The SANCDA supports the prioritization of phase 2 vaccination. However, how this is to happen is less than transparent. PLWNCDs and related civil society organisations keep asking for transparent processes and policy for phase 2 vaccinations. South African policy must show the priority comorbid health conditions which place PLWNCDs at greatest risk for severe COVID-disease or death.
- Publish – COVID-19 deaths statistics by comorbidity/ underlying conditions.
- Compile – priority evidence-based list of comorbid conditions for phase 2 COVID vaccination.
- Communicate with public sector “health users” in phase 2 COVID-19 vaccination
1) Publish – COVID-19 deaths stats by comorbidity
The SANCDA want the ongoing publication on COVID-19 deaths according to the main underlying comorbidities. Civil society believes the release of this information is essential for transparency. The NDoH has this information for hospitalised patients. Sadly the format of publication doesnt show linked comorbidities.
However, before COVID-19 people who die outside of a hospital, the cause of death is notoriously poorly recorded. The challenge to the data collection is a long-standing issue. The most recent report from the 2016 cause of death statistics shows that 32.5% of reported deaths has this information missing. The top category of death is NCDs in 2016 but there has not been a publication on cause of death in SA since then.
This information is critical to ensure that the limited number of doses 12 million (6 million people we think) go those in greatest need according to facts.
The challenge is that outside of the NCDs sub directorate, the NDoH does not respond to our many requests for information. The NCDs civil society experience is that the long-held NDoH priority conditions of HIV, TB and malaria always remain just that. NCDs may get a mention and usually only diabetes and hypertension. So we want all of society to ask on behalf of the people living with NCDs.
2) Compile priority evidence-based list of comorbid conditions
So far in this pandemic we havent seen any transparent evidence based list of priority comorbid conditions. So how is this the priority to be determined? Compared with Millenium Development Goal (MDG) conditions like HIV/TB there are few NCDs indicators as shown in the National Indicator Data Set 2016.
South African health policy appears to be silent on how health priorities are determined. One of the few policies that address the needs of the population (priorities) is still in draft format and relatively recent, NHI Bill 2019.
PLWNCDs and their representative organisations wish to participate in and have a transparent evidence-based process to determine priority need and the criteria upon which this is based.
3) Communicate unambiguously with public sector users
The SANCDA asks for transparent clear communication on how people without health insurance/ medical aid will be selected and notified of vaccination date and time.
There are no adequate health systems information for people with NCDs. The current NHI health systems information is based on HIV and MDG information.
MDG conditions formed the basis for the development of health systems strengthening information system development and programmes such as the “Ideal Clinic.” integrated chronic disease management and CCMDD are all examples.
See the CCMDD access to medicines information and raise a storm.