#EnoughNCDs campaign targeting the UN High-Level Meeting on NCDs 2018

In September 2018 the United Nations High-Level Meeting  on NCDs (UN HLM NCDs) takes place. People around the world are joining together to say: “We have had #EnoughNCDs and action is needed. Now!”

The SANCDA joins the global campaign convened by NCD Alliance together with our global network of people and organizations. We demand that our government prioritize NCDs as they have promised to do since 2011. So we are calling for governments to act going into the UN HLM NCDs.
This is what we are asking for as South Africans:

1. Put people first – you and me who live every day with NCDs.
2. Boost NCD investment so that empty promises stop and there is NCDs action.
3. Step up action on childhood obesity but don’t forget to beat childhood malnutrition in all of its forms.
4. Adopt smart fiscal policies that promote health and then put some money into NCDs prevention and treatment.
5. Save lives through equitable access to NCDs treatment through universal health coverage (NHI).
6. Improve government accountability to the people for progress, results and resources.

Please join us! You can show your support  for the cause by championing a leader or personality who will support the fight against NCDs. Please contact us with your ideas and suggestions. We would love to hear from you. requests. For further information please checkin the  back with the SANCDA  for more on the movement and campaign as it progresses.

 

.

 

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).

A Start -10 Draft Cancer Prescribed Minimum Benefits (PMBs) + plus 1 added

PMBs are a vital tool used by medical schemes because they explain the minimum services for which your medical scheme will pay. These are the “benefits” of belonging to a private medical scheme. As beneficiaries, we must know about these rather than the number of free movies!

The PMBs have been a bone of contention for over a decade because they are outdated and don’t reflect current practice and care. Usually to the user’s detriment. The custodian of PMBs is the Council for Medical Schemes (CMS). Remember, PMBs are just as important for public sector care as this is the process that will be used to start the NHI care benefits.

NCDs categories at last

A recently published draft PMB benefit classification refocuses on health services. The change, from long-criticised disease /condition related benefit packages to one based on services, is welcomed. Look at the draft, it and give your comments. These are your health care benefits which serve as a minimum package that must be available in different settings from a primary care setting to hospitals.

More work is needed to further expand the categories to include the setting in which the service must be accessed:

The classification includes NCDs and communicable diseases in one category. This is probably meant to reflect that the chronic and comorbid nature of the conditions: The SA NCDA hopes it heralds integrated health care. These are the elements of NCDs care:

  • Screening and assessment of risk factors and co-morbidities
  • Initiation of early treatment
  • Screening and management of complications
  • Follow up and monitoring of treatment adherence
  • Interpretation of common laboratory and radiological results
  • Specialised geriatric care, including foot care
  • Referral to a higher level of care when required.

PMB cancer definition starts

The  PMB Benefit Definition Project (started in 2010) must clarify the benefits to which medical scheme users are entitled in terms of the Medical Schemes Act (131 of 1998). Sadly, these guidelines lack a legal status.

The project is a CMS-led process that uses criteria to define the prevention and treatment for a specific condition. There are lots and lots of conditions to get through. Cervical cancer, a major problem, has yet to be published.
A CMS-appointed Clinical Advisory Committee (one per medical discipline) with members drawn from medical and health professions, funders (medical schemes) and patient groups. However, the mechanism of patient group involvement is neither clear nor transparent. Patient groups need to be vigilant on this matter as the CMS does not have a clean record of including patients or “users” in a meaningful way.

Eleven  PMB draft definitions released in the last year all relate to cancer. Medical scheme users should comment to make it relevant. There is no time limit for comments stated in the drafts but another newsletter version shows it to be about 3 weeks from release date. However, you are encouraged to comment no matter the timeline as these are your benefits and make sure that they meet your needs.

Draft PMB definition guideline title with links Date released
1.     Non-small cell lung cancer 26 Feb 2018
2.     Medical nutrition therapy in palliative care (adults) 12 Feb 2018
3.     Small cell lung cancer 1 Feb 2018
4.     Mesothelioma 25 Jan 2018
5.     Hepatocellular carcinoma 6 Dec 2017
6.     Early stage colon and rectal cancer 2nd edition 4 Sept 2017
7.     Metastatic colon and rectal cancer 2nd edition 4 Sept 2017
8.     Early stage pancreatic cancer 2nd Edition 31 Mar 2017
9.     Early stage oesophageal cancer 2nd edition 31 Mar 2017
10.  Best supportive care for 4 cancers 2nd edition 31 Mar 2017
11.  Early stage gastric/ gastro-oesophageal junction cancer 2nd edition 31 Mar 2017

CMS Script on oesophageal cancer

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.

NCDs coordinating body for South Africa

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.