ISDS Site: Alfred Nzo District

Alfred Nzo District is situated in the Eastern Cape and is divided into two local municipalities the Umzimvubu Municipality which forms the provincial boundary with KwaZulu-Natal and the Umzimkhulu Municipality which is an island of the Eastern Cape province within KwaZulu-Natal.

Alfred Nzo has a population of 554 107 people with an average population density of 69 people per square km. It is one of the poorest districts in the country. As part of the former Transkei it inherited poor infrastructure and high levels of poverty. According to the 1996 Household Survey:

• 76% of the people in the district are unemployed
• 75% of the district is living in poverty
• The literacy rate is 55% and 8% of the population has no formal education
• 7% of the road network is tarred
• 93% of the population does not have access to safe drinking water
• 99% of the population has no access to safe sanitation. 73% of the households use pit latrines, 23% have no access to sanitation at all and 4% use buckets or flush toilets.

The boundaries of both the health district and health sub-districts are not coterminous with those of local government. Although there are only two municipalities there are three health sub-districts. All health services in the district are run by the Provincial Department of Health. The majority of the clinics do not have electricity or water. Communication with and between many clinics is a problem as telephones do not work in many of the areas and even cell phone reception does not exist in many areas.

The cross-boundary movement of patients to and from facilities in the Eastern Cape and KwaZulu-Natal provinces complicates health service delivery in this under-resourced district. The major health problems of the district are HIV/AIDS, STIs and TB. These problems are further exacerbated by the lack of doctors and rapid turnover of nursing staff.

ISDS interventions are aimed at assisting the district in TB, HIV/AIDs, clinic supervision, district management and monitoring and evaluation of PHC services.

Umzinyathi is located in the central midlands of KwaZulu-Natal, bordering Zululand on the east and Amajuba on the west. There are four local municipalities making up Umzinyathi, namely Endumeni, Umvoti (Greytown), Umsinga and Nquthu. Major towns are Greytown, Glencoe and Dundee.

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