Roselyne Sachiti Features, Health & Society Editor
SADC is grappling with health challenges, especially on non-communicable diseases (NCDs) that have affected both the rich and poor indiscriminately.
In Zimbabwe, Malawi, South Africa, just to name a few, the disease burden as a result of various cancers, cardiovascular diseases (like heart attacks and stroke), chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes, has kept ordinary people, health officials, research scientists and policy makers alike awake as they try to figure out what has hit the region and how best to solve the headache.
Because of the increase in non-communicable diseases, communities are trapped in what seems to be a spider web — difficult to untangle. In most SADC countries, it has become norm for people to miss work on countless days due to illness. The situation is worse for the self-employed.
First, being absent from work means no earnings for that day, week or even month if illness is prolonged. In the worst case scenario, people die as a result of these NCDs, stripping SADC countries of their valued human resource capital.
For example, in Zimbabwe, the World Bank estimates that cause of death, by NCDs (percentage of total population) stood at 33 percent in 2016. In Malawi, cause of death, by NCDs (percentage of total population) was at 32 percent in 2016. Cause of death by NCDs in South Africa stood at 51 percent.
Then second, such loss of earnings as a result of NCDs has a clear negative impact on the economies of SADC countries. At the annual Board of Health Funders of Southern Africa conference currently underway in Cape Town, South Africa, health funders and government officials from Southern African countries that include Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland and Zimbabwe converged to discuss issues affecting the health industry, seek solutions and share ideas on best practices.
BHF comprises 60 medical aid providers and 20 member boards from the SADC region. What was clear from the four-day meeting is that the economic sustainability of the SADC region is dependent on the health of its population at a time NCDs continue to stalk the region.
South Africa’s Minister of Health Dr Zweli Mkhize said in his country, the major challenge facing the health system is the increasing burden of disease and the twin epidemics of communicable and non-communicable diseases.
“This has been compounded by the challenges of shortages of staff and medicines, aging infrastructure, inequity of access to the health system and inadequate equipment, among others. The country also faces the challenge of low economic growth, inequality, poverty and unemployment.
“This conference also takes place at the appropriate time, as the global community grapples with challenges of inclusive growth and sustainable development,” Dr Mkhize said.
He revealed that South Africa, as part of the global community, was preparing for the 74th United Nations High-Level Meeting (UN-HLM) on Universal Health Coverage (UHC) as part of the UN General Assembly. whose theme will be “Universal Health Coverage: Moving Together to Build a Healthier World”.
“This meeting provides us with an opportunity to reassess our progress towards the UHC goal by mobilising the highest political support for UHC while leaving no one behind. He added that Universal Health Coverage was also a critical component of Sustainable Development Goals (SDGs) as contained in Goal 3 and Target 3.8 of the SDGs.
“It compels us that by 2030, countries should have reached the goal of providing financial risk protection, access to quality essential health services, medicines and vaccines for all. It also emphasises the importance of building strong, resilient health systems for UHC,” he added.
Dr Mhkize revealed that during his recent State of the Nation Address, South Africa’s President Cyril Ramaphosa instructed them to attend to the capacity of the health facilities as they implement NHI.
“The president provided leadership in resolving what has been called the crisis in the health sector through the process of developing social compact for the health sector. The Health Compact process emanated from the deliberations of the Presidential Health Summit that was held in October 2018.
“The outcomes of the Presidential summit are contained in the nine pillars in the Health Compact and are in line with the National Development Plan deliverables. Many stakeholders, including some among yourself present today, participated in the process of developing the Health Compact.
“We have now reached a stage where the Compact is ready to be signed, committing ourselves to collaboratively work together to solve the issues identified. This Compact will be signed on July 25, 2019 with the President of the Republic of South Africa, and the progress will be reported on periodically.”
The signed Compact will confirm and guide the partnerships between government, the private sector, academia, health professionals, civil society and organised labour. South Africa, the economic hub of SADC, is home to millions of immigrants from Zimbabwe, Mozambique, Malawi and Zambia among others who live and work in various fields.
According to the mid-year population estimates report for 2018 released by Statistics South Africa, the country is estimated to receive a net immigration of 1,02 million people between 2016 and 2021. All these migrants will at some point require health services that include maternal and reproductive health, mental, emergency, etc, offered in this country.
Dr Mkhize told The Herald that all foreign nationals living and working legally in South Africa will be taken care of under the proposed National Health Insurance (NHI). He added that the system had factored in all foreign nationals who were properly documented.
“There are two types of non-South Africans here. There is one type that is here and Home Affairs knows them and has given them some form of authorisation to be in the country. These include those with resident and work permits or those that have sought asylum. Those will be taken care of within the NHI because the system knows they are here,” he said.
Dr Mkhize said under the new scheme, it would be difficult to capture undocumented foreigners. “Then there are those who are undocumented. Illegal, unknown. How do you deal with them? That is a difficult one. “How do you deal with people you do not know?” he said.
Health is crucial as it is a key driver of economic development in the SADC region. Multiple studies have demonstrated the positive relationship between health expenditure and economic growth. Kiara Health South Africa president and chief executive officer Dr Skhumbuzo Ngozwana said good health has a general contribution to the Gross Domestic Product (GDP) as it increases life expectancy, decreases morbidity and mortality.
He said when communities are healthy, there is decreased absenteeism from work and school. This, he said, results in increased productivity. “Increased productivity means healthy people work longer and harder. This also increases foreign exchange earnings (MT, exports of LP, clinical trials, etc).
“Good health is also a driver of innovation and entrepreneurship (drives research and development, new innovations, new business models, increased collections by the fiscus),” he explained.
He added that health is an employment engine (direct on the supply side, and indirect, for example, MT — travel agents, hospitality, airline — SAA; forex earnings, positive trade balance, strong currency, reducing inflation. India MT earned US$2,8 billion and US$10,6 billion in 2014 and 2018, respectively.
According to Dr Ngozwana, the United Nations Economic Commission for Africa (UNECA) estimates that Africa’s health sector represents a massive investment opportunity of US$66 billion annually. He revealled that imported medicines cost Africa an estimated US$14 billion annually.
“Healthcare spending in Africa is very low — accounting for only 2 percent of the US$9,7 trillion in global healthcare spent in 2015, yet the continent has 14 percent of the global population and 25 percent of the global disease burden
“US$260 billion health market by 2030, and 15 percent of business opportunities in global health are projected to be in Africa,” he pointed out.
As NCDs continue to lurk in SADC, the regional bloc has responded to the imminent rise, despite being hamstrung by financial challenges. SADC addresses NCD monitoring and risks in Article 13 of its Protocol on Health.
This article encourages member states to “adopt appropriate strategies for the prevention and control of non-communicable diseases.”
SADC member states signed the Protocol on Health on August 18, 1999 to coordinate regional efforts on epidemic preparedness, mapping prevention, control and, where possible, the eradication of communicable and non-communicable diseases.
Education and training, efficient laboratory services and common strategies to address the health needs of women, children and vulnerable groups are discussed within the Protocol. The Protocol encourages the establishment of institutional mechanisms within the health sector of the region to effectively implement the Protocol. According to a paper by BMC public health titled “Non-communicable disease prevention policy process in five African countries”, countries have made efforts in developing NCD prevention policies and adopting the WHO “best buy” interventions.
The six countries under study, South Africa and Malawi included, had all developed NCD strategic plans consistent with WHO global NCD Action Plan, but these policies had not been adequately implemented due to insufficient political commitment, inadequate resources and technical capacity as well as industry influence.
Other countries like Zimbabwe, through the Ministry of Health and Child Care, developed a national NCDs policy. In the case of NCDs, Zimbabwe has adopted a National Health Strategy spanning from 2016-2020, dubbed “Equity and Quality in Health: Leaving No One Behind”.
The strategy provides the framework that guides the efforts by Zimbabwe’s Ministry of Health and Child Care and all stakeholders in contributing to the attainment of the SDG3 (Sustainable Development Goal 3)”. Zimbabwe also developed a national NCDs policy, a palliative care policy, and has engaged United Nations agencies working in the country, to assist in the development of a Cervical Cancer Prevention and Control Strategy to cover the period 2016-2020.
Malawi’s 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Programme was established with subsequent development of a National Action Plan for the Prevention and Management of NCDs launched in 2013.
As the regional bloc continues to find ways of dealing with NCDs, it is also important for member countries to invest heavily in the research and development of vaccines and possible cures by funding young scientists in the region.
It is also important for SADC governments to ensure promotion of health seeking behaviour among men, who usually go for medical treatment when it is too late.
Feedback: [email protected];