1. Phila Mntwana: Child Health Priorities in KZN
Dr Victoria Mubaiwa
KZN – DOH
Isibalo 12/13 September 2013

2. INTRODUCTION:
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 IMCI
Breastfeeding can reduce diarrhoea by up to 27% between the ages of 0-5 months
Hand-washing alone is associated with 35% reduction in diarrhoea
Joint statement by the WHO and UNCEF: community-level treatment of pneumonia can be carried out by well-trained and supervised community health workers
Strengthen the linkages between the health systems and the community

3. 52% 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.

4. POPULATION DISTRIBUTION
10%
36% 9%
6.7%
0-4 years
5-19 years
20-24 years, and
30-34 years
KZN has a young population
KZN second most populous province with population
of 10 Million
5.3 million people were living in poverty and
54% of the population living in rural areas

5. Births 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 eThekwini
44.3% of pop of Uthukela

6. Living conditions Household size 4.0 people/Hhold Formal housing 71.6%
Electricity %
Access to piped H2O 85.9%
Income pc R
Child headed Hhold 0.9%

7. Child mortality - KZN vs RSA
Province
IMR
U5MR
% in Hosp
% SAM
% HIV
CFR GE
ARI
SAM
Eastern Cape
24.4
36.3
46.1
24.3
40.6
10.0
8.1
20.5
Free State
72.4
92.4
47.9
56.7
50.7
13.0
9.7
24.9
Gauteng
50.1
63.2
48.5
32.3
51.2
7.2
6.0
19.5
KwaZulu-Natal
37.2
49.7
62.0
33.8
54.9
7.0
4.8
13.1
Limpopo
32.9
48.9
45.8
38.1
57.1
9.5
10.4
22.9
Mpumalanga
36.5
62.2
50.6
29.8
44.4
12.3
10.1
17.6
Northern Cape
48.1
63.7
49.1
35.5 41
6.3
4.5
21.9
North West
48.4
63.1
39.7
60.6 49
8.2
7.5
18.7
Western Cape
23.4
28.2
49.3
22.6
28.4
0.5
0.3
South Africa
50.0
33.7
47.8
7.3
6.5
18.3

8. Progress in reducing NNMR & U5MR
Lancet 2005; 365,

9. In KZN ...
1 in 20 children die before their 5th birthday
Of these…
38% die outside the health service
55% die in association with HIV
33% have underlying severe malnutrition

10. Age distribution of under 5 deaths

11. Global Practices & Lessons Learnt
With training and supportive supervision,
CCGs - deliver package of less complex maternal & child health and nutrition interventions
E.g. Vitamin A supplementation, antibiotics for community- based management of pneumonia, ORS/ORT/SSS for the management of diarrhoea, plus administration of deworming.

12. Global 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

13. Aim
To Reduce morbidity and mortality from preventable conditions: HIV, Pneumonia, diarrhoea and malnutrition

14. Objectives
To 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 government
To improve access to preventative health services: Growth Monitoring; Oral rehydration, Breastfeeding and Immunization.

15. Phila Mntwana Centre
A simple structure where basic health promotion and therapeutic services can be accessed by communities where formal curative services are not immediately available or accessible.

16. Location
The 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 rooms
Early Childhood Development Centers (ECDs)
Elderly Luncheon Clubs
Any other point in the ward depending on the catchment population under 5 years and the accessibility based on geographical size of the ward
N.B. Each “PHILA MNTWANA CENTRE” should be linked to a local PHC facility or mobile team

17. Child Mortality: Growth Monitoring:
Mid Upper Arm Circumference (MUAC) Tape– early detection of underweight children or weighing where applicable
Effective recognition of sick / malnourished children in the community (OSS).
SASSA/ DOH/ DSD Cooperation on Malnutrition – referral of children with malnutrition for social relief intervention

18. Child Mortality: Oral Rehydration
To prevent dehydration from diarrhoea, sugar/salt water solution is best for rehydration
CCG have been trained to educate all mothers and care givers
CCGs also have ORS for rehydration prior to referral

19. Breastfeeding
New Infant and Young Child Feeding (IYCF) in the Context of HIV Policy launched October – Full implementation 1 July 2011
BREAST IS STILL BEST
Support for appropriate infant and child feeding and nutritional counselling
One-home-one garden

20. wellness Immunization
EPI Screening and /or referral and other Health Services for children under 5 years.
Wellness
Vitamin 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

21. Operation Sukuma Sakhe ‘Mbo’
Home affairs
SASSA and DSD
Various stakeholders
Agriculture: one home, one garden
Community leadership

22. TOOLS AND MATERIALS

23. Mid Upper Arm Circumstance (MUAC) tapes
TOOLS AND MATERIALS
latex gloves
Mid Upper Arm Circumstance (MUAC) tapes
ORS
Hand soap
Vit A
Data tools

24. Monitoring and data management
Set of data elements already in the DHIS
Neonatal death
Maternal death
Children receiving neonatal care
Patients receiving palliative care
Children monitored for Growth
Condoms Distributed
Referrals for Family Planning
Referrals for Antenatal Care
Referrals for Postnatal Care
Referrals to health facility
Child beneficiaries seen
Adult beneficiaries seen
Vitamin A
data tool

25. Future Plans Scale up – full coverage of warrooms
Rapid scale of Ward-based Family Health Teams
Continuing development of CCGs
Opportunities for additional interventional services:
Up and down referral system (being piloted)
Continuing Quality Improvement

26. NGIYABONGA