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DoH: Directorate: Child and Youth Health
Children’s BillChildren’s BillDepartment of Health
presentation to the portfolio committee on Social Development
25 August 2004
DoH: Directorate: Child and Youth Health
Current status of child health in SA
DoH: Directorate: Child and Youth Health
Infant and under 5 mortalityInfant and under 5 mortality Figure 1. Childhood Mortality, South Africa: 1978-1996
45.4
14.7
59.459
23
89
39.2
50.7
16.220.4
54.8
70.1
46
56
19
20
67
80
0102030405060708090100
1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
Per 1
000
live
birth
s
IMR(98) 1-4MR(98) U5MR(98)IMR(90) 1-4MR(90) U5MR(90)
DoH: Directorate: Child and Youth Health
Leading Underlying Causes of Death among Children Aged 0 - 14 years: StatsSA 1997 - 2001
0 5 10 15 20
Intestinal infectious diseasesInfluenza and pneumonia
Unspecified unnatural causes HIV disease
Ill-defined causes of mortalityIntestinal infectious diseases
Influenza and pneumoniaHIV disease
Ill-defined causes of mortalityUnspecified unnatural causes
Mal
esFe
mal
es
%
1997 1998 1999 2000 2001
DoH: Directorate: Child and Youth Health
Causes of Deaths in Under 5's, 2000
HIV AIDS41%
LBW11%
Diarrhoeal10%
LRTI6%
PEM4%
Other28%
HIV AIDS
LBW
Diarrhoeal
LRTI
PEM
Other
Source: Bradshaw D, Bourne D, Nannan N. What are the leading causes of death among South African children? MRC Policy Brief No. 3, December 2003. Bradshaw D, Groenewald P, Laubscher R et al. Initial Burden of Disease Estimates for South Africa, 2000. Cape Town: SAMRC, 2003.
DoH: Directorate: Child and Youth Health
Mortality: CommentMortality: Comment Large inter and intra- provincial variation in
U5MR and IMR Average IMR higher than countries with
comparable economies e.g. Cuba Main causes of deaths are preventable:
– Infants: diarrhoea, chest infections, malnutrition– under-5: trauma, diarrhoea, chest infections,
malnutrition and HIV– 5-14 years: violent intentional trauma and
accidental trauma
HIV Diarrhoea, pneumonia, malnutrition
DoH: Directorate: Child and Youth Health
Morbidity: CommentMorbidity: Comment Mostly preventable causes e.g. diarrhoea,
malnutrition and chest infections
Disabilities often the result of: – delayed recognition / management or – inappropriate management e.g. birth asphyxia
DoH: Directorate: Child and Youth Health
MULTIFACTORIAL FACTORS associated with freq. & severity (incl. death) of child health conditions
e.g. diarrhoea, chest infections, malnutrition, HIV, abuse, accidents
Immediate Causes
Underlying Causes
Basic Causes
Bacterial / Viral load; Availability of and access to health services incl.
PHC package, hospital / institutional care, home care / protection
Feeding pattern / household food security (poverty), Unhygienic conditions;
Smoking; Pollution; Access to safe water, sanitation, environments; Education (esp
maternal)Allocation and distribution of resources; Intersectoral planning; Gender issues; Budgeting and prioritisation of children
To improveTo improveChild health:Child health:
ALL national , provincial
district & localorgans of govt. and all sectors
must be guided byThe best interest of
the child
when making policy
legislativebudgetary and administrative
decisions
DoH: Directorate: Child and Youth Health
INTERNATIONAL AND INTERNATIONAL AND NATIONAL CONTEXTNATIONAL CONTEXT
DoH: Directorate: Child and Youth Health
International Context
CRC: “Putting children first” African charter on the health and welfare of childrenMDGUNGASSA World Fit for childrenGlobal Strategy on Infant and Young Child FeedingNEPADWHA Resolution (54.19), May 2001, on Schistosomiasis and STH infections
DoH: Directorate: Child and Youth Health
International Context: CRCright to survival and development (6)protection from all forms of violence / abuse (19, 25,34)special consideration for all mentally or physically disabled children (23)right to health and facilities for the treatment of illness and rehabilitation of health (24)rehabilitation (39) As a country we need
to further define these rights and provide a supportive milieu to
realise them
In all actions the best interests of the child shall be a primary consideration (3)State parties shall undertake all appropriate legislative, administrative and other measures for the implementation…(4)
DoH: Directorate: Child and Youth Health
International Context
Millennium Development Goals: 3/7 goals are directly related to health
By 2015:Reduce by 2/3 the U5MR Reduce maternal mortality by 3/4Combat HIV/AIDS, malaria and other dx
How far are
we?
DoH: Directorate: Child and Youth Health
International Context
NEPAD Health StrategyNEPAD Health Strategy
Focus on poorest and most marginalised incl. women and childrenReduce IMR and U5MR by 2/3 by 2015Targets:
oEffective implementation of IMCI and EPI; oPolio eradication
Consolidation of:oIMCIoProgr. on HIV and AIDS, TB and malariaoImmunisationoEBF and appropriate nutrition
DoH: Directorate: Child and Youth Health
International ContextNational Context
Legislation
Policy
Strategies
Programmes
DoH: Directorate: Child and Youth Health
National Health Act As it relates to children will be presented by
my colleague at the end of this presentation
DoH: Directorate: Child and Youth Health
Legislation Other health-related legislation that impact
on children exist, including, inter alia: – food fortification– tobacco ControlThese will not be presented
DoH: Directorate: Child and Youth Health
Health sector strategic plans / frameworks
DoH: Directorate: Child and Youth Health
The Health Sector Strategic Framework, 1999-2004 (10 point plan)
aims to– improve access to health care for all (and build on
achievements since 1994);
– reduce inequities in health care, and
– improve the quality of care at all levels of the health care system
DoH: Directorate: Child and Youth Health
The Health Sector Strategic Framework, 1999-2004 (10 point plan)
Prioritises: – improving the quality of care, – speeding up delivery of an essential package of
PHC through the district health system, – decreasing morbidity and mortality through
strategic interventions, – improving resource mobilisation and the
management of resources bearing in mind “equity” issues
DoH: Directorate: Child and Youth Health
The Strategic Plan for HIV / AIDS 2000-2005 4 priority areas:
• prevention; • treatment, care and support; • research and • human and legal rights.
translates into: • preventing primary HIV infection, • preventing unwanted / unintended pregnancies in
HIV+, • PMTCT; • preventing common illnesses, and ensuring
ongoing care and support for mothers and children infected or affected by HIV and AIDS within a human rights paradigm.
DoH: Directorate: Child and Youth Health
Policies / Programmes / Strategies currently offered by the DoH
DoH: Directorate: Child and Youth Health
Child Health Policies and GuidelinesChild Health Policies and GuidelinesPoliciesDraft: Child Health Policy and Implementation GuidelinesDraft: Infant and Young Child Feeding Policy Draft: Policy Framework for non-communicable chronic conditions in children Policy Guidelines for the Management and Prevention of Genetic Disorders, Birth Defects, and DisabilitiesDraft: National Policy Framework for Child Abuse National Health Policy Guidelines for Improved Mental health in South AfricaPolicy Guidelines for Child and Adolescent Mental HealthNational Rehabilitation Policy
Strategies and Guidelines (excluding training packages)Comprehensive Primary Health Care Package + Norms and StandardsDistrict Hospital Service Package for South AfricaDraft Maternal and Neonatal Strategy SA Breastfeeding Guidelines for Health WorkersGuidelines for Nutrition Interventions at Health Facilities to Manage and Prevent Child MalnutritionPMTCT Protocol for Pilot SitesExpanded Programme on Immunisation (South Africa) – Immunisation Schedule and Fact SheetsIntegrated Management of Childhood Illness Strategy: Case Management Guidelines National Guidelines on Palliative Care for ChildrenDraft: Guidelines for health care providers managing suspected child abuse, neglect and exploitationHIV and / or AIDS: Strategic Plan of the National Department of Health: 2000-2005Comprehensive Treatment Plan for HIV and AIDSManagement of Diabetes Type I in children (<18 years) at hospital levelManagement of Asthma in Children National Guidelines on Primary Prevention and Prophylaxis of Rheumatic Fever and Rheumatic Heart Disease for Health Professionals at primary level
DoH: Directorate: Child and Youth Health
Child survival and improved quality of
life in children
MCWHMCWHANC, ATT
Genetics services
KMC
Oral health
EPI +ATT
INP: BFHI; Code,, growth monitoring, PSNP
IMCI
PMTCT
ART
SHS
Services for abused incl. ARV PEP
School health services
Health Health PromotionPromotionHPSI
Healthy environment for children
Anti tobacco
Mental HealthMental HealthVictim empowerment
FAS
Counselling
Rehabilitation
TBTBPrevention
Treatment
DOTS
HIV and AIDSHIV and AIDSVCT
PMTCT
ART
HBC
STIs
Malaria (RBM) / Malaria (RBM) / cholera / other cholera / other VBDVBDPrevention
Case management
Outbreak response
Programmes
or
Strategies
offered
IMCI
DoH: Directorate: Child and Youth Health
IMCI Components and IMCI Components and Intervention areasIntervention areas
Improving case
management
Strengthening the health
system
Improving household, community and family behaviours
Targets:
80% of district must have 60% of health workers trained in IMCI by 2005
HHCC must be implemented in ALL districts by end 2005
DoH: Directorate: Child and Youth Health
Programme Programme ImplementationImplementation
DoH: Directorate: Child and Youth Health
IMCI Expansion in SAIMCI Expansion in SAProvince % facilities with at
least 1 hw trainedNo. hw trained in IMCI in province
HHCC started Pre-service training started
Hospital level
EC 39% 273/700 530 Ukahlamba
P -
NW 47% 170/365 256 P -
G 38% 123/327 550 -
KZN 64% 388/712 1322 Ugu, Uthukela
P -
MP 65% 229 /352 634 -
L 79% 331/474 1506 3 districts
FS 88% 254/350 823 Motheo -
NC **/256 255 P -
WC **/334 653 6 sites -
TOTAL >1768/3870 (>46%) 6529 (50%)
** no data; P planning; --not started and no plans yet
Shortage of funding for training
Shortage of facilitators, course directors
NC: no training this year
No transport for supervision
DoH: Directorate: Child and Youth Health
Fully Immunised (annualised) by Fully Immunised (annualised) by District - 2003District - 2003
Key :Yellow : 60-79%Green : ≥80%
Target: 80%
DoH: Directorate: Child and Youth Health
Fully Immunised (annualised) in Fully Immunised (annualised) in Gauteng Province - 2003Gauteng Province - 2003
Ekurhuleni Metro
Mestweding DMCity of Tswane
Wes
t Ran
d D
M
City of Johannesburg
Sedibeng DM
Key:Red : 0-59%Yellow : 60-79%Green : ≥ 80%
DoH: Directorate: Child and Youth Health
INPINP >25% health facilities are baby friendly
PMTCTPMTCT At >1260 facilities 99% of HIV exposed infants receive nevirapine >2800 health care providers trained in PMTCT
and IFIMCI
DoH: Directorate: Child and Youth Health
Infrastructure for these servicesInfrastructure for these services
• District Health System• Local authorities
DoH: Directorate: Child and Youth Health
Human / Material Resources Human / Material Resources availableavailable
(National ) Chief Directorate: MCWHN Child and Youth Health:
EPI
Child
Youth and Adolescent
Provincial
District
No dedicated structures or
budget for child health at district levels
or in LSAs
DoH: Directorate: Child and Youth Health
Challenges and Gaps:Challenges and Gaps:• Children still die of preventable
conditions • Socio-economic issues impact
negatively on health e.g. poverty• Inequitable distribution of resources • Competing priorities at local levels• Services for children not prioritised
DoH: Directorate: Child and Youth Health
Challenges and Gaps:Challenges and Gaps:• Sub-optimal implementation of
programmes e.g. Immunisation / SHS• Poor inter-sectoral collaboration
resulting in poor / non-existing implementation e.g. SHS
• Data on progress needed (addressed through NHA)
• Ineffective child protection
DoH: Directorate: Child and Youth Health
The Children’s BillThe Children’s Bill
DoH: Directorate: Child and Youth Health
Addressing challenges Addressing challenges through the Billthrough the Bill
Healthy children
Education
Water
Refuse removal
Safe environments
Protection by Justice system
and SAPS
Social Welfare System
Sanitation
DoH: Directorate: Child and Youth Health
Children’s BillChildren’s Bill• Provides unique opportunity to legislate in
favour of one of the most vulnerable groups of society:
CHILDREN
• If properly developed Children’s Bill, can accelerate and improve implementation of health services for children
DoH: Directorate: Child and Youth Health
Children’s BillChildren’s Bill• Currently adopts a piece-meal approach:-
• Needs to go one step further and state that:
“The Minister, after consultation with the Ministers of Justice, Education, Health, Correctional services and Safety and Securty, develop a national policy framework to ensure a uniformed and coordinated approach by all Government departments in dealing with matters pertaining to children to guide the implementation and enforcement and administration of this Act”
• This will facilitate implementation of Health Programmes that optimise the growth and development of our children
DoH: Directorate: Child and Youth Health
Current intersectoral responseCurrent intersectoral response
• Falling short• Not bound / guided / obligated by law • Participation often inadequate /
delegated to junior officials• Faces numerous internal challenges
which has hindered its function and achievements
• Needs to be re-energised
DoH: Directorate: Child and Youth Health
Bill needs to elaborate on rightsBill needs to elaborate on rights• It currently is a re-statement of section 28 of the
Constitution• Needs to include the ffg:
• Basic health care and information about health – (part of PHC package and IMCI)*
• Basic nutrition and appropriate information about nutrition (part of PEM scheme and IMCI)*
• Water and sanitation – stated in chapter 6 (83) – minimum norms and standards for partial care – needs to be mainstreamed to prevent disease in general
• Safe environments • Leisure and recreation• Education• Social security * would not necessitate policy shifts but would assist with implementation of policy
DoH: Directorate: Child and Youth Health
Cont…/ elaboration of rightsCont…/ elaboration of rights• Protection from abuse, neglect, maltreatment,
degredation and other harmful practices• Protection from economic exploitation• Unfair discrimination – with specific reference to
disability; ethnicity, pregnancy• Family / safe alternate care• Property and possessions• Shelter• Social services
DoH: Directorate: Child and Youth Health
Cont…/ elaboration of rightsCont…/ elaboration of rights• Children with special needs deserve recognition
and special mention in relation to their rights:• Long-term health conditions: diabetes, epilepsy,
asthma• Disabilities• Born to parents who are HIV+ / debilitated• Orphans• Child-headed households• Living on street • Care centres• Refugee / unaccompanied minors
DoH: Directorate: Child and Youth Health
Cost ImplicationsCost Implications
DoH: Directorate: Child and Youth Health
CostCost• Would require integrated planning, budgeting and
prioritisation for children at district level
• Cost of ARVs covered by Conditional grants• Cost of school health services: R71 646 505 for full
coverage over 5 years (policy already accepted by Health MINMEC and PHRC)
• Cost of IMCI implementation to ensure 100% coverage still has to be done but plans underway for full implementation