With the largest and most developed economy in Africa, South Africa is classed as a middle-income nation. However, huge inequalities remain in its society and there are large disparities in the quality of education and healthcare services. People living in rural areas are often particularly poorly served by a struggling health system, with many rural clinics reporting a chronic lack of drugs and basic medical equipment, as well as shortages in staff.
Health professionals are becoming concerned that failings in the system may be leading to a rising number of preventable child deaths. According to data from the World Health Organisation, child death rates in South Africa have seen an overall decline in the last two decades (from 62 deaths among children under-five for every 1,000 live births in 1990 to 47 deaths in 2011). However, with mobile clinics no longer running in some rural areas due to a lack of funds and general shortages, experts say children may be dying unnecessarily for want of the right care or the necessary drugs or equipment.
The focus is particularly on how to reduce mortality rates among newborns, where having access to well-trained obstetric staff and the right equipment is particularly vital. According to data in a recent report from the UN’s Child Agency, UNICEF, infants dying within the first day of life account for 16% of under-five deaths in South Africa.
Leading the way in reducing infant deaths
However, in the Eastern Cape province, one of the poorest in South Africa, one rural hospital is showing how infant mortalities can be reduced despite the squeeze on spending and services. A recent article by the news agency IRIN highlights the work of the Zithulele Hospital in Mqanduli, 30km south of the provincial capital Mthatha. Zithulele is the only hospital in an area almost 1,000 square kilometres in size and serves a population of around 150,000 people, many extremely poor.
Yet health professionals here have been managing to decrease the number of newborns dying, to around 20 for every 1,000 live births last year. This has been done through a number of initiatives, such as setting up maternal waiting homes where expectant mothers can live near the hospital when their babies are almost due. The hospital has also put in place other measures such as reinstituting a 24-hour caesarean section service, a retraining programme for midwives and an outreach programme which links to feeder clinics and provides input and advice on antenatal care.
Like many South African facilities, the hospital has faced severe shortages of staff and equipment in recent years. But the arrival of new senior health professionals and the implementation of a monthly audit tool to monitor and analyse hospital results, have helped transform obstetric services. Speaking to IRIN, the manager at Zithulele spoke proudly of his hospital’s “steady decline in perinatal mortality in the past eight years”, though he was keen to stress that “more” could still be done to bring the number of preventable deaths down further.