Transcript the Presentation Here - The Society of Midwives of South
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 Rural Women Population < 15 years Children who are orphans Adults with no education Adults with grade 12 education Matric pass rate 10,3m 54% 53,% 33% 21% 11,4% 22,9% 66%
Health status of KwaZulu-Natal.
Life expectancy at birth Maternal Mortality Rate Under 5 Mortality Rate Immunization coverage < 1 year Immunization drop out rate (DTP 1 – 3 ) ANC HIV+ seroprevalence HAART initiation in pregnant HIV+ women Proportion of HIV+ people Incidence new STIs TB prevalence (per 100,000) TB cure rate Diarrhoea incidence, children < 5 years Mother To Child Transmission of HIV 60yrs 176/100 000 93 97,3% 1,0% 37.4
83% 15,8% 5,1% 1,000 77.1
357,2 2%
Components of the KwaZulu-Natal Public Health System.
• 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.
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 Indicators
Caesarean section rate % 30.0
30.6
29.2
Delivery rate in facility under 18 years
% 8.4
9.7
9.3
Facility mortality under 1 year rate Facility mortality under 5 years rate Low birth weight rate in facility Maternal mortality rate in facility Neonatal mortality rate in facility Perinatal mortality rate in facility Still birth rate in facility
% % % per100000 per1000 per1000 % 6.3
5.1
5.0
4.3
5.6
4.8
12.8
11.1
12.9
12.6
84.8
122.7
168.6
11.3
9.2
32.2
2.3
37.0
2.8
30.3
2.2
29.9
9.1
5.6
4.7
12.7
126.1
10.5
33.0
2.4
KZN Midwives This 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 UThukela iLembe Amajuba uMzinyathi Average deliveries a month
940 908 740 996
UGu District Sisonke uThungulu uMkhanyakude Zululand uMgungundlovu eThekwini PHC,CHC & MOU
1220 830 1372 1080 1234 1410 4383 1865 68 40 73 61 74 47 338 306
# functioning Basic midwives
32 44 37 52
# functioning ADM’s
26 18 34 25 20 16 38 34 42 17 113 88
Total # of midwives functioning
58 62 71 77 88 56 111 95 116 64 451 394
Should have:
145 144 113 160 192 128 224 160 192 224 7008 304
Need [gap/difference ]
87 82 42 83 104 72 113 65 76 160 6557
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) • Hypertension (eclampsia top) • Haemorrhage (post C/S top) 9% • Medical and surgical disorders (cardiac top) • Miscarriage (septic misc top) 48% 10% 8% 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.
t 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
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