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Madiba's neighbours are worst off


One of South Africa’s poorest districts and home to former President Nelson Mandela has scored bottom of the class when it comes to the delivery of health care services.

OR Tambo district in the Eastern Cape home ranked bottom of the 52 districts when measuring the state of health in accordance with a set of indicators.

It has the worst rate of newborn deaths in the country – double the number of newborns died in the district than the national average – 20.8 babies per 1000 births compared to 10.2 nationally.

Almost triple the number of children under five died in the district’s facilities in comparison to the national average (11.4%), while it had the third highest deaths of children under a year.

OR Tambo district also had the second highest teen pregnancy rate in the country (measured by how many births are to women under 18).

The Western Cape districts generally had the lowest child mortality in health institutions in the country, and three of the province’s districts recorded no maternal deaths.

Gauteng has managed to halve its deaths of babies under a year in its facilities, and almost halve deaths of children under five.

A number of Western Cape districts – particularly the Central Karoo and Overberg – slipped in regard to immunisation rates, particularly for measles and rotavirus. Central Karoo also had the worst TB defaulter rate.

Cape Town’s district hospitals were the best used, maintaining high occupation rates.

In a SA Health Review chapter on HIV, Professor Francois Venter of the Wits Reproductive Health and HIV Institute warns that the state of many public health facilities threatens the expansion of the country’s antiretroviral treatment programme, particularly frequent ARV shortages and poor service delivery.

The Eastern Cape, Gauteng and Limpopo have been hard-hit by frequent stock-outs of ARVs causing treatment interruptions for patients – a situation that is life-threatening.

Venter points out that staff costs are the highest single cost of the treatment programme and there is an urgent need for the programme to be nurse-driven at a primary level.

The ARVs of stable patients could also be delivered to their homes to protect them from being exposed to TB and other diseases in hospital waiting rooms.

Venter adds that five “sub-populations” are not getting adequate access to HIV treatment – teens, foreigners, men who have sex with men (MSM), sex workers and men.

In a chapter dealing with National Health Insurance Health Director General Malebona Matsoso and UK Department for International Development (DFID) senior health advisor Dr Bob Fryatt acknowledge that although few changes are visible to Citizen Average, government has been involved in a wide variety of policy and institutional reforms in the last 18 months.

One of the big question marks hanging over the NHI is where all the extra healthworkers are going to come from to make it work. South Africa has once again turned to Cuba to train 1000 South Africans as doctors as well as to supply 95 Cuban doctors due to start work in 2013.

Government has also contracted some 500 private doctors to start providing services in the NHI pilots in under-served places.


Health-e is a news agency that produces news and in-depth analysis for the print and electronic media. Their particular focus is HIV/AIDS, public health and issues regarding health policy and practice in South Africa. They provide print features for newspapers and magazines and well as broadcast packages for national and community radio stations. They also accept commissions. 

Information in this article was accurate in April 3, 2013. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.