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      Collaboration in the formulation and implementation of policies for noncommunicable diseases in South Africa

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          Abstract

          Background

          Collaboration between health and other sectors is necessary and much needed when addressing health issues. The health sector alone does not possess all the necessary resources to address health problems in the country. Thus, the burden of disease because of the noncommunicable diseases (NCDs) requires interventions that are sometimes beyond the health sector’s mandate.

          Aim

          To investigate collaboration in the policy formulation process for prevention and control of NCDs in South Africa. This article presents strategies that could aid South African government to ensure collaboration by various sectors in addressing the NCDs.

          Setting

          This study took place in the provincial Department of Health (DoH) of seven South African provinces.

          Methods

          This was quantitative descriptive study done among purposefully sampled respondents from various health portfolios from seven provincial Departments of Health. Data were collected using questionnaires and analysed using descriptive statistical data analysis techniques.

          Results

          The results indicated that the DoH collaborates with private and government stakeholders in the policy formulation and implementation process but excludes them in the setting the health agenda, adoption of policy options and policy evaluation.

          Conclusion

          The lack of participation by other stakeholders in the critical phases of policy formulation will result in continued burden of disease because of poor prevention and control of NCDs in the country.

          Contribution

          This article provides recommendations that would ensure collaboration among various sectors to accelerate the response to the prevention and control of NCDs in South Africa.

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          Most cited references60

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          NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

          The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4-a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030-will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010-2016 rate of decline in NCD mortality. Most of these are high-income countries with already-low NCD mortality, and countries in central and eastern Europe. An additional 50 (27%) countries for women and 35 (19%) for men are projected to achieve such a reduction in the subsequent decade, and thus, with slight acceleration of decline, could meet the 2030 target. 86 (46%) countries for women and 97 (52%) for men need implementation of policies that substantially increase the rates of decline. Mortality from the four NCDs included in SDG target 3.4 has stagnated or increased since 2010 among women in 15 (8%) countries and men in 24 (13%) countries. NCDs and age groups other than those included in the SDG target 3.4 are responsible for a higher risk of death in low-income and middle-income countries than in high-income countries. Substantial reduction of NCD mortality requires policies that considerably reduce tobacco and alcohol use and blood pressure, and equitable access to efficacious and high-quality preventive and curative care for acute and chronic NCDs.
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            Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017

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              Principles of Clinical Ethics and Their Application to Practice

              An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

                Author and article information

                Journal
                Health SA
                Health SA
                HSAG
                Health SA Gesondheid
                AOSIS
                1025-9848
                2071-9736
                20 March 2023
                2023
                : 28
                : 2100
                Affiliations
                [1 ]Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
                Author notes
                Corresponding author: Richard Rasesemola, richardrasie@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-9449-407X
                Article
                HSAG-28-2100
                10.4102/hsag.v28i0.2100
                10091072
                2f1ad52a-a7e2-46b5-b725-e843a4f45210
                © 2023. The Author

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 04 July 2022
                : 28 November 2022
                Categories
                Original Research

                multisectoral collaboration,multisectoral engagement,coordinating committee,policy improvement strategies,prevention and control of non-communicable diseases

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