Government-funded programmes and services for vulnerable - Unicef

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Department of Health (ii) National Health Act 61/2003, s4(3)(b) (iii) National Health Act 61/2003, s4(3)(a) (iv) Free Primary Health Care for All Policy, 1996 (v) National Health Act 61/2003 (vi) National Health Act 61/2003 (vii) UPFS Fee Schedule, DoH, 1 April 2010, as provided by the Western Cape DoH (viii) Free Health Care for Disabled People at Hospital Level, 2003, DoH, read together with the Standardisation of Provision of Assistive Devices in South Africa, 2003, DoH (ix) Free Health Care for Disabled People at Hospital Level, 2003, DoH (x) www.doh.gov.za/programmes/index.html (xi) Policy Guidelines for the Nutrition Supplementation Programme of the Health Facility Based Nutrition Programme & National Guidelines on Nutrition for People Living with HIV, AIDS, TB and other Chronic Debilitating Conditions, 2007, and The Guidelines for the Management of HIV in Children, 2nd edition, 2010 (xii) The Comprehensive HIV and AIDS, Care, Management and Treatment plan (CCMT), 2003, and The Guidelines for the Management of HIV in Children, 2nd edition, 2010 (xiii) The Guidelines for the Management of HIV in Children, 2nd edition, 2010: 25–26 (xiv) The Guidelines for the Management of HIV in Children, 2nd edition, 2010: 24 (xv) The Guidelines for the Management of HIV in Children, 2nd edition, 2010: 28 (xvi) Breastfeeding guidelines for health workers, 2000 (xvii) Infant and Young Child Feeding Policy, 2007, and Clinical Guidelines: PMTCT, 2010 (xviii) The Road to Health Chart Guidelines for Health Workers, 2003, DoH (xix) The original 2003 CCMT was amended by the introduction of a range of innovative prevention and treatment regimes in 2010, with the objective of reducing mortality rates among infants, children and women through increased prevention of HIV transmission from mother to child and improved treatment of HIV+ pregnant women and women with small children. These innovations are contained in the Clinical Guidelines: PMTCT, 2010; Guidelines for the Management of HIV in Children, 2nd edition, 2010; the Clinical Guidelines for the Management of HIV and AIDS in Adults and Adolescents, 2010; and The South African Antiretroviral Treatment Guidelines, 2010. (xx) Policy Guideline for HIV Counselling and Testing, October 2009, the Children’s Act and the Guidelines for the Management of HIV in Children, 2nd edition, 2010 (xxi) Guidelines for the Management of HIV in Children, 2nd edition, 2010: 14 (xxii) Children’s Act, s132 (xxiii) Policy Guideline for HIV Counselling and Testing, October 2009: 9 (xxiv) Guidelines for the Management of HIV in Children, 2nd edition, 2010 (xxv) Policy Guideline for HIV Counselling and Testing, October 2009: 11 (xxvi) Policy and Guidelines for the Implementation of the PMTCT Programme, 2008, as amended and expanded by Clinical Guidelines: PMTCT, 2010 (xxvii) The South African Antiretroviral Treatment Guidelines, 2010 (xxviii) Wellness services entail follow-up of HIV-infected individuals not yet on ART and include TB screening, nutritional and psychosocial support, cervical cancer screening, monitoring of CD4 cell count, clinical staging and preparedness for ART. (xxix) Guidelines for the Management of HIV in Children, 2nd edition, 2010; Clinical Guidelines: PMTCT, 2010; The South African Antiretroviral Treatment Guidelines, 2010 (xxx) The South African Antiretroviral Treatment Guidelines, 2010 (xxxi) Guidelines for the Management of HIV in Children, 2nd edition, 2010: 31 (xxxii) The South African Antiretroviral Treatment Guidelines, 2010 (xxxiii) Section 28 of Act 32/2007 (xxxiv) Section 28(2) of Act 32/2007 (xxxv) Policy Guideline for HIV Counselling and Testing (HCT), October 2009: 68 (xxxvi) Guidelines for the Management of HIV in Children, 2nd edition, 2010: 21 (xxxvii) School Health Policy and Implementation Guidelines, 2003 (xxxviii) School Health Policy and Implementation Guidelines, 2003 Overview of child and maternal health in South Africa International and regional child rights and development instruments, such as the UNCRC and the ACRWC, place a high premium on the provision of adequate ante- and post-natal care to pregnant women and to infants. This prioritisation is aimed at realising the express goals of reduced infant and maternal mortality rates, which rates are a key indicator of the state of child well-being in a country. It is thus appropriate to review the infant, child and maternal mortality rates in South Africa to gauge the soundness and effectiveness of the national healthcare system to realise the rights of children and their caregivers to adequate healthcare. 125
Government-funded programmes and services for vulnerable children in SA Infant, child and maternal mortality rates There is uncertainty in South Africa about the exact current levels of child mortality. This lack of clarity on the crucial indicator of child well-being is in itself a significant gap. Sanders et al. (2010) note that despite the lack of certainty on the actual current levels, there is consensus that the levels are unacceptably high and that they have not improved, but rather increased, over the last 10 to 15 years, leaving South Africa way behind in meeting its Millennium Development Goal target of reducing the under-five mortality rate to 20 per 1 000 live births by 2015 (Sanders et al. 2010: 29). In 1990, the infant mortality rate was estimated to be 44 deaths per 1 000 live births and the under-five mortality rate was estimated to be 56 deaths per 1 000 live births. UNICEF estimates that this increased to 48 and 67 deaths respectively in 2008 (UNICEF Statistics 2010). ‘The distribution and pattern of morbidity and mortality are shaped by persistent inequalities’ (Sanders et al. 2010: 35). Sanders et al. note that child mortality rates coincide with the rates and demography of poverty in South Africa; both are higher in non-urban areas and the child mortality rate is four times higher among African than white children. Diseases of poverty, including low birth weight, diarrhoea, lower respiratory infections and protein-energy malnutrition account for 30 per cent of these deaths (Bradshaw et al. 2009: 29). There are correspondingly poor levels of maternal health, which are cause for equal concern. At least 1 600 mothers die every year due to complications of pregnancy and childbirth (DoH et al. 2008). At least 60 per cent of these deaths are avoidable and 55 per cent are caused by what Harrison (2009) refers to as health systems failures. Some key policy and service delivery gaps Given the plethora of policies, legislative instruments, programmes and services listed at the start of this chapter which target the health and well-being of pregnant women, infants and young children, the question is why these often avoidable infant, child and maternal mortality rates remain so high. This section reviews some of the broad systemic failings within the healthcare system which contribute to poor health outcomes for children and their caregivers. In addition, the section aims to identify how some of these systemic failings impact negatively on the implementation of some of the child- and family-specific policies and programmes identified in Table 4.1. Unsafe water, sanitation and hygiene In 2000, almost 20 per cent of deaths of children under the age of five years were attributable to unsafe water. As in the case of nutritional status, there are insufficient data to track progress related to diarrhoeal diseases at primary healthcare facilities. Harrison (2009) notes that the introduction of the rotavirus vaccination in 2008 should make a positive difference in this regard, but that these gains may be offset by the poor water management practices of local authorities in marginalised communities. He refers specifically to the death of 80 infants due to contaminated water in 2008 in the Ukhahlamba district in the Eastern Cape (Harrison 2009: 13). He argues that instances such as these call for ‘heightened vigilance and pre-emptive action between the Department of Health and local municipalities’ (Harrison 2009: 12) to ensure better health outcomes in relation to diarrhoeal diseases among children. 126
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Government-funded programmes and services for vulnerable - Unicef

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