SUGGESTIONS FOR NAPHISA BILL By Prof Welile Shasha Public Health Specialist Household Surveys Foundation Pretoria www.hhsfoundation.co.za

Aim of Presentation To make 3 suggestions for legislation that can enable an integrated people- centred approach for disease control, using eradication of TB as an example.

Deaths from TB 2015 TOTAL 54 956 900 460 910 32 952 7.2 PROVINCE POPULATION ALL DEATHS 2015 DUE TB % NORTHERN CAPE 1 185 600 13 725 1 061 7.7 FREE STATE 2 817 900 31 891 2 098 6.6 EASTERN CAPE 6 916 200 68 303 5 874 8.6 NORTH WEST 3 707 000 33 343 2 738 8.2 LIMPOPO 5 726 800 50 448 3 071 6.1 WESTERN CAPE 6 200 100 50 068 2 663 5.3 MPUMALANGA 4 283 900 34 111 2 704 7.9 GAUTENG 13 200 300 97 982 5 401 5.5 KWAZULU NATAL 10 919 100 81 039 7 342 9.1 TOTAL 54 956 900 460 910 32 952 7.2

WHY SO MANY DEATHS? When TB is easily identified? When TB is eminently Curable? When TB is Preventable? When South Africa has got the resources to Eradicate TB in 10 years?

Weak Health System Community Dependence on Gov Poverty & Unemployment Three Main Reasons Weak Health System Community Dependence on Gov Poverty & Unemployment

Integrated People Centred Approach 100% Hosehold Survey in Municipal Ward Assistance of persons with Disease & Poverty – CHW/Community Care Givers Enabling Community Participation Enabling InterDepartmental Cooperation

100% Household Survey Motivation of Mayor & Ward Community; Recruitment & Training of Fieldworkers; Data Download, Analysis & Lists of Persons for TB, HIV, etc; and Social Grants, and Jobs; Assistance of Persons by Gov. Departments Community & Gov to own the Data

List of Persons with TB, Diabetes, Hypertension Village Head of Household Person Gender Age 1 Maya William Vaphi Nomsa Female 35 2 Khulu Mfanto Simon Male 39 3 Noma Mavuso Vuyiswa 32 4 John Booi Phumzile 49 5 Ntlakwefolo Novamna Zibi No amen 46 6 Tyuka Shange Sipho 7 Nonesi Vilani Siphenathi 52 8 Mkhukhwini Nowanisi Kalima Nozibongo 38 The lists are for action by the Department of Health; & WBOT’s will visit each household, and persons assisted

Distribution of disease in the households Maps open the way for collaboration in research & health promotion

Enabling Community Partnership Communities to pay R10.00 per Household (Local Gov to support) Legislation for Ward Health Committee Fund-Raising for Clinic Committees Oversight of Community Care Givers Negotiate with Doctors to work in Clinic

Please Legislate To Enable Eradication of TB, to ensure NHI Ward Health Committee, for Effective Community Participation InterDepartmental Cooperation People Centred Integration

Example: Cost of TB Eradication Process in Eastern Cape District Wards TB Deaths Perm_Jobs Temp_Jobs ESTIMATED COST Alfred Nzo 101 290 808 5 050 R55 752 000 Amathole 120 1 203 960 6 000 R66 240 000 Buffalo City 50 854 400 2 500 R27 600 000 Cacadu 73 421 584 3 650 R40 296 000 Chris Hani 111 701 888 5 550 R61 272 000 Joe Gqabi 45 264 360 2 250 R24 840 000 Nelson Mandela 60 885 480 3 000 R33 120 000 O R Tambo 146 1 256 1 168 7 300 R80 592 000 TOTAL 706 5 874 6 816 35 300 R389 712 000 Source: Statistics South Africa 2015 R552 000 per Municipal Ward

Thank You!