South Africa has launched its new NCD strategy, The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases, 2022-2027. The plan defines define the steps that need to be taken to reach the sustainable development goal (SDG) targets relating to noncommunicable diseases (NCDs), while progressively moving South Africa towards universal health coverage (UHC) through an integrated, people-centred health services approach.

Dr. Vicki Pinkney-Atkinson is Director of the South African NCD Alliance, which worked with the government over eight years to complete the document. Below she discusses the process and results.

NCDA: Overall, how do you feel about this plan?

Vicki Pinkney-Atkinson: “We’re thrilled we’ve got to the point that we’ve actually have a published plan... the fact that we’ve got a plan is the most positive step, and that it’s a policy. It’s a national policy, it’s been through all the processes, and I think that’s huge. And it’s a policy in which civil society – and by that we’re really talking about people living with noncommunicable diseases – participated. And so our voices have been recognised and heard... and that for me is the biggest deal, ever.”

NCDA: I understand that it took eight years to get agreement on this plan. Was one of the reasons that the participation of civil society had not been recognised?

Vicki Pinkney-Atkinson: “Yes, that really was part of it. We have a brilliant system in South Africa that deals with communicable diseases – HIV, TB, etc. There is participation [of civil society] developed by activism over years. The same was not true for NCDs. What we have done was no different from what the activists in the HIV world did to get their condition recognized, to get involvement… We asked step-by-step for the same things and we have been adamant that we have to have the same kind of deal that people living with HIV and AIDS have had… it went all the way back to tracking every part of the plan and fact-checking and making sure that the people were involved and engaged. And of course this was only possible because we had funding through the global NCA Alliance and it allowed us to have a tiny team – and that’s how we did it.”

NCDA: Besides struggling to have your voices heard, was the South African alliance involved in the drafting of the plan?

Vicki Pinkney-Atkinson: “Yes. We did both – content and process parts... Most of an NCD strategic plan is not a mystery. You’ve got to have prevention, you’ve got to have resourcing. All of those are standard parts. The number one starting point for us was we benchmarked our strategic plan against the HIV strategic plan. Did we get everything we wanted? No, but we got a helluva lot more than we started out with… Like the early HIV plans – and I was involved in drafting those plans – we were going back to the very beginning of addressing a neglected problem in our society – NCDs. Eventually I got put on the technical committee, which was very very late in the process.”

NCDA: How do you feel about the level of investment by the government in the NCDs plan?

Vicki Pinkney-Atkinson: “What we’ve got with the [WHO] Best Buys, by and large – which is very sound advice from a public health point of view – means we are treating the so-called lifestyle – and I hate the word ‘lifestyle’ – diseases with these interventions… on a long-term basis; it’s not short-term. As a person living with NCDs I say, ‘Fine, go ahead and do that’ (but)… I’m talking about people getting the treatment so they don’t go blind or lose their legs. I’m talking about people getting treatment now. The primary prevention is perfect, it’s perfect, but it’s not good enough not to treat people living with NCDs and put that down in black and white as a cost-effective intervention. And that for me will never be acceptable, and I think that if you ask any person living with an NCD they will say the same.”

NCDA: Looking ahead, maybe up to 2030 and the SDGs, what will be your main focus?

Vicki Pinkney-Atkinson: “We have to focus on implementing the plan. We are in a federal system… we have nine provinces and for the first time we have provinces meeting next week to draft their own provincial NCD plans… so the big start – and the most wonderful start – is to work with the provinces to develop plans… and to make sure that people are involved and we get the services we need. Like a person with HIV would get for HIV, we want to get treatment for diabetes, hypertension, for many of those things. And that’s a journey of the next six years. However, NCD civil society is poorly funded, unlike HIV/AIDs… One of the things we want to set up urgently – and it’s in the plan – is a coordinating body across society, across government, to make sure that NCDs gets the attention that it needs.”

NCDA: Will NCD civil society be represented on all the provincial bodies?

Vicki Pinkney-Atkinson: “There’s no funding for that to happen… We are incapacitated at all levels. And it’s really people like myself – and I’m not making myself a hero – but many others too, who give of their time and energy to do this, because it needs to be done. But it’s not sustainable at any level.”

NCDA: Now that you’ve worked with the government to come up with this plan, are you at all developing a more collegial relationship?

Vicki Pinkney-Atkinson: “I think that we have always – and I have been at this for a long time – worked in collaboration, as far as possible, with government. It’s not war. And on the day-to-day issues, on consulting, and with many officials it’s fine. But there is a level at which NCDs, and health care, has been politicised. And that’s really where the difficulties have come in… At a higher level they’re not prepared to negotiate – I’ve never had a letter answered by a politician related to any of this.”