National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022-2027

Objectives

The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases, 2022–2027 seeks to secure a long and healthy life for all through equitable access to integrated, people-centred prevention and control of non-communicable diseases and related conditions, including mental health, neurological conditions and disability.[1]Its mission is to promote health and wellness while reducing avoidable and premature morbidity, disability and mortality across the life course, within the Sustainable Development Goals framework.[1]

The Plan supports Sustainable Development Goal target 3.4: reduce premature mortality from non-communicable diseases by one third through prevention and treatment by 2030, while promoting mental health and wellbeing.[2][1]It applies a rights-based, equity-focused and universal-health-coverage approach, emphasising integration, community engagement and empowerment, and action across the life course.[3][4]

• Prioritise cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and mental health including neurological conditions, alongside tobacco use, unhealthy diet, physical inactivity, harmful alcohol use and air pollution.[3][5]
• Strengthen leadership, accountability, partnerships, multisectoral collaboration, advocacy and implementation capacity for prevention and control.[6][7]
• Promote health and wellness by reducing behavioural, environmental, social and commercial determinants of ill health through prevention, health promotion and policy action.[4][2]
• Ensure integrated, people-centred services for prevention, diagnosis, treatment, adherence, rehabilitation and palliative care across the continuum of care.[4][8]
• Build national capacity for high-quality, context-specific research, dissemination and translation of evidence into policy and practice.[4][9]
• Enhance monitoring, evaluation, surveillance and use of data on non-communicable disease trends, determinants and programme performance.[10][9]

The Plan frames prevention comprehensively, spanning primordial and primary prevention through policy and environmental change, risk-factor reduction, screening and early intervention, and tertiary prevention through rehabilitation and palliative care.[11]It also recognises multimorbidity and interactions between non-communicable diseases, tuberculosis, HIV and COVID-19, reinforcing the need for coherent care rather than disease-specific silos.[12]

Implementation

Implementation combines a health-in-all-policies, whole-of-government and whole-of-society model with integrated, people-centred health services.[3][2]The National Department of Health provides national policy leadership, strategy, coordination, oversight and overall monitoring, while provincial departments of health and district health systems adapt and implement plans according to local needs, resources and service contexts.[6][13]

• Develop multisectoral mechanisms, stakeholder-engagement platforms, expert groups and policy-cohesion arrangements at national, provincial and district levels.[7]
• Engage government departments, civil society, communities, people living with non-communicable diseases, professional bodies, researchers, academic institutions, development partners, private providers and suppliers.[14][15]
• Strengthen primary healthcare and district health services, with referral and counter-referral links to secondary and tertiary care, rehabilitation and palliative care.[8][16]
• Develop context-specific health-benefit packages, workforce plans, affordable access to essential medicines and basic technologies, facility training and self-management support.[9]
• Implement care pathways, multidisciplinary teams, clinical governance arrangements and quality-assured services responsive to age, gender, culture, vulnerability and multimorbidity.[17][16]
• Apply lessons from HIV and tuberculosis programmes, including care cascades, treatment literacy, self-management, differentiated care, group support and improved access to essential medicines.[2][5]

An initial 90-60-50 care cascade for hypertension and diabetes is intended to enable 90% of people aged over 18 years to know their blood pressure or blood glucose status, provide an intervention to 60% of those with raised results, and achieve control in 50% of people receiving interventions.[1]Evidence and learning from this model are intended to guide extension to other priority conditions.[1][9]

Implementation follows a cyclical, locally adaptable process: identify a health need with stakeholders, select and adapt an intervention, pilot it, implement it, assess results and decide whether to scale up.[13]Provincial and district plans are expected to incorporate the Plan’s objectives into strategic, annual performance, district health and integrated district development plans.[13][18]

Monitoring should combine Global Action Plan targets and indicators with additional indicators developed alongside implementing stakeholders.[1]The approach includes defining data elements and indicators, integrating priority measures into the Health Management Information System and National Indicator Data Set, conducting baseline and periodic surveys, and incorporating routine surveillance into existing systems.[19]Progress is intended to be reviewed quarterly and annually, supported by clinical-record audits, guideline monitoring, data-quality improvement and accountability for implementation responsibilities.[16]

The Plan also envisages strengthened evidence for equitable and cost-effective interventions, including health technology assessment, economic evaluation, patient-level data, expenditure tracking and a National Health Benefits Database to inform benefit design, strategic purchasing and value-based contracting.[20][21]It does not specify an overall monetary budget, programme allocations or a quantified financing gap.[6][7]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation system that combines global targets, national indicators, routine information systems, surveys, surveillance, implementation reporting and mechanisms for course correction. It uses Sustainable Development Goal target 3.4, namely reducing premature mortality from non-communicable diseases by one-third by 2030 while promoting mental health and wellbeing, as its overarching outcome direction.[2][1]

• Use the World Health Organization Global Action Plan’s nine voluntary targets and 25 indicators to assess progress towards non-communicable disease targets and Sustainable Development Goal 3.4.[1]The global framework includes a 25% reduction in premature mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease by 2025.[22]
• Implement the initial 90-60-50 hypertension and diabetes care cascade: ensure 90% of adults know their blood pressure or blood glucose status, provide an intervention to 60% of people with raised results, and achieve control among 50% of people receiving interventions.[3][1]Develop cascade data-collection systems, begin collection during the plan period and establish a baseline.[1]
• Define data elements and indicators aligned with legislative requirements, government priorities and policy imperatives, and pilot indicators for early detection and control of hypertension and diabetes.[19]Develop additional indicators for each strategic goal and objective with implementing stakeholders, including provincial health departments.[1]
• Integrate priority indicators into the routine Health Management Information System and National Indicator Data Set, and promote integrated electronic patient-level data collection and reporting across the life course.[19]
• Conduct baseline and periodic surveys for hypertension, diabetes and other priority conditions, and incorporate routine surveillance of non-communicable diseases and risk factors into existing and proposed systems at all levels.[19]
• Strengthen national surveillance capacity by reviewing existing systems, standardising non-communicable disease questions in broader surveys, completing the indicator data dictionary using the World Health Organization global monitoring framework, and supporting registries such as the National Cancer Registry.[16]
• Monitor implementation quarterly and annually through provincial and district health plans, with data sources linked to indicators, collection tools piloted at selected sites and preparation for national implementation.[16]
• Disseminate data and knowledge through a stakeholder-informed publication plan at provincial, district and sub-district levels to support priority setting, programme planning, advocacy, policy development and coordinated action.[19]

Accountability is distributed across the National Department of Health, provincial departments of health, district health systems and implementation partners. The National Department of Health is responsible for policy, strategy and overall monitoring, while provincial and district services lead much of implementation.[6]Monitoring across all nine provincial plans, with ongoing review and response, is assigned jointly to district health systems, provincial departments, the National Department of Health and relevant partners.[18]The Presidential Health Compact also holds participating stakeholders accountable for agreed commitments.[23]

Clinical and service-delivery accountability mechanisms include district clinical expert groups, clinical management teams, patient expert groups, clinical-record audits and monitoring of guideline implementation.[9][16]The plan also envisages digital patient-level data collection through a National Health Benefits Database, expenditure tracking against cost norms, health technology assessments and economic evaluations to support benefits review and value-for-money decisions.[20][21]

The implementation timetable includes workshops on provincial implementation plans and the monitoring and evaluation framework in the first quarter of 2022, commencement of provincial planning in the second quarter, progress reporting by four provinces in the third quarter of 2022, and by five provinces in the fourth quarter of 2023.[18]Several supplied sections do not provide indicator definitions, reporting formats, evaluation methodologies, surveillance institutions or accountability schedules beyond these arrangements.[24][25][22][26]

Costing & Financing

The plan promotes investment in equitable, cost-effective non-communicable disease interventions within the transition to National Health Insurance, but the supplied material does not provide a consolidated South African budget, costed implementation plan, financing formula or quantified funding gap.[10][19]

• Strengthen the evidence base for resourcing equitable and cost-effective interventions, including routine evidence generation on health benefits and non-communicable disease services.[10][20]
• Develop the National Health Benefits Database to connect coded conditions, guideline-defined services, patient outcomes, required resources and costs, supporting transparent reimbursement assumptions and health-system planning.[20]
• Prioritise normative and routine costings for a defined health-benefit package, covering public-sector budget allocation and private-sector provider payment.[20]Use improving point-of-service data on population need to incrementally replace the equitable share formula.[20]
• Use provider, district, research and academic expertise to generate costings, track expenditure, identify efficiency savings and inform benefit-package reviews and national dialogue.[20][21]
• Review existing and potential funding mechanisms, establish partnership and funding protocols for delivery, and mobilise sustainable resources and partnerships for implementation.[7]
• Support local implementation partners and stakeholders to cost interventions as part of evidence-informed decision making.[13]

National Health Insurance is identified as South Africa’s health-financing strategy for universal health coverage, with phased implementation accompanied by health-system strengthening to create a single, equitable national health system.[23]The strategy seeks inclusion of non-communicable disease benefits in the National Health Insurance Fund.[7]The Medium Term Strategic Framework does not allocate national funding specifically for non-communicable diseases.[23]

External support contributed to plan development: the Clinton Health Access Initiative supported costing, the World Health Organization South Africa provided technical and financial support, and the Better Health Programme South Africa funded the technical writer and expert committees and consultations.[27]The Better Health Programme South Africa was funded by the United Kingdom Foreign, Commonwealth and Development Office through the British High Commission in Pretoria and managed by Mott MacDonald.[27]

The economic rationale highlights substantial costs to individuals, families, communities and the health system, and warns that healthcare costs may increase exponentially without timely proven interventions, sustainable financing and political support.[28]The costing chapter also identifies global and regional non-communicable disease and diabetes burdens, but no South African monetary allocation or funding requirement is specified in the supplied sections.[19]A health promotion levy on sugar-sweetened beverages was introduced in 2018, although no revenue amount or allocation is provided.[29]