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A poisonous snake slithering through a district hospital, badly cracked walls and rooms filled to the roof with broken equipment were some of the challenges facing researchers as they conducted the first national audit of public health facilities.

For most of last year, 20 data collection teams visited 3 880 public health facilities, throughout the country, ranging from tiny clinics to national central hospitals. The vast majority – 3 074 – were clinics.

The aim was to assess all public health facilities according to six criteria so that problems could be identified and addressed.

A clinic designated as a National Health Insurance pilot project less than a year ago is now operating in a "camp" without water, electricity or refrigeration for medicines.

The Lusikisiki Clinic, in the OR Tambo distric of the Eastern Cape, was shut down for two months and reopened in January - in a field on the far outskirts of the town. It consists of a mobile unit and two tents.

This is despite OR Tambo having received R11.5-million in extra funding as part of the NHI pilot project grant for the 2012-2013 financial year.

There are 10 NHI pilot districts.

Six of the country’s 10 most deprived districts are in KwaZulu-Natal, with Umzinyathi and Umkhanyakude being the poorest in the country.

Umkhanyakude, in the far north of KZN, also has the worst rate of severely malnourished children, with 13 out of 1000 children weighing less than 60% of what they should.

Seven of the 10 districts with the worst malnutrition rates are in KZN, while there has been an increase in severe malnutrition in the Eastern Cape and Limpopo.

In 2006 doctors at an isolated government hospital in the former Transkei took a bold and controversial decision -- they would encourage mothers giving birth at the facility to exclusively breastfeed -- giving their infants nothing to eat or drink other than breast milk -- for the first six months of the babies' lives.

Earlier this year, Health Minister Aaron Motsoaledi announced a national policy along the same lines as the one Zithulele Hospital decided to follow five years ago. In the area surrounding the hospital, which is near the coast about 100km from Mthatha, one out of every four mothers is infected with HIV.

t’s a rare sight but when HIV-positive mothers at Charlotte Maxeke Johannesburg Academic Hospital glimpse another infected mother breast-feeding her baby, they shake their heads in disbelief.

“Most of the HIV-positive moms in our clinics use formula,” explains Dr Louise Gilbert, the programme manager of maternal health at the Wits Reproductive Health and HIV Research Unit. “If they’re sitting in the waiting room, and see another mother breast-feeding, they wonder if she’s crazy.

“It’s going to take a lot to get buy-in from the community (to breastfeed). But it’s really about empowering mothers to make their own decisions and not making decisions for them.”

Health Minister Aaron Motsoaledi on Monday unveiled a R150-million plan to upgrade buildings and services at Chris Hani Baragwanath Academic Hospital -- and halve the number of patients it treats.

The announcement follows countless reports of crumbling infrastructure and deteriorating services at the world's biggest hospital with over 2 800 beds, a number which, after the improvements are completed, will be reduced to only 1 200 beds.