Status Quo and Progress Report Ugu District Municipality Report Presented By : Clr N.H. Gumede District Mayor 20 March 2013

BACKGROUND Review of Ugu District Strategy 2007 -2011 Final Draft Strategy developed, to be adopted by EXCO Operation Sukuma Sakhe (DTT) (26/6/12), delegated to organize 3 task teams to accelerate service delivery on key areas – DOH to deal with HAST matters ,DOE to deal with teenage pregnancy and DAEA to deal with food security . These were identified as key drivers /priority areas/ as reflected by the UDAC in the review 2007-2011 Various stakeholders, including civil society organizations enrolled and participating in the campaign .Intense mobilization targeting the following : -HIV Prevalence, HCT and access to ART, Condom distribution ,MMC, TB/MDR, Sexual Assault under 12yrs, Men-s sector and Teenage Pregnancy. Operation Sukuma Sakhe monitoring Accelerated interventions in place ,commenced July 2012

1. HIV prevalence ,HCT and access to ART Increasing HIV Prevalence was noted. Extensive testing needed. Operation MBO services planned ,to focus on Malnutrition , diarrhoea, breastfeeding. EPI programmes coupled with HCT to high transmission areas e.g. informal settlements -Mobile clinics Dedicated HCT campaigns in industries, farms, churches Weekly Nerve Centre Gains :Number of people tested for HIV this financial year: 87215 end Sept (but still short of the target) Dramaide to initiate behaviour change programmes to reduce incidence NIMART - biggest contributor to achieving the target of number of clients on ARTs. Will continue in the subsequent reporting quarters

Clients - HCT Testing Progress LM Q1 Q2 Q3 Ezinqoleni 3454 3328 3767 Hibiscus 15813 17678 15880 Umdoni 4084 3962 4728 Umuziwabantu 7201 8253 10937 Umzumbe 7658 7332 9135 Vulamehlo 4197 4255 4477 42407 44808 48924

HCT testing Targets are monitored monthly ,from July 2012 –June 2013 . Currently 40% reached. Compared to last quarter, improvement in all LMs exc HCM . Roving mobile vehicle with a dedicated professional nurse in place from March 2013 in HCM. Dedicated roving HCT team for Umdoni in the next quarter Strategies implemented in the current reporting quarter: Operation MBOs AFCON launch event and parliamentary event for disability in Umzumbe Kwa Jali clinic outreach project in Umuziwabantu Roving High Transmission Areas team functional 1 March 2013 in HCM, 2nd one for Umdoni scheduled for the next quarter

Condom Distribution Condom Distribution - at its highest peak in the district Training done with distributors Increase in condom distribution attributed to Hlola Manje campaigns Partners in distribution/and or condo can installation include: SC Hospice and Red Cross Traditional health practitioners in Umzumbe CHUBB security company. CCGs DOE (installation at FET colleges) Private GPs/Gynae’s -female condoms. Ugu Municipality OSS (distribution at war rooms) All LMs apart from Ezinqoleni have shown gains compared to quarter 2.

Condom Distribution Hibiscus operation MBO in January contributed to 4000 female condoms and 30000 male condoms distributed with the assistance of Red Cross Strategy to increase in Ezinqoleni – Operation MBO at Izingolweni taxi rank Umzinto Taxi Rank - Operation MBO with DOH and Red Cross on the 1st Feb Collaboration with private GPs in Umzinto for distribution of female condoms Farmers association to be engaged by Mobiles Public sector plus through distributors is not available per LM

Male Medical Circumcisions Chaplains are engaging FBOs to mobilize initiates Weekly monitoring via nerve centre (MaTCH attending) High volume centre-Nyangwini Functional TMMCs -Advocacy through School governing bodies and radio slots MaTCH providing further technical assistance (doctor support) Neonatal Circumcisions –no one trained to conduct at present and this is a limiting factor. Role players partnering with DOH in undertaking camps Traditional MMC Coordinators

MMC   Q1 Q2 Q3 Hibiscus 932 582 493 Umdoni 293 84 50 Umuziwabantu 348 467 179 Umzumbe 489 1216 260 2062 2349 982 -December (Q3) were not effective in obtaining initiates due to the summer holiday season especially in December . -11 camps planned for q4 to compensate for poor performance. Slots to pastors forum to advocate for and plan for MMC. -DOH Currently strengthening relations between Amakhosi and MMC coordinators by initiating forums Only 4 municipalities. Vulamehlo and Ezinqoleni not linked to a hospital/CHC

Sexual Assault Awareness campaigns in identified problematic areas involving stakeholders. SAPS visiting schools to address learners on sexual assault during the assembly. Engaged community safety liaison officer-via OSS to the premier Presented statistics and sensitize role-players at the Men’s Summit on the 16-17 July 2012 Women’s sexual assault event held to conduct awareness-coordinated by SAPS Hospice – working together with child welfare to identify and refer cases of sexual assault among children. SAP is currently involved in sensitizing Indunas to correct reporting via the existing legal structures i.e. SAP. Submitted request for Sexual offences court to be planned as part of the new court development for Port Shepstone. Harding requires a child/sexual offence court-faced with lack of funding for proposed infrastructure. Investigate progress of ECD in every area of high incident of sexual assault among children Gender forums revived

Sexual Assault Talk show at Thuthuzela with pastors and SAPS regarding 16 days of activism against women. Road shows also held with stakeholders and high risk areas were visited, including the taxi rank. Training done by SA Depression and anxiety programme. Staff at crisis centre have attended DNA training to assist with taking samples Integration with mental health as perpetrators sometimes have mental disorders or substance abuse

Sexual Assault

Sexual Assault under 12 Future plans Revive community structures like men’s and women’s forums that fight against abuse Feedback on sexual assault to relevant managers via OSS In-service staff on new sexual policy Gains – 130 in q4 (11/12) to 94 in q1 and q2(12/13) and 71 in Quarter 3. Number of new sexual assault cases  : Only four subdistricts are covered as reporting is at the hospital/CHC level. No Hospital or CHC linked to Ezinqoleni and Vulamehlo. LM Q1 Q2 Q3 Hibiscus 47 57 38 Umdoni 37 32 20 Umuziwabantu 9 5 8 Umzumbe 1 94 71

Teenage Pregnancy Increase in Learner Teenage pregnancy,1200 reported in 2011. Task Team in place, led by DOE but supported by DOH and other stakeholders . Proposed strategies include: - Rolling out of the anti-sugar daddy campaign, substance abuse campaign and improving recreation facilities in areas with high incidence of teenage pregnancy Explore end of term and matric dance parties *Sinomusa high with Leleti Khumalo project -50% decrease & increased pass rate in 2012 500 learner pregnancies reported for 2012

MDR TB MDR –TB ON THE INCREASE Nurse initiated MDR treatment commenced at Murchison Hospital site IPT Rollout – preventive strategy Intensive case finding NGOs (Red cross) now involved in door to door campaigns Future plans Partners willing to procure gene Xpert-diagnostic to reduce waiting time for results Add 19 new injection teams Screening all pregnant women for TB DOH providing partners with sputum bottles

No subdistrict data is available

TB cure rate has improved to 72%. Results not evaluated are consistent. The challenge experience is lack of transport to render the TB services for outreach teams. Awaiting additional vehicles from Province

COMMENTS ON TB DEFAULTER RATE TB tracers in 2 sub districts are unable to go out due to in consistent transport. Cellphone notification to be implemented to remind patients. District to ensure that clinics allow TB facility Co-Ordinators to telephone their patients

COMMENTS ON SMEAR CONVERSION Improvement in smear conversion. The district has trained 90 nurses on nurse initiated MDR TB management. The intention is for 6 PHC clinics to commence nurse initiated MDR from April 2013.

Men’s Sector -Men’s sector is a subsection of the gender forum of the district. Forums based in municipalities- a basis for planning Advocacy for the Accelerated OSS HAST at the mens’forum. -AFSA to reintroduce youth ambassadors to the facilities and their role in health-clinics to utilize youth ambassadors in health promotion, and marketing of services esp. males health - Engagements with community members -behavior change and strategies for addressing issues of HAST, family planning and service delivery expected - Performing Arts generating discussions with DramAide and Brothers for life , in Vulamehlo and Umdoni (Dumisa and Amahlongwa areas ). To be rolled to other Local Municipalities.

Strategic Objective 1 Intervention area: Community Mobilisation INDICATOR Q1 Q2 Q3 Number of people aged 25-29 reached with prevention information including anti-gender based violence information 5760 3456 5000 Number of young people aged 15-24 reached with prevention information including anti-gender based violence information 7350 2300 4500 COMMENT Increase in quarter 3 due to the implemented accelerated interventions e.g. build up activities for world AIDs day 2012 ,16 days of activism against women and children

Cont’ : Progress on prevention strategies COMMENTS: Baby PCR tested positive around 6 weeks rate There was a decrease in transmission rate. The district has involved partners to assist with survey on the PCR positive children. Letters written to CEOs to seek permission for files on mothers for the mini survey One of the challenges is cross border patients from the Eastern Cape – District manager is reviving communication with EC Challenge with ART initiation of pregnant women. Hence there will be a roll out of NIMART training to mobiles Identification of children and initiate children under 5 by screening and testing all babies that are coming at 18 months for immunization Community dialogues to encourage early ANC booking Sub district data validation sessions to improve the quality of data at facility level, re enforce the monitoring of dash board indicators(a few important indicators that were identified by National that highlights the progress of the programme)

COMMENTS Improvement in testing noted, as a result of integration. Training of staff nurses in well baby clinic to be done. Continuous on site visits will take place Continuous monitoring of baby nevirapine uptake Adherence to treatment by pregnant women before and after delivery Need to review our targets e.g to increase in areas already achieved

Cont’ : Progress on prevention strategies

Comments Extend working hours of clinics to increase accessibility. Meet with traditional leaders, traditional healers and clinic committees. Pregnancy screening of all women of child bearing age ANC still not provided on a daily basis. OMs to ensure that ANC is provided every day and district to monitor daily ANC attendance

Cont’: Progress :Orphans & Vulnerable Children INDICATOR Q1 Q2 Q3 Number of registered OVC 15554 16450 17278 Number of registered OVC of school going age in school 13567 14286 15376 Number of registered OVC receiving care and support 1377 3303 4705 Comments Increase in numbers noted due to accelerated interventions through Operation Sukuma Sakhe in War rooms. Services to OVCs are ongoing hence numbers will be accumulative

Intervention Area : Coordination, Monitoring & Evaluation INDICATOR Q1 Q2 Q3 DAC meetings held as scheduled 1 DAC meeting chaired by designated Chairperson 70% of designated DAC members attended meeting DAC minutes to PCA Number of LACs submitting reports to DAC 4 6 Number of WACs submitting reports to LACs 20 DAC functioning well. Good participation of stakeholders, including sector departments. Programme linked with OSSP. Integrated reporting in place and reports regularly forwarded to PCA

Operation Sukuma Sakhe TOTAL NO OF WARDS NO OF FUNCTIONAL WARROOMS NO OF OUTSTANDING WARDS Vulamehlo 10 Umdoni 9 1 Umzumbe 19 12 7 Hibiscus Coast 29 13 16 Izinqoleni 6 Umuziwabantu TOTAL 84 60 24 Improvement noted ,though 24 wards are still outstanding due to clustered wards in HCM . LTTs in place ,though there are some challenges of delays in reporting. Matter receiving attention .

Other Planned Interventions and WAY forward To strengthen collaboration Continue to enroll above to take ownership Bring the Faith Based organizations on board Enroll other NGOs Working in HIV, AIDS,TB and behavioral change programmes Pursue involvement of ward champions Other collaborating partners include : Broad Reach HC, Match, Thuthuzela Centre, Red Cross, South Coast Hospice, DramAIDE, AIDS foundation ,EPWP, Ugu Health Forum, PLWA ,Senior Citizen’s forum and Business Sector Review our targets (increase in other areas)