1. STRATEGIC PLAN FOR THE PREVENTION AND CONTROL OF NON-COMMUNICABLE DISEASES
Briefing to the Portfolio Committee on Health
S A Singh
Cluster: Non-Communicable Diseases
Branch: PHC
24 May 2017
Cape Town 1

2. Contents Non-Communicable Diseases (NCDs) in South Africa:
4/6/2019
Non-Communicable Diseases (NCDs) in South Africa:
A health and developmental perspective
Implementing The Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013 – 2017: a Response to escalating disease
Achievements
Challenges
Considerations post 2017
Opportunities
Conclusion : Proposed New Policy Framework 2

3. Deaths by Cause BOD 2012 (MRC)
4/6/2019 3

4. Top 10 leading causes of death
BOD 2012 (MRC)
4/6/2019
Deaths related to NCDs accounted for 24.2% 4

5. Percentage of Deaths by Group Stats SA, 2015

6. Leading groups of Causes of Death – Stats SA, 20156

7. Top 10 Leading Causes of death 2014 vs 2015 (Stats SA, 2015)7

8. Top 10 Leading Causes of Death by Sex – Stats SA, 20158

9. Premature mortality attributable to NCD’s in 30-70 year olds9

10. Cancer Incidence 2006 vs 2012
Females 10

11. Cancer Incidence 2006 vs 2012
Males 11

12. Most common cancers in Children
Between 800 and 1,000 children are estimated to be
diagnosed with cancer annually (SA Children’s Tumour
Registry, NCR)
Acute lymphoblastic leukaemia (25.4% of all cancers)
Brain tumours and leukaemia comprise almost half of
childhood cancers in developed countries, brain tumours
represent only 13.4% of the total cancers diagnosed in
children in South Africa.
This discrepancy may be explained by failure to consider or
make the diagnosis, especially in smaller and rural hospitals. 12

13. Background
4/6/2019
Heading
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14. NCDs and Key Co-Morbidities
Non-Communicable Diseases
HIV/AIDS Cancer Cardiovascular Disease Stroke Sensory Impairment including Ear Conditions, Deafness & Hearing Loss, Blindness TB
Diabetes
Hearing Loss
Respiratory Conditions
TB Spine
Maternal Health
Hypertension
Gestational Diabetes
Maternal Nutrition
FAS
Women’s Health
Breast & Cervical Cancer
Child Health
Diabetes TI
Cancer
CVDs
Epilepsy
Asthma

15. National Development Plan 2030 recognizes the growing threat of NCDs to Development
“South Africa’s health challenges are more than medical. Behaviour and lifestyle also contribute to ill-health. To become a healthy nation, South Africans need to make informed decisions about what they eat, whether or not they consume alcohol, and their sexual behaviour, among other factors”.

17. National Response based on “Best Buys”
Strategic Plan for the Prevention and Control of Non-Communicable Diseases
4/6/2019
A National Response to Global call for Action (UN Political Declaration (2011):
Implement Multi-sectoral responses incl private sector and civil society
Reduce risk factors create health –promoting environments
Strengthen national policies and health systems
Increase research and development
Strengthen Monitoring and Evaluation
4 Priority NCDs & 4 common Risk Behaviour
National Response based on “Best Buys” 17

18. Common Risk Factors CARDIOVASCULAR DISEASES DIABETES CANCER
CHRONIC OBSTRUCTIVE PULMONARY DISEASES
MUSCULOSCELETAL
ORAL HEALTH
TOBACCO USE
UNHEALTHY DIET
PHYSICAL INACTIVITY
ALCOHOL

20. Vision and targets for reducing NCDs in South Africa.
A long and healthy life for all through prevention and control of non-communicable diseases.
A comprehensive approach to combating NCDs
Sub-strategy 1: Prevent NCDs and promote health and wellness at population, community and individual levels.
Sub-strategy 2: Improve control of NCDs through health systems strengthening and reform.
Sub-strategy 3: Monitor NCDs and their main risk factors and conduct innovative research.

21. Summit targets
Reduce by at least 25% the relative premature mortality (under 60 years of age) from Non-communicable Diseases by 2020;
Reduce by 20% tobacco use by 2020;
Reduce by 20% the per capita consumption of alcohol by 2020;
Reduce mean population intake of salt to <5 grams per day by 2020;
Reduce by 10% the percentage of people who are obese and/or overweight by 2020;
Increase the prevalence of physical activity (defined as 150 minutes of moderate-intensity physical activity per week, or equivalent) by 10%

22. Summit targets cont
7. Reduce the prevalence of people with raised blood pressure by 20% by 2020 (through lifestyle and medication);
8. Every women with sexually transmitted diseases to be screened for cervical cancer every 5 years, otherwise every women to have 3 screens in a lifetime.
9. Increase the percentage of people controlled for hypertension, diabetes and asthma by 30% by 2020 in sentinel sites; and
10. Increase the number of people screened and treated for mental disorders by 30% by 2030.

23. Key Achievements linked to the Strategy (1)
Policies/ Models of Care:
Scale up of the Integrated Clinical Services Management Model through the Ideal Clinic programme
Roll out of training – July 2017
NCD strengthening in Primary Care : Adult
Development of Health promotion Tool for Primary Care: Adult
NCD Integration in Adherence Guideline and Loss to Follow Up Plan
Training of PHC nurses on Diabetes Guideline
Approved Strategic Framework on Disability and Rehabilitation
Approval of National Policy Framework and Strategy on Palliative Care
svcb 23

24. Key Achievements linked to the Strategy (2)
Regulation on the Compulsory Registration on Cancer strongly supported updating the National Cancer Register since 1999
Cervical cancer screening coverage is moving toward meeting target: 2016/ and the target is 63
Policies on Breast and Cervical Cancer approved by the NHC
9 Year old girls receiving HPV vaccine to date – approx 1 million, considered best practice globally
Regulation on the Reduction of Sodium Content in certain foods
Dates on which Sodium reduction becomes effective 2016 and 2019
Engagement on proposed:
establishing taxation on SSB
Establishment of the National Health Commission 24

25. Key Achievements linked to the Strategy (3)
The Tobacco Products Control Act
Currently being amended to align with the WHO Framework Convention on Tobacco Control (WHOFCTC)
The proposed amendments are completed.
The draft Tobacco Bill is to be presented to the National Health Council Technical Committee on 8 Jun,  for onward approval of the NHC and the parliamentary process  will follow. 25

26. Key Achievements linked to the Strategy (4)
Inter government policy on Harmful use of alcohol
The lead department regulation of alcohol Department of Trade and Industry.
DTI coordinates the inter government policy regarding alcohol production, trade, and use.  In this regard, DTI produced a Liquor policy that was approved by Cabinet.
liquor Act being reviewed to implement the policy changes. The DTI is in the process of finalizing the Liquor Amendment Bill. Among other things, the bill deals with reducing access, curbing alcohol advertising and marketing, legal age for purchasing alcohol etc. 26

27. Challenges
4/6/2019
Measurement of achievement was compromised due to lack of initial baselines
Limited access to data collection tools, poor quality of data, compromised access to collecting parameters eg “controlled hypertension”
Demand for data at all levels varied
Poor data resulting in exclusion from key programmes eg CCMDD
Extent of priority allocated to implementation varied
Reported access to limited resources, stock outs
Extent of coordination of Prevention and Control varied
Extent of Buy in from relevant stakeholders varied
Reported poor “integration “ with Programmes 27

28. Process to develop new strategy commenced: what have we learnt?
Post
4/6/2019
Note achievements of linked policies and strategies
Obtain estimates or actual data : new source of data
Overcome impact of not having baseline data for effective management
Continuum of care, life course integrated approach
Focus on Prevention but don’t forget:
Adults and Children with diagnosed conditions
NB: Consult relevant programmes and stakeholders right from outset of planning in particular civil society,
Strive toward ; All of Government; All of Society Commitment
Process to develop new strategy commenced: what have we learnt? 28

29. Opportunity: Sustainable Development Goals
3.4 By 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment , and promote mental health and well being.
Reduce Modifiable RF
Health Systems
Access: technologies vaccines, medicines
Improve Surveillance

30. Conclusion: Proposed New Policy Framework
Overarching Policy Framework on Prevention and Control of NCDs:
to be read together with relevant Strategies and Implementation Plans
Urgent: Plan on Management and Control of NCDs
Proposed approval by March 2018
Planning involve all stakeholders from the outset
Person centered; cannot ignore social determinants of health
Health system strengthening including NCD Surveillance critical
Balance between Prevention and Management and Control
Optimise existing opportunities for implementation ;Ideal Clinic.
Promote “multi-sectoral” engagement, Common understanding to establish, strengthen and sustain “Multi-Sectoral” policies 30

31. Cluster: Non-Communicable Diseases
Thank you
4/6/2019
Sandhya A Singh
Director: Non-Communicable Chronic Diseases, Disability, Geriatrics, Eye Health, Palliative Care
Cluster: Non-Communicable Diseases
Branch: PHC
Tel (w)
Cell: 31