The Provincial Profile of
KWAZULU NATAL
Introduction
• The Province of KwaZulu-Natal extends over 92,100 square
kilometres in the eastern part of S.A.
• It comprises 7,6% of the total landmass of the country.
• The Province shares borders with Swaziland and
Mozambique in the north, Mpumalanga in the north-west, the
Free State and Lesotho in the west and the Eastern Cape in
the south.
• This area is home to an estimated 10,3 million people [2011
census] or 20% of all South Africans.
• KwaZulu-Natal is thus the third smallest but 2nd populous
province in the country.
Province profile
Total population
10,3m
Rural
54%
Women
53,%
Population < 15 years
33%
Children who are orphans
21%
Adults with no education
11,4%
Adults with grade 12 education
22,9%
Matric pass rate
66%
Health status of KwaZulu-Natal.
Life expectancy at birth
Maternal Mortality Rate
Under 5 Mortality Rate
Immunization coverage < 1 year
Immunization drop out rate (DTP1 – 3)
ANC HIV+ seroprevalence
HAART initiation in pregnant HIV+ women
Proportion of HIV+ people
Incidence new STIs
TB prevalence (per 100,000)
TB cure rate
Diarrhoea incidence, children < 5 years
Mother To Child Transmission of HIV
60yrs
176/100 000
93
97,3%
1,0%
37.4
83%
15,8%
5,1%
1,000
77.1
357,2
2%
Components of the KwaZulu-Natal Public Health System.
• Region 1:South Eastern Area comprising two districts (eThekwini &
ILembe) with one tertiary, four regional ,4 district hospitals and two semi
private to serve a population of about 4,5 million.
• Region 2: Western Area consisting of three districts (Sisonke, UGu, and
uMgungundlovu) with one tertiary, two regional and 9 district hospitals
for an estimated population of 2,2 million people.
• Region 3: North Eastern Area comprising three districts
(UMkhanyakude, Uthungulu and Zululand) with no tertiary, one regional
and sixteen district hospitals for a population of 2,3 million people.
• Region 4: Midlands Area comprising three districts (uMzinyathi; Amajuba
and uThukela) no tertiary, two regional and eight district hospitals to
serve a population of 1.7 million people.
National Health Insurance Sites [NHI]
•
•
•
•
There are three NHI Sites in KwaZulu Natal:uMgungundlovu District
uMzinyathi District and
Amajuba District.
• They have been assessed for CARMMA Compliance in
preparation for accreditation.
• National has also prioritized them with the support for
ESMOE by conducting the baseline assessments and
highlighting the importance of drills ,and supplied them with
the mannequins as per level of care
NHI Cont.
A selection criteria used to guide provincial selection of a NHI pilot district was
based on the following:
•
Vulnerability of the population, mainly looking at the deprivation index and
the socioeconomic profile of the district population as standard measures;
• Access to healthcare: geographical access to health care facilities,
coverage of health services to population served, utilization and service
delivery indicators;
• Equity: equitable distribution of resources looking at PHC per capita budget
allocations and expenditure;
• Burden of Disease: includes Perinatal mortality, HIV and TB outcome
indicators; and
• Functionality and efficiency: leadership, management and governance.
Maternal & neonatal Indicators
Caesarean section rate
%
30.0
30.6
29.2
29.9
Delivery rate in facility under 18 years %
8.4
9.7
9.3
9.1
Facility mortality under 1 year rate
%
6.3
5.0
5.6
5.6
Facility mortality under 5 years rate
%
5.1
4.3
4.8
4.7
Low birth weight rate in facility
%
12.8
12.9
12.6
12.7
Maternal mortality rate in facility
per100000
84.8
122.7
168.6
126.1
Neonatal mortality rate in facility
per1000
11.1
11.3
9.2
10.5
Perinatal mortality rate in facility
per1000
32.2
37.0
30.3
33.0
Still birth rate in facility
%
2.3
2.8
2.2
2.4
KZN Midwives
This is based on the Saving Babies Recommendations, which stipulates that 16
midwives per 100 deliveries a month. There are no staffing norms in SA.
District
Average
deliveries a
month
# functioning
Basic
midwives
# functioning
ADM’s
Total # of midwives
functioning
Should have:
Need
[gap/difference
]
UThukela
940
32
26
58
145
87
iLembe
908
44
18
62
144
82
Amajuba
740
37
34
71
113
42
uMzinyathi
996
52
25
77
160
83
UGu District
1220
68
20
88
192
104
Sisonke
830
40
16
56
128
72
uThungulu
1372
73
38
111
224
113
uMkhanyakude
1080
61
34
95
160
65
Zululand
1234
74
42
116
192
76
uMgungundlovu
1410
47
17
64
224
160
eThekwini
4383
338
113
451
7008
6557
PHC,CHC &
MOU
1865
306
88
394
304
Total
15 113
866
383
1249
24 18
11 69
Saving Mothers 2008-10
KZN Chapter
Summary of data
• 1133 deaths (13% increase)
• Numbers of deaths stable for 5 years (350400)
• Still under-reporting
• 66% post-partum
• HIV status-86% known
• Of those tested, 79% positive
Top 5 causes
•
•
•
•
NPRI (TB top)
Hypertension (eclampsia top)
Haemorrhage (post C/S top) 9%
Medical and surgical disorders
(cardiac top)
• Miscarriage (septic misc top)
48%
10%
8%
6%
CARMMA
• CARMMA was launched in May 2012 by the Minister of
Health in KZN.
• Like all other campaigns a structure was formed and the
ethics of campaign needs to be followed with clear guidelines
on reporting and adherence to time frame.
• The campaign aims to aggressively mobilize resources for
maternal health and bring about positive societal change in
support of improving maternal health in the country
• Seven focus areas were presented by the Health minister
CARMMA STATUS IN KZN
•
Improving Maternal Health and reducing mortality:- There is a noticeable decline in Maternal mortality from 393 in 2010 -320 in
2012.[176/100 000]
• Improved HAART Initiation for pregnant woman:- 83% ANC client initiated on HAART.
• Essential steps in the management of obstetric emergencies:- [ESMOE]:191 people have been trained as ESMOE master trainers
- Obstetric fire drills conducted
• Maternity Waiting Areas
- 14 waiting homes
• Midwives Obstetric Unit :There are 3 different models
-MOU sited within PHC Clinic =32 identified ,18 functional
-MOU sited within CHC =17 all functional
-MOU within hospital =1 functional
• Obstetric Ambulances :38 allocated in KZN district
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SOMSA STATUS IN KZN
The SOMSA president is from KZN
The Representation of KZN Midwives in the SOMSA body is
Chair-person : Kholeka Makhathini
Additional Member:ZO Mzolo
SOMSA belong to KwaZulu Natal Discussion group
The active steering committee has representation from
different spheres in the Health sector e.g. Provincial MCWH
team,DCST, Educators ,Managers, Young Midwives ,Doctors
and Neonatal rep and retired midwives.
The meetings are done on quarterly basis as a means of
updating the members and planning and monitoring of the
progress.
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•
•
•
CONTINUATION OF THE STATUS
The KZN Midwives discussion group conducts 2 provincial
workshops in a year with the support of the KZN DOH AND
Provincial MCWH team in addressing challenges faced within
Maternal Health in meeting the MDG 4,5 AND 6 in May for the
celebration of the international day of Midwives and in
September for the clinical skills.
Membership –Coordination of membership is through the
presence of strong leadership within all the districts
Appointment of champions within all 11 districts is in process
so as to gain full participation in the committee .
The support of Maternal health issues by DOH through
identification of Patrons like our Queen Thandi MaNdlovu
Zulu,Our first lady and in CARMMA , Phila MA and also Child
health issues
STRENGTHES IN KZN
• In KZN all the districts have members of the DCST though not
complete and posts have been advertised
• Orientation and induction of the DCST by the KZN School of
Medicine in Maternal ,child and leadership skills
• Recognition of the KwaZulu Natal Midwives discussion group
by the KZN DOH.
• Strong relationship with our Provincial Maternal Health team
• KZN DOH funding of Midwives annually to attend Midwifery
congresses.
• Active involvement of partner's [NGO] in support of Maternal
Health issues
CHALLENGES
• Staffing Norms
• Recruitment of ADM for training COMPITING WITH
RECRUITMENT FOR phc TRAINING at PHC level
• Membership –constraints in assessing the membership forms
and ongoing reminders for next subscription and membership
cards
FUTURE PLANS
• Marketing strategy to increase membership
and involvement of private sector
• Drafting of the year plan
THE END
• Thank you