Childrens Bill Department of Health presentation to the portfolio committee on Social Development 25

1
Childrens BillDepartment of Health presentation
to the portfolio committee on Social
Development25 August 2004
2
Current status of child health in SA
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Infant and under 5 mortality
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(No Transcript)
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Source Bradshaw D, Bourne D, Nannan N. What are
the leading causes of death among South African
children? MRC Policy Brief No. 3, December 2003.
Bradshaw D, Groenewald P, Laubscher R et al.
Initial Burden of Disease Estimates for South
Africa, 2000. Cape Town SAMRC, 2003.
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Mortality Comment

• Large inter and intra- provincial variation in
  U5MR and IMR
• Average IMR higher than countries with comparable
  economies e.g. Cuba
• Main causes of deaths are preventable
• Infants diarrhoea, chest infections,
  malnutrition
• under-5 trauma, diarrhoea, chest infections,
  malnutrition and HIV
• 5-14 years violent intentional trauma and
  accidental trauma

HIV
Diarrhoea, pneumonia, malnutrition
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Morbidity Comment

• Mostly preventable causes e.g. diarrhoea,
  malnutrition and chest infections
• Disabilities often the result of
• delayed recognition / management or
• inappropriate management e.g. birth asphyxia

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MULTIFACTORIAL FACTORS associated with freq.
severity (incl. death) of child health conditions
e.g. diarrhoea, chest infections, malnutrition,
HIV, abuse, accidents
To improve Child health ALL national ,
provincial district local organs of govt. and
all sectors must be guided by The best interest
of the child when making policy legislative bu
dgetary and administrative decisions
Bacterial / Viral load Availability of and
access to health services incl. PHC package,
hospital / institutional care, home care /
protection
Immediate Causes
Feeding pattern / household food security
(poverty), Unhygienic conditions Smoking
Pollution Access to safe water, sanitation,
environments Education (esp maternal)
Underlying Causes
Allocation and distribution of resources
Intersectoral planning Gender issues Budgeting
and prioritisation of children
Basic Causes
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INTERNATIONAL AND NATIONAL CONTEXT
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International Context

• CRC Putting children first
• African charter on the health and welfare of
  children
• MDG
• UNGASS
• A World Fit for children
• Global Strategy on Infant and Young Child Feeding
• NEPAD
• WHA Resolution (54.19), May 2001, on
• Schistosomiasis and STH infections

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International Context CRC

• right to survival and development (6)
• protection from all forms of violence / abuse
  (19, 25,34)
• special consideration for all mentally or
  physically
• disabled children (23)
• right to health and facilities for the treatment
  of illness and
• rehabilitation of health (24)
• rehabilitation (39)

As a country we need to further define these
rights and provide a supportive milieu to realise
them

• In all actions the best interests of the
• child shall be a primary consideration (3)
• State parties shall undertake all appropriate
• legislative, administrative and other
• measures for the implementation(4)

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International Context

• Millennium Development Goals
• 3/7 goals are directly related to health
• By 2015
• Reduce by 2/3 the U5MR
• Reduce maternal mortality by 3/4
• Combat HIV/AIDS, malaria and other dx

How far are we?
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International Context

• NEPAD Health Strategy
• Focus on poorest and most marginalised incl.
  women and children
• Reduce IMR and U5MR by 2/3 by 2015
• Targets
• Effective implementation of IMCI and EPI
• Polio eradication
• Consolidation of
• IMCI
• Progr. on HIV and AIDS, TB and malaria
• Immunisation
• EBF and appropriate nutrition

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International Context
National Context
Legislation
Policy
Strategies
Programmes
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National Health Act

• As it relates to children will be presented by my
  colleague at the end of this presentation

16
Legislation

• Other health-related legislation that impact on
  children exist, including, inter alia
• food fortification
• tobacco Control
• These will not be presented

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Health sector strategic plans / frameworks
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The Health Sector Strategic Framework, 1999-2004
(10 point plan)

• aims to
• improve access to health care for all (and build
  on achievements since 1994)
• reduce inequities in health care, and
• improve the quality of care at all levels of the
  health care system

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The Health Sector Strategic Framework, 1999-2004
(10 point plan)

• Prioritises
• improving the quality of care,
• speeding up delivery of an essential package of
  PHC through the district health system,
• decreasing morbidity and mortality through
  strategic interventions,
• improving resource mobilisation and the
  management of resources bearing in mind equity
  issues

20
The Strategic Plan for HIV / AIDS 2000-2005

• 4 priority areas
• prevention
• treatment, care and support
• research and
• human and legal rights.
• translates into
• preventing primary HIV infection,
• preventing unwanted / unintended pregnancies in
  HIV,
• PMTCT
• preventing common illnesses, and ensuring ongoing
  care and support for mothers and children
  infected or affected by HIV and AIDS within a
  human rights paradigm.

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Policies / Programmes / Strategies currently
offered by the DoH
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• Child Health Policies and Guidelines
• Policies
• Draft Child Health Policy and Implementation
  Guidelines
• Draft Infant and Young Child Feeding Policy
• Draft Policy Framework for non-communicable
  chronic conditions in children
• Policy Guidelines for the Management and
  Prevention of Genetic Disorders, Birth Defects,
  and Disabilities
• Draft National Policy Framework for Child Abuse
• National Health Policy Guidelines for Improved
  Mental health in South Africa
• Policy Guidelines for Child and Adolescent Mental
  Health
• National Rehabilitation Policy
• Strategies and Guidelines (excluding training
  packages)
• Comprehensive Primary Health Care Package Norms
  and Standards
• District Hospital Service Package for South
  Africa
• Draft Maternal and Neonatal Strategy
• SA Breastfeeding Guidelines for Health Workers
• Guidelines for Nutrition Interventions at Health
  Facilities to Manage and Prevent Child
  Malnutrition
• PMTCT Protocol for Pilot Sites
• Expanded Programme on Immunisation (South Africa)
  Immunisation Schedule and Fact Sheets

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HIV and AIDS VCT PMTCT ART HBC STIs
TB Prevention Treatment DOTS
Programmes or Strategies offered
MCWH ANC, ATT Genetics services KMC Oral
health EPI ATT INP BFHI Code,, growth
monitoring, PSNP IMCI PMTCT ART SHS Services for
abused incl. ARV PEP
IMCI
Child survival and improved quality of life in
children
Malaria (RBM) / cholera / other
VBD Prevention Case management Outbreak response
Health Promotion HPSI Healthy environment for
children Anti tobacco
Mental Health Victim empowerment FAS Counselling R
ehabilitation
School health services
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IMCI Components and Intervention areas
Improving case management
Strengthening the health system
Improving household, community and family
behaviours
Targets 80 of district must have 60 of health
workers trained in IMCI by 2005 HHCC must be
implemented in ALL districts by end 2005
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Programme Implementation
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IMCI Expansion in SA
Shortage of funding for training Shortage of
facilitators, course directors NC no training
this year No transport for supervision
no data P planning --not started and no
plans yet
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Fully Immunised (annualised) by District - 2003
Target 80
Key Yellow 60-79 Green 80
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Fully Immunised (annualised) in Gauteng Province
- 2003
Mestweding DM
City of Tswane
West Rand DM
Ekurhuleni Metro
Sedibeng DM
Key Red 0-59 Yellow 60-79 Green 80
City of Johannesburg
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• INP
• gt25 health facilities are baby friendly
• PMTCT
• At gt1260 facilities
• 99 of HIV exposed infants receive nevirapine
• gt2800 health care providers trained in PMTCT and
  IF
• IMCI

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Infrastructure for these services

• District Health System
• Local authorities

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Human / Material Resources available
Child and Youth Health EPI Child Youth and
Adolescent
(National ) Chief Directorate MCWHN
No dedicated structures or budget for child
health at district levels or in LSAs
Provincial
District
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Challenges and Gaps

• Children still die of preventable conditions
• Socio-economic issues impact negatively on health
  e.g. poverty
• Inequitable distribution of resources
• Competing priorities at local levels
• Services for children not prioritised

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Challenges and Gaps

• Sub-optimal implementation of programmes e.g.
  Immunisation / SHS
• Poor inter-sectoral collaboration resulting in
  poor / non-existing implementation e.g. SHS
• Data on progress needed (addressed through NHA)
• Ineffective child protection

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The Childrens Bill
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Addressing challenges through the Bill
Education
Social Welfare System
Sanitation
Healthy children
Water
Safe environments
Refuse removal
Protection by Justice system and SAPS
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Childrens Bill

• Provides unique opportunity to legislate in
  favour of one of the most vulnerable groups of
  society CHILDREN
• If properly developed Childrens Bill, can
  accelerate and improve implementation of health
  services for children

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Childrens Bill

• Currently adopts a piece-meal approach-
• Needs to go one step further and state that
• The Minister, after consultation with the
  Ministers of Justice, Education, Health,
  Correctional services and Safety and Securty,
  develop a national policy framework to ensure a
  uniformed and coordinated approach by all
  Government departments in dealing with matters
  pertaining to children to guide the
  implementation and enforcement and administration
  of this Act
• This will facilitate implementation of Health
  Programmes that optimise the growth and
  development of our children

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Current intersectoral response

• Falling short
• Not bound / guided / obligated by law
• Participation often inadequate / delegated to
  junior officials
• Faces numerous internal challenges which has
  hindered its function and achievements
• Needs to be re-energised

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Bill needs to elaborate on rights

• It currently is a re-statement of section 28 of
  the Constitution
• Needs to include the ffg
• Basic health care and information about health
  (part of PHC package and IMCI)
• Basic nutrition and appropriate information about
  nutrition (part of PEM scheme and IMCI)
• Water and sanitation stated in chapter 6 (83)
  minimum norms and standards for partial care
  needs to be mainstreamed to prevent disease in
  general
• Safe environments
• Leisure and recreation
• Education
• Social security
• would not
  necessitate policy shifts but would assist with
  implementation of policy

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Cont/ elaboration of rights

• Protection from abuse, neglect, maltreatment,
  degredation and other harmful practices
• Protection from economic exploitation
• Unfair discrimination with specific reference
  to disability ethnicity, pregnancy
• Family / safe alternate care
• Property and possessions
• Shelter
• Social services

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Cont/ elaboration of rights

• Children with special needs deserve recognition
  and special mention in relation to their rights
• Long-term health conditions diabetes, epilepsy,
  asthma
• Disabilities
• Born to parents who are HIV / debilitated
• Orphans
• Child-headed households
• Living on street
• Care centres
• Refugee / unaccompanied minors

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Cost Implications
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Cost

• Would require integrated planning, budgeting and
  prioritisation for children at district level
• Cost of ARVs covered by Conditional grants
• Cost of school health services R71 646 505 for
  full coverage over 5 years (policy already
  accepted by Health MINMEC and PHRC)
• Cost of IMCI implementation to ensure 100
  coverage still has to be done but plans underway
  for full implementation