Government-funded programmes and services for vulnerable - Unicef

Department of Health
Inequitable coverage of maternal, neonatal and child health interventions
There are significant disparities in the coverage of maternal, neonatal and child health
interventions between different parts of the country. Coverage is better in better resourced
districts and provinces. For example, in the Eastern Cape only 71 per cent of women
deliver in facilities, compared to 98 per cent in the Western Cape (Sanders et al. 2010: 35).
This unequal distribution of healthcare services severely compromises the health rights of
children in South Africa. Westwood et al. (2010) argue that healthcare services play a key
role in the prevention and treatment of childhood illnesses. The delivery of these services
through the essential healthcare programmes has been designed to be realised as part of
the district level healthcare package. They conclude that ‘the goal to deliver the package
successfully in all districts is still elusive, with dire consequences for the realisation of the
right to basic [healthcare] services’ (Westwood et al. 2010: 61).
Insufficient healthcare services in the rural areas and informal settlements
Poor children living with sick or dying caregivers are often unable to access healthcare
because there are not enough services in rural areas and informal settlements. As noted,
there is unequal implementation of healthcare services across districts and provinces, with
the poorer, less well-resourced provinces experiencing the greatest difficulties (Sanders et
al. 2010; Westwood et al. 2010).
Free healthcare policy
Lack of knowledge of the free healthcare policy
Grandmothers and older caregivers who are increasingly taking care of vulnerable children
in South Africa are at risk of not knowing about mandatory, free, essential health services
for young children, such as the immunisation programme (Giese, Meintjies et al. 2003).
Cost of transport
The high cost of transport to medical facilities renders free healthcare unaffordable for
vulnerable children (Giese, Meintjies et al. 2003). Four out of every ten children in South
Africa live far from a clinic (more than 30 minutes travelling time). The majority of these
children are African (42%), whereas only 12–13 per cent of those living far from a clinic
are coloured, Indian or white (Lake & Marera 2009: 91).
Unlawful imposition of user fees
There is anecdotal evidence of admission clerks turning children away who qualify for
free healthcare if they are unaccompanied or if their caregivers are unable to pay the
required fee. As such, user fees at hospitals may still pose a barrier to access to healthcare
at hospital level (Shung-King et al. 2005).
Free healthcare limited to children younger than six
Free healthcare for children older than six is limited to primary level care. Children older
than five years of age primarily suffer from health conditions relating to trauma, HIV and
chronic health conditions, among others, all of which are likely to require some level of
hospitalisation.
Free healthcare for children with disabilities
Insufficient services and devices
Services and devices are not available for children with temporary disabilities or a chronic
illness that does not cause difficulty in daily functioning (Philpott 2004).
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