Comment on NCDs policy draft concept note April 2019

An NCDs concept note, that is set to inform the expired national NCDs policy, is up for comment following a stakeholder consultation in April 2019.
Its purpose is to frame and inform South African NCDs policy for the next 5 years. It is the first policy developed in the Sustainable Development era (2015-2030).

Sustainable development goal (SDG) 3 = health.  Target SDG3.t is to reduce early NCDs deaths by 1/3 by 2030

At the stakeholder meeting, NCDs civil society participation was limited at the stakeholder consultation due to 5 days notice. A Zoom connection was supplied but not audible. The link of an audio recording of the meeting is available here. Duration 2 hours.

WHO consultant Melvyn Freeman developed and presented concept noted. He the former Chief Director, NCDs at the South Africa National Department of Health.

Your comments are needed to inform the process.

NCDs insanity – rewriting health policy

The South African elections are over, and it is back to business. It needs to be business as unusual in the case of NCDs prevention and management. Business as unusual? Einstein characterised insanity as doing the same thing over and over again and expecting different results.

When advocates argue, politicians vote, and organizations campaign, they say they are trying to shape or respond to political will. Political will is the ghost in the machine of politics, the motive force that generates political action. Charney Research

Business unusual

NCDs policy is a case in point with the now expired South African NCDs strategic plan (2013-2017) failing dismally even to scratch the surface of the epidemic. Similar to much of SA health policy, it was purely window dressing, with implementation and budgets unmeasurable. For the last decade, communicable disease (like HIV and TB) is the only health concern of politicians. Jacob Zuma and his ilk came to power on that ticket with a policy emphasising “universal access” for people living with HIV. And so national health insurance (NHI) and its identical twin, HIV treatment access, were born. Politicians and deployed officials don’t differentiate between the two. When you add “health systems strengthening” and the “Ideal Clinic” to the HIV/NHI package, it equals the current broken and siloed healthcare system.

Policy consistency as art

Let us not pretend otherwise as we head for the 2nd State of the Nation Address in 2019 with a raft of fledgeling MPs for 6th Parliament. There is zero political will deal with NCDs. Oops, there are two exceptions: fiscal measures and cancers linked to HIV (cervix and breast at a stretch). In the health bit of the 2019 ANC election manifesto, NHI and HIV remain the only priority. The same goes for the 2019 health budget. Policy consistency as an art form, only Einstein says it is insanity

So, business as unusual for people living with NCDs means acknowledging that NCDs like diabetes, stroke, heart disease and chronic lung problems are the biggest killers in South Africa. It means giving NCDs an equivalent priority alongside HIV and TB and putting the missing money where its collective mouth is.

Political will is the missing ingredient in the SDG era. It is going to take more than cheap words and a dawn walk in the name of NCDs prevention.

NHI Bill being pushed for elections?

November 27, 2018

The Presidency and Health Minister Aaron Motsoaledi seem intent on pushing the National Health Insurance (NHI) Bill through Parliament before next year’s election despite major unanswered questions.

The revised NHI Bill was presented to Cabinet’s social cluster sub-committee on 27 November 2018  before going to Cabinet, according to the health department.

However, the department failed to answer a number of other questions including why it was pushing the Bill through the legislative pipeline so fast – when even Health Director-General Precious Matsoso admitted last week that she had not seen the latest draft.

Civil society organisations have called on Cabinet to “send the NHI Bill back to the Department of Health and to require a proper and thorough consultation process and consideration of options available for improvement of access to and quality of health care services in the country”.

Professor Olive Shisana, the NHI advisor in the Presidency, is driving the NHI process and has allegedly changed a number of clauses, according to insiders.

The Bill has not been discussed in the National Health Council established by the National Health Act to advise the Minister of Health on policy and on proposed health legislation.

Acting Director General Ismail Momoniat wrote a letter to Shisana last week saying that Treasury could not support the latest version of the Bill as it had been “very substantively amended in October”, removing various agreements reached between the Ministers of Finance and Health.

Treasury was particularly concerned about amendments to the powers of provinces to deliver healthcare, inadequate costing of functions and the relegation of medical schemes to a complementary role which was “premature” and opened the Bill to legal challenges.

However, after the letter was leaked to the media, Treasury issued a statement describing it as “part of the vibrant and ongoing engagement to ensure policy coherence”.

“We have made substantial progress on key areas and have reached agreement on most of the major issues,” added Treasury. “Many of the issues raised by Treasury have been substantively addressed. We are confident that we will soon publish this important Bill for tabling in Parliament.”

But Treasury stressed that “the NHI must be adequately funded and successfully implemented while reducing the risks involved in the implementation of such a large and complex programme”.

Civil society organisations claim that the draft Bill was prepared even before a Presidential Summit that was supposedly called to consult various parties about the NHI.

“Public comments on the NHI over the past decade do not appear to have been taken into account, either between the Green and White Papers and the Bill or after the draft Bill was published for public comment,” according to a statement from Treatment Action Campaign (TAC), SECTION27, Rural Health Advocacy Project (RHAP), People’s Health Movement (PHM) and Lawyers for Human Rights (LHR).

“This makes a mockery of public consultation as required by the Constitution and opens the Bill up to future attack and delay on these grounds.”

The organisations also argue that the current Bill “risks damage to the functional elements of the health system – public and private” and that “government needs to focus on fixing the crises in private and public health rather than on hastily passing legislation that, in its current state, takes the country in the wrong direction”.

While the health department failed to respond to the civil society statement, last week Treasury said that “the implementation of the NHI and improvements in the quality of the health system go hand in hand and are therefore being addressed concurrently.” – Health-e News

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.