6 EnoughNCDs campaign priorities with South African spin

This post puts the UN High-level Meeting for NCDs priorities in a South African context. It does not dilute the global call but pegs the South Africa response.

1  Put people first

People living with, at risk of and affected by NCDs (PLWNCDs), young people, and civil society must be at the heart of the NCDs response.

For over 20 years the South African policy of Batho Pele  or “people first.” The Life Esidimeni  mental health tragedy it is clear that much more needs to be done to include us.  No more talk. #EnoughNCDs. 

Empowering and involving PLWNCDs and young people has been neglected. The knowledge held by PLWNCDs is undervalued in NCDs programme development, implementation and policy-making. They are under-represented as leaders and in organisations they are largely silent in decision-making processes. Let’s correct this state of affairs to realise the rights and responsibilities of PLWNCDs , which require supportive political, legal, and social environments that give all people the opportunity to speak up, especially those most vulnerable and disenfranchised. Let’s start with the South Africa National Health Commission as a key NHI platform for multisectoral stakeholder engagement and policy coherence.

A close connection with communities, civil society organisations (CSOs) provide people affected by NCDs with an essential voice in decision-making processes. CSOs raise public demand and engage with and apply concerted pressure on governments to ensure that resources and services reach and benefit affected communities, as well as hold governments and other sectors to account. Investing in civil society must be recognised as part of the global public good agenda.

2 Boost NCD investment

Scaling up investment for NCDs is a critical priority to achieve the 2025 NCD targets & the SDGs.

Sustainable and adequate resources for NCDs are severely lacking and remain a bottleneck in the response. NCDs receive just 1.3% of development assistance for health, making NCDs the only major global health priority without international financing. Closing the resource gap will require multiple financing sources, depending on the country-specific context. The expected result will be a blended stream of financing, including creating and optimising fiscal space for NCD investment domestically, exploring innovating financing mechanisms (such as taxation of unhealthy commodities), multilateral/bilateral funding, private sector engagement, and catalytic mechanisms, in line with the recommendations from the Third International Conference on Financing for Development in 2015. While domestic resource mobilisation is critical, for low-income countries allocating less than 5% of the gross domestic product to health, progress on NCDs will be impossible without catalytic funding from donors.
At a NDoH level the

3  Step up action against all forms of childhood malnutrition including obesity 

Childhood obesity is an issue with a clear health and economic imperative for action. 

In Africa this priority has to be balanced and weighed against the SDG goal 2 to end hunger and food insecurity and nutrition. 

Global political targets exist to ensure a ‘zero increase in overweight in under 5s’ and a ‘zero increase in obesity and diabetes’, and a WHO Implementation Plan to End Childhood Obesity to guide the response, centering around a set of population-based interventions. With insufficient progress to date and driven by unsustainable, unhealthy food systems and environments, childhood obesity is a major challenge that extends well beyond the health sector and demands political attention at the highest political level.


4 Adopt smart fiscal policies that promote health

 South Africa has implemented tobacco, alcohol and sugar sweetened beverage taxes. 

The tax on sugar sweetened beverages, the Health Promotion Levy (HPL) came into effect on less than a month ago and took 2 years of negotiations and activism. The tax is instituted with compromise 2,1 c per gram of sugar per 100 ml of the drink. A portion of the HPL is to be used for health promotion and treatment, hence the name.

In the 2018/19 financial year, Treasury has allocated R100 million to the National Department of Health from the HPL. Dr Yogan Pillay (Deputy Director General NDoH Programmes) confirmed, in a meeting this month, that R93 million is to be allocated for human resources to treat people living with cancer. The remaining R7 million is set to be used for a health promotion campaign for cancer prevention.

Alcohol and tobacco taxes taxes go into the broader fiscus with no directed health allocation.  In the health budget on Furthermore, the money needs to be spent in the right places tackling the largest burden NCDs facing the country.In South Africa, we have adopted 3 major healthy lifestyle taxes to curb NCD risk factors and utilise the money collected to benefit the broader population.  

5  Save lives through equitable access to NCD treatment & NHI

Access to prevention and treatment is a fundamental human right so that we can achieve the highest possible standard of physical and mental health and well-being.

Section 27 of the South African constitution entrenches the right to health and care. a number of law cases have upheld this view. The NHI programme for universal health coverage and access (UHC+A) is in Phase 2 of its roll out.  NCDs prevention and treatment needs firm embedding. 

Availability and access to lifesaving treatment, care and support for PLWNCDs is still out of reach for millions of African people almost all of whom live low- and middle-income countries LMICs).

This is despite global targets for 2025 to ensure 80% availability of essential medicines and technologies for NCDs. In South Africa for example, there is no state procurement of diabetes blood testing equipment and strips. Sadly the leading the leading cause of death in women and the group combination of diabetes, heart and vascular disease the number 1 killer over.

Access challenges relate to weak health systems in many LMICs, including the lack of adequate preparation and training of the health workforce, insufficient financial resources, poor procurement policies and weak supply chains, inefficient information systems, and lack of patient education and low health literacy.

Reducing the burden of NCDs is essential to achieve SDG UHC+A (Target 3.8)  and the SDGs,  goals focus on ending poverty in all forms everywhere and reducing inequalities within and among countries. Integration of NCD prevention and treatment the NHI programme and a strong focus on equity is fundamental to strengthen health systems to deliver for NCDs throughout the life-course and protect against financial hardship.

 6  Improve accountability for progress, results & resources

Accountability is a crucial force for political and programmatic change.

Accountability is cyclical process of monitoring, review and action, accountability enables the tracking of commitments, resources, and results and provides information on what works and why, what needs improving, and that requires increased attention.

Accountability ensures that decision-makers have the information required to 

meet the health needs and realise the rights of all people at risk of or living with NCDs. Multiple sets of commitments and targets for NCDs exist at the global level, as set out in the WHO Global NCD Action Plan and Monitoring Framework on NCDs, the 2014 UN Review Outcome Document, and the SDGs. Existing WHO and UN accountability mechanisms for NCDs can be complemented by independent accountability mechanisms, and at the national level, there is a need to strengthen accountability mechanisms, national targets, and improve data collection and surveillance systems.

The SA NDoH 2013-2017 NCDs strategic plan expired over a year ago and requires multisectoral evaluation. The South African NCDs Alliance conducted a review of progress NCDs policy implementation. Since then key indicators for diabetes, high blood pressure and mental health still require operationaliation with a standard operating procedure. PLWNCDs need to be part of the multisectoral evaluation team.  Provincial NCDs budgets and guidelines for expenditure should be transparent.

Myth-busting the new sugar tax – Health-e News

There has been a lot of controversy surrounding the sugar tax which was officially implemented on April 1st. The tax, equivalent to a levy of about 11 percent on a can of coke, is aimed at tackling South Africa’s obesity epidemic and the diseases associated with it. Health-e News busted five common myths.

Why tax sugary drinks because:

  1. Jobs will be lost hurting the South African economy

Industry has repeatedly published different estimates for how many jobs will be lost across the sugary beverage food chain. In May last year Beverage Association of South Africa (BevSA) said that they anticipate job losses in the region of 24 000. They had also previously claimed that up to 72 000 people could lose their jobs across the value chain. But Treasury published a report in June estimating job losses could be as low as 1475. But public health advocates argue that small short-term losses are dwarfed by the substantial cost to the economy of treating lifestyle diseases. Last month Health Minister Aaron Motsoaledi pointed out that “[y]ou cannot dream of growing your economy without good health”.

  1. The health of South Africans is not affected by sugar

South Africans have increasingly been higher-than-average consumers of sugar and sweetened beverages. A study published as far back as 2007 in the Journal of Public Health Nutrition found that South African toddlers in urban areas drank more sugary drinks than milk. We also have rapidly increasing rates of obesity, being the fattest nation in sub-Saharan Africa, and the diseases linked to it. Diabetes now kills more women than any other disease. Drinking just one sugary drink a day increases the risk of being overweight by 27 percent for adults and 52 percent for children, according to a 2009 study published in the same journal. Moreover, a 2012 study published in Circulation found that drinking one to two fizzy drinks a day can increase one’s risk of developing diabetes by more than 25 percent.

  1. The tax won’t reduce consumption

A number of other countries and areas within countries have instituted sugar taxes amid claims that the intervention won’t have any public health effect as people will continue to drink the same amount of fizzy drinks. Mexico introduced a 10 percent tax on sugary drinks in 2014 and saw a 7.6 percent decrease in sales of sugary drinks and an upturn in sales of bottled water within two years, according to 2017 study led by researchers from the University of North Carolina. It also found that consumption reduced the most in poor communities, which is significant because lifestyle diseases can be financially catastrophic to poor families with less access to healthcare.

  1. Eating sugar is the same as drinking sugar

Many have criticised the tax because it doesn’t address the sugar people consume in food products which also contributes to the rise in obesity, but liquid sugar has been found to be more dangerous than the solid version. Drinking calories in the form of sugar instead of eating it can leave people feeling less full, found a 2010 study in the International Journal of Obesity. Eating a muffin or cake, for example, will leave a person more satiated than drinking a cool drink which could lead to the consumption of more calories to achieve a feeling of fullness. Researchers from Penn State University found that people who drank a sugary beverage with their meal consumed on average more than 100 calories more than those who did not, identifying sugary beverages as an independent risk-factor for obesity.

  1. Industry wants to help solve the obesity problem

Industry fiercely fought the implementation of the tax through a fear-inspiring job losses media campaign, including paying for a study to be conducted and by lobbying workers and government. But they have also publicly said they want to work with government to tackle obesity. When the Healthy Living Alliance protested outside of Coca-Cola’s headquarters in Johannesburg last year Maserame Mouyeme head of Public Affairs, Communication and Sustainability said that “we want to fight obesity” and “work with you in the process of finding a solution”. But industry bodies like BevSA continue to ignore the independent health risks sugary drinks pose to South African consumers while companies have consistently targeted poorer communities to increase their sales. Research from Priority Cost-Effective Lessons for Systems Strengthening South Africa, based at Wits University, noted that Coca-Cola, the country’s largest soft-drink franchise, has identified its future growth strategy targeting those falling under the living standards measure (LSM) of one to six “with a specific focus on LSM 1–3” – the poorest consumers. The beverage industry also spends more than R500 million a year on advertising sugary drinks, “including other promotions that appeal to kids”, according to 2017 data from market research company Nielsen AdEx. This marketing does not include education around the risks of sugar or how much these products contribute to the recommended daily intake of sugar. Just one 500ml bottle of a typical soft-drink in South Africa contains around 10 teaspoons of sugar, almost double the six teaspoons per day recommended by the World Health Organisation. – Health-e News

NHI Gets Cash, But Detail Vague

Article from:

Witten by:
Kerry Cullinan

BUDGET: R4,2-billion has been allocated the National Health Insurance (NHI) scheme to be spent over the three years – but exactly how the NHI will work remains vague

Photo – Masutane Modjadji, Health-e News.T

The National Health Insurance aims to make a package of essential healthcare free to all citizens and legal residents of South Africa through compulsory employee contributions to a national NHI Fund – a noble cause with a hefty price tag.

But the health department’s attempt to introduce the scheme has floundered over the past five years, – partly dogged by huge management weaknesses in the public health sector.

According to yesterday’s Budget Review, the NHI will get R4,2-billion made up of allocations of R700 million, R1.4 billion and R2.1 billion over the next three years. This money will come from “an amendment to the medical tax credit”.

Tax credits reduced

It will be used to contract general practitioners to work in the public sector, increase schools’ eye and ear testing, for “community mental health” and “expanding the Chronic Disease Medicine Distribution Programme to enable three million patients to collect chronic medicines at their collection point of choice instead of at a clinic”.

It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this.”

Medical tax credits are given to taxpayers who opt for private medical aid. By offering below-inflation increases in medical tax credits (ranging from 2,2 to 2,5%), government estimates that it will save R700-million this year – the sum total of this year’s NHI allocation.

But Professor Alex van den Heever from Wits University’s School of Governance, says this reduction in tax breaks is unlikely to save much money, as it is likely to drive some of those who are already battling to pay private medical aid back into the state sector.

“The medical tax credit is an entitlement to compensate people who are paying for medical cover themselves rather than depending on the public sector. As most medical schemes have higher-than-inflation annual increases, the reduction in the medical tax credit will mean that people will be out of pocket and some will drop out of cover,” said Van den Heever.

VAT increase ‘wrong’

To Van den Heever, “it makes no sense to take the subsidy away from people but offer no substitute for what is lost. What the R4,2-billion NHI allocation is for is unknown. It is likely to go to institutions and consultants that will not improve healthcare.”

Van den Heever also decried the increase in VAT as “the wrong thing to do as it taxes the poor more than the rich”. Instead, government could have introduced an extra tax bracket for the super-rich, gone after pension tax subsidies for very high end earners and increased corporate taxes, which are “the lowest in 20 years”, said Van den Heever.

“It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this,” he said.

The Rural Health Advocacy Project’s (RHAP) Russell Rensburg was also against the VAT increase, arguing that it would affect poor communities more and “deepen inequality of access”.

Rensburg also warned that money alone would not create a viable universal healthcare system: “Adding additional resources to an increasingly inefficient system does not increase efficiency.”

The “on-going freezing of critical health posts, under-investment in the maintenance of key infrastructure, including medical equipment”, and “the under-allocation of resources” to rural areas were undermining the health system, he said.

Last week, The Davis Tax Committee said that the uncertaintly around how the NHI would be funded was a cause for concern. Government itself has estimated that it will need R256-billion (2010 prices) a year for the scheme. The Davis committee said that, if the economy only grew by 2%, there would be a shortfall of R108-billion by 2025.

Sugary drinks tax on 1 April

“The proposed NHI, in its current format, is unlikely to be sustainable unless there is sustained economic growth,” said committee, which urged more realistic costing and a detailed framework for implementation.

The Department of Health says that an NHI Bill is passing through the last stages of a Cabinet review process on its way to Parliament, and this is likely to also set out the creation of an “NHI Fund” to pay for the scheme.

Meanwhile, the tax on sugary drinks – referred to as the Health Promotion Levy – will be introduced on 1 April, according to the Budget Review. Government expects that this tax – approximately 11% on a can of Coca Cola – will net it around R1,93-billion.

The aim of the levy is to reduce consumption of sugary drinks, a leading cause of obesity – which drives a number of health problems including diabetes, strokes and cancer.

But Wits School of Public Health Professor Karen Hofman said that the tax “has been significantly watered down and needs to be around 20% in order to have a serious impact on reducing obesity”.

“It also exempts fruit juices, which sends the wrong message as fruit juice is also very high in sugar content,” added Hofman, who heads Priority Cost Effective Lessons for System Strengthening South Africa (Priceless SA).

Health Promotion Levy passed – Where to From Here?

With the first and biggest battle won against NCDs at the end of 2017, the Health Promotion Levy (HPL) comes into effect from April 2018.

The tax works in the following way, the first 4g of sugar per 100ml in a drink is exempt from taxation. Any sugar after this is charged at a rate of 2.1c per gram. If a company does not give the exact sugar content of its drink, it will be taxed at a base rate of 20g per 100ml. This tax would see certain drinks like Coca-Cola being taxed 10% of the can.

The second win is the establishment of an NCDs Commission within the frame work of the National Health Insurance. The Commission’s purpose is to coordinate policy and action across government and society to maximize NCDs prevention and control. Its official name is the South African National Health Commission. Combined with the HPL, this will go a great distance to an NCDs free future for all South Africans.

By calling the sugar tax a “health promotion levy” the intention to use a portion for health promotion work. However, there is no clear outline or understanding of how the collections will be spent or allocated.
The SANCDA along with it civil society partners and stakeholders are lobbying for the money to be used to directly fund the fight against NCDs. It is important to have clear measurable plans with a budget to fund education, civil society action, screening and treatment of people at risk and living with NCDs.

The people of South Africa deserve to have a fighting chance against the scourge of NCDs gripping the nation and civil society is best equipped to take this fight to the most basic of ground level where the government cannot or struggles to reach.

NCD Civil Advocacy Atlas 2017

NCDs Atlas of the NCD Alliance has recently been published. This showcases advocacy by civil society groups from around the globe. Four of the reports published in the Atlas became award winners at the Sharjah NCD conference in the areas of:

Coalición Latinoamérica Saludable – Rapid Regional Response to Strengthen and Defend National NCD Policies in Latin America
East African NCD Alliance – Benchmarking to Track and Advance Regional NCD Action
Healthy Caribbean Coalition – Building Civil Society Capacity to Improve Access to Cancer Services for Underserved Populations
Tanzanian NCD Alliance – Creating a Journalists’ Forum to Raise Awareness on NCDs

The SANCDA report titled  “Crafting a Collective Advocacy Agenda in Support of a Sugar-Sweetened Beverages Tax in South Africa”, is contained in the document.
This goes to highlight the journey, problems and lessons learnt in the collective creation of a sugar tax in South Africa.
The journey to getting the tax to work for South African’s has barely begun. The areas of work coming from its implementation in April will be to ring-fence money from the tax collected to help fund civil society in prevention, awareness and care.
The SANCDA is honoured to have been published in the NCDs Atlas and look forward to the next publication and furthering the movement to a sugar-free South Africa.

Download the report here