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- Volume 2000, Issue 1, 2000
South African Health Review - Volume 2000, Issue 1, 2000
Volume 2000, Issue 1, 2000
Author Paula ProudlockSource: South African Health Review 2000, pp 365 –391 (2000)More Less
Children have been prioritised in the process of South Africa's transformation. In the health sector, a number of policies and programmes have been formulated in the past five years. Implementation of these policies and programmes has not been uniformly successful. This chapter examines the progress made within the health sector and whether children's health needs have been adequately addressed. Health status indicators for children reflect a mixture of successes and concerns. The majority of areas in the country still have child mortality rates that are much higher than in other countries with comparable levels of income. Immunisation coverage has not improved much in the last 5 years. Yet, there has been a considerable drop in childhood infectious diseases such as measles, polio and neonatal tetanus. The countrywide Integrated Management of Childhood Illnesses has the potential to improve child health significantly. Two problems that have emerged as serious threats to child health and well being are highlighted. These are the rapidly rising rate of HIV-infections, and the scourge of trauma and violence against children. The current organisation and delivery of child health services are not adequately equipped to deal with these emerging problems. The chapter concludes that some important strides have been made in terms of responding to the health needs of children, but that many gaps and challenges still remain.
Author Sophia LadhaSource: South African Health Review 2000, pp 393 –409 (2000)More Less
The world today is experiencing an unprecedented increase in the number of young people. One in every five persons in the world is a young person. In South Africa, there are currently about 18 million people under the age of 20 years. These young people account for approximately 44% of the total population. Young people are at risk of a broad range of health problems. Sexual and reproductive health behaviours are among the main causes of death, disability, and disease amongst young people; among these health problems are sexually transmitted diseases (STDs), HIV/ AIDS, unwanted pregnancies, and pregnancy-related complications. In the past few years, the spread of HIV infection among South Africa's youth has been daunting. Between 1997 and 1998 alone HIV infection rates amongst young people almost doubled. Although fertility is declining amongst all age groups, one third of all teenagers have been pregnant or had a child by the age of nineteen years. Young people are also at risk of physical and psychological trauma resulting from sexual abuse, gender-based violence, and other forms of physical violence and accidents. Policies and programmes have been developed to address the problems and challenges facing the youth in South Africa. The rapid spread of the HIV epidemic especially amongst adolescents has also meant that programmes have had to focus their attentions on interventions that aim to raise awareness and influence positive behaviour change among adolescents. Such interventions include media campaigns, lifeskills, and peer education. These interventions need to be supported by services that are both accessible and acceptable to adolescents. The National Adolescent Friendly Clinic Initiative (NAFCI) and the Y-Centre model are some examples of how services are being made more accessible and acceptable to adolescents. This chapter aims to bring together information from a wide range of sources to provide a picture about the health status of young people in South Africa. The major health problems and needs of young people are highlighted. The chapter also gives a summary of national policies and programmes for young people in South Africa. Although an attempt has been made to identify the main programmes and key stakeholders in the provision of health care to young people, inadvertently some omissions will have been made. Some recommendations are made for future research and action.
Author Marion StevensSource: South African Health Review 2000, pp 411 –427 (2000)More Less
Women continue to occupy a vulnerable position in society, which is reflected in their health status and in their ability to access relevant health services. In the past few years, great strides have been made in policies to improve women's health, including the passage of the Choice on Termination of Pregnancy Act, the appointment of a National Committee for Confidential Enquiry into Maternal Deaths, and the drafting of the National Contraceptive Policy Guidelines and National Maternity Care Guidelines. However, women's health has yet to improve. Maternal deaths continue to be unacceptably high, even taking into account the effect of HIV/ AIDS on this mortality rate. Women are the majority (59%) of those infected with HIV in this country, which further undermines their health status. Women are still too often victims of violence, with estimates showing that between one in four and one in six women are in abusive relationships. The inadequacy of the health system in caring for victims of violence, as well as in offering women easy access to services such as screening services for cervical cancer and termination of pregnancy, exaccerbates the plight of women in society. This chapter looks at the health status of women in South Africa, the policies designed to improve this and the progress that has been made. It argues that women's health should no longer be seen as limited to reproductive and child health, but should be viewed more holistically, encompassing all the aspects of women's health needs throughout their lives.
Author Yussuf SaloojeeSource: South African Health Review 2000, pp 429 –439 (2000)More Less
During the past six years, the government has discouraged tobacco use through public education, support for smoking cessation programmes, and legislation. Taxation has been a key tobacco control measure. Steep tax increases have simultaneously reduced cigarette consumption and increased government excise revenues. Overall, tobacco use has dropped dramatically in South Africa. The prevalence of cigarette smoking among adults has declined, from 34% in 1992 to 24% in 1998. About 42% of men and 11% of women smoke cigarettes. Among adolescents aged 15-19 years, 14% of boys and 6% of girls are current smokers. The Tobacco Products Control Amendment Act No. 12 of 1999 came into effect on 1st October 2000. The Act prohibits all tobacco advertising, sponsorships and promotions; restricts smoking in enclosed public places to specially designated smoking areas; outlaws the free distribution by the trade of tobacco products; and sets maximum limits on the nicotine and tar yields of cigarettes. The Act provoked fierce attacks by the tobacco and allied industries. The industry used the same standard repertoire of arguments that it has used in other countries considering tobacco control legislation. Their arguments were no more successful in South Africa than they were elsewhere. The shift in policy away from a sole focus on public education to creating supportive environments and social norms that discourage tobacco use, has been successful in South Africa. Opportunities for further reducing tobacco use are discussed.
Source: South African Health Review 2000, pp 441 –454 (2000)More Less
High levels of abuse of alcohol and other drugs (AODs) by certain groups in South Africa are documented as well as an indication of the resulting health and social burden incurred. A critique of the most prominent policy initiatives promoted by various government departments at a national level to address AOD abuse indicates that there have been activities on several fronts. Activities undertaken by the Department of Health specifically have included strategic planning exercises, departmental restructuring, support for research in key areas, the establishment of a committee to look into advertising, and support for certain prevention initiatives. Gains have, however, been less than hoped for at national and particularly at provincial levels. Various recommendations are presented for taking things forward. In the short term priority should be given to addressing AOD treatment and rehabilitation, instituting work place interventions, forbidding or restricting alcohol advertising, and implementing specific harm reduction strategies. In the medium term attention should be given to increasing community support for substance abusers, and education of persons at risk as well as the general public. Other recommendations include the need for the Department of Health to work with other departments, for example, in increasing excise taxes on alcohol, in establishing a national substance abuse clearing house, and in lobbying the Department of Finance to provide the funds needed to implement the National Drug Master Plan.
Source: South African Health Review 2000, pp 455 –465 (2000)More Less
Disasters (events usually characterised by negative human impact and exceptional demands for intervention) are inevitable. Impact can be substantially reduced by adequate preparation, early warning, and swift, decisive responses. Disaster Management encompasses all aspects of planning for and responding to disasters. It applies to management of both risks and consequences of disasters. Disasters need to be declared to secure the release of government resources for intervention. Disasters are not entirely unpredictable. Floods occur in valleys, droughts occur in areas with unstable and low rainfall, and oil spills occur in shipping lanes. This predictability provides opportunities to prevent and to mitigate the impact of disasters. Governments are key players in such prevention and mitigation. They exercise this role through legislation, through resource allocation and through rational planning and sustainable development. The capacity of civil society and NGO's, particularly at local level, play a significant role in mitigation of impact. In South Africa, a White Paper on Disaster Management has been published. Its strength lies in a thoroughly modern and developmental approach with a focus on risk reduction, creation of permanent management structures, and delineation of accountability and responsibility. However, there is a lack of recognition of what is feasible. The White Paper makes incorrect assumptions around capacity of local level government and local civic organisations. Therefore the draft billpoints to the ideal but fails to accommodate the reality of limited peripheral capacity, particularly in rural areas which are most vulnerable. The local shortcomings were all-too-apparent in the 2000 floods in South Africa. Lessons were learnt and recommendations made which highlight the mismatch between policy and operational capacity and which offer suggestions for more appropriate and rapid responses during future disasters.
Source: South African Health Review 2000, pp 467 –477 (2000)More Less
The objective of this section of the Health Review is to present the best available data on a wide range of health and related indicators. Where possible data from multiple years are presented. However, caution should be used when attempting comparisons across time. Data are presented from a variety of sources, not all of which are comparable.