Percy Mabandu and Faraanaz Parker, Mail & Guardian
Speaking this week at the release of this year's District Health Barometer, the annual report produced by research and advocacy NGO the Health Systems Trust, Dr Molefi Sefularo, the deputy health minister, said South Africa is moving backwards on the United Nations' millennium development goals (MDGs) and preventative healthcare.
The report quantifies levels of deprivation across 52 districts in South Africa by looking at factors such as access to piped water, sanitation, electricity and housing.
The most deprived districts are KwaZulu-Natal and the Eastern Cape, where between 63% and 82% of households live on less than R800 a month.
In addition, deprivation levels in the City of Tshwane and Ekurhuleni metros increased dramatically in the past year.
In KwaZulu-Natal about half the population has no access to piped water and only 5.6% of people have medical aid. This is a clear indication that the health department should make a conscious effort to allocate more resources to these provinces, District Health Barometer co-editor Candy Day said.
We're doing particularly badly with regard to MDGs for the prevention of mother-to-child transmission of HIV, Sefularo said. The report showed the Free State recorded declining Nevirapine coverage rates in public clinics for the second consecutive year. Nevirapine is an antiretroviral drug (ARV) used by HIV-infected pregnant women to prevent their babies from contracting the virus during birth.
According to the British medical journal, The Lancet, South Africa's child mortality rate rose from 60 to 69 deaths in 1 000 live births between 1990 and 2006 -- one of only 11 countries in which this figure has deteriorated since the UN set its MDGs. Marion Stevens of the Health Systems Trust said the country's poor performance could be an effect of HIV/Aids.
In Gauteng four of the province's six districts and three of its six metros were found to have among the lowest primary healthcare utilisation rates in the country. Although this would seem to indicate a lack of confidence in the public healthcare system in the province, Day said a more accurate conclusion could be that Gauteng residents have greater access to medical aid and tend to use tertiary healthcare facilities instead of primary healthcare centres.
Nurses' clinical workload -- the average daily number of patients seen by a professional nurse at a primary healthcare facility -- was identified in the report as probably the single most important factor in the delivery of primary care. Although the national average for the number of patients seen daily by nurses is 23.7, some districts in Limpopo report fewer than 15 patients a day.
On the other hand, Fezile Dabi district in the Free State has a nurse clinical workload of 44.2. On an average work day of eight hours that includes an hour for lunch and an hour for tea breaks, a nurse is left with eight minutes to spend on each patient.
But nurses rarely have that much time, said Stevens. They don't just see patients -- they also have to do administration and sometimes even ferry patients around.
When you are seeing so many patients, the quality of care will obviously drop, said Thembeka Gwagwa, the president of the Democratic Nursing Organisation of South Africa. There should be a greater focus on recruiting and also retaining nurses, the union said.
Two indicators absent from the report were doctors' clinical workload and access to ARVs. Despite these being high-profile areas, the data quality has been particularly bad, Day said, adding that ARV uptake had not been well measured across provinces.
The report used information from the Department of Health, Stats SA, the treasury and other sources to evaluate the performance of the public health sector to try to put the best data out there and open it to further research, Day said.
Sefularo specified health information systems as one of two areas the government needs to improve, as well as the health profile of all South Africans.
Source: Percy Mabandu and Faraanaz Parker, Mail & Guardian, 12 July 2009. http://www.mg.co.za/article/2009-07-11-healthcare-in-reverse