The Provincial Profile of

KWAZULU NATAL

Introduction • The Province of KwaZulu-Natal extends over 92,100 square

kilometres in the eastern part of S.A.• It comprises 7,6% of the total landmass of the country.• The Province shares borders with Swaziland and

Mozambique in the north, Mpumalanga in the north-west, the Free State and Lesotho in the west and the Eastern Cape in the south.

• This area is home to an estimated 10,3 million people [2011 census] or 20% of all South Africans.

• KwaZulu-Natal is thus the third smallest but 2nd populous province in the country.

Province profile

Total population 10,3m

Rural 54%

Women 53,%

Population < 15 years 33%

Children who are orphans 21%

Adults with no education 11,4%

Adults with grade 12 education 22,9%

Matric pass rate 66%

Health status of KwaZulu-Natal.Life expectancy at birth 60yrs

Maternal Mortality Rate 176/100 000

Under 5 Mortality Rate 93

Immunization coverage < 1 year 97,3%Immunization drop out rate (DTP1 – 3) 1,0%

ANC HIV+ seroprevalence 37.4

HAART initiation in pregnant HIV+ women 83%

Proportion of HIV+ people 15,8%

Incidence new STIs 5,1%

TB prevalence (per 100,000) 1,000TB cure rate 77.1

Diarrhoea incidence, children < 5 years 357,2

Mother To Child Transmission of HIV 2%

• Region 1:South Eastern Area comprising two districts (eThekwini & ILembe) with one tertiary, four regional ,4 district hospitals and two semi private to serve a population of about 4,5 million.

• Region 2: Western Area consisting of three districts (Sisonke, UGu, and uMgungundlovu) with one tertiary, two regional and 9 district hospitals for an estimated population of 2,2 million people.

• Region 3: North Eastern Area comprising three districts (UMkhanyakude, Uthungulu and Zululand) with no tertiary, one regional and sixteen district hospitals for a population of 2,3 million people.

• Region 4: Midlands Area comprising three districts (uMzinyathi; Amajuba and uThukela) no tertiary, two regional and eight district hospitals to serve a population of 1.7 million people.

Components of the KwaZulu-Natal Public Health System.

National Health Insurance Sites [NHI]• There are three NHI Sites in KwaZulu Natal:- • uMgungundlovu District• uMzinyathi District and • Amajuba District.• They have been assessed for CARMMA Compliance in

preparation for accreditation.• National has also prioritized them with the support for

ESMOE by conducting the baseline assessments and highlighting the importance of drills ,and supplied them with the mannequins as per level of care

NHI Cont.A selection criteria used to guide provincial selection of a NHI pilot district was based on the following:

• Vulnerability of the population, mainly looking at the deprivation index and the socioeconomic profile of the district population as standard measures;•Access to healthcare: geographical access to health care facilities, coverage of health services to population served, utilization and service delivery indicators;•Equity: equitable distribution of resources looking at PHC per capita budget allocations and expenditure;•Burden of Disease: includes Perinatal mortality, HIV and TB outcome indicators; and

• Functionality and efficiency: leadership, management and governance.

Maternal & neonatal IndicatorsCaesarean section rate % 30.0 30.6 29.2 29.9

Delivery rate in facility under 18 years % 8.4 9.7 9.3 9.1

Facility mortality under 1 year rate % 6.3 5.0 5.6 5.6

Facility mortality under 5 years rate % 5.1 4.3 4.8 4.7

Low birth weight rate in facility % 12.8 12.9 12.6 12.7

Maternal mortality rate in facility per100000 84.8 122.7 168.6 126.1

Neonatal mortality rate in facility per1000 11.1 11.3 9.2 10.5

Perinatal mortality rate in facility per1000 32.2 37.0 30.3 33.0

Still birth rate in facility % 2.3 2.8 2.2 2.4

KZN MidwivesThis is based on the Saving Babies Recommendations, which stipulates that 16

midwives per 100 deliveries a month. There are no staffing norms in SA.

District Average deliveries a month

# functioningBasic midwives

# functioningADM’s

Total # of midwives functioning

Should have: Need [gap/difference]

UThukela 940 32 26 58 145 87

iLembe 908 44 18 62 144 82

Amajuba 740 37 34 71 113 42

uMzinyathi 996 52 25 77 160 83

UGu District 1220 68 20 88 192 104

Sisonke 830 40 16 56 128 72

uThungulu 1372 73 38 111 224 113

uMkhanyakude 1080 61 34 95 160 65

Zululand 1234 74 42 116 192 76

uMgungundlovu 1410 47 17 64 224 160

eThekwini 4383 338 113 451 7008 6557

PHC,CHC & MOU

1865 306 88 394 304  

Total 15 113 866 383 1249 24 18 11 69

Saving Mothers 2008-10

KZN Chapter

Summary of data

• 1133 deaths (13% increase)

• Numbers of deaths stable for 5 years (350-400)

• Still under-reporting

• 66% post-partum

• HIV status-86% known

• Of those tested, 79% positive

Top 5 causes

• NPRI (TB top) 48%

• Hypertension (eclampsia top) 10%

• Haemorrhage (post C/S top) 9%

• Medical and surgical disorders(cardiac top) 8%

• Miscarriage (septic misc top) 6%

CARMMA

• CARMMA was launched in May 2012 by the Minister of Health in KZN.

• Like all other campaigns a structure was formed and the ethics of campaign needs to be followed with clear guidelines on reporting and adherence to time frame.

• The campaign aims to aggressively mobilize resources for maternal health and bring about positive societal change in support of improving maternal health in the country

• Seven focus areas were presented by the Health minister

CARMMA STATUS IN KZN• Improving Maternal Health and reducing mortality:-

- There is a noticeable decline in Maternal mortality from 393 in 2010 -320 in 2012.[176/100 000]

• Improved HAART Initiation for pregnant woman:-

- 83% ANC client initiated on HAART.• Essential steps in the management of obstetric emergencies:-

- [ESMOE]:191 people have been trained as ESMOE master trainers

- Obstetric fire drills conducted • Maternity Waiting Areas

- 14 waiting homes• Midwives Obstetric Unit :There are 3 different models

-MOU sited within PHC Clinic =32 identified ,18 functional

-MOU sited within CHC =17 all functional

-MOU within hospital =1 functional• Obstetric Ambulances :38 allocated in KZN district

SOMSA STATUS IN KZN• The SOMSA president is from KZN• The Representation of KZN Midwives in the SOMSA body is• Chair-person : Kholeka Makhathini• Additional Member:ZO Mzolo• SOMSA belong to KwaZulu Natal Discussion group• The active steering committee has representation from

different spheres in the Health sector e.g. Provincial MCWH team,DCST, Educators ,Managers, Young Midwives ,Doctors and Neonatal rep and retired midwives.

• The meetings are done on quarterly basis as a means of updating the members and planning and monitoring of the progress.

CONTINUATION OF THE STATUS• The KZN Midwives discussion group conducts 2 provincial workshops

in a year with the support of the KZN DOH AND Provincial MCWH team in addressing challenges faced within Maternal Health in meeting the MDG 4,5 AND 6 in May for the celebration of the international day of Midwives and in September for the clinical skills.

• Membership –Coordination of membership is through the presence of strong leadership within all the districts

• Appointment of champions within all 11 districts is in process so as to gain full participation in the committee .

• The support of Maternal health issues by DOH through identification of Patrons like our Queen Thandi MaNdlovu Zulu,Our first lady and in CARMMA , Phila MA and also Child health issues

t

STRENGTHES IN KZN

• In KZN all the districts have members of the DCST though not complete and posts have been advertised

• Orientation and induction of the DCST by the KZN School of Medicine in Maternal ,child and leadership skills

• Recognition of the KwaZulu Natal Midwives discussion group by the KZN DOH.

• Strong relationship with our Provincial Maternal Health team• KZN DOH funding of Midwives annually to attend Midwifery

congresses.• Active involvement of partner's [NGO] in support of Maternal

Health issues

CHALLENGES

• Staffing Norms• Recruitment of ADM for training COMPITING WITH

RECRUITMENT FOR phc TRAINING at PHC level• Membership –constraints in assessing the membership forms

and ongoing reminders for next subscription and membership cards

FUTURE PLANS

• Marketing strategy to increase membership and involvement of private sector

• Drafting of the year plan

THE END

• Thank you