H A L E Y B O L I N GP U B L I C H E A LT H I N S O U T H E R N A F R I C A

HEALTH CARE IN SOUTH AFRICA: FOCUSING ON WOMEN

AND CHILDREN

OVERVIEW

• POVERTY AND HIV/AIDS PREVALENCE• How do these factors affect mothers and children?• What is being done to combat these issues?

• FUNDING OF PUBLIC HEALTH CARE• Private healthcare vs. public healthcare

• APARTHEID SIDE EFFECTS• What are the lasting effects of apartheid on the South

African healthcare system

• QUESTIONS

HIV/AIDS epidemic

POVERTY

FUNDING OF

PUBLIC HEALTH-

CARE

HEALTH CARE SYSTEM THAT

IS FAILING MOTHERS AND

CHILDREN

HIV/AIDS

epidemic

POVERTY

FUNDING OF

PUBLIC HEALTH-

CARE

HEALTH CARE SYSTEM THAT

IS FAILING MOTHERS AND

CHILDREN

MILLENNIUM DEVELOPMENT GOALS

•4. Reduce child mortality by two thirds by the year 2015•5. Improve maternal health and reduce maternal mortality

MATERNAL MORTALITY

• Currently is estimated between 230 and 702 per 100,000 live births (2010) – many home deaths may not be reported• South Africa’s maternal mortality rate has

INCREASED since the 1990’s largely due to HIV • 50% of maternal deaths are a result of HIV/AIDS• Many women receive insufficient care during

pregnancy• Unsafe birthing conditions

Fig. 2 Causes of maternal death in South Africa *88% indirect causes were non-pregnancy related infections (HIV/AIDS)

Fig. 1 Maternal mortality ratios (per 100,000), 1980-2008.

CARMMA

• Campaign for Accelerated Reduction of Maternal Mortality in Africa • Launched in May 2012 by Republic of South Africa• Aims to reduce infant and maternal mortality rates

throughout Africa• The MDG target is 38 deaths/100,000 by 2015• Plan to address inequality in underserved areas• Strengthen healthcare system• Follow MNCWH strategies

MNCWHSTRATEGIC PLAN FOR MATERNAL, NEWBORN, CHILD AND

WOMEN’S HEALTH AND NUTRITION IN SOUTH AFRICA

• Guidelines to decrease maternal mortality• Decrease infant mortality• Improve care for mother and child

ANTENATAL CARE

• About 90% of women receive some antenatal care (visit, supplements, etc.)

• Only 38% of women receive care within first 20 weeks of pregnancy

• BANC (Basic Antenatal Care approach) Doctors are trying to persuade women to receive 4 visits during pregnancy

• PMTCT (Prevention of Mother to Child Program)• Every women is tested for HIV during first weeks of pregnancy• If positive, given anti-retrovirals

• Stillborn rate is very high (19/1000) due to immaturity, low birth weight, hypoxia• This can be attributed to the health of the mother in some instances

AFTER THE BIRTH

• Intrapartum care • Can be improved by having stronger protocols for

detecting complications• Better access to Cesarian section• Monitoring during labor• Difficult because many hospitals are understaffed

• Postnatal care• Only 29.9% of babies and 27% of mothers were seen six

days after delivery• Visiting a doctor after delivery can decrease risk of

infection, help the mother, etc.• MNCWH recommends kangaroo care, breastfeeding, etc.

CHILDREN

• South Africa is one of only 5 countries in which the child mortality rate has increased between 1990 and 2008• Main problem: POVERTY• In 2009 61% of children lived in households that

were income poor• Under 1 mortality 41/1000• Under 5 mortality 57/1000• Neonatal mortality 14/1000 • Accounts for 1/3 of all deaths in children under 5

CONTRACEPTION

• 60% of women ages 15-49 use modern contraceptives• Above global average at 57%

• Still many unplanned pregnancies and contraction of STI/STD

• Problem: Risky behaviors• Improper use of contraception, unprotected sex• SADHS (South African Demographic and Health Survey)

indicated that 97% of sexually active women knew about contraceptives- ignorance is not the reason

• Abortion is legal and over 200,000 terminations are carried out annually- abortion is always an option for “contraception” for many women

HIV/AIDS epidemic

POVERTY

FUNDING OF

PUBLIC HEALTH-

CARE

HEALTH CARE SYSTEM THAT

IS FAILING MOTHERS

AND CHILDREN

FUNDING

• South African government spends 8.7% of GDP on health care- of this 60% goes to privately funded healthcare (14% of population)• Amounts to about 285 dollars/person- U.S. spends

4400 dollars/person (17.6% GDP) (WHO)

HOSPITALS

• Not enough money spent on healthcare to properly staff public hospitals, care for patients, etc.

• Standard of care is not comparable to U.S. for ordinary women and children

• Human Rights Watch conducted a survey of 157 women in 2011- Stop Making Excuses

• Women were mistreated on grounds of:• HIV/AIDS status• Whether or not they were a migrant• Inadequate conditions (supplies, nurses, doctors)• Poor communication between nurse and patient• Unaccountability by the hospital staff

• Women have complained of being verbally abused, physically abused, taunted, ignored-overall mistreated in public hospitals

• Nurses sometimes lack the patience and skill to adequately treat patients

• The level of care is decreased, thus more complications with the resulting child and delivery

• The level of care simply does not meet the standards that it should

• Women hear horror stories about abuses and are terrified to go to hospitals-SANGOMAS and traditional healers

STOP MAKING EXCUSES’: ACCOUNTABILITY FOR MATERNAL HEALTH CARE IN SOUTH AFRICA

Babalwa L. “The sister said I was lying about being in labor and sent me to the waiting area.” A doctor examined her three hours later, but it was too late. She delivered a stillborn baby. Neither the doctor nor the nurse explained what may have caused the stillbirth.”

Unnamed woman from the study “She was very rude and said I was lazy. After this experience I told myself I will never again go to government hospitals. If I have no money to go to a private hospital, I will deliver at home.”

HIV/AIDS epidemic

POVERTY

FUNDING OF

PUBLIC HEALTH-

CARE

HEALTH CARE SYSTEM THAT

IS FAILING MOTHERS

AND CHILDREN

EFFECTS OF

APARTHEID

HEALTHCARE HISTORY

• Reforms in the late 1990s changed how funds were distributed• Instead of Minister of Health allocating funds, Department

of Finance • Distributed funds base on the Treasury’s “Equitable

Shares” formula• Result: poor provinces have less spending autonomy based on

this policy and received LESS• Based on economic output, not need

• GEAR strategy (Growth, employment and redistribution)• Thabo Mbeki (1999)• Substantial increase in private healthcare sector

EFFECT OF APARTHEID

• Widening of the race boundaries• Access to health professionals and facilities was

poor• Unable to pay for service• Many Africans rely on public health care, where

as whites and Indians rely on the private sector• Poor education-many Africans turned to

sangomas and traditional healers

Poverty

Lack of education about modern

medicine/cannot access hospitals/care

More maternal and under 1/under 5

deaths- decline in the healthcare system

CONCLUSION

REFERENCES

• https://www.mja.com.au/journal/2008/189/11/south-africa-21st-century-apartheid-health-and-health-care?0=ip_login_no_cache%3D32db43952441569a89fbfef7a38b56c6

• http://www.southafrica.info/about/health/health.htm#.UV4XgVegskJ• http://

www.doh.gov.za/docs/stratdocs/2012/MNCWHstratplan.pdf#page=15&zoom=auto,0,792

• http://www.unaids.org/en/resources/presscentre/featurestories/2012/may/20120508carmma/

• http://epianalysis.wordpress.com/2011/03/01/sainequality/• https://

www.mja.com.au/journal/2008/189/11/south-africa-21st-century-apartheid-health-and-health-care?0=ip_login_no_cache%3D32db43952441569a89fbfef7a38b56c6

• http://shr.aaas.org/loa/hback.htm• http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.184895?view=

long&pmid=21148716&

• http://www.sajog.org.za/index.php/SAJOG/article/view/504/280• http://www.hrw.org/news/2011/08/08/south-africa-failing-maternity-care