Government-funded programmes and services for vulnerable - Unicef

Department of Health
20.5 per cent (in Hendricks et al. 2010: 50). A further example of very poor coverage is the
rate of exclusive breastfeeding. Despite the fact that almost half of all public hospitals are
‘baby friendly’, coverage for exclusive breastfeeding is a low 7 per cent (DoH et al. 2008).
Insufficient/ly trained INP staff
Hendricks et al. (2010) observe that overall the INP has had limited success in addressing
the causes of malnutrition. The reasons for this include a lack of sufficient and/or trained
staff in the public sector, lack of pre and in-service training of healthcare workers on
the INP, and poor implementation of policies due to poor supervision and support. This
is confirmed in the DoH’s 2007 Annual Report, which notes that there are not enough
trained and capacitated personnel to implement the INP and related programmes (DoH
2007b). Staff at health facilities are stretched to provide primary curative services and do
not have the time to provide nutritional and related support. Moreover, the limited staff
are not supported in their role by a strong and active community-based support network.
Consequently, the INP remains clinic-bound, failing to reach into vulnerable communities.
Nutrition Supplementation Programme (NSP)
The nutritional support system is limited in the sustainable difference it can make to
nutritional outcomes for vulnerable children. The primary reason for this is that it is
not designed as a preventative intervention. Nutritional support only becomes available
to vulnerable children once they are severely malnourished and about to be admitted
to hospital. There is not enough community level assessment of the nutritional needs
and vulnerabilities of children before the onset of severe malnutrition and there are
insufficient services to prevent malnutrition when children are found to be at risk. 62
Not only does the programme not make provision for effective preventative community
level screening, it also fails to provide for ongoing nutritional care and support once the
child is discharged from the hospital/clinic. The hospital or clinic needs to work more
closely with community-based organisations. Information must be shared so as to impact
at community level through nutritional counsellors outside of the clinic. 63
The benefits of the NSP are short-lived. Children on the NSP are excluded from the
programme once they gain weight. As a general rule, children are admitted to the NSP
for a maximum of six months. If a child has entered a programme because they became
malnourished due to the socio-economic vulnerability at home, it is likely that they
will be returning to the same circumstances which will expose them to the danger of
malnutrition again. For vulnerable children, the NSP is often the only source of secure
nutrition (Giese & Hussey 2002).
Vitamin A supplementation programme
There is inadequate coverage of the vitamin A supplementation programme. The 2005
National Food Consumption Survey revealed that only 21 per cent of children nationally
between the ages of one and nine had received a high-dose vitamin A supplement in the
six months preceding the survey. At a provincial level, the supplementation coverage ranges
from 10 per cent in Mpumalanga to 33 per cent in the Eastern Cape. More recently, a 2007
62 Personal communication between Nigel Rollins, the Department of Paediatrics and Child Health, Nelson Mandela
School of Medicine, and Laura Markovitz, in Markovitz (2008)
63 Private communication with Gilbert Tshitavadzi, Deputy Director HIV/AIDS, Nutrition Support, DoH, recorded in
Markovitz (2008)
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