Political Will Necessary to End High Child Mortality Rate in South Africa

Cape Town, South Africa – By the time Thandi Khumalo* brought her seven-month-old daughter to the Red Cross Children’s Hospital in Cape Town, help came too late. The infant had developed acute diarrhoea and kwashiorkor, a condition caused by severe protein and calorie deficiency, and died a few days after being admitted.

Khumalo, who is HIV-positive, had decided not to breastfeed her child, probably because health workers at her local clinic did not educate her about the fact that exclusive breastfeeding reduces the risk of transmitting the virus to the baby. And since Khumalo is unemployed and struggles to make ends meet, she was unable to buy formula for her child.

For months, Khumalo had fed her daughter mainly tea, which did not provide the baby with sufficient nutrition and which she prepared from an unclean water source.

Unfortunately, Khumalo’s case is not an exception. Experts say that young children in South Africa are bearing the brunt of the country’s failure to meet the Millennium Development Goals (MDGs) partially due to the state of the country’s public health system.

In South Africa, HIV and childhood infections (such as diarrhoea and lower respiratory infections) are the leading causes of death for children under five, according to the South African Child Gauge 2009/2010, an annual review of the situation of children in the country, which was released on Jul. 27 by the Children’s Institute (CI) of the University of Cape Town (UCT).

The report shows clearly that South Africa has failed to reduce child mortality for the past two decades, since 1990. This means that the country will not be able to meet MDG 4, which aims to reduce child mortality by two thirds by 2012.

On other MDG targets for reducing child hunger, HIV and tuberculosis, South Africa is not making any progress, either, the report states. Although there have been some slow improvements for access to basic sanitation, education and gender equality.

“The bottom line is that, currently, children are dying needlessly in South Africa,” warned Professor Haroon Saloojee, head of the division of community paediatrics at the University of the Witwatersrand in Johannesburg, and one of the authors of the Child Gauge.

Poor child health causes a vicious circle of poverty and death that will have a lasting effect on generations of South Africans. Malnutrition, for example, leads to poor cognitive development, which in turn causes poor school performance, which means that affected children are likely have reduced career opportunities as they enter adulthood and thus a smaller chance to be economically successful and a higher risk of suffering from poverty.

“If we don’t address child health today, we are trapping children in a cycle of ill health and poverty. It is extremely important to break this cycle early on,” cautioned CI commissioning editor Lori Lake. She further noted that the indicators of the Child Gauge report are “of extreme concern” since they show that young children bear the brunt of South Africa’s failure to address the MDGs.

Despite all this, child health is not made a priority in South Africa. “We are calling for concerted action across government departments, led by the health department, to urgently improve child health in the country,” said Lake, who blames the “ongoing and protracted crisis” in South Africa’s public health system for the lack of progress. “We have known at least since 2000 that we are in trouble, but child health has still not been made a priority,” she lamented.

Health specialists believe South Africa will only achieve true progress in the field of child health if there is sufficient political will to do so. Professor Louis Reynolds, senior specialist at UCT’s School of Child and Adolescent Health, calls on government to “put child health at the centre of the national development agenda” and ensure coherent action across all sectors of government. “We need to make budgets available not only for primary health care, but also for sanitation, education and job creation,” he explained.

National health minister Dr Aaron Motsoaledi admits that “there needs to be a renewed commitment to caring for children” if South Africa wants to reduce child mortality and calls on “communities and health workers, researchers and policy-makers to place children first.” Health experts say they are relieved to see renewed political commitment from the national health department.

But it is not only about allocating more finances towards child health. It is also crucial to better manage available health budgets.

Saloojee says poor quality of basic services are often caused by inefficient management and use of financial and human resources, primarily due to poor leadership and the absence of accountability in the public health care system. The health department should therefore set clear norms and standards for all public health facilities so that they can be held accountable for their performance.

Saloojee suggests that, apart from bigger budgetary allocations towards child health, improved staffing ratios at clinics and community health centres should translate into shorter queues and better performance. He also recommends improving the quality of care at district hospitals through training and support from paediatricians and other health professionals.

*Not her real name.

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