1. 1 MPUMALANGA DEPARTMENT OF HEALTH BRIEFING TO THE SELECT COMMITTEE ON WOMEN, CHILDREN AND PEOPLE WITH DISABILITIES 05 JANUARY 2014 COMMITTEE ROOM 2, 120 PLEIN STREET CAPE TOWN

2. Presentation Outline 1.Purpose 2.Background 3.Stakeholders 4.Strategies 5. Role of the Department 6.Role of the Ingoma Forum 7.Responsibility of the initiate 8.Responsibility of the Ingoma Holder 9.Training of Traditional Surgeons 2

3. Purpose To brief the Committee on:  Circumcision deaths in the province during the 2013 season  Strategies by the Provincial Department of Health to prevent further deaths 3

4. Background  2009 has seen an unprecedented incidents of complications presenting at the Health facilities from Traditional Circumcision Sites.  Such cases from initiation schools needed attention on corrective surgery and management.  The Department responded by Establishing a team for medical and surveillance support to the Ingomas. 4

5. Background In the year 2013:  134 Traditional Leaders were authorised by His Majesty.  57 traditional surgeons were trained by the forum.  30 148 initiates were covered by the Ingoma forum  31 deaths were experienced. 5

6. Stakeholders  MDOH  COGTA  SAPS  General Practitioners  Traditional Leaders  Social Development  Local Municipalities 6

7. Strategies  Strengthening planning prior departure of initiates and monitoring of the initiation schools  Dedicate more health professionals to upscale support to the traditional leaders on health related issues  Legislation of the Ingomas to get them regulated. 7

8. Strategies To mitigate against the loss of life during the initiations focus should be on the promulgation of the Ingoma Bill. The main objective of the Bill:  To regulate the holding of the Ingoma  To provide for the prohibition of forced attendance of the Ingoma 8

9. Objectives of the Ingoma Bill cont..  To provide commodities for the implementation and monitoring of health and hygienic standards  To prevent unnecessary loss of life that seeks to undermine the cultural practice. 9

10. Role of the D epartment  To ensure availability of resources to train traditional surgeons.  To conduct health screening to all registered initiates and treat all minor ailments detected prior to traditional circumcision.  High risk cases will be classified as not fit to undergo traditional circumcision. 10

11. Role of the D epartment cont……  To provide necessary commodities for the period (gloves and surgical blades)  All initiates on Chronic medication will be given enough supply to cover the initiation period  Health professionals both from the department and private practitioners who have undergone initiation to be deployed to assist during Ingoma at all sites 11

12. Role of the Department cont……  EMS services will be on standby to assist in case of any eventuality.  Tents will be erected on major site for the management of minor adverse events and assess initiates for quick referral to the hospital.  Ensuring availability of transport for health professional to support all the Ingoma sites as per the demarcation/clustering. 12

13. Role of the Department  Provision of Forensic Pathology Services.  Development of a data base for all traditional Initiation Schools. 13

14. Role of the Ingoma Forum  To provide platform for male discussion and dialogue talks  To share ideas relating to male initiation  To harmonize ideas between tribal and health so as to ensure safe initiation process.  The identification and co-ordination of stakeholders, their roles, needs and expectations  Ensure that all Ingoma Holders are authorised by the House of Traditional Leadership 14

15. Responsibility of initiate  The initiate (minor) must obtain a signed consent form from parent/guardian  Produce the consent form for the general health screening which is to take place at least two months before initiation begins (Ukugwaba)  Take treatment as prescribed by a health professional.  Report without any delay any adverse event for management. 15

16. Responsibility of the Ingoma Holder  The person who wants to hold Ingoma must first obtain approval for such from the king, queen of the traditional community or the MEC for COGTA  She/he must also obtain approval for the use of the private land from the owner or the municipality 16

17. CONCLUSION The Department acknowledges that South Africa is a country that embraces cultural diversity. The department strives to create an enabling and conducive environment. 17

18. Thank you 18