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Date: 14/08/2008 Source: Department of Health Title: SA: Tshabalala-Msimang: Strengthening maternal, women's and child health and nutrition meeting
Speech by the Minister of Health to the United Nations (UN) Agencies Re: Strengthening maternal, women's and child health and nutrition (MCHW&N)
Thank you programme director Dr George Nsiah, Acting United Nations (UN) Resident Co-ordinator, All other members of the United Nations (UN) team, and Officials from the Department of Health,
A very good morning!
I wish to thank the members of the United Nations (UN) team for accepting my invitation to this meeting. Your presence here highlights the readiness of the UN agencies, represented in South Africa, to support the Department of Health in our work.
This meeting follows from the meeting that we held some weeks ago at the Birchwood Hotel and Conference Centre at which we met a large number of our development partners. At that meeting a specific request was made to the department to highlight areas in which we require additional focused support. It was agreed that a technical meeting will be held to discuss the specific areas of support needed. This meeting is in the process of being organised by the department.
However, maternal, women's and child health and nutrition are critical to our ability to meet the Millennium Development Goals (MDG) targets and I thought I should prioritise today's meeting even as we plan the larger technical meeting. In addition, you all know that this has and continues to be my passion as reflected in the confidence that my colleagues, the Ministers of Health of Africa, expressed in me when they asked that I be the Goodwill Ambassador and Champion for maternal and child health for Africa - and I do hope that you will also support me in this role.
I wish to apologise at the outset that I will not be able to stay for the entire meeting as I must attend the Southern African Development Community (SADC) Summit which is being held at the Sandton Convention Centre. However, the team that will remain, led by the newly appointed Deputy Director General (DDG) for Priority Health Programmes Dr Yogan Pillay, will engage with you on the specifics and I hope that by the end of the meeting we will find each other with respect to the support that we need almost immediately.
We are currently finalising our maternal, women's and child health and nutrition (MCWH&N) strategy. I have asked the department to make copies available to you today so that you can see what direction we wish to take and revise your technical support to the department accordingly. We would value your comments on the draft so that we can strengthen it before it is officially launched.
Key to the development of the strategy is our aim to accelerate progress toward meeting the MDG targets. As I have aid previously dealing with the social determinants of health are central to our ability to meet the health related MDG targets. This clearly implies a multi-sectoral effort.
In addition to the MDGs we also recognise the contribution of non-communicable diseases and injuries and trauma to the burden of disease that we need to respond to. This strategy therefore focuses on all three major contributors to our burden of disease and does not only deal with the MDGs.
I wish to highlight a few areas from the strategy to provide a framework for our deliberations today.
Firstly, it is clear that the department and this government have introduced a range of policies to improve maternal, women's and child health as well as nutrition over the past 14 years. It is only when one does an audit of these interventions that one realises how many initiatives have been implemented. There are, however in our assessment, some gaps that need to be closed and some areas in which are interventions need to be strengthened. These areas are listed in the draft 5-year strategic plan which I shall highlight.
The vision for the next five years is: an accessible, caring, high quality health and nutrition services for women, mothers, newborns and children. And our mission is: to reduce mortality and to improve the health and nutritional status of women, newborns and children through the promotion of healthy lifestyles and the provision of an integrated, high quality health care and nutrition services.
The strategic plan is built around eight strategies that we think will assist us to achieve our vision and mission.
These are: * addressing inequity and the social determinants of health * strengthening of a co-ordinated framework for the provision of maternal, child and women's health and nutrition services * strengthening the capacity of the health system to support the provision of maternal, child and women's health and nutrition services * strengthening community-based maternal, child and women's health and nutrition interventions * scaling-up the provision of key maternal, child and women's health and nutrition interventions at Primary Health Care (PHC) level in the provinces * scaling-up provision of maternal, child and women's health and nutrition interventions at district hospital level * strengthening human resource capacity for the delivery of maternal, child and women's health and nutrition services and * strengthening systems for monitoring and evaluation.
In order to achieve these objectives we have outlined a range of activities with targets that should be reached. These are in the draft strategic plan so I would not provide the details. It is this part of the plan that provides the detailed implementation plan and this is where we need your support.
As you know we have adapted and implemented the community and household component of Integrated Management of Childhood Illness (IMCI). However, we wish to accelerate implementation of this component of IMCI because we fully recognise that what happens in homes and communities and their interface with health facilities are key to improving maternal and child health in particular.
The proposal is to have a team of community health workers supported by a professional nurse who will be responsible for assisting selected sub-district. This means that they will visit households and particular communities identified as vulnerable and focus on the 17 items in the community and household component of IMCI. This approach, to target the most vulnerable is based on the tuberculosis (TB) tracer team approach which has had remarkable success in reducing the defaulter rate in targeted sub-districts.
Using a mix of deprivation and performance on health indicators we have prioritised the following districts for urgent attention:
We have held meetings with some of our other development partners to discuss with them how they are refocus their efforts in the districts they are already working to include community and household IMCI. For example the Integrated PHC project (which is United States Agency for International Development (USAID) funded) will focus on Chris Hani, Alfred Nzo, Bojanala and additional funding from USAID will assist us in Ukhahlamba, Bophirima and Umkhanyakude. In addition, we have asked the Centres for Disease Control and Prevention to instruct their partners who work in a number of districts on community based HIV to expand their work to also focus on community and household IMCI. It cannot be that a community health worker visits a household only to focus on HIV and AIDS and not ask about the health of children in the household or pregnant women!
We therefore seek your support in also prioritising these districts and finding ways of working with other partners without duplicating our efforts.
To enhance the efficacy of community and household IMCI we wish to add the following components as well for which we seek your support:
* Basic Antenatal Care (BANC) * World Health Organisation (WHO) 10 steps for the management of severe malnutrition within hospitals * strengthening mortality reviews at health institutions * identifying mortality outside the health institutions * increasing screening and appropriate management of cervical and breast cancers and * the introduction of the human papillomavirus (HPV) Vaccine to prevent cervical cancer which is promoted by Stop Cervical Cancer in Africa.
As you are aware I appointed three Ministerial Committees to investigate child and maternal mortality and to report to me on their findings as well as to make recommendations on how services can be strengthened to prevent avoidable deaths. The work of these committees is extremely important and should also be supported by all of us.
I am informed that at present WHO, United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) are directly supporting maternal and child health interventions. Given that we have prioritised the social determinants of health I would hope that United Nations Development Programme (UNDP), will also either find ways to support us or that we more clearly identify what UNDP currently does and link these efforts to our own especially but not exclusively in the targeted districts and sub-districts.
UNFPA has already commenced with research in the 21 urban and rural nodes. We need to better understand what needs to be done in these nodes as there is complementarily between these nodes and those targeted by our MCWH and N strategy. In addition, we need to use the lessons in developing capacity in these nodes in expanding capacity building in the districts that I have listed above especially as its relates to successful implementation of community and household IMCI and the other priority interventions that I have mentioned.
UNFPA is also working with faith-based organisations in rural nodes in the Eastern Cape and North West. We need to expand partnerships with faith-based organisations in the expansion of community and household IMCI. In addition, UNFPA is working with the KwaZulu-Natal Department of Health to strengthen sexual and reproductive health in Ugu, Umzinyathi, Unkhanyakude and Zululand. We need to link this initiative to the work that other development partners will be doing in these districts and to the priority areas that I identified earlier. A similar approach should be taken to the work that UNFPA is doing in the Chris Hani and Ukhahlamba districts in the Eastern Cape and Sekhukhune and Bohlabela in Limpopo.
As is clear from the work that UNFPA is doing there are already a number of synergies between the strategic plan and the priority that we have given to community and household IMCI. We need to ensure that each of the districts that we have identified has a workplan that clearly shows how development partners will assist us to achieve the Millennium Development Goals (MDGs).
Similarly the WHO included in its biennial plan the aim to target one district per province to implement community and household IMCI and the reach every district Expanded Programme of Immunisation (EPI) strategy. We need to work together to identify these districts so that all targeted districts and within each of the targeted districts as many sub-districts as possible are covered with our expanded initiative to strengthen IMCI and the other interventions that we have prioritised. The WHO has also provided for: supporting six provinces to implement school-based deworming programmes and provision of training in IMCI in one district per province and supporting its implementation in these districts.
We are yet to finalise our work programme with UNICEF but UNICEF too has supported us in the past in a number of areas. The country programme supported the largely rural provinces: Eastern Cape, KwaZulu-Natal, North West, Mpumalanga, Limpopo and the Northern Cape.
I have highlighted just of few activities of each organisation to illustrate the need to strengthening co-ordination across development partners and to focus our efforts on the districts and sub-districts that the department has now prioritised.
We must determine the baseline for all activities that we wish to strengthen and then monitor the impact of our interventions in each of the sub-districts and districts that we work in. As well we must ensure that our interventions are indeed sustainable. I have informed the officials of the MCWH and N cluster that I expect the first progress report in January 2009. I would like to therefore request that all UN agencies represented today work closely with the department to ensure that especially in the targeted districts and sub-districts we are able to report progress in our interventions to reduce child and maternal mortality and to improve the health status of women, children and the youth.
In summary therefore I request that by the end of this meeting we achieve agreement on the following:
* Provision of comments on the draft maternal and child and nutrition strategic plan within a week. * Agreement on which partner will be the primary source of support for each of the districts and sub-districts that we have highlighted as most vulnerable. * The development of work plans for each of these districts that clearly identify what we shall be doing to strengthen child and maternal health with specific reference to community and household IMCI, the strengthening of basic antenatal care, the strengthening of the use of the 10 steps, the strengthening of child and maternal mortality reviews in health facilities and the expansion of coverage of cervical and breast cancer screening, prevention and management of the early lesions.
This is the challenge. To reiterate, the first set of reports that I expect from the department in January must illustrate what progress we are making. I urge our partners, the UN agencies, to work closely with us to accelerate progress with respect to maternal and child health.
I thank you and wish to well in your further deliberations.
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