In the past decade the best-equipped hospital in Africa, the new Inkosi Albert Luthuli central hospital, has been built in Durban, along with almost a third of the KwaZulu-Natal’s 366 clinics. In addition, two new district hospitals are being built in the eThekwini area (Durban Metro) to cope with the demand for health care. Yet Health Department research shows that almost two million of the 9,4-million residents, mostly in rural areas and informal settlements, still don’t have adequate care.
Demand for health care has been exacerbated by epidemics of malaria, cholera and HIV/Aids, while poverty ensures that 88% of the population depends on the public health sector.
The malaria epidemic, which peaked in 1999 in the sub-tropical region, has been brought under control through a combination of spraying households at risk with DDT and treating patients with a new combination drug.
The World Health Organisation has praised the way in which the department dealt with the 1999-2000 cholera epidemic, which infected more than 120 000 people. But the only safeguard against further outbreaks is to improve communities’ access to clean water and sanitation. Only 34,6% of households have piped water.
HIV/Aids remains the province’s biggest challenge. Many families have been affected by the epidemic, including those who are powerful and well-known, as demonstrated by the recent death of Mangosuthu Buthelezi’s son, Prince Nelisuzulu.
Yet at times the epidemic has been a political football kicked around between the Inkatha Freedom Party and the African National Congress.
Health superintendent general Professor Ronald Green-Thompson has overseen transformation in the province for the past 10 years.
He concedes that at times the political power-sharing between the IFP and ANC has hampered service delivery. However, he believes that, with the ANC’s victory, “that is behind us now”.
About 36,5% of pregnant women tested HIV-positive in 2002, the highest rate in the country. A number of hospitals in Durban now report a rate of more than 40%.
To address this, the province launched the “biggest prevention of mother-to-child transmission programme in the world” in June 2001, says Green-Thompson. Pregnant HIV-positive women can now get the anti-Aids drug nevirapine at any clinic or hospital. About 233 000 women have been counselled on HIV, while about 34 000 women and their babies have been given nevirapine, which is believed to cut the HIV transmission rate by 50%.
Treating the condition is more of a problem, as up to 1,8-million people are living with HIV and an estimated 450 000 of these need anti-retroviral treatment.
However, until now, training of health workers on the use of anti-retrovirals has been uneven.
Different levels of health workers have been trained separately rather than as teams, which has caused problems when they return to facilities and are unable to work together.
In addition, the national Department of Health chose not to accredit the Greys hospital complex in Pietermaritzburg, which has been running one of KwaZulu-Natal’s most successful HIV/Aids clinics for several years.
Green-Thompson says efforts are being made to coordinate the training and he believes that Greys will be accredited as soon as it has attended to a few minor issues. This will mean that all health districts will have at least one site where anti-retrovirals are available.
However, it is sobering to note that the province’s TB cure rate in 2000 was 48,9%, the lowest in the country. TB treatment is for six months only, while anti-retroviral treatment is life-long.
One obstacle to effective TB treatment, says infectious disease expert Dr Ayo Olowolagba, is that it is difficult to follow up with patients to ensure that medication is taken correctly.
Olowolagba runs the province’s biggest TB clinic, which oversees 5 000 patients a month. He says that the majority of patients who default live in informal settlements.
His clinic, based in the busy transport hub of Warwick Triangle in the heart of Durban, has employed a team of fieldworkers with cars to go out and find patients, deliver their medication and link them up with people who can observe them taking the medication each day.
Such an approach has not yet been adopted for the anti-retroviral programme, although Green-Thompson says his department will soon issue a tender for organisations that can train volunteers to support those on anti-retroviral treatment.
KwaZulu-Natal’s population is almost evenly split between rural and urban areas, with a third of residents living in eThekwini.
This has put pressure on the ageing hospitals of the metro, many of which also act as referral centres for rural patients who need more specialised care.
To ease this pressure and facilitate equal access to care for patients from outlying areas, Empangeni’s Ngwelezana-Lower Umfolozi complex is being upgraded to offer tertiary care.
More specialised care will also become available at the Madadeni-Newcastle complex, and Ladysmith, Port Shepstone and Stanger are being upgraded to regional hospitals.
But the operation of the new clinics and hospitals, as well as increased access to specialised care, is being seriously undermined by a lack of healthcare staff.
Provincial minister of health Dr Zweli Mkhize says KwaZulu-Natal is short of 8 000 nurses and 2 000 doctors. The province is trying to address this by doubling its intake of student nurses, and encouraging institutions that train health workers to do the same.
Many rural district hospitals are run by people with strong religious beliefs, and this has resulted in few of these facilities offering terminations of pregnancy. Only 17 facilities in KwaZuluNatal’s offer abortions, yet teenage pregnancy is a serious problem.
Green-Thompson says that while there is a need to improve patients’ access to termination, “you can’t force a person to perform an abortion”.
“But we need to open up the debate and explore a range of options, including establishing a relationship with private organisations such as Marie Stopes, which do [terminations],” he says. — Health-e News Service.
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