Noncommunicable diseases a threat to the health system

Author: Amy Green

Source: Health-e News

Non-communicable diseases (NCDs) threaten to overwhelm a health system already under strain from HIV and tuberculosis. Illnesses like cancer, diabetes and high blood pressure need stronger prevention and community-based programmes, including those involving community healthcare workers (CHWs), to “avert the growing burden of NCDs”.

This is according to the 20th edition of the South African Health Review published by the Health Systems Trust (HST) on Wednesday.Published annually, the review noted that South Africa is experiencing a surge in the prevalence of NCDs “which imposes a heavy burden on healthcare services”.

Multiple disease burden

While successes in the HIV programme have raised the life expectancy of South Africans by about a decade since 2006, these patients are living longer and many are experiencing other health problems as well.

It noted that South Africa has the highest prevalence of diabetes on the continent affecting about four million people. Rates of high-blood pressure are also high in many communities: one study found that almost half of Durban Indians have hypertension.

Many patients have more than one NCD at a time and most diseases are preventable through lifestyle changes.

“Prevention and early detection measures are therefore crucial for the control and management of NCDs, and failure to implement such interventions can be costly,” it noted.

Community level intervention

Most NCD care is done at the facility level and a chapter in the review argued that CHWs are under-utilised in the management of patients with NCDS. Research has shown that CHWs can deliver services in communities, especially in rural communities where transport costs are a barrier to health care, efficiently and effectively. These services could include weight, blood sugar and blood pressure checks.

“Although prevention of NCDs should be part of [primary health care] services, these services are still weak in many places in South Africa,” noted the authors.

Utilising CHWs, or ‘task-shifting’, to promote prevention and awareness, including about healthy eating and physical activity, would further unburden public facilities that are struggling to cope with high patient loads.

Policy initiatives, including the proposed tax on sugary beverages, will help, the review noted, but more needs to be done to adequately manage patients, especially those with multiple chronic conditions for which they will likely need treatment for life.

Financing NCDs

The costs of treating this disease burden in the future will be significant as will be the costs to the economy of early deaths.

Although it is not clear how much is spent on community services, funding for NCDs in total forms less than 0.1 percent of the national health budget.

To control the growing burden, and offset the costs, the authors noted that a new approach needs to be taken and the “importance of health financing for management and control of NCDs at community level cannot be overemphasised.” – Health-e News.

An edited version of this story was published on