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Analysis of Non-Communicable Disease Prevention Policies in South Africa

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Analysis of Non-Communicable Disease Prevention Policies in South Africa Analysis of Non-Communicable Disease Prevention Policies in South Africa FINAL REPORT 2017 Analysis of Non-Communicable Disease Prevention Policies in South Africa Submitted to: AFRICAN POPULATION AND HEALTH RESEARCH CENTER By Population, Health, Health Systems & Innovation Programme Human Sciences Research Council (HSRC) Private Bag X41 Pretoria, 0001 REPUBLIC OF SOUTH AFRICA Recommended Citation: Ndinda, C, & Hongoro, C. (2017). Analysis of non- communicable diseases prevention policies in Africa (ANPPA) – A case study of South Africa. A technical research report developed for the African Population & Health Research Centre (APHRC). FINAL REPORT | 2017 Acknowledgements This study was carried out with contract funding from the International Development and Research Centre (IDRC) through the African Population & Health Research Centre (APHRC). The research team is grateful to the Human Sciences Research Council (HSRC) executive for their support in this study. Disclaimer The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions or policies of the APHRC. Public domain notice All material appearing in this report is the property of the APHRC and HSRC. Until released to the public domain by the APHRC and HSRC, it may not be reproduced or copied without permission from the APHRC or HSRC. Citation of the source is required. The publication may not be reproduced or distributed for a fee. This report was compiled and produced for the African Population & Health Research Centre (APHRC) by the Population Health, Health Systems and Innovation (PHHSI) Programme of the Human Sciences Research Council (HSRC) of South Africa. ii Analysis of Non-Communicable Disease Prevention Policies in Kenya Report | 2017 Table of Contents Acknowledgements ii List of Tables v Abbreviations vi Executive Summary and Key Messages xi 1.0 Background and Context of the Study 1 1.1 Introduction 2 1.2 Study background 2 1.3 Methods 3 2.0 Current Status of NCDs (epidemiology, burden of risk factors) and NCD Policies in South Africa 6 2.1 Introduction 7 2.2 State of NCDs in South Africa 7 2.3 NCD Policy landscape in South Africa 9 3.0 The Context of NCD Prevention Policy Development 11 3.1 Introduction 12 3.1.1 Global context 12 3.2. Political context and events 12 3.3 Socio-economic context 14 3.4 Economic context 16 3.5. Technological context 17 4.0 Case Study 1: Application of Multi-sectoral Action in the Formulation of the Salt Reduction Regulations 18 4.1 Introduction 19 4.2 History of Policies on unhealthy diets 19 4.3 Factors that led to the development of the salt regulations 21 4.4 Policy process 21 4.5 Multi-sectoral action 22 4.5.1. Application of Multi-sectoral Action in the formulation of the salt legislation 22 Analysis of Non-Communicable Disease Prevention Policies in Kenya Report | 2017 iii 4.5.2 Facilitators of the use of Multi-sectoral Action in policy formulation 25 4.5.3 Barriers to the use of Multi-sectoral Action in policy formulation 26 4.6 Application of Multi-sectoral Action in policy implementation 27 4.6.1 Facilitators of the use of Multi-sectoral Action in policy implementation 27 4.6.2 Barriers to the use of Multi-sectoral Action in implementation 27 4.6.3 Funding, monitoring and evaluation 28 4.7 Gaps in the Multi-sectoral Action approach 28 5.0 Case Study 2 – Application of Multi-sectoral Action in Tobacco Control Policies 30 5.1 Introduction 31 5.2 History of tobacco control legislation 31 5.3 Factors that led to the drafting of the tobacco legislation in South Africa 34 5.4 Policy process 34 5.5 Multi-sectoral Action 35 5.5.1 Facilitators of using Multi-sectoral Action in policy formulation 39 5.5.2 Barriers to the use of Multi-sectoral Action in formulating the tobacco control policy 40 5.5.3 Facilitators of Multi-sectoral Action in the implementation of the tobacco control policies 40 5.5.4 Barriers to the use of Multi-sectoral Action in implementing tobacco control policies 41 5.6 Implementation, monitoring and funding 42 6.0 Case Study 3 – Application of Multi-sectoral Action in Alcohol Control Policies 44 6.1 Introduction 45 6.2 History of alcohol control legislation 45 6.3 Factors that led to the drafting of the alcohol legislation in South Africa 47 6.4 Policy process 48 6.5 Implementation, monitoring and funding alcohol control policies 49 6.6 Multi-sectoral Action 50 6.6.1 Multi-sectoral Action application in policy formulation and implementation 51 6.6.2 Role of the sectors involved in the formulation of the policies 52 iv Analysis of Non-Communicable Disease Prevention Policies in Kenya Report | 2017 6.6.3 Barriers to the use of Multi-sectoral Action in alcohol control policy formulation 53 6.6.4 Facilitators of the use of Multi-sectoral Action in implementing alcohol control policies 53 6.6.5 Barriers to implementing alcohol control policies 54 6.6.6 Monitoring and evaluation 54 7.0 Case Study 4: Application of Multi-sectoral Action in Physical Activity Policies 55 7.1 Introduction 56 7.2 Policy content and history 56 7.3 Factors that led to policy development 59 7.4 Policy process 60 7.5 Implementation/actions plans stated 61 7.6 Application of Multi-sectoral Action in the implementation of the sports policy 65 7.6.1 Implementation facilitators 65 7.6.2 Barriers to the application of the Multi-sectoral Action in the implementation of sports policy 67 7.7 Funding and monitoring 67 8.0 Discussion 70 8.1.Introduction 71 8.2.Gaps in NCD policy development in South Africa 71 8.3.The Application of Multi-sectoral Action in policy formulation 71 8.4.Conclusion 74 9.0 Recommendations 76 BIBLIOGRAPHY 78 Annexures 88 Analysis of Non-Communicable Disease Prevention Policies in South Africa Report | 2017 v List of Tables Table 1: Recommended best buys 88 Table 2: Link between study propositions, data and types of interpretation 88 Table 3: Total number of participants interviewed for the study 89 Table 4: South African NCD policies 89 Table 5: Targeted implementation status of best-buy interventions 90 Table 6: Processes leading up to the sodium legislation 91 Table 7: Monitoring and evaluation 91 Table 8: Maximum limits of sodium content in targeted food products 91 Table 9: Multi-sectoral involvement in drafting salt regulations 92 Table 10: Tobacco control policies in South Africa 92 Table 11: Stakeholders in regulations to ban the advertising of alcohol 93 Table 12: Alcohol-related regulations in South Africa 93 Table 13: Monitoring and evaluation 94 Table 14: Physical activity policy development timelines 95 vi Analysis of Non-Communicable Disease Prevention Policies in South Africa Report | 2017 Abbreviations AA Alcoholics Anonymous AIDS Acquired Immune Deficiency Syndrome ACDP African Christian Democratic Party ANC African National Congress ANPPA Analysis of non-communicable diseases prevention policies in Africa APHRC African Population & Health Research Centre APP Annual performance plan ARA Association for Responsible Alcohol Use ASGI-SA Accelerated Shared Growth Initiative—South Africa BAT British American Tobacco B-BBEE Broad-Based Black Economic Empowerment BMI Body Mass Index CANSA Cancer Association of South Africa CBO Community-based organization CDL Chronic diseases of lifestyle CHIP Community health intervention programme CSO Civil society organisation CVD Cardiovascular disease DA Democratic Alliance DAAF Department of Agriculture and Forestry DENOSA Democratic Nursing Organization of South Africa DOA Department of Agriculture DAC Department of Arts & Culture DOE Department of Education Analysis of Non-Communicable Disease Prevention Policies in South Africa Report | 2017 vii DOH Department of Health DOSD Department of Social Development DSA Diabetes South Africa DTI Department of Trade and Industry EC Eastern Cape ECLB Eastern Cape Liquor Board ECT Electro-convulsive therapy EHP Environmental health practitioners EU European Union FAS Foetal Alcohol Syndrome FBO Faith-based organisation FCTC Framework Convention on Tobacco Control FEDHASA Federation Hospitality Association of South Africa FS Free State GEAR Growth, employment and redistribution GP Gauteng Province HFCS High-fructose corn syrup HIV Human Immune Deficiency Virus HSF Heart and Stroke Foundation HSRC Human Sciences Research Council IDRC International Development and Research Centre IMC Inter-ministerial committee IMF International Monetary Fund IPAP Industrial Policy Action Plan viii Analysis of Non-Communicable Disease Prevention Policies in South Africa Report | 2017 ISA Inter-sectoral action KII Key informant interview KZN KwaZulu-Natal LP Limpopo Province MDGs Millennium Development Goals MP Mpumalanga Province MRC Medical Research Council MSA Multi-sectoral action MTEF Medium Term Expenditure Framework NC Northern Cape NCAS National Council Against Smoking NCD Non-communicable disease NDP National Development Plan NGO Non-governmental organization NGP New Growth Path NKF National Kidney Foundation NLA National Liquor Authority NLB National Liquor Board NP Nationalist Party NPC National Planning Commission NSRA National Sports and Recreation Act NWP North West Province PA Physical activity PAC Pan Africanist Congress Analysis of Non-Communicable Disease Prevention Policies in South Africa Report | 2017 ix PHANGO Patient Health Alliance Non-Governmental Organization PHC Primary healthcare RDP Reconstruction and Development Programme REC Research Ethics Committee RIP Reduced Ignition Propensity RSA Republic of South Africa SA South Africa SAB South African Breweries SABC
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