How Attainable are the Millennium Development Goals for a Developing Country like South Africa Minister Theuns Botha Western Cape Government: Health UCT South African Medical Students Association 6 March 2013

What are MDG’s 8 international development goals Set after UN Millennium Summit in 2000 Signed by all 193 member states and 23 international organisations They set very specific targets o be attained by 2015

MDG’s recognise the importance of social determinants PRE-DETERMINANTS Material: food, water, air, income, housing Policies: childcare, minimum wage, benefits, occ. Health Society: cohesion, values, tolerance, diversity Differential exposure Differential vulnerability Differential outcomes Differential consequences Material: food, water, air, income, housing Policies: childcare, minimum wage, benefits, occ. Health Society: cohesion, values, tolerance, diversity Dalgren and Whitehead framework 1991

The MDG’s Eradicating extreme poverty and hunger Achieving universal primary education Promoting gender equality and empowering women Reducing child mortality rates Improving maternal health Combating HIV/AIDS, malaria and other diseases, Ensuring environmental sustainability Developing a global partnership for development.

MDG 1 Eradicate extreme poverty Poverty generally results in poor levels of nutrition, increased levels of food insecurity and incidence of malnutrition. Multiple deprivation is key risk factor for the Burden of disease

Inequity: Areas of high Multiple Deprivation have highest BOD!

One health-related MDG goal From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Severe Malnutrition Western Cape has achieved this target

Systematic review of nutrition studies in the Western Cape Dual epidemic Under nutrition Over nutrition

What are we doing about this? Promotion of breast feeding: Mother and Baby friendly health facilities Vitamin A supplementation in children under 5years at health facilities Nutrition programme at primary schools Mandatory fortification of maize & bread

MDG 4 Reduce child mortality The overall health of children is reflected in infant and child mortality and coverage of immunisation for preventable diseases such as polio and measles.

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Immunised against measles in SA very high

Even though not likely to achieve target child mortality rates are reducing in SA 56 53 Target 20 18 40 42 37 30

Infant mortality in the Western Cape Target 20 18 26 21 Achievable in Western Cape

What are we doing about it? Improve key socio-economic factors that impact on health status of children e.g. water, sanitation, food security Enhance access to and quality of child health services, particular PHC services Expand PMTCT and nutrition programmes Prioritise integrated management of childhood illnesses (IMCI) Promotion of breast feeding Improve immunisation coverage

Life expectancy at birth is increasing but target of 70 years will not be achieved WC: In 2001-2006 males was 57.yyears and 63.9 years for females, in 2006-2011 has increased to 59.9 years for males and 65.8years for females. (SOURCE: StatsSA, mid term population estmates 2011)

MDG 5 Improve maternal health Good maternal health reflects on the quality of and access to maternal (reproductive and sexual) health care and the status of women in society Related to MDG goal 3 “Promote gender equality and empower women”.

MDG goals From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Maternal mortality has been increasing largely due to HIV

Maternal Mortality Western Cape (per 100 000 live births) Target 36 Confidential Inquiry MMR Unlikely to be achieved in Western Cape

Proportion of deliveries attended by skilled personnel in SA Target 100%

Use of modern contraceptive method Target 70% Achievable in Western Cape

What are we doing about it? Standardised protocols to manage causes of maternal mortality Improve obstetric skills Improve management of pregnant women Improve referral systems Strengthen post natal care Improve quality of family planning services Eliminate deaths from unsafe abortions

MDG 6 Combat HIV/AIDS malaria other diseases Dealing with the challenges of HIV and TB and malaria where this is endemic.

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

HIV goals From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Prevention Tap = incidence Bucket = population ART HIV prevalence Treatment Plug hole = mortality

HIV prevalence in South Africa Target <22.8%

HIV in Western Cape Target <9.3% Western Cape 11.6%

Condom use at last sex (not necessarily high risk sex) Target for condom use at last high risk sex 100%

Access to antiretorvirals in SA Target 100% Western Cape close to 100%

Coverage of adult ART in Western Cape

PMTCT in WC: Success Story

Tuberculosis From Millenium Development Goals Republic of South Africa Country report UNDP 2010

TB incidence in Western Cape Target <253/100 000

Siamese twins: HIV and TB in areas of deprivation ~300,000 HIV infected individuals ~50,000 diagnosed TB cases per annum Of HIV-infected people, 86% are in 14 sub-districts Of TB diagnoses, 76% are in the same 14 sub-districts All these sub districts have multiple deprivation!

In a nut shell Signifant progress has been made but unlikely to meet all targets SA has met the target for getting orphaned children in school & antenatal coverage SA is likely to meet targets for: Increasing immunisation coverage Having all births attended to by a professional SA will possibly meet targets for Reducing severe malnutrition Reducing HIV in young people BULLET 1: Will explain why I believe this is only one aspect of wellness AFTER BULLET 2: Also made link btw health and development. Development can be judged by: the quality of the population’s health how fairly health is distributed across the social spectrum the degree of protection against disadvantage resulting from ill-health.

We are not alone e.g. child mortality SOURCE: Global MDG report 2012

Where to from here? Likely that MDG’s will continue beyond 2015 Likely other issues will be included such as: eradicating poverty and hunger by 100% and not just 50% Include other diseases such as chronic diseases (?injuries) Empowering both men and women Global agenda on defeating corruption, as well as for good governance

Provincial Strategic Plan Strategic Objective 1: Creating opportunities for growth and jobs Strategic Objective 2: Improving education outcomes Strategic Objective 3: Increasing access to safe and efficient transport Strategic Objective 4: Increasing wellness Strategic Objective 5: Increasing safety Strategic Objective 6: Developing integrated and sustainable human settlements Strategic Objective 7: Mainstreaming sustainability and optimising resource use efficiency Strategic Objective 8 &9: Promoting social inclusion and reducing poverty Strategic Objective 10: Integrating service delivery for maximum impact Strategic Objective 11: Increasing opportunities for growth and development in rural areas Strategic Objective 12: Building the best-run provincial government in the world.  

The six priorities for wellness Decreasing the incidence Infectious Diseases (HIV and TB) Preventing violence and road injuries prevention Healthy lifestyles to address non communicable diseases Women’s health Maternal and child health Mental Health

What can you do as a health professional? Understand that health is more than just the absence of disease Provide effective and efficient health services but these are not the only essential ingredient required for increasing wellness recognise the importance of other disciplines e.g. CHW balanced health services (CBS, PHC, Hospital services) Patient centred care not a nice to have: improved outcomes Become an upstream advocate and become an health activists Do your job to the best of your ability Challenge other sectors to also do their bit!

Thank you Worcester Hospital