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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
50
AFRICA
gaps and exploited loopholes.
42
South Africa has been part of the
WHO framework convention on tobacco control (FCTC) since
2005 when its national tobacco-control plan was approved.
43,44
Collaborative projects for NCD interventions, which
include CVD, have been implemented between the Ministry
of Health and non-health ministries and civil societies.
38
These include organisations/institutions such as the South
African Medical Research Council, Human Sciences Research
Council and Statistics South Africa. The percentage of total
annual government expenditure on cardiovascular healthcare
is not known. South Africa was part of the WHO-CHOICE
(CHOosing Interventions that are Cost Effective) project that
assessed cost-effective health outcomes for CVD prevention and
control using mathematical modelling.
45
Assessment of policy response
The costs relating to CVD in South Africa have been discussed
in various publications.
46,47
However, no legislation mandating
health financing, specifically for CVD or other NCD risk factors,
is available. Although legislation of affordable essential CVD
medicines is available, South African pharmaceutical policies
do not meet the lowest prices of those achieved internationally.
48
Indirectly, through the Constitution and the National Health Act
(No. 61 of 2003),
49
as amended, patients’ rights are protected and
improved interventions, facilities and health-system procedures
or resources, which could include CVD, are mandated.
50,51
Legislation is employed in areas where smoking is banned.
Advertising, promotion and sponsorship of all forms of
tobacco, along with measures to protect tobacco-control policies
from tobacco industry interference, have been implemented.
43
However, clear and visible warnings appear on less than half
of the main display areas of tobacco packs.
43
Furthermore, the
amended Act provides for control over smoking, advertising of
tobacco products and other related matters.
42
In South Africa,
the excise tax of the final consumer price of tobacco products in
2018 was 52%
43
and that for alcohol 23%.
52
The national Department of Health (NDoH) commissioned
the University of Cape Town’s Lung Institute to develop a
symptom-based integrated clinical management guideline that
included the screening of individuals at high risk of CVD
and other related NCD.
53
Finding sustainable funding for
these diseases is challenging, and only available for research;
consequently, none is available from taxation.
54
Equitable
nationwide access to healthcare professionals and facilities are in
progress, although at a slow pace.
55
In 2016, National Treasury documented recommendations
to implement taxes on unhealthy foods, and particularly sugar-
sweetened beverages (SSB), which were introduced in 2018.
56
In South Africa, these taxes were passed at 11%, although
20% was proposed.
57
Legislation on banning the marketing of
unhealthy foods to minors has been drafted but not yet tabled.
58
No legislation exists mandating clear and visible warnings on
foods that are high in calories, sugar or saturated fats, mostly
because there is no universal agreement on what these should
be.
59
However, the South African Bureau of Standards oversees
labelling and marketing in the food and health category.
60
Policy
interventions that promote a diet to reduce CVD risk and those
that facilitate PA have been introduced through the Healthy
Lifestyle campaign of the NDoH.
61,62
Stakeholder action
Non-governmental organisation advocacy for CVD policies and
programmes in South Africa is visible and effective, as indicated
in the 2018 annual report of the Heart and Stroke Foundation of
South Africa (HSFSA).
63
Professional education for healthcare
providers and patients is provided through participation at
international and national conferences, which are organised by
the South African Heart Association (SA Heart).
64
SA Heart
has several specialised interest groups, such as the Heart Failure
Society of South Africa (HeFFSA), South African Society
of Cardiovascular Intervention (SASCI), and the Cardiac
Arrhythmia Society of Southern Africa (CASSA), among
others.
64
Continuing medical education can also be accessed
online via the South African Medical Association and other
bodies. RhEACH is a non-governmental organisation providing
education for people living with RHD.
65
Civil societies, such as the South African NCD Alliance
(SANCDA), were involved in the development and
implementation of a national tobacco-control plan.
43,66
The
NDoH addresses NCD (and consequently CVD) in its National
Development Plan,
62
which involves various stakeholders such as
the SANCDA
67
and HSFSA.
63
These professional associations
also aim at reducing premature CVDmortality by 25% in 2025.
63,67
SANCDA is involved in a national multi-sectoral co-ordination
mechanism for NCD/CVD as discussed at their first stakeholder
meeting held on 11–12 February 2014.
68
Kolbe-Alexander
et al
.
69
identified a need for worksite health promotion to address the
prevalence of CVD and related risk factors, which were on the
increase. These researchers proposed this strategy to be the better
choice to reach at-risk persons.
69
Health/wellness screening,
which includes BP measurement at workplaces, is promoted and
encouraged by many companies and specifically the medical aid
industry. The HSFSA, through its health promotion programme,
offers services such as the employee wellness programme.
63
The following strengths, weaknesses, threats and priorities are
summarised as part of the scorecard data collected for South
Africa.
Strengths
At the 2011 United Nations General Assembly meeting, the
former minister of health, Dr Aaron Motsoaledi, said that South
Africa had led efforts to implement tobacco-control legislation.
He continued to mention the country had passed regulations in
reducing the use of trans fats, along with those to reduce the
salt content in processed food.
70
In the SANHANES, conducted
in 2012, investigators noted substantial gains had been made to
reduce tobacco use.
71
South Africa’s national tobacco-control
plan, as part of the FCTC, has been hailed by the WHO, among
others.
43,44
The 2015–2020 strategic plan of the NDoH was drafted to
‘achieve measurable improvement in critical public health’ in
which requests were made for partnership with communities
in disease prevention and promotion of health and wellness.
72
In this plan, NCD, of which CVD rank the highest, will be
addressed as part of the strategic goals of the NDoH. These,
among other things, are to prevent disease and reduce its burden,
re-engineer primary healthcare and improve the quality of care.
72
A new updated strategic plan 2030 is being commissioned.