing that neither HIV nor AIDS makes this list, but TB does. Perhaps is shows the extent to which HIV is institutionalised in South African society.

In a related victory, NCDs featured for the first time in the acronym list of the HIV, TB and STIs stratgic plan!

Hope springs eternal

It took the South African NCDs+ Alliance 10 years and lots of activism to be included in the development of the NCDs+ National Strategic Plan. Real blood, sweat and tears stuff. We had to take extreme measures including delaying tactics and staking sham policy consultations. After 5 years of delays it was finally passed and launched last year. It does allow scope for increasing the priority of NCDs prevention and treatment. However, without futher clarification of the NDP review recommendation is nuanced. What do “legislative and regulatory interventions” mean? Is it just another way of maintaining the status quo?

Make this cynic think paranoid thoughts. Especially as the health minister and officials havent responded to letters for years. What do you think?

Letter to minister -NCDs strategic plan implementation & resourcing

The SANCDA’s founding partners ask the Minister of Health, Dr Joe Phaahla, to work together to solve the NCD epidemic sent  19 April 2023. Still awaiting a response. From 2013 until today, the SANCDA has never received a written response from its political leadership or executive officials.
Summary of contents

  • Annexure A: SANCDA members, allies, and partners.
  • Annexure B: List of policy requiring coordination and update by date and government Department
  • Annexure C: Contextualisaton of NDOH NCDS+ subprogramme allocations (1010-2026) with the Health Promotion Leavy and & HIV NPOs
SANCDA Letter to Minister Apr 2023 and annexures A B C
2023 NDoH Annual Performance Plan presentation

2023 NDoH Annual Performance Plan presentation

Today is the health budget speech at 14:00, and in the interests of transparency and inclusivity, it would be great if we, the people, had a look at it beforehand. The budget speech is a version of the Annual Performance Plan (APP) for the financial year to 31 March 2023.

So we are already into the financial year, and the APP23 s already in progress. Having asked for said APP23 PDF, and scouring government and parliamentary websites, we are still in the dark. The closest we came to is a presentation from the health portfolio committee.

220422NDOH_APP_PRESENTATION_-_22_APRIL_2022Download


The most positive aspect for NCDs+ is that NCDs+ are still in stream, branch or programme 3 along with communicable diseases. At least it hasn’t be shoved back in Programme 4 Primary Health Care where it languished without food or water.

Mind you it is unlikely to change much since the Medium Term Strategic Framework 2019-2024 (MTSEF24) does not prioritise NCDs+ or allocate funding. Except in the most peripheral way. I call this the legacy of 3M era: MDGs, Motsoaledi and Mkhize. Too bad that we are in SDG times and need different action to achieve universal health coverage (UHC target 3.8) and there is more than the target 3.4to achieve action on NCDs.

The MTSF 2019-2024 – a lasting legacy courtesy of the 3M era, MDGs, Motsoaledi and Mkhize.
The absence of national budgets for NCDs+ is not the only issue. At the last count maybe one province had a sort-of-NCDs plan. Clear budget line items are awaited as an evolutionary step like the missing link. It would would great to have progress at the implementation level and within National Health Insurance budgets.

Joy there is a change to the number of outcomes and outputs covering NCDs+ in the APP23. That means a lot without a programme budget and an implementation plan.


NDoH “Implementation” Review of 2nd NCDs NSP 2013-2017

NDoH “Implementation” Review of 2nd NCDs NSP 2013-2017

The date of the review is August 2018.  This is the first version. Later,  in November 2018, a second version was circulated.

The NCDs National Strategic Plan 2013-2017 is also known as the 2nd NCDs NSP. It was reviewed in 2018 by a WHO country office contracted consultant on behalf of the NDoH.
It is grandiosely called The “Implementation Review of the  NCDs NSP 2013-2017”  The title is a farce since this plan was never implemented and unfunded. The review is supposed to imply an authentic evaluation of the plan, processes and outcomes. It does nothing of the sort
The WHO consultant Mel Freeman was also the NDoH official responsible for the development and implementation of the 2nd NCDs NSP during his tenure as Chief Director, NCDs

NDOH implementation review 2NN 2018 aug