1. The Provincial Profile of KWAZULU NATAL

3. Introduction The Province of KwaZulu-Natal extends over 92,100 square kilometres in the eastern part of S.A. It comprises 7,6% of the total landmass of the country. The Province shares borders with Swaziland and Mozambique in the north, Mpumalanga in the north-west, the Free State and Lesotho in the west and the Eastern Cape in the south. This area is home to an estimated 10,3 million people [2011 census] or 20% of all South Africans. KwaZulu-Natal is thus the third smallest but 2nd populous province in the country.

4. Province profile Total population10,3m Rural54% Women53,% Population < 15 years33% Children who are orphans21% Adults with no education11,4% Adults with grade 12 education22,9% Matric pass rate66%

5. Health status of KwaZulu-Natal. Life expectancy at birth60yrs Maternal Mortality Rate176/100 000 Under 5 Mortality Rate93 Immunization coverage < 1 year97,3% Immunization drop out rate (DTP 1 – 3 )1,0% ANC HIV+ seroprevalence37.4 HAART initiation in pregnant HIV+ women83% Proportion of HIV+ people15,8% Incidence new STIs5,1% TB prevalence (per 100,000)1,000 TB cure rate77.1 Diarrhoea incidence, children < 5 years357,2 Mother To Child Transmission of HIV2%

6. Region 1:South Eastern Area comprising two districts (eThekwini & ILembe) with one tertiary, four regional,4 district hospitals and two semi private to serve a population of about 4,5 million. Region 2: Western Area consisting of three districts (Sisonke, UGu, and uMgungundlovu) with one tertiary, two regional and 9 district hospitals for an estimated population of 2,2 million people. Region 3: North Eastern Area comprising three districts (UMkhanyakude, Uthungulu and Zululand) with no tertiary, one regional and sixteen district hospitals for a population of 2,3 million people. Region 4: Midlands Area comprising three districts (uMzinyathi; Amajuba and uThukela) no tertiary, two regional and eight district hospitals to serve a population of 1.7 million people. Components of the KwaZulu-Natal Public Health System.

7. National Health Insurance Sites [NHI] There are three NHI Sites in KwaZulu Natal:- uMgungundlovu District uMzinyathi District and Amajuba District. They have been assessed for CARMMA Compliance in preparation for accreditation. National has also prioritized them with the support for ESMOE by conducting the baseline assessments and highlighting the importance of drills, and supplied them with the mannequins as per level of care

8. NHI Cont. A selection criteria used to guide provincial selection of a NHI pilot district was based on the following: Vulnerability of the population, mainly looking at the deprivation index and the socioeconomic profile of the district population as standard measures; Access to healthcare: geographical access to health care facilities, coverage of health services to population served, utilization and service delivery indicators; Equity: equitable distribution of resources looking at PHC per capita budget allocations and expenditure; Burden of Disease: includes Perinatal mortality, HIV and TB outcome indicators; and Functionality and efficiency: leadership, management and governance.

9. Maternal & neonatal Indicators Caesarean section rate%30.030.629.229.9 Delivery rate in facility under 18 years%8.49.79.39.1 Facility mortality under 1 year rate%6.35.05.6 Facility mortality under 5 years rate%5.14.34.84.7 Low birth weight rate in facility%12.812.912.612.7 Maternal mortality rate in facility per100000 84.8122.7168.6126.1 Neonatal mortality rate in facilityper100011.111.39.210.5 Perinatal mortality rate in facilityper100032.237.030.333.0 Still birth rate in facility%2.32.82.22.4

10. KZN Midwives This is based on the Saving Babies Recommendations, which stipulates that 16 midwives per 100 deliveries a month. There are no staffing norms in SA. District Average deliveries a month # functioning Basic midwives # functioning ADM’s Total # of midwives functioning Should have: Need [gap/difference ] UThukela 94032265814587 iLembe 90844186214482 Amajuba 74037347111342 uMzinyathi 996 52 257716083 UGu District 1220682088192104 Sisonke 83040165612872 uThungulu 13727338111224113 uMkhanyakude 108061349516065 Zululand 1234744211619276 uMgungundlovu 1410471764224160 eThekwini 438333811345170086557 PHC,CHC & MOU 186530688394304 Total 15 113866383124924 1811 69

11. Saving Mothers 2008-10 KZN Chapter

12. Summary of data 1133 deaths (13% increase) Numbers of deaths stable for 5 years (350- 400) Still under-reporting 66% post-partum HIV status-86% known Of those tested, 79% positive

13. Top 5 causes NPRI (TB top)48% Hypertension (eclampsia top)10% Haemorrhage (post C/S top)9% Medical and surgical disorders (cardiac top)8% Miscarriage(septic misc top)6%

14. CARMMA CARMMA was launched in May 2012 by the Minister of Health in KZN. Like all other campaigns a structure was formed and the ethics of campaign needs to be followed with clear guidelines on reporting and adherence to time frame. The campaign aims to aggressively mobilize resources for maternal health and bring about positive societal change in support of improving maternal health in the country Seven focus areas were presented by the Health minister

15. CARMMA STATUS IN KZN Improving Maternal Health and reducing mortality:- - There is a noticeable decline in Maternal mortality from 393 in 2010 -320 in 2012.[176/100 000] Improved HAART Initiation for pregnant woman:- - 83% ANC client initiated on HAART. Essential steps in the management of obstetric emergencies:- - [ESMOE]:191 people have been trained as ESMOE master trainers - Obstetric fire drills conducted Maternity Waiting Areas - 14 waiting homes Midwives Obstetric Unit :There are 3 different models -MOU sited within PHC Clinic =32 identified,18 functional -MOU sited within CHC =17 all functional -MOU within hospital =1 functional Obstetric Ambulances :38 allocated in KZN district

16. SOMSA STATUS IN KZN The SOMSA president is from KZN The Representation of KZN Midwives in the SOMSA body is Chair-person : Kholeka Makhathini Additional Member:ZO Mzolo SOMSA belong to KwaZulu Natal Discussion group The active steering committee has representation from different spheres in the Health sector e.g. Provincial MCWH team,DCST, Educators,Managers, Young Midwives,Doctors and Neonatal rep and retired midwives. The meetings are done on quarterly basis as a means of updating the members and planning and monitoring of the progress.

17. CONTINUATION OF THE STATUS The KZN Midwives discussion group conducts 2 provincial workshops in a year with the support of the KZN DOH AND Provincial MCWH team in addressing challenges faced within Maternal Health in meeting the MDG 4,5 AND 6 in May for the celebration of the international day of Midwives and in September for the clinical skills. Membership –Coordination of membership is through the presence of strong leadership within all the districts Appointment of champions within all 11 districts is in process so as to gain full participation in the committee. The support of Maternal health issues by DOH through identification of Patrons like our Queen Thandi MaNdlovu Zulu,Our first lady and in CARMMA, Phila MA and also Child health issues t

18. STRENGTHES IN KZN In KZN all the districts have members of the DCST though not complete and posts have been advertised Orientation and induction of the DCST by the KZN School of Medicine in Maternal,child and leadership skills Recognition of the KwaZulu Natal Midwives discussion group by the KZN DOH. Strong relationship with our Provincial Maternal Health team KZN DOH funding of Midwives annually to attend Midwifery congresses. Active involvement of partner's [NGO] in support of Maternal Health issues

19. CHALLENGES Staffing Norms Recruitment of ADM for training COMPITING WITH RECRUITMENT FOR phc TRAINING at PHC level Membership –constraints in assessing the membership forms and ongoing reminders for next subscription and membership cards

20. FUTURE PLANS Marketing strategy to increase membership and involvement of private sector Drafting of the year plan

21. THE END Thank you