STRATEGIC HEALTH
PROGRAMMES
SECOND QUARTERLY REVIEW
2011/12
Number of Trauma Centres for victims
of violence
District
Quarter 1
Quarter 2
UGU
4 (1 Thuthuzela)
4 (1 Thuthuzela)
UMGUNGUNDLOVU
4 ( I Thuthuzela)
4 (1 Thuthuzela)
UTHUKELA
3 (No Thuthuzela)
3 (No Thuthuzela)
UMZINYATHI
4 (No Thuthuzela)
4 (No Thuthuzela)
AMAJUBA
3 (No Thuthuzela)
3 (No Thuthuzela)
ZULULAND
5 (No Thuthuzela)
5 (No Thuthuzela)
UTHUNGULU
7 ( No Thuthuzela)
7 ( No Thuthuzela
UMKHANYAKUDE
2 ( No Thuthuzela)
2 ( No Thuthuzela)
ILEMBE
2 ( 1 Thuthuzela)
2 ( 1 Thuthuzela)
ETHEKWINI
5 (3 Thuthuzela)
5 (3 Thuthuzela)
SISONKE
4
4
PROVINCE
43 ( 6 Thuthuzela)
43 ( 6 Thuthuzela)
COUPLE YEAR PROTECTION RATE
(35%)
DISTRICT
Q1 11/12
Q2 11/12
Amajuba
20.5%
27%
Ethekwini
20%
23%
Ilembe
22.7%
32%
Sisonke
25.9%
24%
Ugu
23%
29%
UMgungundlovu
22%
UMkhanyakude
18%
28%
Umzinyathi
24.2%
26.4%
Uthukela
23.2%
25%
UThungulu
20.7%
21%
Zululand
21.6%
26%
Province
21.9%
26.1%
NUMBER OF SEXUAL ASSAULT CASES
NEW
DISTRICTS
Quarter 1
Quarter 2
UGU
221
242
UMGUNGUNDLOVU
359
399
UTHUKELA
254
310
UMZINYATHI
68
88
AMAJUBA
186
237
ZULULAND
198
120
UTHUNGULU
155
166
UMKHANYAKUDE
67
89
ILEMBE
134
156
ETHEKWENI
887
822
SISONKE
46
50
2575
2679
PROVINCE
Sexual Assault children under 12 years
old
DISTRICT
Quarter 1
Quarter 2
UGU
90
105
UMGUNGUNDLOVU
217
221
UTHUKELA
75
66
UMZINYATHI
24
45
AMAJUBA
80
108
ZULULAND
32
36
UTHUNGULU
48
41
UMKHANYAKUDE
24
27
ILEMBE
31
57
ETHEKWINI
414
513
SISONKE
11
10
PROVINCE
1046
1229
ANC booking < 20 weeks rate (45%)
DISTRICT
Amajuba
Q4 10/11
Q1 11/12
Q 2 11/12
37%
29%
40%
42%
Ethekwini
36%
34%
Ilembe
32%
36%
33%
Sisonke
39%
33%
35%
Ugu
37%
35%
31%
UMgungundlovu
40%
47%
49%
UMkhanyakude
42%
45%
41%
Umzinyathi
42%
38%
43%
Uthukela
38%
35%
38%
UThungulu
42%
35%
42%
Zululand
38%
37%
42%
Province
38.1%
38.6%
38.6%
ANC client HIV re-test at 32 weeks rate
(50%)
DISTRICT
Q1 11/12
Q2 11/12
37.6%
29.7%
43.9%
44.1%
36.1%
31.7%
Ilembe
38%
59.7%
50.9%
Sisonke
18.8%
22.7%
36.8%
Ugu
30%
38.2%
42.1%
UMgungundlovu
26.1%
45.9%
43.9%
UMkhanyakude
28.1%
43.9%
59.7%
Umzinyathi
29.9%
32.4%
35.6%
Uthukela
29.8%
36.3%
37.5%
UThungulu
36%
45.4%
53.1%
Zululand
15.7%
36.4%
40.7%
Province
29%
39.3%
40.8%
Amajuba
Ethekwini
Q4 10/11
ANC client CD4 1st test rate (80%)
DISTRICT
Q4 10/11
Q1 11/12
Q2 11/12
Amajuba
77.7%
77.4%
93.5%
Ethekwini
75.6%
77.1%
77.3%
Ilembe
79.4%
77%
72.9%
Sisonke
69.1%
71.2%
72.3%
Ugu
84.7%
71.5%
66.6%
UMgungundlovu
77.1%
71.6%
78.4%
UMkhanyakude
70.8%
73%
73.3%
Umzinyathi
74.2%
73.4%
69.1%
Uthukela
66.6%
76.4%
72.5%
UThungulu
78.9%
74.8%
72.1%
Zululand
75.7%
78.5%
82.3%
Province
75.6%
75.4%
75.8%
ANC client initiated on HAART
rate (85%)
DISTRICT
Q4 10/11
Q1 11/12
Q2 11/12
Amajuba
67.3%
106%
73.6%
Ethekwini
68.8%
82.5%
83.4%
Ilembe
87.6%
72.1%
86.4%
Sisonke
75%
58.6%
60.1%
Ugu
101.9%
83.8%
88.5%
UMgungundlovu
74.3%
85.8%
63.3%
UMkhanyakude
77%
71.1%
77.6%
Umzinyathi
55.5%
60.5%
59.8%
Uthukela
79.9%
70%
74.4%
UThungulu
74.2%
84.5%
65.3%
Zululand
74.3%
85.1%
87.4%
Province
73.5%
80.4%
77.6%
PCR positive around six weeks rate
(MTCT)
DISTRICT
Q4 10/11
NHLS
Q1 11/12
Amajuba
1.9%
3.8%
3%
Ethekwini
7.2%
3.1%
Ilembe
3.7%
Sisonke
NHLS
Q2 11/12
NHLS
2.8%
1.7%
0.6%
5.3%
2.6%
6.1%
2.4%
1.5%
2.6%
3.3%
4.1%
4.4%
4.1%
2.8%
4.2%
1.9%
2.4%
2.3%
Ugu
4.9%
3.7%
2.8%
2.5%
5.5%
5%
UMgungundlovu
4.9%
1.7%
3%
1.9%
3%
2.4%
UMkhanyakude
4.3%
3.7%
3.5%
2.6%
3.5%
5%
Umzinyathi
4.9%
6.4%
3.3%
3.8%
3.6%
2%
Uthukela
3.1%
2.6%
3.9%
3%
3.6%
3.2%
UThungulu
4%
3.4%
3.1%
2.4%
2.3%
2.8%
Zululand
4.6%
2.9%
5.3%
2.3%
5.4%
3.7%
Province
5% (MRC 2.8%) 3.1%
4%
2.5%
4.4%
3%
Infants with PCR test positive started
on ART (60%)
DISTRICT
Q1 11/12
Q2 11/12
Amajuba
64%
27%
Ethekwini
15%
31%
Ilembe
53%
68%
Sisonke
48%
139%
Ugu
95%
72%
UMgungundlovu
74%
82%
UMkhanyakude
98%
47%
Umzinyathi
60%
117%
Uthukela
60%
63%
UThungulu
54%
50%
Zululand
15%
38%
Province
42%
51%
POSTNATAL VISIT WITHIN 6 DAYS RATE
(60%)
DISTRICT
Q4 10/11
Amajuba
88%
Ethekwini
Q1 11/12
Q2 11/12
90%
66%
67%
70%
72%
66%
74%
66%
67%
60%
Ilembe
65%
64.9%
68%
68%
59%
59%
Sisonke
50.6%
49%
41%
42%
42%
42%
Ugu
47%
34%
37%
34%
46%
45%
UMgungundlovu
36.8%
34.8%
52%
62%
59%
70%
UMkhanyakude
48%
47%
45%
45%
45%
47%
Umzinyathi
80%
64%
70%
71%
67%
57%
Uthukela
54.9%
54.7%
58%
55%
58%
57%
UThungulu
39.7%
32.9%
73%
68%
77%
78%
Zululand
33.4%
32%
50%
50%
47%
46%
Province
54.3%
51.7%
68.3%
57%
57.9%
61.3%
MATERNAL MORTALITY RATIO (160)
DISTRICT
Q1 11/12
Q2 11/12
Amajuba
120
221
Ethekwini
150
218
Ilembe
131
107
Sisonke
139
86
Ugu
268
143
UMgungundlovu
318
360
UMkhanyakude
140
127
Umzinyathi
113
226
Uthukela
158
298
UThungulu
330
519
Zululand
293
218
Province
196
229
Prevention of Mother to Child
Transmission of HIV
Data Source: MRC 2011
Transmission measured in Aug 2010 within
the general population of children who
attended post natal care
14
Institutional Maternal Mortality
Ratio 2008 -2010
350.0
Ins. MMR/100000 live births
300.0
250.0
200.0
150.0
100.0
50.0
0.0
EC
FS
Gau
KZN
Lim
Mpu
NW
NC
WC
SA
15
Maternal Health
Top four causes of maternal mortality (2008 2010)




Non-pregnancy-related infections (HIV) 48%
Hypertensive disorders
10%
Obstetric haemorrhage
9%
Miscarriage
6%
HIV & AIDS
 85% maternal deaths tested (69% in 2005-2007)
 79% of those tested were HIV positive
16
Maternal and Child Health
 Other pregnancy related issues:
 Extending access to safe delivery facilities – 33 Basic Emergency
Obstetric Care Units
 Deploying District and Mentorship Teams – 11 Teams
 Continuous training on management of emergency obstetric cases
 Dedicated maternal health ambulances deployed in all districts
 Extending ANC/PNC to the community through Operation Sukuma Sakhe

Child Health Programmes
 Implementation of the WHO 2010 IYCF Guidelines
 Diarrhoea and malnutrition campaigns through Operation Sukuma Sakhe
17
School Health and Youth Health
School Health Services
District
No. of Schools
No. of G1
Learnners
No. of Learners
Screened
No. reffered
Amajuba
28
2566
2213
545
Ethekwini
8
454
395
28
Ilembe
9
2800
2731
467
Sisonke
42
2841
2086
1415
Ugu
61
1977
1806
770
Umgungundlovu
53
24000
23644
632
Umzinyathi
49
4046
3532
432
Uthukela
41
2320
1942
338
Uthungulu
120
9336
2998
814
Zululand
71
3000
2040
580
Umkhanyakude
66
3001
3145
490
Province
567
56321
45632
6614
PACKAGE OF
INTERVENTIONS
Pregnancy
Community based
interventions
and Child
birth
Complication
s
Ante Natal Care
 Training of Community Care Givers
in MNNCW
 Empowerment of women ito of
knowledge of danger sighs
 Promotion of early booking
 Integration into Operation Sukuma
Sakhe
 Coordination and partnerships with
various NGOs
 PMTCT interventions
 Initiation of pregnant women on
HAART
 Provision of the integrated ANC in
line with the ANC/PNC Policy
(utilization of the revised job aids)
 Promotion of Family Planning
Pregnancy and Emergency
Obstetric Care
Child birth
Complications
 ESMOE training of mid-wives
and medical officers
 Correct management of obstetric
complications and neonatal
resuscitation
 Establishment of fully functional
MOU
 (functional is MOU adequately
staffed and equipped and
conducts more than 50 deliveries
a month
 Adequately and appropriately
staffed and equipped maternity
wards
 Provision of emergency obstetric
emergency vehicles
 Waiting Mothers Lodges in all
delivery facilities
Pregnancy and Post Natal Care
(3 day, 6 weeks)
Child birth
Complications
 Counseling on newborn and
maternal danger signs
 3 day and 6 week visits
 Support for breastfeeding or
appropriate feeding
Neonatal
care
KINC





Implementation of KINC
across the province
Care of pre-term baby in all
hospitals (Kangaroo Mother
Care)
Management of Birth Asphyxia
Infant feeding counseling and
support
Appropriate equipped and
staffed nurseries
Childhood
Community
illnesses
based
health


child 

IMCI/
management
emergency
illnesses
Growth Monitoring
Oral rehydration
Breast feeding
Food security (OSS)
 Immunization
 IMCI case management
of  Early diagnosis and initiation
on HAART
 Testing of exposed infants at
six weeks and cotrimoxazole
Women’s
health
Family planning
 Training of all health workers on
FP
 Community education and
mobilization
 Promote Healthy Timing and
Spacing of Pregnancies by
Improving Contraceptive
Awareness and Access at Health
Facilities and in the Community
 Contraceptive Method Mix
 Integration of Contraceptive
Services with other Services
 Improve Health Care Provider
Training and Mentoring on
Contraception
Women’s
Health
Exposure  Counseling and provision of
comprehensive package for NOPEP
Prophylaxis
 Partnerships and participation in
local and provincial victim
empowerment Fora
Post
Phila Ma
Youth
and
School Health
 Screening, early detection and
treatment of breast and cervical
cancers
 Youth Friendly services
 Integrated school health services
What are we looking to achieve?
•Impact on maternal health (NSDA Output 1, 2 &3)
- HIV status
- ANC booking < 20 weeks
- If positive and eligible – on treatment
- Prevention of unwanted pregnancies – contraception strategy
- Postnatal Care within 6 days
•Impact on Mother To Child transmission of HIV (NSDA Output 3)
- PMTCT regime (ANC, labour/delivery, postnatal)
- HIV Re - testing at 32 weeks
- ART access for eligible clients
•Impact on child survival (NSDA Output 2)
- HIV free survival (prophylaxis, infant feeding in the context of HIV)
- ART access for eligible babies
- Mother linked to care and treatment
Child Health
For every 1000 live births, 60 die by the age of
5
Of the under 5 deaths, 75% die in the first year
(infant death)
Of the under 5 deaths, 25% die in the first
month (neonatal death)
48% die at home
28
Causes of child health in
KZN (source: Saving Children
2005 – 2007)
TOP 5
2005
2006
2007
% of deaths
Pneumonia, ARI
19.9
18.3
18.7
Septicaemia
10.1
14.5
15.9
Acute diarrhoea
11.6
14.4
14.2
PCP (suspected)
5.0
6.9
6.2
Chronic diarrhoea
9.5
4.8
4.6
Thank You
Anthropometrics: Children 19 yrs. in KZN
YEAR
Stunting
Underwei Wasting
ght
Overweigh
t
1994
(SAVACG)
16%
4%
1%
7%
1999 (NFCS) 19%
4%
9%
4%
2005 (NFCS) 15%
5%
1%
6%
• Recording of Birth Date on RtHC was 49.4% and
recording of receiving of a Vitamin A dose for 12NFCS
2005
59 months old children was 54.8%.
• Vitamin A supplementation of 12-59 months
was low at 27.9%.
• Only 1.3% of infants are exclusively breastfed at
4-5 months ( 8 % Nationally)
INP PROVINCIAL
PRIORITIES
 Priority 1:
• Adequate and optimal feeding for children aged 0 – 2
years.
 Priority 2:
• Prevention and treatment of nutrition-related diseases
 Priority 3:
• Improvement in the nutritional status of individuals
through targeted micronutrient supplementation.
Breastfeeding Promotion
Protection & Support
Participants of the National Breastfeeding
Consultative Meeting (22-23 August 2011) concluded
with a declaration known as the “Tshwane
Declaration of Support for Breastfeeding” which
declared South Africa as a country that will actively
promote, protect and support exclusive breastfeeding
as a public health intervention to optimise child
survival, irrespective of the mother’s HIV status.
35
Commitments of the
Declaration
ACTIONS TOWARDS BREASTFEEDING PROMOTION
• To achieve this the following will be implemented
– Human milk banks to be promoted and supported for vulnerable
children .
– Mandatory Implementation of Baby Friendly Health Initiative
(BFHI) and a quality assurance tool and Kangaroo Mother Care
(KMC) including community support. Target is 100% by 2015
– Formula feeds will no longer be provided at public health facilities
with the exception of certain medical conditions
36
KwaZulu-Natal MBFI Designated
Facilities Trends 2008 - 2011
84%
76%
76%
63%
2008
2009
2010
2011
Progress to date
•
•
•
•
•
•
•
•
All Lay counselors trained- 3 days
District Trainers – 5 days
In service for all health workers – 1day
PN training -3 days
DMs Advocacy meeting for MBFI
District Advocacy Meetings for MBFI
District community Advocacy meetings
Communication Strategy
COMMUNICATION
• Advocacy
– Government Departments
– NGOs
– Advocacy Groups
• Community Level
–
–
–
–
CBOs
District Outreach structures
NGOS
Local Media
• Mass Communication
–
–
–
–
Radio
Newspapers
Posters
Breastfeeding Promo DVDs
Current Plans for Early detection of growth
faltering
REQUIREMENTS
ACTIVITY
Promote growth monitoring
Procurement of height sticks,
Training of public and private sector length boards, scales and MUAC
complete in 2010
tapes
Second revision of RtHB
Procurement
and
funding
allocation
Monitor implementation of the National Ongoing Support and Training on
Road to Health Booklet
the National Road to Health
Booklet
Community
sites
based
growth
monitoring PHC Outreach teams
Implementation of an Integrated
programme on the management of acute
malnutrition in priority areas
ACTIVITY
REQUIREMENTS
Monitor and support implementation of WHO 10 Steps guidelines for the
management of severe malnutrition.
Support Visits to districts and
facilities.
Establishment of Community based projects to
implementation of severe acute malnutrition guidelines
MUAC screening
strengthen
the
District training of health workers on management of severe acute
malnutrition
Support to Districts
 Training of Doctors
Support to hospital staff
Implementation and monitoring of the PEM register
PHC support
Framework for Accelerating Community-based
Maternal, Neonatal, Child and Women’s Health and
Nutrition Interventions
C- Framework for MCWH &
N
• Development of MCWH & N Community Framework
complete
• Training Manual developed
• Facilitators Guide, Flip Charts and Job Aids developed
• Training of Community Care Givers Supervisors / Facilitators
complete
• District Advocacy Meetings complete
• Training commencement of CCGs
• CCG Kits procured
Expansion of Vitamin A
coverage
•
•
•
•
•
•
•
Current coverage of 38-42% (12-59mths)
Target 80%
MCC approval for use of CCGs
Implementation Plan developed
Policy & resource materials in process
Training to commence February 2012
Implementation date 1 April 2012
Vitamin A Campaign 2010
CONCLUSION
Mutual benefits of collaboration cannot be overemphasized
- goals and objectives
- technical support
- pace of implementation and upscale
- ease of procurement
- building NGO capacity
-