Cardiovascular Journal of Africa: Vol 32 No 1 (JANUARY/FEBRUARY 2021)

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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 systems89
• 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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