Presentation on behalf of SACSoWACH Good evening, the presentation will be done by myself, Patricia Martin and Lene Øverland, representing the coalition South African Civil Society for Women’s, Adolescents’ and Children’s Health, also known as SACSoWACH. Public Hearings on NAPHISA Presentation on behalf of SACSoWACH

Introduction to SACSoWACH SACSoWACH is an alliance of 23 civil society organisations with a shared commitment to ensuring that every child, adolescent and women enjoys their rights to survive and develop to their full potential. SACSoWACH is united in its efforts to ensure the health system advances the rights of women and children, and fulfils its development potential We believe that the NHI and NAPHISA have the potential to strengthen the health system to support the survival and healthy development of all children, adolescents and women

NHI Policy Prioritises vulnerable groups Recognises social determinants of health Can contribute to reducing poverty and inequalities Health is key to the development of children The NHI prioritises vulnerable groups – women, children, older persons and persons with disabilities. It recognises that Social Determinants of Health are key to improving health outcomes and ensuring a long and healthy life for all. As we know the policy aims to transform delivery of healthcare services by universalising health promotion, disease prevention and empowered communities. Through the correct implementation the NHI can contribute to the reduction of poverty and inequalities, which were inherited from the past, and break the intergenerational cycle of poverty driven by poor health and development. Especially in children. Health is key to the sustainable development of children and the country as a whole.

Key Gaps Slow progress with maternal mortality reduction Adolescent health Burden of developmental difficulties and disabilities Maternal and child health, development and nutrition is key to achieving the NHI goals and development potential. There are major gaps in the current health system that the NHI and NAPHISA can address, these include Reducing the maternal mortality rates Improving the provision of adolescent health Maintaining the focus on child survival while shrinking the burden of developmental difficulties and disabilities, which has increased over the years as child mortality is and will continue to grow. There is an estimated 250 million children in lower and middle income countries are at risk of poor development.

Key Gaps (continued) High malnutrition rates High levels of preventable disability and development delays There has been persistently high malnutrition rates with little progress during the last 30 years. This is especially noticeable in stunting – which also increases the risk of poor child development. A quarter of children under the age of 3 are stunted and the rate has increased in the past few years. There are also high levels of preventable disability and development delays in young children which go undiagnosed and untreated. Where it is picked up, it is often too late. For example: Sight is essential for early development. 80 percent of early development is vison-based. But many cases poor vision and blindness which can be prevented if picked up early (before age 6) when the brain and the eye are still developing.

Focus of our submission Importance of early childhood development Life course approach Holistic approach to health services Early childhood development is one of the most effective ways to redress inequity. The roots of inequality are established in early life. There is a need for a life course approach that provides support for healthy development from conception through the life of a child into adulthood. This requires the universalisation of early and comprehensive health promotion and prevention through the NHI, particularly aimed at MCWH&N To use a sight example again: As an infant and child (5 years of age) sight enables us to play, interact socially and develop During our school going years sight gives us access to education and opportunities At 25 with sight we can work and provide At 45 Sight connects families and enables individual growth In our later years sight ensures social inclusion and cohesive communities

Cross-cutting priority areas are addressed Our Ask Cross-cutting priority areas are addressed Key experts in maternal, adolescent and early child health and development We must ensure that these cross-cutting priority areas are addressed adequately at all levels of planning, budgeting, implementation and oversight of roll out of the NHI To make sure this happens: We stress the importance of including key experts in maternal, adolescent and early child health and development in strategic leadership roles on the board and at a technical level Failure to do so raises the risk of maintaining the status quo despite huge investment The National Development Plan places health and early development at the heart of sustainable development it is our hope that the NHI and NAPHISA realizes this. [I would ask for both and add an argument on how prevention ensures full development and links into poverty elimination When we speak to all levels of planning it will be critical to also make sure appropriate budgets/resources are made available]

Thank you