Non-communicable diseases (NCD), in particular diabetes mellitus, cardiovascular disease, cancer and chronic respiratory diseases, which share common risk factors, can no longer be allowed to flourish as a silent epidemic, as they account for 60% of all deaths globally. The vast majority of these are in developing countries. The United Nations Resolution in May 2010 called for the convening of a high-level meeting of the General Assembly, on the prevention and control of NCDs in September 2011. This high-level meeting was intended to give political impetus to the efforts necessary to combat these diseases.
The Gauteng Department of Health and Social Development (GDHSD) hosted a high-level summit on NCDs on 5 July 2011 in Sandringham, Johannesburg. The summit primarily aimed at developing a position paper detailing a NCD Agenda for the Province, aligned to the agenda issued by the NCD Alliance and formulated with the assistance of relevant stakeholders. The summit was attended by National and Provincial Departments of Health, Non-Governmental Organisations (NGO), universities, research institutions and other stakeholders involved in NCD prevention, control and management in the Province.
The event was divided into three sessions:
The Opening Session was chaired by the Chief Director of District Health, Mrs N Mekwe, who emphasized the importance of NCDs in the context of the re-engineering of Primary Health Care which is currently underway in South Africa. Mr Sagie Pillay (CEO, NHLS) drew attention to the fact that South Africa has a burden of NCDs 2-3 times that of other developing countries and the large amounts of money spent on health care has not translated to improved health outcomes. He stressed that collaboration and government partnerships with the private sector, NGOs, academia and civil society would be fundamental to success. The NHLS has a major role to play as a laboratory service in screening, diagnosing and monitoring NCDs, as well as promoting new technologies like point of care testing. Additionally, the NHLS in collaboration with Virgin (Richard Branson) and the Department of Health (DoH) has plans to establish the National Institute for Non-Communicable Diseases in Sandringham which should play a key role in data generation and monitoring and evaluating NCD care in the country.
Dr Kamy Chetty (Head of Department, GDHSD) stressed that the Department is cognisant of the health problems faced and it is now time for policy implementation and innovative approaches at ground level. She highlighted that NCDs are preventable, but neglected and there is a dire need to re-orientate the healthy lifestyles campaign concentrating on prevention and promotion in addition to treatment and cure. Dr Chetty identified community health workers (CHW) as an invaluable resource and spoke of a pilot project with a CHW team attending to 200-300 households. She also stressed the need for adequate financial resources to carry out the projects.
The key-note address by Madam Excellency Bongi Ngema-Zuma emphasized the dramatic increase in the number of individuals suffering from diabetes mellitus from 250 to 350 million in 2010, highlighting her own familial experiences with diabetes mellitus. Madam said her foundation works at community level and aims to spread the word amongst communities. She emphasised education as being the best intervention South Africa could invest in. The BNZ foundation focuses on diabetes among Blacks and makes use of schools and churches to educate individuals in the community. She highlighted an experience where her foundation partnered with a pharmaceutical company in providing screening tests including blood pressure, glucose, cholesterol and weight for 1800 women in a day as part of the initiative. Madam concluded saying that sound and sustainable partnerships and a concerted effort to curb complications are fundamental to a reduction of NCD related morbidity and mortality.
The second session was the Stakeholder Discussion bringing together key role-players in NCDs in Gauteng. The NGOs embraced the opportunity for inter-sectoral collaboration and welcomed the opportunity to forge links with other NGOs and the government as they believe many of the issues they face within their organisations are cross cutting with the agendas of other organisations. There was a resonating theme of bringing the user voice to the fore emphasised by Reach for Recovery and the Treatment Action Campaign. The presentation by the Treatment Action Campaign highlighted the challenges they encounter but importantly stressed the massive gains made in the management of chronic diseases. Prof Jeffery Wing (Head: Clinical Medicine, Charlotte Maxeke Johannesburg Academic Hospital & University of the Witwatersrand) presented a synopsis of an inner city ART intervention (linking primary, secondary and tertiary levels of care) as a possible model for NCD control. The Summit also potentially unveiled the opportunity to expand communications and collaborations beyond South African borders through pre-existing associations e.g. the South African National Tuberculosis Association (SANTA) and the International Union Against Tuberculosis and Lund Disease (IUATLD), and Diabetes South Africa and the International Diabetes Federation. The underlying message was clear from the NGOs attending: to support the goals of the NCD Summit and commit to working with the DoH to ensure effective NCD care throughout South Africa, as well as affiliate with other organisations.
The purpose of the third session was the development of the Summit Declaration – a tool to map strategies and initiatives that guides the management and control of NCDs in Gauteng in moving forward. Prof Melvyn Freeman (Cluster Manager NCDs, National DoH) emphasized the need for true inter-sectoral collaboration within government departments to control NCDs with greater focus on cost-effective prevention campaigns rather than treatment provision. Health service provision should be patient-centred rather than disease-centred. The National DoH has several objectives for assisting provinces to prevent and manage NCDs including health promotion campaigns, doing collaborating work with other government departments/NGOs/CBOs, making structural changes in our communities to promote healthy lifestyles, and aligning strategic and operational plans between national and provincial governments. The following commitments were made by the Provincial D0H:
Dr Chika Asomugha (Medical Manager & Acting Director: Public Health, GDHSD) expressed concern regarding the high prevalence of NCDs in Gauteng and highlighted the aims of provincial government to reduce the prevalence significantly by 2014. The Gauteng DoH initiatives include training clinicians in the management of NCDs, establishing support groups for people living with NCDs and surveillance and training in Rheumatic Heart Disease and Rheumatic Fever to better equip clinicians in managing these conditions. The Department has capitalized on awareness days such as the World Diabetes Day to conduct mass screening and refer newly diagnosed patients for treatment. Increasing prevalence of NCDs, disabilities and premature death despite interventions means that much is still to be done.
The round table discussion was chaired by Professor Petrus Rautenbach (Head: Department of Community Health, University of Limpopo) and Professor John Matjila (Head: Department of Community Health, University of Pretoria). The call was for further strengthening of existing partnerships between the private sector, NGOs, research institutions and academic institutions. Resources will need to be made available to ensure successful implementation of these plans. Areas to consider include:
The discussion was aligned to the NCD Alliance 10 Proposed Priority Outcomes document, and written up in a Declaration of the summit. https://sites.google.com/site/gautengncdsummit/summit-details/summit-event-details
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