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It’s a plan! The new NSP for NCDs. July 2022
BETTER HEALTH PROGRAMME SOUTH AFRICA
CASE STUDY
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JULY 2022
IT’S A PLAN!
THE NEW NSP FOR NCDs
Deputy Minister of Health Dr Sibongiseni Dhlomo with community health workers, Somerset East, NSP launch.
One bright wintry morning in May, people gathered on a playing field in a small township in the Eastern Cape province. This was no ordinary community meeting, but an occasion to commemorate World No Tobacco Day and launch the government’s new national plan to combat noncommunicable diseases (NCDs). Local community health workers set up a smaller tent outside the main marquee to check the blood pressure of willing participants, and mobile clinics were offering screening for other noncommunicable diseases as well as advice on quitting smoking. This was the healthy festive atmosphere that welcomed speakers including the Deputy Health Minister, Dr Sibongiseni Dhlomo, dignitaries from the Eastern Cape government, and representatives from the World Health Organization, the British High Commission and civil society organisations.
NSP launch, Somerset East, left to right: Atiya Mosam (BHPSA technical writer), Prof Debashis Basu (Steve Biko academic Hospital), Tori Bungane (British High Commission Health Attaché), with Razana Allie and Busi Nkosi representing the SANCD Alliance.
THE LAUNCH ABOUT THE PLAN
Dr Owen Kaluma from the WHO Country Office spoke about the growing burden of NCDs on the continent and Myles Ritchie from the UK-funded Better Health Programme South Africa (BHPSA) spoke about the importance of partnerships in the implementation of the new multisectoral National Strategic Plan for Non-communicable Diseases (2022-2027). Dr Dhlomo used his keynote speech to focus on smoking data released as part of the Global Adult Tobacco survey. The survey, conducted in South Africa by the SA Medical Research Institute, showed that 29% of adults (41.7% of men and 17.9% of women) are currently using tobacco. Dhlomo said “These results are demonstrating the urgency for government to tighten regulatory measures to control tobacco. The GATS results will address some of the clauses of the draft Tobacco Bill [Control of Tobacco Products and Electronic Delivery Systems Bill] that is currently being processed.” Dhlomo is also concerned about the expense of smoking. “South Africans spend about R263 per month on manufactured cigarettes. That is 75% (three-quarters) of the monthly COVID-19 social relief of R350,’ he said. “Cigarettes exacerbate poverty.” After the launch, he told a journalist from the SABC that the government would ramp up its anti-smoking awareness campaign. While industry objects to the potential loss of R12billion to the economy, Dhlomo said the actual cost of premature death and illness from smoking is R43billion – nearly four times greater. The National Strategic Plan for the Prevention and Control of Non-communicable Diseases (2022-2027) aims to move the country closer to the Sustainable Development Goals of reducing premature mortality from NCDs+ by one third by 2030. (The + indicates mental disorders and disabilities in addition to conventional NCDs such as diabetes and hypertension). The NSP was developed by a team of experts and validated through a lengthy consultation process that included all stakeholders within and outside of the health system. This important process was facilitated by an expert writer funded by BHPSA.
(Left) Sandhya Singh, Director: Noncommunicable Diseases; National Department of Health (Below) Dr Sibongiseni Dhlomo (Deputy Minister of Health) with Vimla Moodley (BHPSA NCD lead) left, and Tori Bungane (British High Commission Health Attaché) right, at NSP technical launch, Johannesburg.
5 NCD s
Cardiovascular
Unhealthy diet
Chronic respiratory
Tobacco use Cancer
Harmful use of alcohol Diabetes
Physical inactivity Mental and neurological
Air polution5 RISK FACTORS
Figure 1: 5x5 strategy
Two key strategies of the NSP are:
■ The 5x5 strategy. This refers to approaches to address the five major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and mental health, including neurological conditions); and the five behavioural risk factors for NCDs (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution). ■ A cascade providing targets for hypertension and diabetes outcomes. The NSP has adopted a 90-60-50 cascade for diabetes and hypertension, meaning that by 2030: • -90% of all people over 18 will know whether they have raised blood pressure and/or raised blood glucose. • -60% of those diagnosed with raised blood pressure or blood glucose will receive intervention; and • -50% of people receiving interventions are controlled.
It is the first time South Africa has used a cascade approach, which has been so successful for tracking and advocacy for HIV treatment globally.
The five detailed goals of the NSP are to:
• Prevent and control NCD+; • Promote and enable health and wellness across the life course; • Ensure people living with NCDs+ receive integrated, people-centred health services; • Promote and support national capacity for high-quality research and development for the prevention and control of NCDs+; and • Monitor strategic trends and determinants of
NCDs+ to evaluate progress in their prevention and control.
The NSP spells out detailed activities to achieve each one of these goals. The provincial departments of health are responsible for implementing the NSP through the district health system. Other health and non-health stakeholders are also critical to the success of this multisectoral plan.
WHO’s Joseph Mwangi Kibachi wakes up the meeting, NSP technical launch, Johannesburg. Dr Vicki Pinkney-Atkinson, Director of the SA NCD Alliance (SANCDA), left and Vimla Moodley, BHPSA NCD lead at the NSP technical launch, Johannesburg
WHAT HAPPENED NEXT
At the end of June, the National Department of Health (NDoH) hosted a WHO-funded consultation with the provinces on the NSP. This was the technical launch of the NSP, in which provinces presented the first drafts of their NCD implementation plans for the next five years. A range of NCD experts and stakeholders also presented at the meeting, adding a rich context for provincial planners. Civil society speakers included Dr Vicki Pinkney-Atkinson, Director of the SA NCD Alliance (SANCDA) who said “I am so thrilled with this strategic plan, and I am so thrilled that the provinces are here. It has to work, and it has to work for me!” Pinkney-Atkinson praised the multisectoral process of developing the plan, saying that since 2020 SANCDA had worked hard to ensure that the plan reflected the needs of people living with NCDs. She also spoke about her trials in accessing NCD care in the public sector. The director of NCDs in the NDoH, Sandhya Singh, gave a high-level overview of the plan and stressed that a paradigm shift is needed at all levels to prioritise NCDs. She said, “Provincial and civil society teams will be the true champions”, in ensuring the NSP goals are met. She identified surveillance as one of the biggest health system challenges to measuring, and therefore meeting, the NCD targets. BHPSA participated actively in the planning of a dedicated session at the technical launch on the challenges of NCD surveillance and data systems.
Download the full NSP here…
Read more about the GATS/SA survey here…
BHPSA is a health system strengthening programme funded by the UK government through the British High Commission in Pretoria and managed by Mott MacDonald.
