Government-funded programmes and services for vulnerable - Unicef

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.
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