Vicki and David Pinkney-Atkinson
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.