South Africa
is a middle-income country with high rates of inequality and poverty -
contributors to ill-health and death. People who study poverty talk about its
transmission from parents to children. If a mother or grandmother is poor, she
may be unable to provide the nutrition, environment, education and opportunities
for her child to have a better life. In such a case, her child is likely to
travel a road of poverty too.
That destiny can be changed if the family gets access to
new resources, a job for example, that will provide the income to choose better
food and better schools. It can also be changed if public institutions give
chances to a child from a family with few resources - good primary health care,
water and toilets, safe environments, and schools that provide good education.
South Africa
has the capacity and resources to prevent these deaths
For most children in
South Africa
whose lives end before they turn five, death comes in the form of HIV and AIDS
and diseases of poverty diarrhoea, respiratory tract infection and
malnutrition.
According to the Medical Research Council, 40 percent of
children who die before they are five die as a result of HIV and AIDS. Another
30 percent die as a result of diseases of poverty.
South Africa
has the capacity and resources to prevent these deaths. Nevirapine can be
administered to an HIV-positive mother before and during labour, significantly
reducing the likelihood that her child will be HIV positive. In the few months
after birth, she should be able to get baby feeding formula from her local
clinic.
This needs to be mixed with clean tap water, and heated
with something less dangerous than paraffin. Babies can also be immunised
against common and potentially fatal diseases.
But for the poorest, basics such as clean water and fuel
can be hard to access. In
South Africa
, a little over half of all children live in rural areas, where the challenge of
survival is often related to the most basic of needs.
One third of children did not get what they needed from a clinic
Take the following example as a case in point: When driving
from the town of
Butterworth
towards the coast, you'll see hillsides dotted with the villages of the former
Transkei
. This is the fourth poorest magisterial district in the
Eastern Cape
, and average monthly expenditure is less than R800 per household. There is
virtually no employment.
The road to the villages where the Children's Institute has
been conducting research is untarred, dusty in winter, and almost impassable in
summer. When it rains, you need a 4x4 to drive it - and so does everybody else.
The Department of Health's mobile clinics cannot get through when it rains,
leaving about 3 000 people with virtually no access to health care services. The
schools complain that bread trucks for the feeding scheme cannot get through
either.
One of the many ways in which this area is under-developed
is a fundamental lack of services - water, electricity, sanitation. There is no
bulk-water supply. For the vast majority of people here, water is collected from
streams and springs at the bottom of the hills. People complain that the same
water is used for the animals and laundry. Environmental health tests have
confirmed that the water is polluted and inadequate for human consumption.
In one of the villages, a few houses have electricity. This
allows their families to escape from the drudgery and danger of collecting
firewood, paying for paraffin, and inhaling the smoke from cooking fires.
There are no sanitation services. While a few residents
have dug their own pit latrines and bought zinc or ready-made top structures,
the majority use the bucket system, open veld or the ruins of old buildings for
their facilities. These bring all the difficulties of a lack of privacy and
dignity, as well as environmental health concerns.
Clinics are often left without medicines and supplies when
roads are flooded. For mothers of children who are malnourished or part of the
Prevention of Mother-to-Child Transmission (PMCTC) programme, a visit to the
clinic is often frustrated by the fact that there is no formula feed available.
This can mean the difference between life and death for a baby.
The Children's Institute last October surveyed care givers
in this area about child wellbeing. More than one third of all the children had
been sick in the previous three months with one or more of the following
diseases: asthma, flu, diarrhoea or vomiting.
One in 10 had suffered from diarrhoea or vomiting, and one
in 10 was an asthma sufferer. This is related to respiratory problems associated
with smoke inhalation from cooking fires. Younger children were most likely to
suffer from these health problems, and almost half of all children under six
years had ill health.
In this context, one third of children did not get what
they needed from a clinic. This includes those who, despite being poor, were
taken to private doctors and pharmacies in Butterworth, as well as those who
went to clinics but found that the medicines they needed had run out. For their
care givers, it made more sense to pay money than to go to a free facility but
receive no treatment.
As we celebrate Child Protection Week, it is crucial to
reflect on the fact that it is essential that public goods interrupt the
transmission of poverty from parent to child. In the early years of a child's
life, access to water, toilets, health care facilities, good nutrition and care
are absolutely essential for survival.
For this reason the efforts of municipalities, town
planners, water suppliers, health facilities, Eskom, public works and housing to
supply infrastructure and access are essential to prevent early death from
diseases of poverty.
Annie Leatt and Katharine Hall, Children's Institute,
University
of
Cape Town
.
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