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

2. 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
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

3. 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: 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

5. Clients - HCT Testing ProgressLM 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

6. HCT testing
Targets are monitored monthly ,from July 2012 –June 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

8. 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.

9. Condom Distribution
Hibiscus operation MBO in January contributed to 4000 female condoms and 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

12. 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

13. 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

15. 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 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

16. 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

17. Sexual Assault

18. 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

20. Teenage Pregnancy
Increase in Learner Teenage pregnancy,1200 reported in 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

21. 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

22. No subdistrict data is available

23. 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

25. 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

27. 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.

28. 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.

29. Strategic Objective 1 Intervention area: Community Mobilisation
INDICATOR Q1 Q2 Q3
Number of people aged reached with prevention information including anti-gender based violence information
5760
3456
5000
Number of young people aged 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

31. 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)

33. 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

34. Cont’ : Progress on prevention strategies

35. 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

36. 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

37. 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

38. 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 .

39. 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)