Phila Mntwana: Child Health Priorities in KZN

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

4. POPULATION DISTRIBUTION • 0-4 years • 5-19 years • 20-24 years, and • 30-34 years • 10% • 36% • 9% • 6.7% • 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. Children of KZN • Births • 220,100 • 20.3% of all births in RSA • U5 U15 • No 1,198,180 3,276,121 • Children in RSA 22.1% 22.1% • Population of KZN 11.8% 32.3% • Live in eThekwini 27.4% 26.4% • U15 25.2% of pop of eThekwini 44.3% of pop of Uthukela

6. Living conditions • Household size 4.0 people/Hhold • Formal housing 71.6% • Electricity 77.9% • Access to piped H2O 85.9% • Income pc R 20 762.00 • Child headed Hhold 0.9%

7. Child mortality - KZN vs RSA

8. Progress in reducing NNMR & U5MR Lancet 2005; 365, 1891 - 900

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 2010 – 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’

22. TOOLS AND MATERIALS

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

24. Monitoring and data management • Set of data elements already in the DHIS 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