REPUBLIC OF MACEDONIA HEALTH SYSTEM -OVERVIEW AND CHALLENGES- Minister of Health Bujar Osmani, MD
Minister of Health
Transcript of Minister of Health
Minister of Health
Briefing to the Portfolio Committee on Women, Youth, Children and People with
Disabilities
Department’s Programmes
pertaining to Women, Children, Youth and People with Disabilities
26 January 2011
2
Dr. Aaron Motsoaledi
: Minister of Health
2
HIV and AIDS : Business as Usual ?
33
HSRC, MRC, & CADRE
South
African
National
HIV
Prevalence,
Incidence,&Behaviour
and
Communication
Survey, 2008
NDoH
2008
National
Antenatal
Sentinel
HIV
and
Syphilis
Prevalence Survey
NCCEMD
Saving
Mothers
2005‐2007:
Fourth
Report
on
Confidential Enquiries into Maternal Deaths in South
Africa
MRC
Saving
Babies
2006‐2007:
Sixth
report
on
perinatal
care in South Africa
MRC
Saving
Children
2005‐
2007:
A
fourth
survey
of
child
healthcare in South Africa
Overview of the Data
44
Stats SA
Midyear population estimates 2009
Mortality
and
causes
of
death
in
South
Africa,
2007:
Findings from death notification
The Lancet
Volume 374, Issue 9693, 12 September 2009
IEC
Independent Electoral Commission data on the voters
roll
Dept. Home Affairs
Historical Data 2008
ARKSA
Meeting
the
HIV
Treatment
Gap
in
SA
presentation,
August 2008
WHO
Global
Tuberculosis
Control,
Surveillance,
Planning,
Financing 2009
WHO NDoH
TB Review
Overview of the Data
5
The LancetSouth Africa's Health: Departing for a Better Future?
66
HIV prevalence epidemic curve among antenatal women, 1990‐2008
77
HIV prevalence among 15‐49 year olds by Province, 2008
88
HIV prevalence trends among antenatal women by Province, 2008
99
HIV prevalence trends among antenatal women by age group, 2008
Ukhahlamba29.4%
O.R. Tambo30.3%Chris Hani
30.2%
Cacadu20.0%
NMM28.9%
Amatole29.2%
Ukhahlamba23.5%
O.R. Tambo29.8%Chris Hani
27.1%
Cacadu24.3%
NMM30.7%
Amatole27.2%
Ukhahlamba27.9%
O.R. Tambo29.7%Chris Hani
27.1%
Cacadu22.8%
NMM31.9%
Amatole28.7%
Ukhahlamba21.9%
O.R. Tambo29.6%Chris Hani
27.0%
Cacadu23.8%
NMM29.0%
Amatole26.5%
EC 2006 EC 2007
EC 2008 EC 2009
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%
Alfred Nzo25.1%
Alfred Nzo25.1%
Alfred Nzo25.1%
Alfred Nzo25.1%
10
Fezile Dabi33.2%
Thabo Mofutsanyan30.6%Lejweleputswa
37.0%
Xhariep23.9%
Motheo27.4%
Fezile Dabi
27.9%Thabo Mofutsanyana
31.3%Lejweleputswa33.4%
Xhariep25.7%
Motheo27.8%
Key
20 -30%30 –40%
Fezile Dabi29.5%
Thabo Mofutsanyana32.2%Lejweleputswa34.1%
Xhariep19.7%
Motheo30.5%%
Fezile Dabi34.5%
Thabo Mofutsanyana33.1%Lejweleputswa
33.8%
Xhariep26.9%
Motheo31.6%
FS 2006 FS 2007
FS 2008 FS 2009
10 – 20%Key
20 – 30%30 – 40%
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%11
Waterberg
Vhembe
CapricornMopani
Sekhukhune
.16.6%
26.2%
14.3%
23.8%28.8%
LP 2006
Waterberg
Vhembe
Capricorn Mopani
Sekhukhune
.16.1%
24.7%
14.1%
24.2%27.5%
LP 2008
Waterberg
Vhembe
Capricorn Mopani
Sekhukhune
-.21.8%
25.2%
14.7%
21.0%23.6%
LP 2007
Waterberg
Vhembe
Capricorn Mopani
Sekhukhune
.21.3%
23.8%
15.1%
19.8%25.4%
Key10 – 20%20 – 30%
Key10 – 20%20 – 30%
Key10 – 20%20 – 30%
Key10 – 20%20 – 30%
12
.
.Metswedin
g32.8%
Sediben g
32.8%
West Rand32.4 %
Ekurhu leni
33.3%
Tshwan e
26.7%
CoJ 29.9%
GA 2007
GA 2009
.Metswedin
g33.3%
Sedibe ng
28.9%
West Rand30.1 %
Ekurhul eni
34.0%
Tshwan e
25.7%
CoJ 29.0%
.
GA 2006
Key
.Metswedin
gNot done
Sedibe ng
35.0%
West Rand34.6 %
Ekurhu leni
32.3%
Tshwan e
26.5%
CoJ 30.6%
.Metswedin
g25.1%
Sedibe ng
31.8%
West Rand27.8 %
Ekurhul eni
31.5%
Tshwan e
26.1%
CoJ 31.0%
GA 2008
Municipal dispute
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%
Key20 – 30%30 – 40%
20 – 30%30 – 40%
13
>40%200Kilometers
.
KZN 2009
>40%50 Kilometers
.
Amajuba37.3%
Ugu40.2%
Sisonke35.2% Ethekwini41.5%
Umzinyathi28.2%
Umkhanyakude39.7%
Zululand36.7%
Uthukela46.4%
Ilembe40.6%
Uthungulu37.7%
Umgungundlovu40.9%
KZN 2006
>40%
.
Amajuba46.0%
Ugu38.9%
Sisonke31.9%Ethekwini
41.6%
Umzinyathi27.9%
Umkhanyakude36.3%
Zululand36.9%
Uthukela35.1%
Ilembe39.1%
Uthungulu34.6%
Umgungundlovu44.4%
KZN 2008
.
Amajuba34.7%
Ugu40.6%
Sisonke35.8% Ethekwini40.3%
Umzinyathi29.2%
Umkhanyakude39.9%
Zululand36.1%
Uthukela38.6%
Ilembe35.8%
Uthungulu36.1%
Umgungundlovu45.7%
KZN 2007
>40%200
.
Amajuba39.3%
Ugu37.3%
Sisonke34.1%
Ethekwini41.6%
Umzinyathi31.6%
Umkhanyakude39.8%
Zululand34.6%
Uthukela38.6%
Ilembe41.4%
Uthungulu35.9%
Umgungundlovu40.8%
Ilembe
Key20 – 30 %
30 - 40 %
> 40%
Key20 – 30 %
30 - 40 %
> 40%
Key20 – 30 %
30 - 40 %
> 40%
Key20 – 30 %
30 - 40 %
> 40% 14
MP 2007
Gert Sibande
Nkangala
Ehlanzeni
40.6%
27.5%
36.1%
MP 2009
Gert Sibande
Nkangala
Ehlanzeni
38.2%
32.6%
33.8%
Key30 – 40%
MP 2006
Gert Sibande
Nkangala
Ehlanzeni
38.9%
26.8%
32.1%
Key20 – 30%30 - 40%
MP 2008
Gert Sibande
Nkangala
Ehlanzeni
40.5%
31.8%
34.9%
Key30 –40%>40%
Key20 – 30 %
30 - 40 %
> 40%
15
Pixley ka SemeNamaqua
SiyandaFrances Baard
Key
.
17.3%
7.3%
10.9%
14.2%
22.4%
J.T. Gaetsewe
Pixley ka SemeNamaqua
SiyandaFrances Baard
.
17.2%
0.0%
12.4%
12.1%
25.2%
J.T. Gaetsewe
Pixley ka SemeNamaqua
SiyandaFrances Baard
.
18.4%
5.3%
12.3%
10.7%
22.7%
J.T. Gaetsewe
Pixley ka SemeNamaqua
SiyandaFrances Baard
.
18.7%
2.2%
13.0%
13.3%
21.8%
J.T. Gaetsewe
NC 2006 NC 2007
NC 2008 NC 2009
10 – 20%20 – 30%
<10%
Key<10 %10 - 20%20 -30 %
Key<10 %10 - 20%20 -30 %
Key<10 %10 - 20%20 -30 %
Key<10 %10 - 20%20 -30 %
16
Dr. R.S. Mompati
NgakaModiriMolema
Bojanala
Dr. K. Kaunda25.7%
34.9 %
25.1%
29.2%
Dr. R.S. Mompati
NgakaModiriMolema
Bojanala
Dr. K.Kaunda26.8%
33.3%
27.0%
32.4%Dr. R.S. Mompati
NgakaModiriMolema
Bojanala
Dr. K. Kaunda21.8 %
33.6%
23.6%
31.5%
Dr. R.S. Mompati
NgakaMMolema
Bojanala
Dr. K. Kaunda28.1%
31.8%
28.2%
35.2%
NW 2006 NW 2007
NW 2008 NW 2009
Key
20 - 30%30 - 40%
Key
20 - 30%30 - 40%
Key
20 - 30%30 - 40%
Key
20 - 30%30 - 40% 17
EdenC. Winelands
CentralKarooWest Coast
OverbergCity of CPT
20.8%18.0%
11.8%
18.2%
9.5%
13.2%EdenC. Winelands
CentralKarooWest Coast
OverbergCity of CPT
15.9%17.9%
14.8%
13.0%
9.3%
12.0%
EdenC. Winelands
CentralKarooWest Coast
OverbergCity of CPT
19.4%16.0%
23.6%
13.0%
10.1%
13.2%EdenC. Winelands
CentralKarooWest Coast
OverbergCity of CPT
13.0%17.0%
8.3%
11.5%
7.3%
13.2%
WC 2006 WC 2007
WC 2008 WC 2009
Key<10%10 – 20%
Key<10%10 – 20%20 – 30 %
Key<10%10 – 20%20 – 30 %
Key<10%10 – 20%20 – 30 %
18
19
Conclusions from Antenatal Survey
• Average antenatal prevalence is 29.3%
• 4 districts recorded HIV prevalence above 40%
• 17 districts recorded between 30% and 40%• 6 in KZN• 3 in Gauteng• 4 in FS• 2 in Mpumalanga• 2 in NW
• 19 districts recorded HIV prevalence between 20% and 30%
2020
• 31.4%
of
the
population
(15.48
million)
are children aged younger than 15 years
• Of those younger than 15 years:• 23% (3,54 million) live in KZN
• 17,9% (2,78 million) live in Gauteng
Stats SA: Mid‐year Population Estimates 2009
2121
Actuarial Society of SA estimate life expectancy in South Africa
to
be 13 years below what it would be without HIV.
Country Gender ReferenceAlgeria Female UNPD World Population Prospects 2006
estimate Years 72
Algeria Male UNPD World Population Prospects 2006
estimate Years 70
Senegal Female UNPD World Population Prospects 2006
estimate Years 64
Senegal Male UNPD World Population Prospects 2006
estimate Years 60
South Africa Female UNPD World Population Prospects 2006
estimate Years 56
South Africa Male UNPD World Population Prospects 2006
estimate Years 51
Life expectancy at birth
2222
In
2006,
59.3%
of
deaths
(6
out
of
10)
were deaths of those younger than 50 years.
Stats SA: Mortality
23230-4 5 – 9 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 – 74 75 – 79 80 – 84 > 85
0
10000
20000
30000
40000
50000
60000
70000
199719981999200020012002200320042005
Age
Num
ber o
f Dea
ths
The number of deaths and age distribution of those deaths for every
year from 1997–2005:
2424
2525
TB is the main cause of death of people with HIV
• 22,071 people died of TB in 1997
• 73,903 people died of TB in 2005.
(334.8% increase)
Estimated number of South Africans with TB (2007)
481,584 (1%)
SA population as a % of world population
0.7%
SA population as a % of world population with dual HIV & TB
28%
Tuberculosis and HIV
27
D.A.L.Y.A measure of the burden of ill health
Disease, Injury or Condition Proportion of total DALYs (%)
HIV / AIDS 30.9%
Tuberculosis 3.7%
[Combined] [34.6%]
Interpersonal violence or injury 6.5%
Road traffic injury 3.0%
28
Maternal Mortality
59% of maternal deaths were tested for HIV from 2005‐
2007. 79%
of those tested were HIV infected.
Institutional MMR
• for HIV‐negative women:
34/100,000 live births
• for HIV‐positive women:
328/100,000 live births
• for women not tested for HIV:
275/100,000 live births
29
HIV Status of Maternal Deaths2005‐2007 compared with 2002‐2004
2002 ‐
2004 2005‐2007
HIV Status Number % Number %
Positive 1226 36% 1884 46.2
Negative 351 10.3% 511 12.5%
Not tested 1829 53.7% 1682 41.3%
Total 3406 4077
3030
Mortality
31
HIV Prevalence by sex and age
3232
• 57% of deaths of children under the age of 5 during 2007 were as a result of HIV.
• Babies who are HIV‐positive are 15 times (1500%) more likely to die within the first six
months of life than uninfected babies.
Child Mortality
33
Natural Deaths (adjusted) Mpumalanga Province
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4 5 6 7 8 9 10 11
age in months
1998
1999
2000
2001
2002
2003
2004
2005
2006
Infant Mortality
34
Natural Deaths (adjusted) Western Cape Province
0.0
0.5
1.0
1.5
2.0
2.5
3.0
0 1 2 3 4 5 6 7 8 9 10 11
age in months
1998
1999
2000
2001
2002
2003
2004
2005
2006
Infant Mortality
35
Independent Electoral Commission
Voters Removed from the Voters' Roll(1 Sep 2008 to 31 Aug 2009)
Province IDsEastern Cape 60 047Free State 32 037Gauteng 78 153KwaZulu‐Natal 88 954Limpopo 33 289Mpumalanga 32 621North West 30 347Northern Cape 10 320Western Cape 30 568Total 396 336
Doubling of death rate
• Stats SA death rate 1997‐2006
36
38
35
47
33
40
51
44
79
69
76
Angola
Sierra Leone
SA
Swaziland
Lesotho
Botswana
Afghanistan
EU
India
UAE
Life Expectancy at BirthInfant Mortality
(per 1,000)
5
6
9
20
27
61
69
76
124
NL
UK
Chile
Brazil
China
Namibia
SA
India
Botswana
Maternal Mortality(per 100,000 births)
16
13
31
260
300
250
230
6
8
16
110
210
230
300
400
450
NL
UK
Chile
Brazil
Namibia
China
Iraq
SA
India
20052000
Source: Unicef; WHO Maternal Mortality Report, 2007, StatsSA
Health Outcomes Relative to Other Nations
YOUTH AND ADOLESCENT HEALTH
MATERNAL MORTALITY
AGE AND HYPERTENSION DEATHS< 20
108
17.3
20 – 24
145
23.325 –
29
120
19.3
30 –
34
127
20.435 –
39
83
13.3
• Most deaths among those less than 25 are due to Eclampsia: need for making family planning
accessible
YOUTH AND ADOLESCENT HEALTH – AIDS
Age
2005 –
2007 and 2002 – 2004
< 20
3.0
3.3
20 – 24
19.9
23.1
25 – 29
36.2
33.1
30 – 34
25.6
26.7
35 – 39
12.5
10.4
YOUTH AND ADOLESCENT HEALTH – AIDS
Parity
2005 –
2007 and 2002 – 2004
0 25.2 28.1
1
33.1
31.3
2
19.6
22.7
3 12.3 8.9
4
3.5
2.3
5 1.2 0.9
YOUTH AND ADOLESCENT HEALTH ‐
<18
>18
unknown age
TOTAL
• 97
2716
17433
6252
26401
• 98
2492
14245
22440
39177
• 99
2799
24060
19329
46188
• 00
3983
27863
17844
49690
• 01
4440
32848
20349
57637
• 02
4058
37059
18434
59551
• 03
7854
63568
130
71552
• 04
9103
76543
428
86074
• 05
9189
80652
9
89850
• 06
10000
73764
149
83913
• 07
7368
50255
243
57866
• 08
4749
29603
103
34455
TOTAL
68751
527893
105710
702354
Couple Year Protection RateSouth Africa: Couple Year Protection Rate 2007/08 - 2009/2010
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
EC FS GP KZN LP MP NW NC WC NationalAverage
Perc
enta
ge
2007/2008 2008/2009 2009/2010
National Target 2014 = 75%
National Average 2009/2010 = 31.7%
The rate at which couples (specifically women) are protected against pregnancy using modern contraceptive methods INCLUDING sterilisations
43
PHC Utilisation RateSouth Africa: PHC Utilisation Rate 2007/08- 2009/2010
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
EC FS GP KZN LP MP NW NC WC NationalAverage
Num
ber
2007/2008 2008/2009 2009/2010
National target 2014 = 3.5
National average 09/10 = 2.5
The rate at which PHC services are utilised by the catchment population, represented as the average number of visits per person per year in the catchment population. The denominator is usually Census-derived population estimates.
44
PHC Supervision RateSouth Africa: PHC Supervision Rate 2007/08 - 2009/10
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
EC FS GP KZN LP MP NW NC WC NationalAverage
Perc
enta
ge
2007/2008 2008/2009 2009/2010
National target 2014 = 100%
National average 09/10 = 69.9%
The PHC supervision rate is defined as the percentage of PHC clinics and CHCs visited by a supervisor at least once a month. Implicit in such a visit is a written visit report and feedback to facility staff. It is one of the most important determinants of quality of care as these supervisory visits are meant to highlight problem areas which the supervisor is expected to assist clinic staff to help resolve.
45
4646
Thank You