Contributions of WHO to South Africa’s health agenda: evaluation of the Country Cooperation Strategy 2016-2020: abridged version

Contributions of WHO to South Africa’s Health Agenda: Evaluation of the Country Cooperation Strategy 2016-2020 ISBN: 978-929023469-2 © WHO Regional Office for Africa 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Designed in Pretoria, South Africa CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION 2 The World Health Organization (WHO) Country Cooperation Strategy (2016- 2020) for South Africa had four strategic priorities: 1. Support to the implementation of National Health Insurance (NHI) to achieve universal health coverage (UHC); 2. Prevent and reduce the disease burden of HIV, hepatitis, STIs and tuberculosis (TB), with a view to increasing life expectancy gains; 3. Promote longer healthier lives by supporting the prevention and control of noncommunicable diseases, injuries and accidents, and mental health; and 4. Help South Africa meet its global health obligations while contributing to international health and development. CCS evaluation objective To assess achievements, challenges and lessons learnt during implementation of CCS 2016-2020 for informing the development, implementation, and monitoring & evaluation of the next CCS 3CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION Support on UHC and NHI included: • Technical support on NHI legislation, • Serving as member of technical working groups on the Presidential Health Compact, and • Leading the quality improvement workstream of NHI. WHO’s contributions in some key outputs: • NHI white paper and the NHI bill, • Medical Schemes bill, • Presidential Health Compact, • Human Resources for Health Strategy, and • Health Market enquiry report. Evaluation methodology  Mixed methods  Independent (external consultant)  Participatory  Triangulation of information Data Sources No. and type of participants Primary Online Structured Questionnaire 26 (NDoH, OHSC, SANAC, SAHPRA, academia, private sector, civil society, and donors) Key Informants Interview 22 (NDoH, OHSC, SANAC, SAHPRA, academia, private sector, civil society, and donors) Focus Group Discussion 3 (WCO staff) Secondary Programme Briefing Notes Produced by WCO staff WHO Global Management System (GSM) Financial and planning information from GSM extracted by WCO staff Key contributions of WHO in CCS strategic priorities and focus areas towards improving the health and health systems in South Africa Universal Health Coverage and NHI Launch of the Presidential Health Compact CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION 4 Contributions of WHO to South Africa’s Health Agenda: Evaluation of the Country Cooperation Strategy 2016-2020 WHO also facilitated and supported hosting of key workshops/meetings: • Presidential Health Summit (October 2018); and • NHI expert workshop (March 2020). Use of WHO technical tools: • Using WHO-HAPT tool, National Health Accounts produced for 2014/15, 2015/16 & 2016/17, and the process has been institutionalized for future estimations, • Workload Indicators of Staffing needs (WISN) used for district hospitals, • Capacity building of SAHPRA on the Global Benchmarking Tool, and • IPC tools used for facility assessment and improvement. “We are fortunate in that we are not alone in many of the challenges we face. The lessons we have learnt from the World Health Organization and others are instructive as we plan our version of universal health coverage.” South Africa Vice President: Mr. David Mabuza Communicable Diseases Key support in HIV: • Initiation and roll out of the Pre-Exposure Prophylaxis (PreP) programme for key populations and pregnant women, • Development of the South African National consolidated HIV Testing Services guidelines, • Development, dissemination, and roll-out of the National Consolidated Antiretroviral therapy guidelines, and • External Quality Assurance for Voluntary Medical Male Circumcision sites and development of National Integrated Men’s Health Strategy: 2020-2025. Deputy President, Mr David Mabuza addressing the Health Leaders during the opening session of the Presidential Health Summit HIV prevention ambassador engaged in demand generation efforts for HIV prevention and other sexual and reproductive health services (Photo credit: Project PrEP - Unitaid) 5CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION Key support in TB: • Conducted the first South African National TB prevalence survey (2018/19), • Supported the scaling up of the Bedaquiline Clinical Access Programme for Drug Resistant TB programme, • TB patient cost survey, and • Joint Review of the HIV, STI, TB, PMTCT and Hepatitis programmes in 2019. Noncommunicable Diseases • Key highlights of the support provided by WHO in non-communicable diseases included work on salt, sugar, tobacco and alcohol legislations, and road safety campaigns. • WCO developed a few documents during the CCS period: a NCD strategic plan, guidelines for prostate and lung cancer as well as Hypertension guidelines which are in the publication pipeline. Listeriosis outbreak in South Africa Health Emergencies As part of the multi-sectoral incident management team (IMT) under NDoH, WHO supported in developing an updated Listeriosis Emergency Response Plan (ERP) that quickly responded to control and end the outbreak. WHO further strengthened health and food safety systems to prevent future outbreaks in the country. Field monitoring of TB prevalence survey Listeriosis outbreak 2017/2018 CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION 6 Sexual Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition WHO provided timely preparedness and rapid response to the COVID-19 emergency outbreak through technical leadership, information sharing, guidelines development, training, review and assessment, and data management. WHO deployed technical experts at national and provincial level, resulting in an effective response. COVID-19 Response SRHR Guideline Dissemination National Workshop, 09-13 November 2020 in Cape Town • WHO supported the NDoH in producing a number of policy and guideline documents on SRMNCHAN that included the Revised PMTCT guidelines; Maternal, Perinatal and Neonatal Health policy; draft Malnutrition guidelines; National integrated SRHR policy guidelines; Revised National Contraception Clinical Guidelines; National clinical guidelines for implementation on choice of termination of pregnancy Act; and Clinical guidelines for genetics services. • For polio and vaccine preventable diseases, WHO was highly commendable for employment of surveillance officers in the provinces and for WHO’s role in South Africa’s regain of polio-free status. Training for health promotion team in North West focusing on addressing vaccine misinformation and demand creation 7CCS 2016-2020 EVALUATION REPORT - ABRIDGED VERSION Looking forward: the next five- years of the CCS cycle Health systems strengthening • Continued support to the realization of UHC through the implementation of NHI and Presidential Health Compact. • The disease and procedures coding system needs to be finalized. The coding system should be robust and be able to integrate and align with the public and private health sectors systems. • Build capacity on national health accounts for NHI. • Support the completion of the costing exercise of the Human Resources for Health Strategy, followed by development of an investment case for the strategy for presentation to national treasury. • Support for a robust data management and electronic data system needed for the data intensive NHI. • Share evidence and best practices to inform implementation of UHC. • Strengthening health care delivery at primary health care. • Monitoring and evaluation of implementation of NHI and Presidential Health Compact • Support capacity building on health standards. Communicable Diseases & RMNCHAN • Continue to support the HIV Testing services and PrEP programmes. • Provide evidence on the most effective methods/ interventions that reduce HIV incidence. • Support social and behaviour change intervention models to complement biomedical interventions for HIV. • Revive and strengthen the support for Integrated management of childhood illnesses (IMCI), including the PMTCT Programme. • Support the TB programme to improve key outcomes. • Review the action plan for the NTD to support the drafting and costing of the new 3-year plan. • Support implementation of prevention programme for schistosomiasis using the new drug focusing on provinces at greatest need. • Despite the end of the Polio funding, WHO to continue providing support on VPD surveillance programme. • Support new components of the school health policy such as Sexual reproductive health and social services. Non-Communicable Diseases • Support the implementation of the National Strategic plan for NCDs through a multi- sectorial approach. • Support NDoH to implement the new Health Promotion strategy, with a focus on reducing the negative impact of obesity, tobacco, and alcohol. • Support behaviour change communication to tackle NCD risk factors such as tobacco, alcohol, nutrition, obesity, etc. • Enhancing health services for people with disabilities. • Collaborate on ageism campaign. • Support in implementing the WHO resolution on palliative care. • Support school health policy review and revision and development of a new 5-year plan.