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.
This is billed as being about the Checka Impilo or National Wellness Campaign … but some how it got to be more about a failing health system. Take a look.
Deputy President Mabuza used the Health 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 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 non-communicable diseases 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.
RPN (ICU) Diabetes Nurse Specialist
SA NCD Alliance (SANCDA) Associate and Diabetes Education Society of South Africa (DESSA) member
Ramadan is approaching and people living with diabetes are advised to plan before starting the month-long fast. Approximately 100 million people with diabetes world-wide fast during Ramadan and most are able to fast the whole month. But this takes planning by all involved, including families, communities and health professionals.
What is Ramadan?
Ramadan is the ninth Islamic month and fasting during the day light hours is one of the five pillars of Islam. Muslims have been fasting during Ramadan for over 1400 years as prescribed in the Qur’an. Fasting is one part of the religious practices during Ramadan and adults must abstain from eating, drinking, sexual intercourse, use of oral medications, and smoking from before the sunrise to after sunset. There are no restrictions on food or fluid intake between sunset and dawn, however moderation is prescribed.
Most people consume two meals per day during Ramadan: one after sunset (referred to in Arabic as iftar or breaking of the fast meal), and the other before dawn of suhur (predawn).
When is Ramadan?
It varies according to the Muslim (lunar) calendar. This year it is approximately May 15th to June 14th 2018.
What are the diabetes numbers?
Over 425 million people worldwide live with diabetes
1 out of 2 adults with diabetes are undiagnosed.
About 80% of the world’s population live in low- and middle-income countries, like South Africa, where the greatest increase in diabetes will occur.
Diabetes is the #1 cause of death of females and the #2 cause of death for all in South Africa.
Muslims comprise almost ¼ of the world population and there are 148 million Muslims living with diabetes.
The International Diabetes Federation (IDF) projects that by 2045 the number of people living with the disease will more than double in the Middle East, Africa and South East Asia where the largest populations of Muslims live.
How does fasting affect people living with diabetes?
In people with diabetes the control of blood glucose needs more attention. Complications like low blood sugar (hypoglycaemia) and high blood glucose (hyperglycaemia), dehydration, and blood clots may occur. These are considered to be the “risks” of fasting and are potentially life threatening and require planning to avoid them such as changes to medication.
Preparation pre-Ramadan is essential and should include risk stratification. All planning must include education, nutrition, exercise, medication adjustments and monitoring. Ideally this should take place 6 – 8 weeks before Ramadan.
What about fasting when one takes medication for diabetes?
Islam does not burden its followers, there are exceptions for those who are unable to observe the obligatory fast. It is forbidden in Islam to exert oneself in any act that will bring harm upon oneself. Thus, if one is ill and the illness would be aggravated, or the pain would increase through fasting, then fasting is not required.
Those who do fast, are required to review their medication together with a health care practitioner and diabetes nurse specialist before Ramadan so adjustments can be made. In the event of any hypoglycaemia, the fast should be broken immediately and it is advised that the person should not resume fasting until a they consult a health care practitioner..
Who is a high risk during Ramadan?
Risk is assessed according to the following factors: type of diabetes, medication, previous Ramadan experience, hypoglycaemic risk, current complications, co-morbidities and individual work and/or social circumstances. Examples are old age with ill health, vascular complications, pregnancy and those doing intense physical labour.
What can be done to manage those at high risk of having complications?
Very high risk and high-risk patients should not fast. However, many will fast and these persons should be given the education on how to minimise the possible complications while fasting and thereafter. They should also be given an individualised management plan for reducing their risk for further complications.
The management plan should include pre-Ramadan visits, regular self-blood glucose monitoring before, during and after fasting, and a nutrition and exercise plan.
The plan must be individualised and tailored to the person’s circumstances, there is no “one size fits all.”
It is important to provide additional support to include emergency contacts and availability of a trained health care professionals in diabetes management at all times.
Include religious and community leaders, families and community members in the successful and uneventful fasting period.
Where can people find more information about diabetes and Ramadan?
Guidelines on the management of diabetes in Ramadan published in 2016 by the IDF Diabetes and Ramadan Alliance. These guidelines assist health care professionals and persons living with diabetes on the best practices in the preparation and treatment of those who will be fasting.
Every year the 3rd of December is commemorated as International Day of Persons with Disabilities (IDPD). As part of the Disability Month activities that have been taking place over the past few weeks, Government has been drawing attention to the fact that this year marks the 20th Anniversary of the Release of the White Paper on an Integrated National Disability Strategy and the 10th Anniversary of the Ratification of the UN Convention on the Rights of Persons with Disabilities. Although the fact that these policies have been part of the South African disability sector for many years now is indeed something to be celebrated, the SA Federation for Mental Health (SAFMH) feels it is important to acknowledge all the ways that these and other policies, like the Mental Health Policy Framework and Strategic Action Plan (MHPF), are not being implemented, and are currently failing persons with mental disabilities as a result.
On IDPD last year, which was declared a day of mourning for those who lost their lives as a result of the Life Esidimeni tragedy, SAFMH and the South African Mental Health Advocacy Movement (SAMHAM), delivered a report regarding the state of Mental Healthcare in Gauteng, specifically focusing on the issues that had unfolded with Life Esidimeni, to the Gauteng Department of Social Development. The aim of the report was to show how a better implementation of the MHPF was needed to improve the services and care offered to mental health care users. In the report, SAFMH made the some of the following recommendations:
Mental health services need to be prioritised and developed with an equal level of (high) importance across all provinces in SA, and across rural and urban areas
Services and resources at community level should be developed in consultation with mental health care users, their families, NGOs and other key partners to ensure that the development of such services are done in an informed and collaborative way
The prioritisation/resourcing/implementation/monitoring of the Mental Health Policy Framework and Strategic Action Plan at provincial level is essential, and provincial Departments of Health need to be held accountable for failure to do so
Savings generated through budget cuts in tertiary Psychiatric Care Facilities (such as what happened with the termination of the Life Esidimeni contract) need to be transferred to support community-based care
Government needs to address the widely pervasive shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements
There is a need for NGOs to become more recognised as key partners in the delivery of mental health services and to be respected and treated as such. Government needs to recognise that without the upscaling of and provision of community-based services SA’s commitment towards deinstitutionalisation will never be realised
SA requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payments of subsidies to ensure continuity in community-based mental health service delivery
There is a need for more family empowerment programmes to ensure that MHCUs who return to their homes are able to receive the support they require from their families and those family members are sufficiently equipped with the necessary skills to help them take care of mental health care users within their homes
Not only was there no response to the report or any of its findings or recommendations, but since then the scale of human rights abuses that mental health care users faced has was sadly highlighted in the Ombudsman’s report on Life Esidimeni, which was released two months after the SAFMH report.
Today the number of people known to have lost their lives as a result of the Life Esidimeni tragedy stands at 143, and with the arbitration hearings currently taking place, more disturbing details emerge on a daily basis of the gross neglect and abuse that the patients suffered at the hands of those who were responsible for their care. Despite the severity of these claims, those responsible for the project, such as former MEC Qedani Mahlangu, have been using every method to try an avoid testifying at the hearings.
Celebrating the existence of legislation and policies aimed at improving the lives of those living with mental and physical disabilities, while not prioritising the implementation of these legislations and policies, leads to a system that values the lives of persons with disabilities in word but not indeed.
Government has not been able to ensure that those responsible for the tragic and preventable deaths of Life Esidimeni patients face justice, nor has Government been able to ensure that the MHPF and other important legislation is implemented in a timeous and correct fashion. Until such important things start taking place, IDPD will remain a reminder of the horrific treatment and abuse that vulnerable persons with mental disabilities experienced because of Government’s lack of action.
SAFMH will continue to put pressure on provincial government departments to commit towards developing a plan to implement and monitor the allocation of resources for the successful implementation of the MHPF in all provinces. SAFMH will also be hosting the Movement for Global Mental Health Summit from 8-9 February 2018, which will provide mental health care users with the opportunity to share their experiences and lead the call for improved mental health care services in line with the Sustainable Development Goals.
SAFMH calls on Government to prioritise the implementation of legislation like the MHPF and the UNCRPD and to recommit to upholding the rights of persons with mental disabilities.
Statement from the South African Mental Health Advocacy Movement (SAMHAM) on IDPD–
We as mental health care users (MHCUs) have historically been living our lives in silence while decisions have been made about our lives without our participation. Our lives have value and our views and opinions matter, and we can help to create a society where people celebrate diversity. We want to see an end to the complete disregard for our fundamental human rights – when we speak, we demand to be listened to and when decisions are being made that affects us, we demand to be involved in making those decisions. Contrary to common beliefs, we as MHCUs can add value to society and we can achieve recovery to our full potential, provided our rights are respected and protected.
The South African NCDs Alliance (SANCDA) and its NCDs partners are celebrating a pivotal win with the creation of a national NCDs coordinating body. In July after four years of consistent advocacy, the South African National Health Commission (SANHC) was created.
It marks an advocacy tipping point with the official acknowledgement of NCDs as the leading class of disease mortality in South Africa. At last, there is parity for NCDs with HIV/AIDS and TB. Well, at least on the co-ordination continuum. More successes along the lines of achieved for the MDG communicable diseases are needed.
The SANHC is one of the institutions created to implement and coordinate the South African version of universal health coverage and access, National Health Insurance (NHI). The NHI is in the second phase of the rollout which will target on vulnerable groups: mother, child, school health, elderly and disabled.
The revised [i] SANHC objectives are
“to address the social determinants of health through a multi-sectoral and development approach involving key government departments and non-state actors. SANHC will co-ordinate key sectors in implementing a health in all policies and an all-inclusive approach to the prevention and control of NCDs, including mental health. Promoting health and preventing illness is central to NHI well as to social and economic growth and development in South Africa.”
Plans for a SANHC were outlined by the National Department of Health in early 2013 with implementation due the following year. Initially, its scope was to address only “social determinants” and their prevention. From 2014 onward the SANCDA advocated for a wider scope that included NCDs prevention and treatment in a co-ordinated multistakeholder and multisectoral approach. This whole of government and whole of society context is critical for complex societal and health problems as addressed by the United Nations’s transformational 2030 Sustainable Development Agenda. The SA National Development Plan (2011) is a visionary precursor.
By the end of the end of 2014 all the activity culminated in a meeting with the Deputy Minister of Health where the SANCDA once more called for the swift formation of this high-level body.
The SANCDA’s 2015 Civil Society Status Report underlined it as a major element necessary to combat NCDs and lamented the lack of action. There was a ray of hope by later in that year with the proposed link to the SANHC to NHI. The 2015 NHI White Paper (1st version) mentioned the creation of a SANHC but still with a very limited scope which was a key focus area for reform and contestation. The SANCDA in its written comments reiterated its call for a national NCDs co-ordinating body as framed by the Sustainable Development Goals.
In July 2017 a raft of NHI related policy was published including the NHI White Paper (2nd version) plus the formation of seven NHI implementation institutions. There was little change to the SANHC scope and the objectives. However, a swift draft revision was circulated (text box 1) in the SANHC serves as the guardian of NCDs prevention and care. The SANCDA awaits official confirmation of the objectives and structure.
And, as a show of good faith, has nominated SANCDA director, Dr Vicki Pinkney-Atkinson, as a civil society representative. The SANCDA will report on further developments.
Box 1: SA National Health Commission revised terms of reference [i]
a. Identify the social & economic factors that drive premature illness and death from NCDs.
b. Interrogate the means & mechanisms through which these determinants can be addressed, including the interventions required from different government departments and non-state actors.
c. Utilise scientific evidence on the causes of NCDs and how to prevent these. Based on this information draw up feasible and implementable plans to promote health and prevent diseases through interventions by the relevant stakeholders.
d. Research & utilise international best practice on health promotion and disease prevention interventions across sectors, analyse these for their feasibility and relevance to South Africa and make recommendations on implementation through SANHC to member government departments and non-state actors.
e. Periodically analyse surveillance data on NCDs and adapt strategies to changing patterns.
f. Analyse cost-effectiveness and cost-benefit of interventions to reduce NCDs and ensure the most effective and efficient use of resources across sectors.
g. Assist government departments and non-state actors to draw up strategic and operational plans that will positively impact on the social determinants of health.
h. Consider and provide input into strategic and operational plans drawn up by government departments and other non-state actors vis-à-vis objectives and activities aimed at promoting health and preventing disease.
i. Monitor the implementation of the plans and activities of all sectors with regards to the plans submitted to redress the social determinants of health.
j. Evaluate existing interventions aimed at the promotion of health & the prevention of illness as well as programmes and projects that derive from the SANHC and make applicable recommendations to the relevant department or non-state actors.
k. Ensure collaboration between and across government and non-state actors including non-government organizations, academia, representatives of labour and the private sector, to systematically improve the health status of South Africans and reduce the need for healthcare interventions.
l. Ensure that all sectors that contribute to health and development outcomes of NCDs are aware of their responsibilities and that they implement relevant policies and interventions as directed by the SANHC;
m. Where circumstances permit, the SANHC may act as a conduit for channelling funding to relevant sectors dealing with the social determinants of health.
n. Co-ordinate sectors synergistically & eliminate wasteful duplication.
[i] This draft revision awaits official confirmation.
