New research by the Human Sciences Research Council and the Medical Research Council shows that the rise of non-communicable diseases (NCD) in South Africa is an ‘emerging epidemic’ that threatens to destabilise the country’s already fragile health care system.

Chronic diseases of lifestyle such as cardiovascular disease, cancer, diabetes and hypertension account for 40 percent of all deaths in South Africa, and the National Department of Health has sounded a call to arms for health providers and the general public to respond to the near-epidemic levels of chronic disease-related deaths. All parties are urged to work together to improve the health profile of South Africa.

The government’s recently developed national strategic plan to control the rising NCD epidemic, emphasises the need to improve the detection, early intervention and management of NCD lifestyle-related risk factors, particularly at the level of primary healthcare.

In line with this, the iChange4Health initiative, a partnership between the Chronic Disease Initiative for Africa (CDIA) and leading local generics manufacturer, Pharma Dynamics, has released a research-driven manual to enhance healthcare providers with knowledge and skills that will enable them to effectively motivate and assist patients to make healthier lifestyle choices. 

The manual, which is also supported by the Heart and Stroke Foundation, is the first of its kind in South Africa – it uses an evidence-based approach that forms a crucial part of effective interventions aimed at reducing the risk of chronic diseases of lifestyle by way of brief behavioural change counselling.

“Early diagnosis as a preventative measure is especially key as a health care intervention. Consider non-symptomatic conditions, such as high blood pressure, high blood sugar levels and high blood cholesterol levels – if caught early, these are easily treatable. At a more developed stage, where hardening of the arteries has developed, heart attacks and strokes can possibly follow,” says Doctor Kathy Murphy of the Chronic Diseases Initiative for Africa (CDIA), and lead-author of the manual.

The 68-page online manual entitled “Helping People Change: A Busy Practitioner’s Guide to Providing Brief Behaviour Change Counseling for Chronic Disease Lifestyle Risk Factors” is intended for use by medical doctors, nurses, dieticians, nutritionists, health promoters, biokineticists and health professionals in the specialist fields of preventing and reducing the impact of diabetes, hypertension, cardiovascular disease and cancer. The protocol and tools can be easily incorporated into usual clinical care and do not necessarily require any prohibitive or significant, additional investment of time and resources.

The manual forms part of a resource package for health care providers, which also includes educational and motivational materials for distribution directly to patients, on the topics of smoking, diet, physical activity and alcohol use.

Professor Krisela Steyn, associate director of the CDIA, says that in South Africa, patients get very little information about how lifestyle change can help prevent, manage and avoid complications for these conditions. “According to the World Health Organisation, 80 percent of deaths due to heart disease could be prevented by making healthy lifestyle choices such as following a healthy eating plan, taking part in regular physical activity, quitting smoking and reducing alcohol intake,” she said.
In this regard, the manual will serve to inform and educate across the board, and through a medium that has not been attempted before. “This is the first time that healthcare providers are being offered such a comprehensive resource pack which provides guidelines and good materials to better equip them to effectively counsel and help patients. Local research shows that most patients want more information about lifestyle from their healthcare providers and trust what they say,” said Steyn.

Chief executive officer of the Heart and Stroke Foundation South Africa, Dr Vash Mungal-Singh, agrees that the manual is a tremendous step towards lowering the risk of chronic disease in South Africa.  “Living a healthy lifestyle has long been proven to be one of the most effective ways of preventing heart disease. It is important that people realise how dangerous unhealthy lifestyle choices like smoking, excessive alcohol consumption, poor diet and limited physical activity are.”

In order to optimise effectiveness of the manual, training in how to use it is being carried out across the country. Physicians from the eight Family Medicine Departments at various universities around the country have already been trained by co-author of the manual Professor Bob Mash, Head of Family Medicine and Primary Care at Stellenbosch University and colleagues. These physicians will in turn go on to train other General Practitioners in their respective provinces in order to spread the message as widely as possible.

– John Scharges (john@rothko.co.za) is a writer at Chronic Disease Initiative for Africa.