3. MDG 4 Target: Reduce by two- thirds, between 1990 & 2015, the mortality rate of children under five years.

4. At the close of the MDG period South Africa had made substantial progress, but not sufficient to achieve its MDG 4 target based on the set indicators WHERE ARE WE AS A COUNTRY? Goal indicators 1994 baseline (or nearest year) 2010 Status (or nearest year) 2013 Status (or nearest year) 2015 Current status (2014 or nearest year) 2015 2015 Target Target achievability Indicator Under-five mortality rate (per 1,000 live births) 38 (1998) 38.7 (2011) 37.5 (2012) 34.3 (2013) 20Not Achieved Infant mortality rate (per 1,000 live births) 54 (1998) 26.5 (2011) 24.9 (2012) 23.6 (2013) 18Not Achieved Proportion of 1 year- old children immunised against measles 68.5 (2001)84.887.391.2> 95Not Achieved

5. Under five & Infant mortality rate since 1998 and the 2015 MDG target

6. Neonatal mortality rate

7. Proportion of under-one year old children who received all primary vaccinations

8. Measles immunisation of children under the age of 1 year

9. Life expectancy at birth Goal indicators1994 baseline (or nearest year) 2010 Status (or nearest year) 2013 Status (or nearest year) 2015 Current status (2014 or nearest year) 2015 (RMS) 2015 Target Life expectancy at birth 53.4 (2002) 60.4 (2007) 60.262.2No target

10. Key drivers of progress in the reduction of child mortality rates Access to clean water and sanitation for many households and Introduction of child support grants played an important role in improving nutritional, educational and health outcomes among children. Key child survival strategies such as immunisations, breastfeeding promotion, PMTCT, anti-retroviral therapy (ART) and treatment of common childhood illnesses (such as diarrhoea and pneumonia) using the Integrated Management of Childhood Illness (IMCI) approach, have contributed to the decline in child mortality noted above.

11. TOWARDS SUSTAINABLE DEVELOPMENT GOALS (SDGS) Related Sustainable Development Goal (SDG) Goal 3: Ensure healthy lives and promote well-being for all at all ages. Related cross cutting goals: Goal 1: End poverty in all its forms everywhere. Goal 2: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. Goal 6: Ensure availability and sustainable management of water and sanitation for all.

13. MDG 5 TARGETS To reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. To achieve by 2015, universal access to reproductive health

14. WHERE ARE WE AT THE CLOSE OF THE MDG ERA? South Africa has made significant progress with regard to the improvement of maternal health and the reduction of maternal mortality rate but could not achieve all the goal indicators.

15. WHERE ARE WE AS A COUNTRY IN RELATION TO THE SET INDICATORS? Goal indicators1994 baseline (or nearest year) 2010 Status (or nearest year) 2013 Status (or nearest year) 2015 Current status (2014 or nearest year) 2015 2015 Target Target achievabi lity Maternal mortality ratio (deaths per 100,000 live births) 134 (2002) 270 (2010) 141 (2013) 141 (2013) 38Not achieved Proportion of births attended by skilled health personnel (percent) 84 (1998) 91 (2003) 100Not achieved NA Delivery rate in health facilities (percent). [Proxy for skilled birth attendance] 67 (2003)79.5 (2010) 81.5 (2013) 85.6 (2014) 96 Contraceptive prevalence rate (percent) 50.1 (1998) 50.2 (2003) 100Not Achieved Antenatal care coverage (at least one visit and at least four visits) (percent) 76.6 (2001) 102.8 (2009) 100.6 (2011) 92.9 (2014) 100Not achieved

16. Maternal mortality ratio

17. Contraceptive prevalence rate Data not available. Proxy used is couple year protection rate Source: DHIS

18. Adolescent birth rate Data not available. Proxy used is under 18 facility deliveries Source: DHIS

19. Antenatal care coverage (1 st visit) Source: DHIS Population based data unavailable. Facility data are used

20. Key drivers of progress in the reduction of maternal mortality rate Progress on improving maternal health has occurred due to several policy and programme changes that have increased the coverage of essential interventions The strong PMTCT programme, which has seen a significant reduction in HIV related deaths during pregnancy.

21. Key drivers of progress cont… Contraceptives are freely available in public clinics and the 2012 National Contraception Clinical Guidelines and National Contraception has seen an expansion of contraceptive choices. The 1996 Choice on Termination of Pregnancy Act has seen an increase in the uptake of safe and legal pregnancy termination.

22. Key drivers of progress cont… Regular audits of maternal deaths are conducted. The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD), which makes recommendations for the reduction of maternal mortality.

23. TOWARDS SUSTAINABLE DEVELOPMENT GOALS (SDGS) Goal 3.1: by 2030 reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births. Goal 3.7: by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. The question is, What to we need to do to reach these development goals?

24. Conclusion and Recommendation cont… There is a need to strengthen the existing surveillance strategies for monitoring maternal and child morbidity and mortality in South Africa. Data based on the current surveillance system do not accurately reflect maternal and child mortality rates in South Africa. Improving the maternal and child morbidity and mortality surveillance systems would allow a more reliable comparison of South Africa with other countries and provide a rational basis for public health prevention strategies and improvement of health care services.

25. Behind Every Healthy Child Is a Healthy Mother Improve maternal health & reduce child mortalities No reason for mothers and babies to die of preventable and treatable causes

26. THANK YOU