STRATEGIC HEALTH PROGRAMMES SECOND QUARTERLY REVIEW 2011/12

DistrictQuarter 1Quarter 2 UGU4 (1 Thuthuzela) UMGUNGUNDLOVU4 ( I Thuthuzela)4 (1 Thuthuzela) UTHUKELA3 (No Thuthuzela) UMZINYATHI4 (No Thuthuzela) AMAJUBA3 (No Thuthuzela) ZULULAND5 (No Thuthuzela) UTHUNGULU7 ( No Thuthuzela)7 ( No Thuthuzela UMKHANYAKUDE2 ( No Thuthuzela) ILEMBE2 ( 1 Thuthuzela) ETHEKWINI5 (3 Thuthuzela) SISONKE44 PROVINCE43 ( 6 Thuthuzela) Number of Trauma Centres for victims of violence

COUPLE YEAR PROTECTION RATE (35%) DISTRICTQ1 11/12Q2 11/12 Amajuba 20.5% 27% Ethekwini 20% 23% Ilembe 22.7% 32% Sisonke 25.9% 24% Ugu 23% 29% UMgungundlovu 22% UMkhanyakude 18% 28% Umzinyathi 24.2% 26.4% Uthukela 23.2% 25% UThungulu 20.7% 21% Zululand 21.6% 26% Province 21.9% 26.1%

DISTRICTSQuarter 1Quarter 2 UGU UMGUNGUNDLOVU UTHUKELA UMZINYATHI6888 AMAJUBA ZULULAND UTHUNGULU UMKHANYAKUDE6789 ILEMBE ETHEKWENI SISONKE4650 PROVINCE NUMBER OF SEXUAL ASSAULT CASES NEW

Sexual Assault children under 12 years old DISTRICTQuarter 1Quarter 2 UGU90105 UMGUNGUNDLOVU UTHUKELA7566 UMZINYATHI2445 AMAJUBA80108 ZULULAND3236 UTHUNGULU4841 UMKHANYAKUDE2427 ILEMBE3157 ETHEKWINI SISONKE1110 PROVINCE

ANC booking < 20 weeks rate (45%) DISTRICTQ4 10/11Q1 11/12Q 2 11/12 Amajuba 36% 37%29% Ethekwini 34%40%42% Ilembe 32%36%33% Sisonke 39%33%35% Ugu 37%35%31% UMgungundlovu 40%47%49% UMkhanyakude 42%45%41% Umzinyathi 42%38%43% Uthukela 38%35%38% UThungulu 42%35%42% Zululand 38%37%42% Province 38.1%38.6%

ANC client HIV re-test at 32 weeks rate (50%) DISTRICTQ4 10/11Q1 11/12Q2 11/12 Amajuba 37.6% 43.9%44.1% Ethekwini 29.7%36.1%31.7% Ilembe 38%59.7%50.9% Sisonke 18.8%22.7%36.8% Ugu 30%38.2%42.1% UMgungundlovu 26.1%45.9%43.9% UMkhanyakude 28.1%43.9%59.7% Umzinyathi 29.9%32.4%35.6% Uthukela 29.8%36.3%37.5% UThungulu 36%45.4%53.1% Zululand 15.7%36.4%40.7% Province 29%39.3%40.8%

ANC client CD4 1st test rate (80%) DISTRICTQ4 10/11Q1 11/12Q2 11/12 Amajuba 77.7%77.4%93.5% Ethekwini 75.6%77.1%77.3% Ilembe 79.4%77%72.9% Sisonke 69.1%71.2%72.3% Ugu 84.7%71.5%66.6% UMgungundlovu 77.1%71.6%78.4% UMkhanyakude 70.8%73%73.3% Umzinyathi 74.2%73.4%69.1% Uthukela 66.6%76.4%72.5% UThungulu 78.9%74.8%72.1% Zululand 75.7%78.5%82.3% Province 75.6%75.4%75.8%

ANC client initiated on HAART rate (85%) DISTRICTQ4 10/11Q1 11/12Q2 11/12 Amajuba 67.3%106%73.6% Ethekwini 68.8%82.5%83.4% Ilembe 87.6%72.1%86.4% Sisonke 75%58.6%60.1% Ugu 101.9%83.8%88.5% UMgungundlovu 74.3%85.8%63.3% UMkhanyakude 77%71.1%77.6% Umzinyathi 55.5%60.5%59.8% Uthukela 79.9%70%74.4% UThungulu 74.2%84.5%65.3% Zululand 74.3%85.1%87.4% Province 73.5%80.4%77.6%

PCR positive around six weeks rate (MTCT) DISTRICTQ4 10/11 NHLSQ1 11/12 NHLSQ2 11/12 NHLS Amajuba1.9% 3.8% 3% 2.8%1.7% 0.6% Ethekwini 7.2% 3.1%5.3% 2.6%6.1% 2.4% Ilembe 3.7% 1.5%2.6% 3.3%4.1% 4.4% Sisonke 4.1% 2.8%4.2% 1.9%2.4% 2.3% Ugu 4.9% 3.7%2.8% 2.5%5.5% 5% UMgungundlovu 4.9% 1.7%3% 1.9%3% 2.4% UMkhanyakude 4.3% 3.7%3.5% 2.6%3.5% 5% Umzinyathi 4.9% 6.4%3.3% 3.8%3.6% 2% Uthukela 3.1% 2.6%3.9% 3%3.6% 3.2% UThungulu 4% 3.4%3.1% 2.4%2.3% 2.8% Zululand 4.6% 2.9%5.3% 2.3%5.4% 3.7% Province 5% (MRC 2.8%) 3.1%4% 2.5%4.4% 3%

Infants with PCR test positive started on ART (60%) DISTRICTQ1 11/12Q2 11/12 Amajuba 64% 27% Ethekwini 15% 31% Ilembe 53% 68% Sisonke 48% 139% Ugu 95% 72% UMgungundlovu 74% 82% UMkhanyakude 98% 47% Umzinyathi 60% 117% Uthukela 60% 63% UThungulu 54% 50% Zululand 15% 38% Province 42% 51%

POSTNATAL VISIT WITHIN 6 DAYS RATE (60%) DISTRICTQ4 10/11Q1 11/12Q2 11/12 Amajuba 88% 90%66% 67%70% 72% Ethekwini 66%74% 66%67% 60% Ilembe 65% 64.9%68% 59% Sisonke 50.6% 49%41% 42%42% Ugu 47% 34%37% 34%46% 45% UMgungundlovu 36.8% 34.8%52% 62%59% 70% UMkhanyakude 48% 47%45% 45% 47% Umzinyathi 80% 64%70% 71%67% 57% Uthukela 54.9% 54.7%58% 55%58% 57% UThungulu 39.7% 32.9%73% 68%77% 78% Zululand 33.4% 32%50% 47% 46% Province 54.3% 51.7%68.3% 57%57.9% 61.3%

MATERNAL MORTALITY RATIO (160) DISTRICTQ1 11/12Q2 11/12 Amajuba Ethekwini Ilembe Sisonke Ugu UMgungundlovu UMkhanyakude Umzinyathi Uthukela UThungulu Zululand Province

14 Prevention of Mother to Child Transmission of HIV Transmission measured in Aug 2010 within the general population of children who attended post natal care Data Source: MRC 2011

15 Institutional Maternal Mortality Ratio

16  Top four causes of maternal mortality ( )  Non-pregnancy-related infections (HIV) 48%  Hypertensive disorders 10%  Obstetric haemorrhage 9%  Miscarriage 6%  HIV & AIDS  85% maternal deaths tested (69% in )  79% of those tested were HIV positive Maternal Health

17  Other pregnancy related issues:  Extending access to safe delivery facilities – 33 Basic Emergency Obstetric Care Units  Deploying District and Mentorship Teams – 11 Teams  Continuous training on management of emergency obstetric cases  Dedicated maternal health ambulances deployed in all districts  Extending ANC/PNC to the community through Operation Sukuma Sakhe  Child Health Programmes  Implementation of the WHO 2010 IYCF Guidelines  Diarrhoea and malnutrition campaigns through Operation Sukuma Sakhe Maternal and Child Health

School Health and Youth Health

School Health Services DistrictNo. of SchoolsNo. of G1 Learnners No. of Learners Screened No. reffered Amajuba Ethekwini Ilembe Sisonke Ugu Umgungundlovu Umzinyathi Uthukela Uthungulu Zululand Umkhanyakude Province

Pregnancy and Child birth Complication s Community based interventions  Training of Community Care Givers in MNNCW  Empowerment of women ito of knowledge of danger sighs  Promotion of early booking  Integration into Operation Sukuma Sakhe  Coordination and partnerships with various NGOs Ante Natal Care  PMTCT interventions  Initiation of pregnant women on HAART  Provision of the integrated ANC in line with the ANC/PNC Policy (utilization of the revised job aids)  Promotion of Family Planning PACKAGE OF INTERVENTIONS

Pregnancy and Child birth Complications Emergency Obstetric Care  ESMOE training of mid-wives and medical officers  Correct management of obstetric complications and neonatal resuscitation  Establishment of fully functional MOU  (functional is MOU adequately staffed and equipped and conducts more than 50 deliveries a month  Adequately and appropriately staffed and equipped maternity wards  Provision of emergency obstetric emergency vehicles  Waiting Mothers Lodges in all delivery facilities

Pregnancy and Child birth Complications Post Natal Care (3 day, 6 weeks)  Counseling on newborn and maternal danger signs  3 day and 6 week visits  Support for breastfeeding or appropriate feeding

Neonatal care KINC  Implementation of KINC across the province  Care of pre-term baby in all hospitals (Kangaroo Mother Care)  Management of Birth Asphyxia  Infant feeding counseling and support  Appropriate equipped and staffed nurseries

Childhood illnesses Community based child health  Growth Monitoring  Oral rehydration  Breast feeding  Food security (OSS) IMCI/ management of emergency illnesses  Immunization  IMCI case management  Early diagnosis and initiation on HAART  Testing of exposed infants at six weeks and cotrimoxazole

Women’s health Family planning  Training of all health workers on FP  Community education and mobilization  Promote Healthy Timing and Spacing of Pregnancies by Improving Contraceptive Awareness and Access at Health Facilities and in the Community  Contraceptive Method Mix  Integration of Contraceptive Services with other Services  Improve Health Care Provider Training and Mentoring on Contraception

Women’s Health Post Exposure Prophylaxis  Counseling and provision of comprehensive package for NOPEP  Partnerships and participation in local and provincial victim empowerment Fora Phila Ma  Screening, early detection and treatment of breast and cervical cancers Youth and School Health  Youth Friendly services  Integrated school health services

What are we looking to achieve? Impact on maternal health (NSDA Output 1, 2 &3) - HIV status - ANC booking < 20 weeks - If positive and eligible – on treatment - Prevention of unwanted pregnancies – contraception strategy - Postnatal Care within 6 days Impact on Mother To Child transmission of HIV (NSDA Output 3) - PMTCT regime (ANC, labour/delivery, postnatal) - HIV Re - testing at 32 weeks - ART access for eligible clients Impact on child survival (NSDA Output 2) - HIV free survival (prophylaxis, infant feeding in the context of HIV) - ART access for eligible babies - Mother linked to care and treatment

28  For every 1000 live births, 60 die by the age of 5  Of the under 5 deaths, 75% die in the first year (infant death)  Of the under 5 deaths, 25% die in the first month (neonatal death)  48% die at home Child Health

Causes of child health in KZN ( source: Saving Children 2005 – 2007) TOP % of deaths Pneumonia, ARI Septicaemia Acute diarrhoea PCP (suspected) Chronic diarrhoea

Thank You

Anthropometrics: Children 1- 9 yrs. in KZN YEARStuntingUnderwei ght WastingOverweigh t 1994 (SAVACG) 16%4%1%7% 1999 (NFCS)19%4%9%4% 2005 (NFCS)15%5%1%6%

NFCS 2005 Recording of Birth Date on RtHC was 49.4% and recording of receiving of a Vitamin A dose for months old children was 54.8%. Vitamin A supplementation of months was low at 27.9%. Only 1.3% of infants are exclusively breastfed at 4-5 months ( 8 % Nationally)

INP PROVINCIAL PRIORITIES  Priority 1: Adequate and optimal feeding for children aged 0 – 2 years.  Priority 2: Prevention and treatment of nutrition-related diseases  Priority 3: Improvement in the nutritional status of individuals through targeted micronutrient supplementation.

Breastfeeding Promotion Protection & Support Participants of the National Breastfeeding Consultative Meeting (22-23 August 2011) concluded with a declaration known as the “Tshwane Declaration of Support for Breastfeeding” which declared South Africa as a country that will actively promote, protect and support exclusive breastfeeding as a public health intervention to optimise child survival, irrespective of the mother’s HIV status. 35

Commitments of the Declaration ACTIONS TOWARDS BREASTFEEDING PROMOTION To achieve this the following will be implemented –Human milk banks to be promoted and supported for vulnerable children. –Mandatory Implementation of Baby Friendly Health Initiative (BFHI) and a quality assurance tool and Kangaroo Mother Care (KMC) including community support. Target is 100% by 2015 –Formula feeds will no longer be provided at public health facilities with the exception of certain medical conditions 36

KwaZulu-Natal MBFI Designated Facilities Trends

Progress to date All Lay counselors trained- 3 days District Trainers – 5 days In service for all health workers – 1day PN training -3 days DMs Advocacy meeting for MBFI District Advocacy Meetings for MBFI District community Advocacy meetings Communication Strategy

COMMUNICATION Advocacy –Government Departments –NGOs –Advocacy Groups Community Level –CBOs –District Outreach structures –NGOS –Local Media Mass Communication –Radio –Newspapers –Posters –Breastfeeding Promo DVDs

ACTIVITYREQUIREMENTS  Promote growth monitoring  Training of public and private sector complete in 2010  Second revision of RtHB  Monitor implementation of the National Road to Health Booklet  Community based growth monitoring sites  Procurement of height sticks, length boards, scales and MUAC tapes  Procurement and funding allocation  Ongoing Support and Training on the National Road to Health Booklet  PHC Outreach teams Current Plans for Early detection of growth faltering

ACTIVITYREQUIREMENTS  Monitor and support implementation of WHO 10 Steps guidelines for the management of severe malnutrition.  Establishment of Community based projects to strengthen the implementation of severe acute malnutrition guidelines  District training of health workers on management of severe acute malnutrition  Training of Doctors  Implementation and monitoring of the PEM register  Support Visits to districts and facilities.  MUAC screening  Support to Districts  Support to hospital staff  PHC support Implementation of an Integrated programme on the management of acute malnutrition in priority areas

Framework for Accelerating Community-based Maternal, Neonatal, Child and Women’s Health and Nutrition Interventions

C- Framework for MCWH & N Development of MCWH & N Community Framework complete Training Manual developed Facilitators Guide, Flip Charts and Job Aids developed Training of Community Care Givers Supervisors / Facilitators complete District Advocacy Meetings complete Training commencement of CCGs CCG Kits procured

Expansion of Vitamin A coverage Current coverage of 38-42% (12-59mths) Target 80% MCC approval for use of CCGs Implementation Plan developed Policy & resource materials in process Training to commence February 2012 Implementation date 1 April 2012

Vitamin A Campaign 2010

CONCLUSION Mutual benefits of collaboration cannot be over- emphasized - goals and objectives - technical support - pace of implementation and upscale - ease of procurement - building NGO capacity -