Presentation on theme: "Phila Mntwana: Child Health Priorities in KZN"— Presentation transcript:
1Phila Mntwana: Child Health Priorities in KZN Dr Victoria MubaiwaKZN – DOHIsibalo 12/13 September 2013
2INTRODUCTION:What do we know already:50% of under five year old die in the community with little or no contact with the health system.Many of the deaths are attributable to preventable and treatable conditions that can be managed thru IMCIBreastfeeding can reduce diarrhoea by up to 27% between the ages of 0-5 monthsHand-washing alone is associated with 35% reduction in diarrhoeaJoint statement by the WHO and UNCEF: community-level treatment of pneumonia can be carried out by well-trained and supervised community health workersStrengthen the linkages between the health systems and the community
352% of population in the 7 municipalities making largest contribution to KZN Economy; 48 % of population living in areas where economic development has not been performing; Dispersed rural settlements on Ingonyama Trust Land; 54% of the population living in rural areas. Women and school children majority in rural KZN; Need to accommodate an additional 3.6 mil people in urban environment by 2030 of which 85% will migrate to eThekwini if the current situation prevails.Furthermore, the fact that Kwazulu-Natal’s population is predominantly rural with 54% of the population living in rural areas makes it one of the most rural provinces in the country and this puts considerable pressure on provision of social services and infrastructure on which economic growth and development relies.The highest concentration of population densities is found within the eThekwini and Mzunduzi complexes, followed by the Newcastle and Umhlatuze complexes. A third level of density concentrations is also evident in the areas of Emnambithi, Hibiscus Coast and KwaDukuza. In general, the highest population densities are recorded within the coastal regions.The most densely populated areas described above, also represent the areas where the highest number of social challenges including lack of access to services such as education, markets, health care, and lack of services including water, sanitation, roads, transportation, and communications occur. Evidently the concentration of people in these areas generates additional pressures on all these services and requires adequate local and provincial responses.
4POPULATION DISTRIBUTION 10%36%9%6.7%0-4 years5-19 years20-24 years, and30-34 yearsKZN has a young populationKZN second most populous province with populationof 10 Million5.3 million people were living in poverty and54% of the population living in rural areas
5Births U5 U15 Children of KZN 220,100 20.3% of all births in RSA Children in RSA % 22.1%Population of KZN % 32.3%Live in eThekwini % 26.4%U % of pop of eThekwini44.3% of pop of Uthukela
6Living conditions Household size 4.0 people/Hhold Formal housing 71.6% Electricity %Access to piped H2O 85.9%Income pc RChild headed Hhold 0.9%
7Child mortality - KZN vs RSA ProvinceIMRU5MR% in Hosp% SAM% HIVCFRGEARISAMEastern Cape24.436.346.124.340.610.08.120.5Free State72.492.447.956.750.713.09.724.9Gauteng22.214.171.1242.351.27.26.019.5KwaZulu-Natal37.249.762.033.854.97.04.813.1Limpopo32.948.945.8126.96.36.1990.422.9Mpumalanga36.562.250.629.844.412.310.117.6Northern Cape48.163.749.135.5416.34.521.9North West48.463.139.760.6498.27.518.7Western Cape23.428.249.322.6188.8.131.52South Africa50.033.7184.108.40.2068.3
8Progress in reducing NNMR & U5MR Lancet 2005; 365,
9In KZN ...1 in 20 children die before their 5th birthdayOf these…38% die outside the health service55% die in association with HIV33% have underlying severe malnutrition
11Global Practices & Lessons Learnt With training and supportive supervision,CCGs - deliver package of less complex maternal & child health and nutrition interventionsE.g. Vitamin A supplementation, antibiotics for community- based management of pneumonia, ORS/ORT/SSS for the management of diarrhoea, plus administration of deworming.
12Global Practices & Lessons Learnt Even with presumably weak health systems, Malawi, Mozambique, Madagascar, Ethiopia and Eritrea reduced child mortality significantly between 1990 and 2006.Attributed to effective community-based delivery of health and nutrition interventions through CCG programmes, home visits, child health days & community mobilisation
13AimTo Reduce morbidity and mortality from preventable conditions: HIV, Pneumonia, diarrhoea and malnutrition
14ObjectivesTo provide comprehensive prevention and health promotion package for children at community level.To provide the community leadership and warroom members with a simple diagnosis of the status of the children in the community, so that corrective measures may be taken when necessary.To monitor the Nutritional and Health Status of all Children under 5 years at community level on a monthly basis.To ensure early identification of children with malnutrition, diarrhoea, TB and other health conditions as early as possible and to refer for health care.To identify children who require referral for governmentTo improve access to preventative health services: Growth Monitoring; Oral rehydration, Breastfeeding and Immunization.
15Phila Mntwana CentreA simple structure where basic health promotion and therapeutic services can be accessed by communities where formal curative services are not immediately available or accessible.
16LocationThe location of the “PHILA MNTWANA CENTRE” will be dependent on the decision by the local leadership as part of the OSS operations in the ward. The location will include but not limited to the following structures:War roomsEarly Childhood Development Centers (ECDs)Elderly Luncheon ClubsAny other point in the ward depending on the catchment population under 5 years and the accessibility based on geographical size of the wardN.B. Each “PHILA MNTWANA CENTRE” should be linked to a local PHC facility or mobile team
17Child Mortality: Growth Monitoring: Mid Upper Arm Circumference (MUAC) Tape– early detection of underweight children or weighing where applicableEffective recognition of sick / malnourished children in the community (OSS).SASSA/ DOH/ DSD Cooperation on Malnutrition – referral of children with malnutrition for social relief intervention
18Child Mortality: Oral Rehydration To prevent dehydration from diarrhoea, sugar/salt water solution is best for rehydrationCCG have been trained to educate all mothers and care giversCCGs also have ORS for rehydration prior to referral
19BreastfeedingNew Infant and Young Child Feeding (IYCF) in the Context of HIV Policy launched October – Full implementation 1 July 2011BREAST IS STILL BESTSupport for appropriate infant and child feeding and nutritional counsellingOne-home-one garden
20wellness Immunization EPI Screening and /or referral and other Health Services for children under 5 years.WellnessVitamin A supplementation to children 12 – 59 months administered 6 monthly.HIV counseling and referral.TB screening and/or referral.DSD (social worker) referral for further assessments and intervention
21Operation Sukuma Sakhe ‘Mbo’ Home affairsSASSA and DSDVarious stakeholdersAgriculture: one home, one gardenCommunity leadership
23Mid Upper Arm Circumstance (MUAC) tapes TOOLS AND MATERIALSlatex glovesMid Upper Arm Circumstance (MUAC) tapesORSHand soapVit AData tools
24Monitoring and data management Set of data elements already in the DHISNeonatal deathMaternal deathChildren receiving neonatal carePatients receiving palliative careChildren monitored for GrowthCondoms DistributedReferrals for Family PlanningReferrals for Antenatal CareReferrals for Postnatal CareReferrals to health facilityChild beneficiaries seenAdult beneficiaries seenVitamin Adata tool
25Future Plans Scale up – full coverage of warrooms Rapid scale of Ward-based Family Health TeamsContinuing development of CCGsOpportunities for additional interventional services:Up and down referral system (being piloted)Continuing Quality Improvement