SOUTH AFRICA PUBLIC HEALTH MARCH 10 2006 ISSUE

UNCLAS SECTION 01 OF 04 PRETORIA 000990 SIPDIS SIPDIS DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER HHS FOR THE OFFICE OF THE SECRETARY/WSTEIGER, NIH/HFRANCIS CDC FOR SBLOUNT AND DBIRX E.O. 12958: N/A TAGS: ECON KHIV SOCI TBIO EAID SF SUBJECT: SOUTH AFRICA PUBLIC HEALTH MARCH 10 2006 ISSUE Summary -------------- ¶1. Summary. Every two weeks, Embassy Pretoria publishes a public HEALTH newsletter highlighting South African HEALTH issues based on press reports and studies of South African researchers. Comments and analysis do not necessarily reflect the opinion of the U.S. Government. Topics of this week's newsletter cover: SA's Aid to Orphans; HEALTH Department Cites HIV/AIDS Progress in South Africa; HEALTH Department Plans to Improve HIV Data; South Africa's Contribution to UN AIDS Report; South Africa Silent on HIV/AIDS Airline Tax; Findings from the District HEALTH Barometer; HEALTH Inequalities between Khayelitsha and Cape Town Still Present; South Africa to Develop Vaccine Manufacturing Facility; and Firms Begin to Feel HIV/AIDS Impacts on Work Force. End Summary. SA's Aid to Orphans -------------- ¶2. A Human Sciences Research Council (HSRC) report, "A situational analysis of orphans and vulnerable children (OVC) in four districts of South Africa" details the South African governmental policies aimed at vulnerable children. The four- year study concentrated on the Free State and North West provinces, which have high HIV/AIDS prevalence rates. Insufficient capacity and inadequate resources are two of the most crucial challenges faced by the government dealing with an increasing number of OVC and high levels of poverty, said Donald Skinner, ONE of the authors of the HSRC study. The foster care grant is currently $100 (R590) a month and is important to families (often grandparents) taking care of OVC who have no other source of income. Foster parents or guardians can also apply for other grants such as care dependency and child support which amount to about $30 each. According to Selwyn Jehoma, acting Deputy Director-General of Social Security in the Department of Social Development, governmental strategies to increase the number of social workers and allow OVC in foster care to access grants have increased coverage. The government adopted a policy to retain and recruit social workers by offering them higher salaries to address the problem of capacity. All nine provinces are expected to almost double the number of social workers over the next two years. In addition, by making it easier to access foster care grants, the foster care applicants have increased. In 2002, 150,000 children were registered under foster care, 300,000 are currently registered. The HSRC report points out that the government has begun a national action plan where fast track delivery of services is emphasized. Government will focus on services such as access to birth certificates and identity documents, access to grants, protection from abuse and neglect as well as provision of psychosocial support and the monitoring of vulnerable households. According to the UN Children's Fund (UNICEF),HIV/AIDS has orphaned more than a million children in South Africa. Source: HIV-AIDS, IOL, February 22. Health Department Cites HIV/AIDS Progress in South Africa -------------- -------------- ¶3. According to HEALTH Minister Manto Tshabalala-Msimang, South African HIV prevalence is no longer increasing as significantly as it was in the early 1990s. The Minister cited as positive developments youth heeding prevention messages regarding abstinence, faithfulness and condom use. Minister Tshabalala-Msimang stated that in order to mark 2006 as the SIPDIS year of accelerated HIV and AIDS prevention, government will intensify its interventions targeted at particular risk groups including people between ages of 25 to 29 years. She also cited the need to intensify interventions aimed at improving the socio-economic status of women, people living in informal settlements and other vulnerable groups. Through the implementation of the Comprehensive Plan for HIV/AIDS, there are now service points in every HEALTH district for the provision of a range of interventions including prevention, nutrition, management of opportunistic infections and antiretroviral treatment. The HIV/AIDS budget allocation spent by the HEALTH Department increased from R264-million in 2001 to R1.5-billion in 2005. More than R3.4 billion will be spent on antiretroviral drugs for the next three years. The number of health facilities providing voluntary counseling and testing PRETORIA 00000990 002 OF 004 increased from 1,500 in 2002/03 to more than 3,700 in 2004/05 with the numbers of people using them increasing from 691,000 in 2002/03 to more than 1.3 million in 2004/05. As of now, the available data includes: accumulative number of patients assessed; accumulative number of patients initiated on treatment; CD4 counts and viral loads; and the number of accredited HEALTH facilities. Source: SAPA, HIV/AIDS, IOL, March 2; The Star and Pretoria News, March 3. Health Department Plans to Improve HIV Data -------------- ¶4. Dr. Nomonde Qundu, the HEALTH Department's head of HIV/AIDS, announced implementation plans for a nationwide monitoring system for HIV patients by the end of 2006. Lack of data makes it difficult for the Department to determine how many patients have dropped out of the antiretroviral program, how many have died, or how many have had to change drugs because of side effects. Pilot patient monitoring systems operate in Free State, Mpumalanga, Limpopo, Eastern Cape and Gauteng provinces and staff are being trained to expand the program. Source: Business Day, March 3. South Africa's Contribution to UN AIDS Report -------------- ¶5. The HEALTH Department is preparing a status report on its HIV/AIDS treatment plans as a contribution to a larger United Nations AIDS report. Few civil organizations had responded to the Department's request for comments to the initial draft of the report. Representatives from these civil organizations (such as Treatment Action Campaign, Cosatu and AIDS Law Project) objected to relying on the South African National AIDS Council (SANAC) for information. SANAC cancelled its December meeting that was supposed to discuss the first draft. In addition, SANAC relied only on questionnaires distributed to members for input to the draft. Source: City Press, March 5. South Africa Silent on HIV/AIDS Airline Tax -------------- ¶6. As of yet, National Treasury has yet to decide whether it will impose a new AIDS and poverty tax initially proposed by France and Britain to raise money for developing countries so that they can meet Millennium Development Goals. Spokesmen for the Department of Transport announced that the South African government would contribute to the international fund, but would follow the International Civil Aviation Organization guidance regarding the tax imposition. Source: Business Day, February 27, Sunday Independent, March 5. Findings from the District HEALTH Barometer -------------- ¶7. The District HEALTH Barometer publishes HEALTH statistics of the country's 53 HEALTH districts. The Barometer was complied by the HEALTH Systems Trust (HST),based on statistics supplied by the districts themselves. HST researchers caution that not all the figures are reliable as some districts are not yet keeping accurate records. Ekurhuleni Metro on Gauteng's East Rand spends more per person on primary healthcare services than other HEALTH district in the country, but Ekurhuleni scores low in some key HEALTH services. While Ekurhuleni spent R389 ($65) per person, the Gert Sibande (Ermelo) district in Mpumalanga spent R42 ($7) per person on primary HEALTH care, according to figures for 2001 (the latest year that these statistics are available). Despite relatively high HEALTH expenditures, Ekurhuleni scores low in key service provision areas. Only 15% of women attending antenatal clinics in Ekurhuleni in 2004 were tested for HIV. This contrasts sharply with the Western Cape and KwaZulu-Natal, where most HEALTH districts test over 80% of pregnant women. Ekurhuleni also had the lowest caesarean birth rate of the metropolitan areas (13.9%),two points lower than the internationally recommended rate of 16%. The most caesareans were performed in KwaZulu's eThekwini metropolitan area (Durban) at 27.2%, a number that is high but could be related to the HIV epidemic in the province. Caesareans decrease the likelihood of mother passing HIV to their babies. All the rural districts in the Eastern Cape and Limpopo provinces have low caesarean section rates of close to 10% or below, probably PRETORIA 00000990 003 OF 004 reflecting poor quality of maternity services. ¶8. Another indicator of maternal services is the stillbirth rate, or the number of full-term babies per 1000 that are born dead. Developed countries have a stillbirth rate of about 10 per 1000 births (1%). Some districts report high stillbirth rates, with the highest rates reported in urban areas. The worst reported rate in South Africa is the West Rand in Gauteng, where 68 babies per 1000 were born dead in 2004. Poorer rural areas in Limpopo (Vhembe and Mopani) have the lowest stillbirth rate. Of the metropolitan areas, Johannesburg and Ekurhuleni have the worst stillbirth rate (35),followed by Tshwane (34). Cape Town has the lowest rate (21). HST researchers assert that while Gauteng districts have consistently high stillbirth rates, this could be because women from neighboring provinces choose to deliver in Gauteng, complicated pregnancies are referred there and the recording of stillbirths may be more accurate. ¶9. The most overworked nurses in the country are in the Southern district (Klerkdorp-Potchefstroom-Ventersdorp) of the North West, where clinics reported that their professional nurses saw an average of 92 patients a day. The recommended average is 35 patients per day. Nurses in the Northern Cape's Kgalagadi district were the most overworked of all rural districts, seeing 63 patients each every day. Nurses in Chris Hani district in the Eastern Cape saw the least patients, around 21 per day. In the metropolitan areas, Cape Town nurses were busiest, seeing 54 patients. eThekwini followed close behind with 50 patients. These nurses had more than double the workload of Johannesburg nurses, who saw 21 patients in a day. ¶10. Tuberculosis is ONE of the country's most common infectious diseases, yet in many districts the cure rates are very low. The cure rate is defined as people who test negative for TB after six months of treatment. The country's average cure rate is 56%, and covers people hospitalized as well as attending clinics. The worst performing district is Sisonke (Kokstad area) in KwaZulu-Natal, which cures less than a quarter of its patients (23.7%). Eden district (Mossel Bay to Knysna) in the Western Cape performed best with over three- quarters of its TB patients (77.9%) being cured after six months. The Western Cape, which has ONE of the country's highest TB rates, is the best performer and the Cape Town is the best performing metropolitan area (70%). Six of the ten worst performing districts are in KwaZulu-Natal, and the eThekwini is the worst performing metropolitan area, curing less than a third of its patients (30.1%). The HIV epidemic in the province is a likely complicating factor as TB is the most common opportunistic infection. ¶11. A high rate of diarrhea usually means that people do not have access to clean water. This is evidently the case in Mopani in Limpopo (Phalaborwa-Tzaneen) where close to 400 children under five per 1000 were treated for diarrhea. The 10 districts with the highest incidence of diarrhea were all in rural areas, the majority in KwaZulu-Natal and Limpopo. The eThekweni area also had an exceptionally high rate of 270 cases of diarrhea per 1000 children, double that of the next highest metropolitan area. With the exception of eThekwini, urban areas have the lowest rate of diarrhea. The 10 districts with the lowest incidence of diarrhea include all six districts of Gauteng, three Western Cape districts and the Nelson Mandela metropolitan area. Source: HEALTH E-News, February 28. Health Inequalities between Khayelitsha and Cape Town Still Present -------------- -------------- ¶12. In Khayelitsha, diarrhea and gastro-enteritis have overtaken HIV/AIDS as the biggest killers of children under five years with the deaths doubling over the last four years. By mid- 2004, 60 Khayelitsha toddlers had died of diarrheal disease, a preventable and treatable illness. The Cape Town Equity Gauge, established to address the inequities in Khayelitsha, assessed the public HEALTH facilities in the township. At least 55% of people in Khayelitsha, with approximately 500,000 residents, live below the poverty line. Half of all adults are unemployed while ONE in three people have no access to water in their homes. There is an average of 105 people per toilet in Sites B and C in Khayelitsha, or ONE PRETORIA 00000990 004 OF 004 toilet per seven households where toilets have been provided. Several toilet systems have been tried in Khayelitsha but most fail as the systems are unable to handle the demand. ¶13. The infant mortality rate in 2003 (deaths of babies under a year old) was 43 per 1000 live births in Khayelitsha, while in Cape Town, it was 25. In 2004, the Infant Mortality Rate in Khayelitsha was reduced to 36. Almost 30% of residents do not have easy access to water and 80% of Khayelitsha residents live in shacks. A total of 14,521 households do not have access to water while the sanitation backlog is around 29,811 households. Top 5 causes of death among the under 1 year olds (2004) include: (1) Ill defined and unknown causes including natural (55 deaths at 19.2%); (2) Diarrhea and gastro-enteritis (52 deaths at 18.8%); (3) Short gestation and low birth weight (39 deaths at 13.5%); (4) HIV/AIDS (37 deaths at 11.7%); and (5) Pneumonia (27 deaths at 9.2%). In 2005, there were 26,794 cases of Tuberculosis treated in Khayelitsha, a yearly increase of 9.7%. ONE clinic in Khayelitsha had the same number of TB cases as the three entire districts in Cape Town. In 2005, over 2000 cases of TB were registered at the Site B Clinic alone. Epidemiologists believe the AIDS epidemic is fuelling the TB epidemic with 74% of TB patients in Khayelitsha also HIV positive. At Site B, nine out of ten TB patients are HIV positive. Source: HEALTH E-News, February 28. South Africa to Develop Vaccine Manufacturing Facility -------------- -------------- ¶14. The Cape Biotech Trust, an initiative of the Department of Science and Technology, finalized an agreement with the Biovac Consortium, a public/private partnership with the Department of Health to develop a manufacturing and research facility for vaccines. South Africa is the first sub-Saharan country with this capacity. Egypt is the only other African country having this capability. Once completed, the facility will speed development work on various pediatric vaccines, including DTP, hepatitis B and HIB into a single dose. The Cape Biotech Trust will provide R24 billion ($6 billion) to develop the facility in Cape Town. Source: Sunday Argus, February 19. Firms Begin to Feel HIV/AIDS Impacts on Work Force -------------- -------------- ¶15. According to Grant Thornton's 2006 International Business Owners Survey (IBOS),South African business owners are increasingly starting programs to intervene against HIV/AIDS. Concern runs particularly high in the Eastern Cape cities of Port Elizabeth and East London, where 97% of the businesses surveyed reported a sizable impact on their business growth. The sectors showing the highest growth in concern were construction and retail, where the percentages increased to 87% and 88%, respectively, from 75% and 74% in 2005. Training proved the most popular element in companies' HIV/AIDS management plans, with 65% participating in these programs. However, only 35% of companies pay for employees' treatment costs. Lee-Anne Bac, the director of strategic solutions at Grant Thornton, said the extent of interventions is increasing compared to 2005, when the majority of business owners did not have any companywide policies. A study commissioned by AIC Insurance in 2005 showed that South Africa loses an estimated R12 billion a year due to absenteeism in the workplace, of which between R1.8 billion and R2.2 billion could be directly attributed to HIV/AIDS. In the mining sector, Harmony estimated costs related to HIV/AIDS would amount to 7.5% of total labor costs over the next 15 years, while its HIV/AIDS workplace program cost R10 million ($1.7 million) in the last financial year. AngloGold Ashanti spent R14.6 million ($2.4 million) in 2005 providing antiretrovirals, voluntary counseling and home-based care for terminally ill former employees, as well as research, monitoring and evaluation. Recently, the Epicenter AIDS Risk Management Foundation was appointed as consultant for a R2.4 million ($400,000) research project funded by the Global Fund for HIV/AIDS. The study will also examine the impact of the pandemic on the business sector, focusing on KwaZulu-Natal, which has been the hardest-hit province. The Grant Thornton IBOS Survey contacted 300 business owners who employ between 50 and 250 staff in South Africa. Source: Business Report, March 8. TEITELBAUM