Windows of Opportunity Project: Review and Analysis of Maternal and Child Health Development Data for Four Project Districts in South Africa
Up to half a million African babies die on the day they are born, and every year 1.16 million babies die in the first month of life while another one million babies are stillborn. In addition, about 250 000 women die of pregnancy-related causes every year in Africa. The majority of these deaths are preventable. However due to factors such as critical shortage of health professionals and essential materials and infrastructure, ineffective intervention programmes as well as the impact of the HIV and AIDS epidemic, the Africa continent continues to lose millions of babies and mothers every year. Hence, there is a need to strengthen the health systems in many African countries through effective maternal and child health (MCH) intervention programmes.
A Community Health Worker (CHW) may be defined as any health worker delivering health care services and who is trained in the context of the intervention but has no formal professional, certificated or degreed tertiary education. CHW is an umbrella term used for a heterogeneous group of health workers, their scope of practice ranging from implementing biomedical interventions to acting as community agents for social change.
MATERNAL, NEONATAL AND CHILD HEALTH AND NUTRITION PROJECT
The 1998 Review concentrates on equity and attempts to highlight progress that has been made as well as identify blocks to providing equitable public sector services throughout South Africa. Research commissioned specifically for the Review sheds light on the health status of South Africas population and key areas of the health system including finance and expenditure, human resources, information systems, pharmacy, and service delivery in clinics and district hospitals. This is provides a comprehensive, authoritative and independent review of South Africas health system.
In 1998 the greatest inequity remains the difference between those who predominantly use private sector health care and those who do not. Just under one fifth of South Africas population belong to a medical aid scheme, yet this group has access to 85% of pharmacists and 60% of medical specialists working in South Africa.
In the field of public sector spending comparisons of provincial health budgets indicate that great steps forward were made in the years 1995/6 and 1996/7 with most budgets coming closer to the national average. However since that time progress has stagnated, with the gap between expenditure per person in the North West, Mpumalanga and Northern provinces and the national average remaining a cause for concern. Comparisons of spending within provinces indicate that disparities are greater even than those between provinces. In Potchefstroom and Grahamstown Districts for example, for every R4 spent on health services in the public sector, R1 was spent in the Odi and Mount Frere Districts.
With regard to the distribution of health sector personnel, disparities tend to occur between the more urbanised and historically better funded provinces and those which are predominantly rural. For example there are forty nurses per 10,000 population in the Western Cape whereas in the Northern Cape and Mpumalanga there are only 20 and Gauteng has 2000 people to every pharmacist while the comparable figure in the Northern Province is 16000.
A survey of 294 clinics and 84 regional and district hospitals provides information about service delivery and indicates the variations that exist between provinces and between rural and urban facilities. While 100% of clinics in the Northern Cape have all TB drugs available this is true for only 20% of clinics in the Northern Province and HIV testing is available in less than half of clinics in the Eastern Cape, North West, KwaZulu-Natal, and Northern Provinces. The investigation of maternal deaths was used as one of the indicators to measure the quality of care in hospitals and it was found that less than half of hospitals have meetings where infant and maternal deaths are investigated and discussed.
Results of this survey are compared with a survey of clinics undertaken in 1997 and the findings indicate improvements in some areas. Seventy one percent of all clinics have a functioning telephone in 1998 as compared with 63% in 1997 and 83% of clinics provide family planning services on a daily basis in 1998 as compared with 72% in 1997.
The South African Health Review is accompanied by Technical Reports that provide more detail in the areas of financing, the private sector, pharmacy and service delivery in hospitals and clinics.