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.
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.
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