Minister of Health

Minister of Health

Briefing to the Portfolio Committee on Women, Youth, Children and People with

Disabilities

Department’s Programmes

pertaining to Women, Children, Youth and People with Disabilities

26 January 2011

2

Dr. Aaron Motsoaledi

: Minister of Health

2

HIV and AIDS : Business as Usual ?

33

HSRC, MRC, & CADRE

South

African

National

HIV

Prevalence,

Incidence,&Behaviour

and

Communication

Survey, 2008

NDoH

2008

National

Antenatal

Sentinel

HIV

and

Syphilis

Prevalence Survey

NCCEMD

Saving

Mothers

2005‐2007:

Fourth

Report

on

Confidential Enquiries into Maternal Deaths in South

Africa

MRC

Saving

Babies

2006‐2007:

Sixth

report

on

perinatal

care in South Africa

MRC

Saving

Children

2005‐

2007:

A

fourth

survey

of

child

healthcare in South Africa

Overview of the Data

44

Stats SA

Midyear population estimates 2009

Mortality

and

causes

of

death

in

South

Africa,

2007:

Findings from death notification

The Lancet

Volume 374, Issue 9693, 12 September 2009

IEC

Independent Electoral Commission data on the voters

roll

Dept. Home Affairs

Historical Data 2008

ARKSA

Meeting

the

HIV

Treatment

Gap

in

SA

presentation,

August 2008

WHO

Global

Tuberculosis

Control,

Surveillance,

Planning,

Financing 2009

WHO NDoH

TB Review

Overview of the Data

5

The LancetSouth Africa's Health: Departing for a Better Future?

66

HIV prevalence epidemic curve among antenatal women, 1990‐2008

77

HIV prevalence among 15‐49 year olds by Province, 2008

88

HIV prevalence trends among antenatal women by Province, 2008

99

HIV prevalence trends among antenatal women by age group, 2008

Ukhahlamba29.4%

O.R. Tambo30.3%Chris Hani

30.2%

Cacadu20.0%

NMM28.9%

Amatole29.2%

Ukhahlamba23.5%


27.1%

Cacadu24.3%

NMM30.7%

Amatole27.2%

Ukhahlamba27.9%


27.1%

Cacadu22.8%

NMM31.9%

Amatole28.7%

Ukhahlamba21.9%


27.0%

Cacadu23.8%

NMM29.0%

Amatole26.5%

EC 2006 EC 2007

EC 2008 EC 2009

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%

Alfred Nzo25.1%

Alfred Nzo25.1%

Alfred Nzo25.1%

Alfred Nzo25.1%

10

Fezile Dabi33.2%

Thabo Mofutsanyan30.6%Lejweleputswa

37.0%

Xhariep23.9%

Motheo27.4%

Fezile Dabi

27.9%Thabo Mofutsanyana

31.3%Lejweleputswa33.4%

Xhariep25.7%

Motheo27.8%

Key

20 -30%30 –40%

Fezile Dabi29.5%

Thabo Mofutsanyana32.2%Lejweleputswa34.1%

Xhariep19.7%

Motheo30.5%%

Fezile Dabi34.5%

Thabo Mofutsanyana33.1%Lejweleputswa

33.8%

Xhariep26.9%

Motheo31.6%

FS 2006 FS 2007

FS 2008 FS 2009

10 – 20%Key

20 – 30%30 – 40%

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%11

Waterberg

Vhembe

CapricornMopani

Sekhukhune

.16.6%

26.2%

14.3%

23.8%28.8%

LP 2006

Waterberg

Vhembe

Capricorn Mopani

Sekhukhune

.16.1%

24.7%

14.1%

24.2%27.5%

LP 2008

Waterberg

Vhembe

Capricorn Mopani

Sekhukhune

-.21.8%

25.2%

14.7%

21.0%23.6%

LP 2007

Waterberg

Vhembe

Capricorn Mopani

Sekhukhune

.21.3%

23.8%

15.1%

19.8%25.4%

Key10 – 20%20 – 30%

Key10 – 20%20 – 30%

Key10 – 20%20 – 30%

Key10 – 20%20 – 30%

12

.

.Metswedin

g32.8%

Sediben g

32.8%

West Rand32.4 %

Ekurhu leni

33.3%

Tshwan e

26.7%

CoJ 29.9%

GA 2007

GA 2009

.Metswedin

g33.3%

Sedibe ng

28.9%

West Rand30.1 %

Ekurhul eni

34.0%

Tshwan e

25.7%

CoJ 29.0%

.

GA 2006

Key

.Metswedin

gNot done

Sedibe ng

35.0%

West Rand34.6 %

Ekurhu leni

32.3%

Tshwan e

26.5%

CoJ 30.6%

.Metswedin

g25.1%

Sedibe ng

31.8%

West Rand27.8 %

Ekurhul eni

31.5%

Tshwan e

26.1%

CoJ 31.0%

GA 2008

Municipal dispute

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%

Key20 – 30%30 – 40%

20 – 30%30 – 40%

13

>40%200Kilometers

.

KZN 2009

>40%50 Kilometers

.

Amajuba37.3%

Ugu40.2%

Sisonke35.2% Ethekwini41.5%

Umzinyathi28.2%

Umkhanyakude39.7%

Zululand36.7%

Uthukela46.4%

Ilembe40.6%

Uthungulu37.7%

Umgungundlovu40.9%

KZN 2006

>40%

.

Amajuba46.0%

Ugu38.9%

Sisonke31.9%Ethekwini

41.6%

Umzinyathi27.9%

Umkhanyakude36.3%

Zululand36.9%

Uthukela35.1%

Ilembe39.1%

Uthungulu34.6%

Umgungundlovu44.4%

KZN 2008

.

Amajuba34.7%

Ugu40.6%

Sisonke35.8% Ethekwini40.3%

Umzinyathi29.2%

Umkhanyakude39.9%

Zululand36.1%

Uthukela38.6%

Ilembe35.8%

Uthungulu36.1%

Umgungundlovu45.7%

KZN 2007

>40%200

.

Amajuba39.3%

Ugu37.3%

Sisonke34.1%

Ethekwini41.6%

Umzinyathi31.6%

Umkhanyakude39.8%

Zululand34.6%

Uthukela38.6%

Ilembe41.4%

Uthungulu35.9%

Umgungundlovu40.8%

Ilembe

Key20 – 30 %

30 - 40 %

> 40%

Key20 – 30 %

30 - 40 %

> 40%

Key20 – 30 %

30 - 40 %

> 40%

Key20 – 30 %

30 - 40 %

> 40% 14

MP 2007

Gert Sibande

Nkangala

Ehlanzeni

40.6%

27.5%

36.1%

MP 2009

Gert Sibande

Nkangala

Ehlanzeni

38.2%

32.6%

33.8%

Key30 – 40%

MP 2006

Gert Sibande

Nkangala

Ehlanzeni

38.9%

26.8%

32.1%

Key20 – 30%30 - 40%

MP 2008

Gert Sibande

Nkangala

Ehlanzeni

40.5%

31.8%

34.9%

Key30 –40%>40%

Key20 – 30 %

30 - 40 %

> 40%

15

Pixley ka SemeNamaqua

SiyandaFrances Baard

Key

.

17.3%

7.3%

10.9%

14.2%

22.4%

J.T. Gaetsewe



.

17.2%

0.0%

12.4%

12.1%

25.2%

J.T. Gaetsewe



.

18.4%

5.3%

12.3%

10.7%

22.7%

J.T. Gaetsewe



.

18.7%

2.2%

13.0%

13.3%

21.8%

J.T. Gaetsewe

NC 2006 NC 2007

NC 2008 NC 2009

10 – 20%20 – 30%

<10%

Key<10 %10 - 20%20 -30 %

Key<10 %10 - 20%20 -30 %

Key<10 %10 - 20%20 -30 %

Key<10 %10 - 20%20 -30 %

16

Dr. R.S. Mompati

NgakaModiriMolema

Bojanala

Dr. K. Kaunda25.7%

34.9 %

25.1%

29.2%

Dr. R.S. Mompati

NgakaModiriMolema

Bojanala

Dr. K.Kaunda26.8%

33.3%

27.0%

32.4%Dr. R.S. Mompati

NgakaModiriMolema

Bojanala

Dr. K. Kaunda21.8 %

33.6%

23.6%

31.5%

Dr. R.S. Mompati

NgakaMMolema

Bojanala

Dr. K. Kaunda28.1%

31.8%

28.2%

35.2%

NW 2006 NW 2007

NW 2008 NW 2009

Key

20 - 30%30 - 40%

Key

20 - 30%30 - 40%

Key

20 - 30%30 - 40%

Key

20 - 30%30 - 40% 17

EdenC. Winelands

CentralKarooWest Coast

OverbergCity of CPT

20.8%18.0%

11.8%

18.2%

9.5%

13.2%EdenC. Winelands


OverbergCity of CPT

15.9%17.9%

14.8%

13.0%

9.3%

12.0%

EdenC. Winelands


OverbergCity of CPT

19.4%16.0%

23.6%

13.0%

10.1%

13.2%EdenC. Winelands


OverbergCity of CPT

13.0%17.0%

8.3%

11.5%

7.3%

13.2%

WC 2006 WC 2007

WC 2008 WC 2009

Key<10%10 – 20%

Key<10%10 – 20%20 – 30 %

Key<10%10 – 20%20 – 30 %

Key<10%10 – 20%20 – 30 %

18

19

Conclusions from Antenatal Survey

• Average antenatal prevalence is 29.3%

• 4 districts recorded HIV prevalence above 40%

• 17 districts recorded between 30% and 40%• 6 in KZN• 3 in Gauteng• 4 in FS• 2 in Mpumalanga• 2 in NW

• 19 districts recorded HIV prevalence between 20% and 30%

2020

• 31.4%

of

the

population

(15.48

million)

are children aged younger than 15 years

• Of those younger than 15 years:• 23% (3,54 million) live in KZN

• 17,9% (2,78 million) live in Gauteng

Stats SA: Mid‐year Population Estimates 2009

2121

Actuarial Society of SA estimate life expectancy in South Africa

to

be 13 years below what it would be without HIV.

Country Gender ReferenceAlgeria Female UNPD World Population Prospects 2006

estimate Years 72

Algeria Male UNPD World Population Prospects 2006

estimate Years 70

Senegal Female UNPD World Population Prospects 2006

estimate Years 64

Senegal Male UNPD World Population Prospects 2006

estimate Years 60

South Africa Female UNPD World Population Prospects 2006

estimate Years 56

South Africa Male UNPD World Population Prospects 2006

estimate Years 51

Life expectancy at birth

2222

In

2006,

59.3%

of

deaths

(6

out

of

10)

were deaths of those younger than 50 years.

Stats SA: Mortality

23230-4 5 – 9 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 – 74 75 – 79 80 – 84 > 85

0

10000

20000

30000

40000

50000

60000

70000

199719981999200020012002200320042005

Age

Num

ber o

f Dea

ths

The number of deaths and age distribution of those deaths for every

year from 1997–2005:

2525

TB is the main cause of death of people with HIV

• 22,071 people died of TB in 1997

• 73,903 people died of TB in 2005.

(334.8% increase)

Estimated number of South Africans with TB (2007)

481,584 (1%)

SA population as a % of world population

0.7%

SA population as a % of world population with dual HIV & TB

28%

Tuberculosis and HIV

27

D.A.L.Y.A measure of the burden of ill health

Disease, Injury or Condition Proportion of total DALYs (%)

HIV / AIDS 30.9%

Tuberculosis 3.7%

[Combined] [34.6%]

Interpersonal violence or injury 6.5%

Road traffic injury 3.0%

28

Maternal Mortality

59% of maternal deaths were tested for HIV from 2005‐

2007. 79%

of those tested were HIV infected.

Institutional MMR

• for HIV‐negative women:

34/100,000 live births

• for HIV‐positive women:


• for women not tested for HIV:


29

HIV Status of Maternal Deaths2005‐2007 compared with 2002‐2004

2002 ‐

2004 2005‐2007

HIV Status Number % Number %

Positive 1226 36% 1884 46.2

Negative 351 10.3% 511 12.5%

Not tested 1829 53.7% 1682 41.3%

Total 3406 4077

3030

Mortality

31

HIV Prevalence by sex and age

3232

• 57% of deaths of children under the age of 5 during 2007 were as a result of HIV.

• Babies who are HIV‐positive are 15 times (1500%) more likely to die within the first six

months of life than uninfected babies.

Child Mortality

33

Natural Deaths (adjusted) Mpumalanga Province

0

2

4

6

8

10

12

14

16

18

20

0 1 2 3 4 5 6 7 8 9 10 11

age in months

1998

1999

2000

2001

2002

2003

2004

2005

2006

Infant Mortality

34

Natural Deaths (adjusted) Western Cape Province

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0 1 2 3 4 5 6 7 8 9 10 11

age in months

1998

1999

2000

2001

2002

2003

2004

2005

2006

Infant Mortality

35

Independent Electoral Commission

Voters Removed from the Voters' Roll(1 Sep 2008 to 31 Aug 2009)

Province IDsEastern Cape 60 047Free State 32 037Gauteng 78 153KwaZulu‐Natal 88 954Limpopo 33 289Mpumalanga 32 621North West 30 347Northern Cape 10 320Western Cape 30 568Total 396 336

Doubling of death rate

• Stats SA death rate 1997‐2006

36

38

35

47

33

40

51

44

79

69

76

Angola

Sierra Leone

SA

Swaziland

Lesotho

Botswana

Afghanistan

EU

India

UAE

Life Expectancy at BirthInfant Mortality

(per 1,000)

5

6

9

20

27

61

69

76

124

NL

UK

Chile

Brazil

China

Namibia

SA

India

Botswana

Maternal Mortality(per 100,000 births)

16

13

31

260

300

250

230

6

8

16

110

210

230

300

400

450

NL

UK

Chile

Brazil

Namibia

China

Iraq

SA

India

20052000

Source: Unicef; WHO Maternal Mortality Report, 2007, StatsSA

Health Outcomes Relative to Other Nations

YOUTH AND ADOLESCENT HEALTH

MATERNAL MORTALITY

AGE AND HYPERTENSION DEATHS< 20

108

17.3

20 – 24

145

23.325 –

29

120

19.3

30 –

34

127

20.435 –

39

83

13.3

• Most deaths among those less than 25 are due to Eclampsia: need for making family planning

accessible

YOUTH AND ADOLESCENT HEALTH – AIDS

Age

2005 –

2007 and 2002 – 2004

< 20

3.0

3.3

20 – 24

19.9

23.1

25 – 29

36.2

33.1

30 – 34

25.6

26.7

35 – 39

12.5

10.4

YOUTH AND ADOLESCENT HEALTH – AIDS

Parity

2005 –

2007 and 2002 – 2004

0 25.2 28.1

1

33.1

31.3

2

19.6

22.7

3 12.3 8.9

4

3.5

2.3

5 1.2 0.9

YOUTH AND ADOLESCENT HEALTH ‐

<18

>18

unknown age

TOTAL

• 97

2716

17433

6252

26401

• 98

2492

14245

22440

39177

• 99

2799

24060

19329

46188

• 00

3983

27863

17844

49690

• 01

4440

32848

20349

57637

• 02

4058

37059

18434

59551

• 03

7854

63568

130

71552

• 04

9103

76543

428

86074

• 05

9189

80652

9

89850

• 06

10000

73764

149

83913

• 07

7368

50255

243

57866

• 08

4749

29603

103

34455

TOTAL

68751

527893

105710

702354

Couple Year Protection RateSouth Africa: Couple Year Protection Rate 2007/08 - 2009/2010

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

EC FS GP KZN LP MP NW NC WC NationalAverage

Perc

enta

ge

2007/2008 2008/2009 2009/2010

National Target 2014 = 75%

National Average 2009/2010 = 31.7%

The rate at which couples (specifically women) are protected against pregnancy using modern contraceptive methods INCLUDING sterilisations

43

PHC Utilisation RateSouth Africa: PHC Utilisation Rate 2007/08- 2009/2010

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0


Num

ber

2007/2008 2008/2009 2009/2010

National target 2014 = 3.5

National average 09/10 = 2.5

The rate at which PHC services are utilised by the catchment population, represented as the average number of visits per person per year in the catchment population. The denominator is usually Census-derived population estimates.

44

PHC Supervision RateSouth Africa: PHC Supervision Rate 2007/08 - 2009/10

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Perc

enta

ge

2007/2008 2008/2009 2009/2010

National target 2014 = 100%

National average 09/10 = 69.9%

The PHC supervision rate is defined as the percentage of PHC clinics and CHCs visited by a supervisor at least once a month. Implicit in such a visit is a written visit report and feedback to facility staff. It is one of the most important determinants of quality of care as these supervisory visits are meant to highlight problem areas which the supervisor is expected to assist clinic staff to help resolve.

45

4646

Thank You

Minister of Health

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