This year the Department of Health’s priorities have a strong ECD focus and offer numerous opportunities for advocacy engagement to improve the lives of young children in South Africa.The Minister of Health’s priorities for the coming financial year focus on the four pandemics currently facing South Africa, namely: HIV and AIDS and TB; unacceptably high maternal and child mortality; increasing non-communicable diseases such as high blood pressure, cardiovascular diseases, cancers and mental health; and the pandemic of violence and injury.

The Minister recognised a serious anomaly in the ratio of health budget to health outcomes in South Africa. Whilst the ratio of GDP on health (8,7%) is higher than any other country in Africa, our health outcomes are much worse than in many of these countries.

The Department’s budget for the 2011/12 year is given as “R25,731,554 billion”.

HIV and AIDS and TB

The Minister announced that improved treatment measures which commenced in April 2010 are already yielding benefits. There has been a 50% reduction of transmission of HIV and AIDS from mother to child by 6 weeks post-delivery.

On the TB front, improved diagnostic machinery is being rolled out in districts with high caseloads in the next six months, and to all facilities in the next eighteen months. In addition, a programme of home visits to families affected by TB has commenced and the objective is that by world TB day next year, 200,000 families will have been visited and screened. The third strategy has been the design of nine MDR hospitals – one per province – specifically for the long-term and effective treatment of TB patients.

High maternal and child mortality rate

A primary element of the improved HIV and AIDS health protocol specifically targets pregnant women and children, and the results speak for themselves.

Additional measures planned include an intensive immunization campaign and the calling of a breastfeeding summit in August 2011 to address the 51% mixed breast-and-formula infant feeding rate in South Africa – the most dangerous type of feeding in a country with high HIV- prevalence.

Non-communicable diseases

These are largely lifestyle diseases caused by smoking, harmful use of alcohol, bad eating patterns and lack of exercise. South Africa is committed to the “Moscow Declaration” – a WHO and UN statement on responses necessary by countries to address non-communicable diseases through lifestyle changes.

South Africa will, for example, be introducing legislation to compel the reduction of salt levels in foodstuffs. Studies in South Africa show that just be reducing the salt content on bread will save close to 6,500 lives per year.

Obesity is another key risk factor, and it is cause for grave concern that school children are increasingly overweight in South Africa. Between 2002 and 2008, the number of overweight children jumped from 17,2% to 19,7%. In 2008, a total of 23% of school children were either obese or overweight – close to a quarter of the school-going population. The Minister called for urgent action, and indicated that plans are in development to limit child-targeted advertising for junk food and other harmful foodstuffs.

Violence and injury

The Minister stated that the cost of treating the number of people hurt by violence and motor vehicle accidents is crippling the health system, implying an urgent need for measures to reduce these causes of injury.

National Health Insurance (NHI)

The Minister divided the nation into two camps in relation to attitudes to NHI: (1) “those who correctly and legitimately hope that the NHI will bring relief in their everyday hardships as far as their health is concerned”; and (2) “those consumed by self-interest and greed that will shame the devil ... waiting for any development and vow[ing] to do anything in their power to stop NHI dead in its tracks.” He appealed for patience amongst both groups, saying that the current health care system will not be able to sustain any NHI system in its current state, and that the introduction of the NHI system must be preceded by the re-engineering of the whole health care system – both public and private. This is going to take time.

The current system will be re-engineered at three levels:

• A district-based model in terms of which five specialists will be deployed to each district, where they will focus on maternal and child mortality. The team will consist of a principal obstetrician, paediatrician, family physician, advanced midwife and senior primary care nurse. Once appointed they will deal with guidelines and protocols at Antenatal Care Clinics, Labour Wards, Post-natal Health care and Paediatricians and Child Health Clinics. They will follow up on every case of mortality; they will train interns, community service doctors and medical officers, and will focus on midwives to help bring down the maternal mortality rate.
• A School Health Programme will be launched, with the Ministers of Education and Social Development under the leadership of a task team that has already been appointed. The programme will deal with basic health issues such as eye care, dental problems, hearing and immunisations in our schools, as well as more complex issues such as contraceptives and HIV and AIDS programmes amongst learners. The programme will be initiated in the poorest quintile 1 and 2 schools which are also far from the nearest health centres.
• A ward-based Primary Health Care model which will deploy at least 10 well trained PHC workers per ward.

Additional commitments include: remedying poor standards of management at health care facilities; the improvement of the quality of health care services through the Office of Health Standards Compliance; and improved Health Workforce development.

There are numerous opportunities for NGOs and other stakeholders to support the priorities and goals stated in the Minister’s speech. For example, the inclusion of appropriate messaging and education from an early age about good lifestyle choices such as good eating habits, the promotion of exercise and other similar interventions in infant and ECD programmes and curricula are essential. There is a traditional African saying that to bend the branch of a tree, one must do so while the tree is young. If children are taught from the earliest possible age about healthy lifestyle choices, we are very likely to contribute to the reversal of the non-communicable disease pandemic in the next generation.

In this regard, it is worrying that the Minister’s proposed School Health Programme appears to be limited to primary schools. What are the plans for improved health services at ECD sites and facilities? We need to be asking this question at a national, provincial and local level.

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View a copy of the Minister of Health’s speech.