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Health care in south africa : FOCUSING ON WOMEN AND CHILDREN

Health care in south africa : FOCUSING ON WOMEN AND CHILDREN. Haley Boling PUBLIC HEALTH IN SOUTHERN AFRICA. OVERVIEW. POVERTY AND HIV/AIDS PREVALENCE How do these factors affect mothers and children? What is being done to combat these issues? FUNDING OF PUBLIC HEALTH CARE

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Health care in south africa : FOCUSING ON WOMEN AND CHILDREN

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  1. Health care in south africa: FOCUSING ON WOMEN AND CHILDREN Haley Boling PUBLIC HEALTH IN SOUTHERN AFRICA

  2. OVERVIEW • POVERTY AND HIV/AIDS PREVALENCE • How do these factors affect mothers and children? • What is being done to combat these issues? • FUNDING OF PUBLIC HEALTH CARE • Private healthcare vs. public healthcare • APARTHEID SIDE EFFECTS • What are the lasting effects of apartheid on the South African healthcare system • QUESTIONS

  3. POVERTY HIV/AIDS epidemic HEALTH CARE SYSTEM THAT IS FAILING MOTHERS AND CHILDREN FUNDING OF PUBLIC HEALTH-CARE

  4. POVERTY HIV/AIDS epidemic HEALTH CARE SYSTEM THAT IS FAILING MOTHERS AND CHILDREN FUNDING OF PUBLIC HEALTH-CARE

  5. Millennium development goals • 4. Reduce child mortality by two thirds by the year 2015 • 5. Improve maternal health and reduce maternal mortality

  6. Maternal Mortality • Currently is estimated between 230 and 702 per 100,000 live births (2010) – many home deaths may not be reported • South Africa’s maternal mortality rate has INCREASED since the 1990’s largely due to HIV • 50% of maternal deaths are a result of HIV/AIDS • Many women receive insufficient care during pregnancy • Unsafe birthing conditions

  7. Fig. 1 Maternal mortality ratios (per 100,000), 1980-2008. Fig. 2 Causes of maternal death in South Africa *88% indirect causes were non-pregnancy related infections (HIV/AIDS)

  8. Carmma • Campaign for Accelerated Reduction of Maternal Mortality in Africa • Launched in May 2012 by Republic of South Africa • Aims to reduce infant and maternal mortality rates throughout Africa • The MDG target is 38 deaths/100,000 by 2015 • Plan to address inequality in underserved areas • Strengthen healthcare system • Follow MNCWH strategies

  9. MNCWHStrategic plan for maternal, newborn, child and women’s health and nutrition in south africa • Guidelines to decrease maternal mortality • Decrease infant mortality • Improve care for mother and child

  10. ANTENATAL CAre • About 90% of women receive some antenatal care (visit, supplements, etc.) • Only 38% of women receive care within first 20 weeks of pregnancy • BANC (Basic Antenatal Care approach) Doctors are trying to persuade women to receive 4 visits during pregnancy • PMTCT (Prevention of Mother to Child Program) • Every women is tested for HIV during first weeks of pregnancy • If positive, given anti-retrovirals • Stillborn rate is very high (19/1000) due to immaturity, low birth weight, hypoxia • This can be attributed to the health of the mother in some instances

  11. After the birth • Intrapartum care • Can be improved by having stronger protocols for detecting complications • Better access to Cesarian section • Monitoring during labor • Difficult because many hospitals are understaffed • Postnatal care • Only 29.9% of babies and 27% of mothers were seen six days after delivery • Visiting a doctor after delivery can decrease risk of infection, help the mother, etc. • MNCWH recommends kangaroo care, breastfeeding, etc.

  12. children • South Africa is one of only 5 countries in which the child mortality rate has increased between 1990 and 2008 • Main problem: POVERTY • In 2009 61% of children lived in households that were income poor • Under 1 mortality 41/1000 • Under 5 mortality 57/1000 • Neonatal mortality 14/1000 • Accounts for 1/3 of all deaths in children under 5

  13. contraception • 60% of women ages 15-49 use modern contraceptives • Above global average at 57% • Still many unplanned pregnancies and contraction of STI/STD • Problem: Risky behaviors • Improper use of contraception, unprotected sex • SADHS (South African Demographic and Health Survey) indicated that 97% of sexually active women knew about contraceptives- ignorance is not the reason • Abortion is legal and over 200,000 terminations are carried out annually- abortion is always an option for “contraception” for many women

  14. POVERTY HIV/AIDS epidemic HEALTH CARE SYSTEM THAT IS FAILING MOTHERS AND CHILDREN FUNDING OF PUBLIC HEALTH-CARE

  15. Funding • South African government spends 8.7% of GDP on health care- of this 60% goes to privately funded healthcare (14% of population) • Amounts to about 285 dollars/person- U.S. spends 4400 dollars/person (17.6% GDP) (WHO)

  16. hospitals • Not enough money spent on healthcare to properly staff public hospitals, care for patients, etc. • Standard of care is not comparable to U.S. for ordinary women and children • Human Rights Watch conducted a survey of 157 women in 2011- Stop Making Excuses • Women were mistreated on grounds of: • HIV/AIDS status • Whether or not they were a migrant • Inadequate conditions (supplies, nurses, doctors) • Poor communication between nurse and patient • Unaccountability by the hospital staff

  17. Women have complained of being verbally abused, physically abused, taunted, ignored-overall mistreated in public hospitals • Nurses sometimes lack the patience and skill to adequately treat patients • The level of care is decreased, thus more complications with the resulting child and delivery • The level of care simply does not meet the standards that it should • Women hear horror stories about abuses and are terrified to go to hospitals-SANGOMAS and traditional healers

  18. Stop Making Excuses’: Accountability for Maternal Health Care in South Africa Babalwa L. “The sister said I was lying about being in labor and sent me to the waiting area.” A doctor examined her three hours later, but it was too late. She delivered a stillborn baby. Neither the doctor nor the nurse explained what may have caused the stillbirth.” Unnamed woman from the study “She was very rude and said I was lazy. After this experience I told myself I will never again go to government hospitals. If I have no money to go to a private hospital, I will deliver at home.”

  19. POVERTY HIV/AIDS epidemic HEALTH CARE SYSTEM THAT IS FAILING MOTHERS AND CHILDREN FUNDING OF PUBLIC HEALTH-CARE EFFECTS OF APARTHEID

  20. Healthcare history • Reforms in the late 1990s changed how funds were distributed • Instead of Minister of Health allocating funds, Department of Finance • Distributed funds base on the Treasury’s “Equitable Shares” formula • Result: poor provinces have less spending autonomy based on this policy and received LESS • Based on economic output, not need • GEAR strategy (Growth, employment and redistribution) • Thabo Mbeki (1999) • Substantial increase in private healthcare sector

  21. effect of apartheid • Widening of the race boundaries • Access to health professionals and facilities was poor • Unable to pay for service • Many Africans rely on public health care, where as whites and Indians rely on the private sector • Poor education-many Africans turned to sangomas and traditional healers

  22. conclusion

  23. references • https://www.mja.com.au/journal/2008/189/11/south-africa-21st-century-apartheid-health-and-health-care?0=ip_login_no_cache%3D32db43952441569a89fbfef7a38b56c6 • http://www.southafrica.info/about/health/health.htm#.UV4XgVegskJ • http://www.doh.gov.za/docs/stratdocs/2012/MNCWHstratplan.pdf#page=15&zoom=auto,0,792 • http://www.unaids.org/en/resources/presscentre/featurestories/2012/may/20120508carmma/ • http://epianalysis.wordpress.com/2011/03/01/sainequality/ • https://www.mja.com.au/journal/2008/189/11/south-africa-21st-century-apartheid-health-and-health-care?0=ip_login_no_cache%3D32db43952441569a89fbfef7a38b56c6 • http://shr.aaas.org/loa/hback.htm • http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.184895?view=long&pmid=21148716& • http://www.sajog.org.za/index.php/SAJOG/article/view/504/280 • http://www.hrw.org/news/2011/08/08/south-africa-failing-maternity-care

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