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Title: “HOW XYZ IS GOING TO IMPROVE THE PUBLIC HEALTH SECTOR AND MAKE SOUTH AFRICA A BETTER PLACE”.
SITUATION

Fetal Alcohol Syndrome (FAS) is a pattern of physical and mental birth deficiencies (retardation), caused by alcohol consumption by the pregnant mother.
– FAS is a real crisis in South Africa (SA).
– South Africa has the highest prevalence in the world.
– South Africa has an incidence of 111 per 1000 children.
– 2nd Croatia at 53 per 1000 children.
– 3rd Ireland at 47 per 1000 children
– Global average at 7.7 per 1000 children. (SA 14 times global average)
This is a problem of national proportion if compared to the statistic of 12% of adults with HIV/AIDS in SA. (www.FasFacts.org.za)
According to the NGO FasFacts 2-3 million people have FAS. It points out though that 5-6 million have fetal alcohol exposure (lesser symptoms but still affected). Hence 7-9 million are permanently damaged by pre-natal alcohol exposure.
FAS is spread across SA. Accurate data is not readily available. The main provinces affected are Western Cape, Northern Cape, North West, Eastern Cape and Gauteng. Today SA has a high culture of drinking (ranked 19th in the world for alcohol consumption per capita. There is a complex social, cultural and political history to alcohol consumption in SA. Colonists introduced a system of paying farm labour with alcohol. During apartheid the practice was intensified to economically and socially controlled mine and farm workers.

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FAS is 100% preventable and sadly 100% irreversible.
FAS lead to birth defects, physical growth deficiency, hearing and sight problems, and specific facial features such as small head, thin upper lip and short eye opening. Most significantly it affects brain and nervous system development effectively leaving the person mentally retarded with a range of disorders including demised emotional intelligence, learning impairment, poor social skills and communication difficulties. FASD individuals are mentally and socially disabled for life.
Impact of FAS :
– Lack if impulse control or “Do without thinking” – the most serious problem
– Poor logic and reasoning skills
– Early school drop out
– Unemployment and continuing cycle of poverty
– Low self esteem
– Early substance abuse (beyond alcohol)
– Crime – from petty crime to rape and murder
– Illegal shebeens
– Unwanted pregnancies
– Sexual promiscuity
– HIV & AIDS
Illegal shebeens – De Aar, a small Karoo town has over 100 illegal shebeens. Taking away the well-off mainly white town folk, each shebeen caters to about 300 people – that is a lot of drinking! The shebeens have also become crime hotspots and other drugs have also infiltrated these markets (supplied by the more organised criminals).
Cost of FAS to SA
Very little data is available for SA. In a 2009 study by the Canadian Society of Pharmacology, an annual cost of $ 14342 per person was estimated. This included costs of medical procedures, special schooling and social services. Ignoring inflation and assuming half the Canadian cost in a developing country like SA – i.e. C$ 7000 per person (approx. R70000 pp.) – 9 million FAS sufferers will cost R630 billion. The total SA health budget for 2018/19 is R205bn (12.3% of total budget and the 3rd biggest item behind Education at 21% and Social services at 15.5%). SA just has not got the money to deal with this problem. In addition, there are priority health problems such as TB, HIV/AIDS and programs focussed on child and maternal mortality. FAS is recognized but it is low priority.
Alcohol Industry
The liquor industry was valued at R106billion in 2016. It is an important employer and a world class producer of products, especially wines. It adds to Brand SA from international perspective.
While the Alcohol industry’s thirst for profits which drives marketing of cheap alcohol and the use of inappropriate advertising to recruit young drinkers, the industry recognises its social responsibility. It funds the Arrive Alive campaign which focuses on drink driving during periods of high road usage. In addition, it assists with funds for the NGO, Foundation for Alcohol Related Research (FARR) and encourages responsible drinking.
The industry has a responsibility to contribute more to the FAS problem. The ugly problem that surrounds them and their workers viewed commercially does have a negative impact on their brands.
Current Initiatives to address FAS:
– Government prevention programmes are currently limited to areas identified as high risk: Kimberley, De Aar and Upington in the Northern Cape, and Witzenberg and the West Coast in the Northern Cape.
– Limited screening for (alcohol exposed pregnancy) AEP in primary health care.
– Health service provider lacks the skills to carry out the brief intervention where indicated.
– Few alcohol rehabilitation programmes in the country.
– It is expensive to diagnose FAS.
– People are in denial about FAS.
– FARR, funded by the industry, focuses on research and some awareness programs
– FASFACTS operating out of Wellington, funded by donor funds and Industry, does awareness programs primarily in rural Western Cape
The status quo / and problems with the current initiatives:
• They appear to be a lack of political will to recognise and address the problem. Hence, they lack of pressure on the liquor industry.
• In addition, there is a focus on preventative awareness programs only in a few selected areas.
• They also appear to be no co-ordination of initiatives within the Health Department or co-ordination of initiative with other departments such as Social development, Education, Public works and Safety and Security to provide holistic solutions.
• There is recognition of the conflict between awareness educational interventions with women and the marketing campaigns and societal pressures that encourage women to drink.
• Recognising that drinking by rural women is as a result of alcoholic dependence and living conditions which give them few alternatives
• Government effectives outsources most work to NGOs
• Government has neither reliable data nor program to get that data
• Government focus on FAS is crowded out by TB, HIV/AIDS and nutrition programs for children
• No focus on the drinking men in the family unit
• Lack of focus on the poverty, low self-esteem and unemployment causes

Seeking Solutions:
We need to go to the root causes and tackle the problem holistically.
This will require coordinating all stakeholders who need to play a role;
– the community itself
– Community organisations including Faith based organisations
– Government: Department of Health, Safety ;Security, Education, Public works, Social development
– The Industry
– Existing NGOs already operating
A coordinating body should be created consisting of representatives from all these institutions; a professional CEO and qualified staff to run this organisation. This body could either staff up implementation capacity themselves or work through other bodies with the necessary capacity.
Funding should be provided from all the Government Department budgets as well as the Industry (or from the special taxes levied on the industry).

The problem should also be segmented with initiatives and priorities determined for each segment.
Segmentation suggested;
– A. Women of child bearing age with a further cut into;
• A1 – Women in High School
• A2 – Pregnant women
• A3 – Women not pregnant or in school
– B. People (men and women) living with FAS with further cuts into;
• B1 – School going primary
• B2 – School going – High School
• B3 – Adults
• B4 – Adults with too much disability to care for themselves
• B5 – Adults in jails
• B6 – Adults who have criminal record but currently not in jail
Task 1 should be to gather comprehensive data on the problem – rates of FAS, causes, economic conditions, crime, unemployment, number of shebeens etc.
Solutions should be tailored as specifically as possible to the community circumstances and the actual data discovered – i.e. let the data inform the solution.
The data will also determine the priority areas to target.
Awareness programs:
Will be for all segments; A1 through to B6. Implementation techniques may differ however. For example, while smartphone penetration is lower in rural areas, many young people (A1, A2, B2, and B3) in small and larger rural towns have basic smartphones and access to data. Social media marketing campaigns educating about FAS can be easily launched – I am sure some cell phone operators would consider free Facebook data and ads in those geographies educating about FAS.
(SA has over 20million smartphones in use in 2018, with 78% of web traffic on mobile phone and with Facebook being the most popular social platform and the 13-34 year old the vast majority of Facebook users.
A2 – could be addressed at clinics, via local doctors and hospitals.
A1, B1, B2 – preventative educational awareness programs done at the schools with support from Department of Education. Include skilling teachers with the content and pamphlet takeaways.
A3, B3 – Social media as above. Awareness programs at churches – look at skilling church staff and use a pamphlet distribution point. Consider also at sporting events.
Importantly programs aimed at building self- esteem – getting success stories / role models which originated from these communities to do talk, example sports stars, entertainment stars etc.
Public works can introduce low skill training and government funded business ventures for example metalwork and woodwork training to build school desks as a public works program which Department of Education / schools in area will buy – with budgets pre allocated for this.
B5, B6 – could possibly be used in such public works programs as well
B4 – State care must be provided to prevent predicted outcomes of FAS e.g. criminality etc.
Safety and Security / SAPS – should proactively reduce illegal activity regarding drugs and illegal alcohol distribution. They should work with communities and this structure to get information and coordinate their activities.
Social services – should share the information regarding the amounts of money entering communities via grants, pensions etc. Education programs can be tailored to help with money management skills. Also acknowledge of where the money is going.
A1, B6 – Life skills and conflict resolution skills programs.
Considerations for Stakeholders
Why fund this initiative:
1. Government
– Because it is their duty and responsibility to help their people fix this kind of problem.
– This is an embarrassment for the country as South Africa is number 1 on the list for FAS cases in the world.
– FAS is preventable that is why they must do something about it.
– They are paying for the impact of negative effects among the following:
• unemployed people that the state has to support
• impact of crime
? Micro – theft, murder, rape, car crashes, violence, child and spousal abuse, etc.
? Macro – businesses will not invest in South Africa and the country will not grow.
2. Alcohol industry
– They are already committed
– This will enhance their brands
– Responsible corporate citizens

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