Department of Social Development nodal baseline survey: Sekhukhune results

1. Department of Social Development nodal baseline survey: Sekhukhune results

2. Objectives of overall project • Conduct socio-economic and demographic baseline study and situational analyses of DSD services across the 14 ISRDP and 8 URP Nodes • Integrate existing provincial research activities in the 10 ISRDP nodes of the UNFPA’s 2nd Country Programme • Monitor and evaluate local projects, provide SLA support • Identify and describe types of services being delivered (including Sexual Reproductive Health Services) • Establish the challenges encountered in terms of delivery & make recommendations regarding service delivery gaps and ultimately overall improvement in service delivery • Provide an overall assessment of impact of these services • Project began with baseline & situational analysis; then on-going nodal support; and will end in 2008 with second qualitative evaluation and a second survey, a measurement survey that looks for change over time.

3. Methodology for generating these results • First-ever integrated nodal baseline survey in all nodes, urban and rural • All results presented here based on original, primary data • Sample based on census 2001; stratified by municipality in ISRDP and wards in URP; then probability proportional to size (PPS) sampling used in both urban and rural, randomness via selection of starting point and respondent; external back-checks to ensure fieldwork quality • 8387 interviews completed in 22 nodes • Sample error margin: 1.1% - nodal error margin: 4.9% • This presentation is only Sekhukhune data: national report and results available from DSD.

4. How to read these findings • Baseline survey on 5 major areas of DSD/government work: • Poverty • Development • Social Capital • Health Status • Service Delivery • Indices created to track strengths and challenges in each area; and combined to create a global nodal index. Allows comparison within and across node, overall and by sector. • Using this index, high index score = bad news • Nodes colour-coded on basis of ranking relative to other nodes • Red: Really bad compared to others • Yellow: OK • Green: Better than others

5. Findings • Detailed baseline report available • Published November 2006 • Detailed findings across all nodes • Statistical tables available for all nodes • Background chapter of secondary data available for each node • Qualitative situation analysis available per node • This presentation • High level Sekhukhune-specific findings • Sekhukhune scorecard on key indicators • Identify key strengths/weakness for the node and target areas for interventions • What next? • 2008 will see qualitative evaluation and second quantitative survey to measure change over time

6. Sekhukhune Scorecard Compared with other nodes, Sekhukhune has predominantly mid-range (yellow) and positive (green) scores, suggesting that in comparison with other ISRDP nodes, it is performing well - though with room to improve, and warning red lights flashing where service delivery is concerned.

7. Poverty index The poverty deficit index is based on 10 indicators (see table below), given equal weighting. Sekhukhune is towards the middle of the 14 nodes, as the 9th poorest node.

8. Poverty deficit Priority Areas For example, read as: Sekhukhune respondents 28% more likely to have no refuse removal; 22% more likely to have no RDP sanitation; and so on. Note the positives where the node scores above the ISRDP average

9. Poverty analysis • Relative to other nodes in the ISRDP, Sekhukhune has the 6th lowest level of poverty as measured by this index. • Key challenges in the node revolve around service delivery: • 77% of Sekhukhune respondents did not have water to RDP standards, 20% higher than the ISRDP average • 97% did not have RDP sanitation, 22% higher than the average • 96% did not have refuse removal, 28% higher than the average • Unemployment is endemic to ISRDP nodes, and with a rate of unemployment of 78%, Sekhukhune had the same as the average for the ISRDP nodes as a while • On the more positive side, Sekhukhune residents were 67% less likely to be living in shacks (17% did so), illiteracy was lower than the programme average, as was incidence of no regular income • Female-headed households were also less common than the average: 43% of Sekhukhune households were headed by women, compared with a programme average of 53%

10. Social capital deficit • This graph measures the social capital deficit - so high scores are bad news. • Social capital includes networks of reciprocation, trust, alienation and anomie, membership of civil society organisations, and so on. • Sekhukhune has the 3rd best score on the social capital index, suggesting there is a strong foundation on which to build partnerships and livelihoods. • Just 4 in 10 respondents do not belong to a CSO, suggesting that outreach and partnerships should be a key area of focus by building on an existing strength.

11. Social capital deficit Priority Areas For example, read as: Sekhukhune respondents were more likely than ISRDP average to show incidence of anomie and alienation, and not to have a religion.

12. Development deficit • This index measures respondents’ awareness of development projects, of all types, carried out by government and/or CSOs. It is a perception measure - not an objective indication of what is actually happening on the ground. • Sekhukhune rates 6th of the 14 ISRDP nodes, suggesting that development activities are happening on the ground and that people are aware of them. This is presumably enhanced by the high levels of social capital seen earlier.

13. Development deficit Two weakest areas are lack of awareness of who is providing - government or CSOs - rather than lack of knowledge of types of development activity. Everything else is a positive, scoring better than the ISRDP average.

14. Service delivery deficit Sekhukhune has the fourth worst rating on service delivery amongst the 14 ISRDP nodes, i.e. it was rated 7% worst in terms of service delivery.

15. Service delivery – weaknesses Read as: Quality of DSD service delivery is worse in Sekhukhune than the average for all ISRDP nodes, e.g. staff compassion is perceived to be a fifth (21%) worse than across all ISRDP nodes. Weaknesses Access to DSD offices was also perceived to be poor, 20% worse than the ISRDP average. Basic service delivery was rated as inadequate, e.g. quality of roads were seen to be 42% worse than the average for ISRDP nodes

16. Service delivery – strengths Strengths Read as: Nevertheless, strengths with service delivery in Sekhukhune can be found, e.g. households in the node are a third (33%) less likely to rate the quality of health delivery as poor compared with the ISRDP average

17. Service delivery: main features • Other important services provided by DSD such as Children Homes, Rehabilitation Centres and Drop-In Centres worryingly received no mention by respondents and signals very low awareness of these critical services. • Urgent thought should be given as to how best to raise awareness across the node with respect to these under utilised services - and how to increase penetration of DSD services as well as grants in the node.

18. Sekhukhune is rated the second best ISRDP node with respect to health measures, with less than half of all households (46%) perceiving their health status as poor. Health deficit

19. Health deficit Priority Areas Despite high health status rating in this node, households reported that they were 21% more likely to have difficulty accessing health care than the ISRDP average.

20. Health • TB was seen as the major health problem in Sekhukhune by a third of respondents (33%) (the average was 22% across all nodes). • HIV and AIDS was also reported to be a significant health problem in the node (28% reported this, slightly lower than an average of 30% across all nodes) • Men were as likely as women to rate their health as poor • Youth were as likely as older adults to rate their health as poor • Access to services also impacts the health of those in the node, with respondents in the node 21% more likely than the ISRDP average to report access to health services as a problem, in particular • 62% of households reported distance to health facility as being a problem • 60% of households reported paying for health services as being a problem • These findings highlight the key health issues facing those in the node and point to the need for an integrated approach that focusses on the issues of HIV and AIDS, and TB and also takes into account the challenges respondents face in accessing health care • Difficult to see how a sectoral or targetted approach would work to improve access to health, rather it requires a provincial or even national intervention to remove this obstacle • Poverty and the dual health challenge of HIV and AIDS and access to health cannot be separated and whatever intervention is decided upon should be in the form of an integrated response to the challenges facing Maruleng residents

21. Proportion who agree that both parties in a relationship should share decision - making Read as: Majority in the node support the view that most decisions in the household require joint decision-making by both partners

22. Proportion supporting statements about female contraception Read as: Node is still deeply conservative as myths about contraception are widely held.

23. Proportion who agreed that a man is justified in hitting or beating his partner in the following situations Read as: Support for violence against women in all situations is higher in this node than the ISRDP average and points to catastrophic attitudes about Gender Based Violence in the node. Disturbing to note that the differences between males and females, and young and old, in terms of attitudes towards Gender Based Violence are not large - these negative attitudes have been absorbed by men and women, young and old, and interventions are needed to break this cycle

24. Attitudes towards abortion Read as: Abortion is NOT supported by two out of three respondents (63%) in this node, far higher than the ISRDP average (42%)

25. Sexual Reproductive Health & GBV • Findings point to the need for nuanced campaigns around contraception and their very close link with inappropriate attitudes to women in Sekhukhune • Disturbing to note the high levels of support for Gender Based Violence, coupled to very limited support for abortions and widespread belief in a range of different myths about contraception. Hence the need for a campaign that is based on a solid understanding of local attitudes towards both sexual reproductive health and GBV as opposed to the interests of a national campaign • In theory, at least, majority support the idea that many decisions in the household require joint decision-making by both partners • But many across the nodes not only do not support joint decision-making but go further and endorse physically abusing women • Need to develop an integrated approach that takes poverty and the health challenges facing nodal residents into account and also integrate critical aspects of GBV and Sexual Reproductive Health • Challenge is to integrate Sexual Reproductive Health and GBV issues with other related services being provided by a range of governmental and non-governmental agencies - integration and co-ordination remain the core challenges in the ISRDP and URP nodes.

26. HIV & AIDS: Awareness levels Read as: Prevalence rates are high and secrecy is relatively low, suggesting stigmatization may be dropping in face of unavoidability of the epidemic

27. HIV & AIDS: Proportion who accept the following statements Read as: High awareness of how HIV is transmitted

28. HIV and AIDS • Evidence suggests that previous campaigns (and the high incidence of the pandemic in the node) have led to high awareness of impact of HIV and AIDS. • Encouraging to see how many in the node have correct knowledge about the transmission of the disease (node better than average scores for ISRDP) • Despite high levels of awareness of AIDS sufferers in their communities few respondents can actively assist • Less than 1% of households in the node reported on providing support to orphans or providing Home Based Care • Despite high incidence of HIV across Sekhukhune, levels of poverty are so crippling few can do much to assist those who are infected and suffering • These findings support the need for an urgent integrated intervention in the node that incorporates health, poverty, GBV, HIV and AIDS

29. Conclusions Sekhukhune has a positive JGlobal Development Rating compared with other ISRDP nodes. Key challenges and existing strengths as they emerged from the statistical analysis are summarised below.