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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021

54

AFRICA

public sector, with more people using it than in the private

sector. However, in most provinces, it is only made available at

designated international normalised ratio clinics and hospitals,

as opposed to primary care clinics or community centres.

85,86

In a report to inform the minister of health, SANCDA

emphasised that although action plans to address diabetes and

hypertension had been assembled, these were merely window

dressing and without any support.

66

Sustainable funding for CVD from the taxation of tobacco

or other ‘sin’ products does not exist. Although legislation exists

mandating clear and visible warnings on at least half of the

principal display areas of tobacco packs, only 40% of the space

is covered.

67

In 2012, adjusted transparent alcohol excise taxwas introduced

that distinguished between alcoholic beverages (wine 23%, clear

beer 25% and spirits 48%).

87

However, in 2018, excise taxes for

alcohol were based on the rate of beer at 23% and lag behind

those of tobacco products.

52

In May 2014, the Department of

Health published draft regulations relating to the labelling of

foodstuffs that will see severe restrictions on the advertising of

unhealthy foods to children.

58

By 2016, this draft legislation was

still under discussion.

88

Priorities and the way forward

Twenty-five years after South Africa underwent a peaceful

transition from apartheid to democracy, the country has a

complex and two-tiered healthcare system that has not been

able to address the health needs of most of its population.

89

The

public system serves 84% of the population but is chronically

underfunded and understaffed, with enormous challenges. The

wealthiest 16% of the population has access to private healthcare,

consuming 58% of the GDP expenditure on health.

89

Over 70%

of doctors in the country are employed in the private sector.

Furthermore, the healthcare system has to contend with multiple

colliding epidemics, which include HIV and tuberculosis, CVD,

mental health and other NCD such as injuries, substance abuse

and violence, and unacceptably high mortality rates attributable

to maternal and childhood diseases. More than 12% of the South

African population of 57 million is HIV infected, having the

world’s largest antiretroviral therapy programme, subsidised by

the government and provided free of charge. South Africa is one

of the few African countries that has universal healthcare for

people with HIV.

89

South African priorities for dealing with CVD have to be

seen in the overall context of all those colliding conditions,

89

and a simplified multi-sectoral approach is needed.

80

Because

of the stretched and competing resources and limited health

infrastructure, the following strategies are currently planned and

partially underway:

improvement in diagnosis and management of NCD/CVD

at the primary care level, including via an integrative service

with infectious diseases such as HIV/tuberculosis

development of human resources including task sharing and

task shifting (e.g. use of non-physician technicians)

improving salaries for health professionals to retain them in

the public workforce domain

increased and easier access to essential medicines for CVD by

promoting simplified regimens, generic drugs and combina-

tion tablets

development of context-specific guidelines and algorithms for

risk stratification and medical management appropriate to the

South African context

population-wide interventions to promote a healthy diet,

physical activity, healthy environment and cessation of smok-

ing and alcohol abuse

strengthening surveillance and quality assurance systems

89

increasing the partnerships between industry and government

to map out the promotion of healthy food options and a

healthier work environment

strengthening the Directorate for Chronic Diseases, Disability

and Geriatrics that has produced and distributed several

national guidelines for preventing and controlling NCD.

More effective collaboration between the medical and

non-medical government sectors with the public and industry

will facilitate better overall use of resources, tackling the larger

burden of CVD affecting South Africans from childhood to old

age.

This publication was reviewed by the PASCAR governing council and

approved by the South African Heart Association.

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