1. 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

2. 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

3. 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

4. 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.

5. 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

6. Inequity: Areas of high Multiple Deprivation have highest BOD!

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

8. Severe Malnutrition
Western Cape has achieved this target

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

10. 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

11. 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.

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

13. Immunised against measles in SA very high

14. Even though not likely to achieve target child mortality rates are reducing in SA56 53
Target 20 18 40 42 37 30

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

16. 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

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

18. 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”.

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

20. Maternal mortality has been increasing largely due to HIV

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

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

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

24. 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

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

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

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

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

29. HIV prevalence in South Africa
Target <22.8%

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

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

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

33. Coverage of adult ART in Western Cape

34. PMTCT in WC: Success Story

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

36. TB incidence in Western Cape Target <253/100 000

37. 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!

38. 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.

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

40. 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

41. 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.

42. 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

43. 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!

44. Thank you
Worcester Hospital