The social, health, and economic burden of non-communicable diseases (NCDs) to the South African economy and social fabric has not gone unnoticed. South Africa has frequently updated its strategies to combat NCDs in order to slow and even reverse their impact on GDP over time. In this blog we outline more recent NCD action in South Africa, research to support the action, and recommendations that consider where implementation is challenged and concerted efforts are needed to advance a multi-level, multisectoral, and multi-actor integrated approach.
The importance of NCD action in South Africa
Addressing NCDs is an enormous challenge, everywhere. The growing burden of NCDs in South Africa led to political commitment from the government at the UN High Level Meeting on NCDs in 2011. South Africa enhanced its efforts by developing the National Strategic Plan for the Prevention and Control of NCDs 2013–2017, followed by the National Strategic Plan for the Prevention and Control of NCDs 2020–2025. This strategy aims to help South Africa to achieve Target 3.4 of the Sustainable Development Goals (SDGs) (By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being). The strategy will simultaneously address several other SDGs that are impacted by NCDs.
In order to support evidence-informed interventions and approaches to NCD prevention, research and implementation teams have partnered across the country to provide the government with context-relevant evidence to guide decision-making. One such research consortium is the Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+).
Research to guide NCD action in South Africa
CEBHA+ (2017–2023) aimed to:
- establish long-term capacity and infrastructure for evidence-based healthcare and public health in sub-Saharan Africa;
- strengthen African research institutions; and
- build competence in the understanding and rapid uptake of evidence in health system institutions.
Three South African institutions – Stellenbosch University, Cochrane South Africa, and the Chronic Diseases Initiative for Africa (CDIA) – worked together to produce research evidence and then translate these into policy and practice implications for key NCD stakeholders.
Often research teams do great research but fail to share that information appropriately with the intended users. The CEBHA+ team incorporated an Integrated Knowledge Translation (IKT) approach, which engages stakeholders throughout the research process – from priority setting to results integration – and ensures that the evidence is tailored to the various end-users.
In South Africa, the CEBHA+ team focused on research related to screening diabetes and hypertension, integrated models of care for diabetes and hypertension, and population-level interventions to prevent diabetes and hypertension. These were all priorities identified in collaboration with the Western Cape and National Departments of Health at the start of the project and aligned well with the existing NCD strategic plan. The results of these studies were shared through meetings, conferences, academic peer-reviewed publications, issue briefs, and policy dialogues. This paper explains how IKT was employed to advance noncommunicable disease policy and practice in South Africa.
Issue Briefs for policy and practice: A tool for communicating action
Given that most research is not packaged for decision-makers, doesn’t include suggested actions, and often ignores the real-world implications of recommended actions, the CEBHA+ team summarised the various studies in Issue Briefs that highlighted the problem, the suggested solutions, and the implications of those actions.
What was found and what needs to be done by the National and Provincial Departments of Health in South Africa?
The research recommendations have implications for different actors and stakeholders. For the Departments of Health it is imperative to understand the results and what actions are required on their part.
Implications for implementation
- Much of this is only going to be possible using a multisectoral approach.
- Engage stakeholders from all levels of policymaking, prevention, and management from the planning stages onwards to ensure appropriate and effective implementation.
- Partner with researchers and funders to ensure that planned and ongoing programmes are evaluated adequately to inform future cost-effective policies. M&E requires involvement across sectors.
- The health information system should document the reach of effective PEC, and medical records should both record what PEC has been given and support continuity of care.
- Increase the health workforce: Approx 450 CHWs per million people are needed to screen the entire adult SA population for CVD (~20,000 of the 700,000 CHWs proposed by the South Africa National Planning Commission).
- Buy-in from a variety of actors will require genuine and authentic engagement by government.
- Address challenges at primary healthcare level such as staff shortages, drug stock-outs and malfunctioning equipment to ensure sustainability of integrated care.
- Primary-care providers will need training to become experts in NCDs and the lifestyle modifications and communication skills that motivate and empower patients.
- PEC will need to be supported with educational resources and supplies.
We recognise that there is other evidence and there will be new data that should also be considered. While it is unlikely that the above recommendations and implications will be a surprise for the NDoH, we urge key decision-makers to be guided by the evidence to implement these recommendations in full. Otherwise, the next strategy will have the same concerns and recommendations with no sign of progress.
The question is: Will these results, and those of other research teams, compel action – so that we can move beyond intention and implement change? Let’s hope so!
All of the CEBHA+ Issue Briefs are available to download:
- Population level interventions targeting risk factors for diabetes and hypertension in SA: moving from policy to action
- Integrated care for multimorbidity in South Africa
- Screening for hypertension: Still critical! But what strategy is best?
- Training community health workers for CVD risk screening: a call to action
- Implementing new approaches to patient education and counselling for NCDs
- The prevalence of multimorbidity in people living with HIV and on ART attending Gugulethu community health clinic
- Preventing non-communicable diseases in South Africa: Time to evaluate what works
For access to peer-reviewed publications linked to each of these Issue Briefs see the publications sections of the CEBHA+ website.
Acknowledgements: The author would like to thank Anke Rohwer, Peter Delobelle and Taryn Young for their contributions to this blog. The research mentioned in these Issues Briefs was funded by the German Federal Ministry of Education and Research.
Disclaimer: The views expressed in published blog posts, as well as any errors or omissions, are the sole responsibility of the author/s and do not represent the views of the publisher, its secretariat, advisory or reference groups, or its funders; nor does it imply endorsement by the aforementioned parties.
 CEBHA+ consists of seven African partners in Uganda, Malawi, Rwanda, Ethiopia, and South Africa, and two German partners. It was funded by the German Federal Ministry of Education and Research (BMBF) as part of the Research Networks for Health Innovation in Sub-Saharan Africa Funding Initiative.