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CSU 17/2008: MATERNAL AND CHILD MORTALITY IN SOUTH AFRICA

Friday, 25th of April 2008 Print

CSU 17/2008: MATERNAL AND CHILD MORTALITY IN SOUTH AFRICA
 
 
 South Africa, where health care is almost entirely self-financed, is
 nearly unique in subsaharan Africa in seeing practically no morbidity or
 mortality from malaria and measles (1 measles death in a population of 45
 million in 2006!), which remain two of the big killers in the rest of the
 continent. Public health and medical expenditure, at R2000 per capita per
 year, gives South Africa the chance to do things which other African
 countries cannot.
 
 
 In this brief analysis of maternal and child mortality from South
 Africa, the authors propose the following five actions by policy makers to
 cut infant, child and maternal mortality.
 
 1- Invest in the implementation of the HIV & AIDS and STI National
 Strategic Plan 2007-2011, concentrating on provider-initiated testing, dual
 therapy in PMTCT and universal coverage of antiretroviral therapy, and
 supporting the integration of HIV & AIDS and nutrition programmes with
 maternal, newborn and child healthcare packages.
 This requires equitable and accessible healthcare services, prioritising
 single-parent families, orphans and vulnerable children. Sustained
 commitment to scale-up is the way to meet the nationally-agreed target of
 reducing mother-to-child transmission of HIV to 5%.
 
 2- Ensure full implementation of the high impact packages outlined in
 this report, including high quality antenatal and intrapartum care; new
 policies for the provision of postnatal care visits and support after the
 fi rst week after childbirth, community and facility-based IMCI and the
 Integrated Nutrition Programme. Increase funding for the highest burden
 districts, redressing the current imbalance of primary health care
 spending.
 
 3- Provide an enabling environment through defi ned norms, standards and
 operational plan for human resources and quipment, effective referral, and
 investment in capacity-building and support for provincial and district
 managers.
 
 4- Increase monitoring and evaluation efforts through the completion of
 maternal, perinatal and child mortality audits at all hospitals and request
 quarterly reports for management at the district and provincial level so
 these audits are linked to management action and promote higher coverage
 and quality of birth and death certifi cation.
 
 5- Develop and widely promote an agreed set of family health messages to
 save the lives of mothers, newborns and children, particularly recognition
 of danger signs and information regarding the care every family has the
 right to receive.
 
 Why does South Africa, like so many other countries, omit birth spacing
 from its list of high impact interventions?
 
 Good reading.
 
 BD

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