Registered users can save articles to their personal articles list. Login here or sign up here

How South Africa can build a child-centred healthcare system

Child healthcare remains uneven in South Africa and varies between provinces and districts.

It is more than 20 years since the South African constitution first guaranteed children’s “right to basic healthcare services”. This is part of a broader commitment to ensure children’s rights to optimal survival, health and development. The question is how close South Africa is to realising these rights in practice.

We address this issue in a chapter of the South African Child Gauge 2019 report.

Unlike adults’ right to health, children’s right to basic healthcare services is not subject to progressive realisation. Children should, therefore, be prioritised within the healthcare system. Yet the state has still not defined an essential package of healthcare services for children. This makes it difficult to determine what they are entitled to and what the state should be held accountable for.

Without a defined package, there’s a danger that the drive for efficiencies and cost saving may result in a limited basket of care that doesn’t address the complex needs of children. This is particularly true for those with chronic (long term) health conditions.

This essential package of care needs to be supported by a set of norms and standards. These need to specify the infrastructure, equipment, medicines and staff needed to meet the unique needs of children and adolescents. A clear package will also make explicit how healthcare establishments need to be equipped. These would include neonatal and paediatric wards as well as emergency medical services and primary healthcare services, where children currently have to compete for attention with sick and injured adults.

In other facets of the health system, too, budgets, building of infrastructure and medicine supplies need to consider children’s unique needs.

A child rights approach to health requires health professionals to treat children and their caregivers with respect and communicate effectively. healthcare providers also need to build children’s and adolescents’ capacity to take responsibility for their own health and include them in decision making.

These fundamental shifts in the balance of power between adult and child, doctor and patient have been found to relieve pain and suffering. They also improve diagnosis, compliance with treatment, patient satisfaction and health outcomes.

Training health workers

The United Nations Committee on the Rights of Child has called for children’s rights to be integrated in the curriculum and performance criteria of all professionals working with children. These include health and allied professionals, teachers and social workers. The aim is to ensure that they are better attuned to children’s needs and rights.

For example, the LinCARE programme, where a team of health workers provides mother and child healthcare in Limpopo province, aims to reduce neonatal mortality. It does this by improving the quality of care during pregnancy and labour. The programme is aimed at ensuring that all women have a positive pregnancy and birth experience. It includes antenatal classes and ensures that women have practical and emotional support from a birth companion and kind, respectful and technically competent clinical staff.

As part of current preparation for a national health insurance system, which is aimed at extending universal healthcare to all South Africans, bolstering the primary healthcare system offers three opportunities to strengthen the child health workforce and improve the quality of care:

  • Community health workers play a central role in bringing healthcare services close to home, particularly for children living in poor or remote households. It’s therefore encouraging to see the national department of health’s commitment to employing them and paying them the minimum wage. This should improve supervision and support and ensure greater continuity of care between community-based services and healthcare facilities.

  • School health teams are another essential ingredient of the child system, helping to screen older children and address barriers to learning. Yet coverage reaches only one third of pupils in their first year of schooling and 20% of grade 8 learners. Its effectiveness is compromised by the shortage of health and other social service professionals, such as social workers, oral hygienists and dentists, psychologists, physiotherapists, speech and language therapists and occupational therapists.

  • Finally, district clinical specialist teams provide essential leadership for child and adolescent health at district level. For example, neonatal mortality has dropped by 30% in districts where there are paediatricians and paediatric nurses, yet less than half of specialist teams have a full paediatric team.

What needs to be done

The progress for child health has been uneven in South Africa with significant variation between provinces and districts. For example, immunisation varied from 90% in Mpumalanga to 69% in the Eastern Cape – signalling persistent inequities in access and coverage of care.

Given these challenges, greater investment is needed to strengthen systems and build a workforce for child and adolescent health. National health insurance provides an important opportunity to ensure universal health coverage and financial risk protection for the poor, as well as to improve the quality of care.

This requires leadership for child health at every level of the healthcare system – from individual encounters with children and their families, to ensuring that child health is adequately represented on key decision-making structures that will decide how resources are allocated.

Very importantly, it requires that the health sector works with and alongside other sectors. Interventions such as sufficient good quality food, good quality education, safe water and sanitation, good housing, safe roads and safe communities can significantly promote the health and well-being of children.

The South African Child Gauge 2019 report is published by the Children’s Institute at the University of Cape Town. The theme of the 2019 issue – “Child and adolescent health: leave no one behind” – is a call to prioritise child and adolescent health and put children at the heart of the healthcare system.

Lori Lake, a co-editor of the Child Gauge report, also contributed to this article.The Conversation

Maylene Shung-King, professor, Health Policy, University of Cape Town.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Get access to Moneyweb's financial intelligence and support quality journalism for only
R63/month or R630/year.
Sign up here, cancel at any time.

COMMENTS   6

To comment, you must be registered and logged in.

LOGIN HERE

Don't have an account?
Sign up for FREE

Good child care starts with the quality of the individual family unit.

It’s astonishing how LITTLE attention is paid to this aspect by researchers and politicians, who instead focus on interventions after the problems arrive.

A stitch in time saves nine!

Basics first. We have a population growth that exceeds GDP by miles …. we have how many millions of illegal immigrants . So first step should be to kill social grants to stop breeding and clean up the immigration side of things. ANC got their priorities all wrong…focus on 1st Industrial revolution before we see a real revolution with millions of unemployment.

The sad thing is that all the clinics and hospitals were there and they worked. Then it went to the dogs when the ANC took over.
And they saw the neglect and failure but did nothing to stop it.

Load All 6 Comments
End of comments.

LATEST CURRENCIES  

USD / ZAR
GBP / ZAR
EUR / ZAR
Insider GOLD
ONLY R63pm

Moneyweb's premium subscription is a membership service which will give you access to a number of tools to take charge of your investments.
Choose a yearly subscription at R630pa - SAVE R126

Get instant access to all our tools and content. Monthly subscription can be cancelled at any time.

Podcasts

NEWSLETTERS WEB APP SHOP PORTFOLIO TOOL TRENDING CPD HUB

Follow us:

Search Articles:Advanced Search
Click a Company: