Government-funded programmes and services for vulnerable - Unicef

Government-funded programmes and services for vulnerable children in SA
Insufficient and inappropriate assistive devices
Many children who do qualify for assistive devices do not get them as they are not easily
available. When they do manage to get them, they are often not appropriate to the needs
of the patient. This results in a greater chance of secondary disabilities and increased
dependency on the state. The application process for assistive devices – even in the case
of a child with severe, progressive or multiple disabilities that require specialised devices –
is complicated and the delivery of the devices is not guaranteed. The child’s treatment
team will have to motivate for the device, based on the child’s home circumstances, his
or her physical needs, and the potential for enrolment at school. The team would have to
build a reasoned case motivating for the purchase of the device. Even if the motivation
succeeds, there is no guarantee the child will receive the device as it depends on the
availability of funds (Philpott 2004).
The budgets for assistive devices are not ring-fenced so allocation within provincial
budgets for purchasing these devices is discretionary. In practice, this often means that
there is no budget available for the provision of these services to children who are
disabled (Philpott 2004).
Integrated Nutrition Programme
Overview of child underweight/under-nutrition
Harrison (2009) notes that, given the importance of child nutrition to child well-being, it is
cause for concern that our knowledge in South Africa of the nutritional status of children
is seriously inadequate. There are insufficient data to gauge, with any accuracy, the
progress that has been made in this regard since 1994.
The data that are available show significant levels of under-nutrition among children and
a failure to improve child nutrition levels over time. In 1999, 11.1 per cent of children
between the ages of 12 and 71 months were underweight, 23.8 per cent suffered stunting
and 3.8 per cent suffered from wasting. 61 According to the National Food Consumption
Survey 2005, stunting and underweight are by far the most common nutritional disorders
affecting, respectively, almost one out of five and one out of ten children aged one
to nine years. Younger children in the one- to three-year age group are most severely
affected, having almost a twofold higher prevalence of stunting and wasting than the
seven- to nine-year-old group. Furthermore, the nutritional status of children has only
marginally improved in comparison with the 1999 data.
Sanders et al. (2010) confirm that severe childhood malnutrition is a common and often
fatal condition that presents regularly in hospitals, but it is poorly managed, especially in
rural districts, contributing to high levels of child mortality in the country.
Poor coverage of INP interventions
Several of the interventions provided by the INP, such as the promotion of breastfeeding
and complementary feeding, vitamin A and zinc supplementation and the appropriate
management of childhood malnutrition have the potential to reduce child mortality by
25 per cent and stunting by 33 per cent when implemented to scale (Hendricks et al.
2010: 50). However, rather than seeing these interventions being implemented to scale,
the contrary is true. For example, a 2005 National Food Consumption survey showed an
increase in vitamin A deficiency in children aged one to five, with a coverage rate of only
61 Health Systems Trust, South African Health Reviews, in Harrison (2009: 13)
128