Hon members, we will now proceed to Question 198 that was put by the hon Frolick to the Minister of Sport and Recreation. I have been informed that the hon Minister has requested that the question stand over. Therefore, hon Frolick, we will proceed to the next question.
Identification of reasons for worsening maternity mortality rate 178. Mr M Waters (DA) asked the Minister of Health:
(1) What was the maternal mortality rate in (a) 1995 and (b) 2008;
(2) whether his department has indentified the reasons for the continuing worsening of health indicators such as the maternal mortality rate despite rising expenditure on public health care; if not, what is the position in this regard; if so, what are the reasons? NO2077E
Hon Madam Chair, the maternal mortality rate is typically measured every few years. The best baseline estimate of maternal mortality that we have post-1994 is that recorded in the first ever demographic and health survey conducted in South Africa in 1998. The maternal mortality rate in 1998 was estimated at 150 per 100 000 live births. We do not have any figures for 1995.
The most recent estimate for the maternal mortality rate provided by Statistics SA was 124 per 100 000 live births for 2002. The recently released triennial report for the period 2005 to 2007 by the National Committee on Confidential Enquiries into Maternal Deaths estimated that the health-facility-based maternal mortality rate is 140 per 100 000 live births.
These figures are significantly lower than the estimated 400 per 100 000 live births used by the United Nations Statistics Division, the 2008 global progress report on the Millennium Development Goals and the report on maternal and child health published in the international medical journal, The Lancet, in August this year. The difference between the facility-based maternal mortality rate and the estimate by the UN Statistics Division is that the UN-based figures take into account maternal deaths that occurred in communities that did not attend our health facilities, whether private or public. We do not have such figures.
Whatever figures you take, whether from Statistics SA, our own confidential enquiries into maternal deaths, or from the United Nations, we are not satisfied with the maternal mortality rate and we are going to do something about it. That is why, when I received the report on the confidential enquiries, I convened a national summit on August 25. It was a national summit of national and provincial practitioners responsible for maternal health, and of representatives of health professional organisations, especially those that represent doctors and nurses and other stakeholders. We called them together to discuss the maternal, perinatal and under-five mortality rates.
This summit reviewed all the ministerial reports and put forward a series of recommendations. We have processed these recommendations and shared them with provincial managers for action. We have also started a process of in- service training for doctors and midwives in the essential steps in the management of obstetric emergencies, which the National Committee on Confidential Enquiries into Maternal Deaths found to be weak in some of our hospitals.
In addition, during this month I met with representatives of the SA Society of Obstetricians and Gynaecologists before an international conference which was held in Cape Town two weeks ago. I also met with the Society of Midwives of SA and we are developing partnerships on what to do. [Time expired.] [Applause.]
Thank you, House Chair. Minister, I thank you for your frank answer. South Africa has made very little progress and, really, we are not going to be able to reach the Millennium Development Goals of reducing the maternal mortality rate by three quarters. In September, ministers of health worldwide met at the United Nations to discuss the poor progress.
I would like to ask the hon Minister: What is your new commitment to meeting the goal with specific reference to providing and sustaining antiretrovirals for HIV-positive pregnant women, especially in view of the recent statement by the Department of Health that at least three provinces in our country are in danger of not having an adequate budget to provide antiretroviral treatment?
Indeed, that is so. But I must also add that it is not only South Africa which is in danger of not reaching the Millennium Development Goal on maternal mortality. This fact was discussed very thoroughly at the World Health Organisation Regional Office for Africa in Kigali in August, where all the ministers of health in Africa met. We accepted this fact and that we needed to do something about it. We are doing something about it.
In South Africa, I must also agree with you that of the big five causes of maternal mortality, HIV and Aids is number one at 43,7%. It is definitely number one. To this extent, I have submitted very clear plans to Cabinet and we will make an announcement very soon. It is not just three provinces in South Africa that are likely to run out of antiretrovirals before the end of the financial year, but in fact eight provinces.
We are doing something about it, and we will make sure that that does not happen. If we do not act, yes, it is going to happen in eight provinces except for the Northern Cape. But because we are taking particular action, we believe that it is not going to happen. Thank you.
Chairperson, hon Minister, how is the Department of Health ensuring that national maternal health protocols, guidelines and strategies that are given to health facilities are not only put up in the halls, filed or shelved but are used to prevent maternal deaths? Thank you.
Indeed, hon Chairperson, when I was given the statement for the first time, before it was submitted as a question, I alluded to the fact that the report from the professors involved in the national confidential enquiries did mention that one of the reasons for high mortality was the fact that some of our health facilities did not follow the normal protocols.
I have already said that I have met with the people who are responsible for that. I have met the gynaecologists and the midwives. I also intend to meet all the clinical managers and the CEOs of the hospitals because, indeed, it is true: These protocols do exist and people have been ignoring them. We want to make them accountable. Thank you.
Hon Minister, the maternal mortality rate is an international barometer to evaluate the efficacy of any public health system. Today we are celebrating Africa Human Rights Day, and our Constitution confers the right "of health care services, including reproductive health care". But the government is expected to guarantee this. In light of the masses of our mothers who are dying like flies, do we have a new reason to celebrate Africa Human Rights Day?
Chairperson, I am sure we have not been talking about two things that are completely unrelated. I have been talking about the rate of maternal mortality and what we are actually doing about it, on the whole continent, and that ministers of health met in Kigali because there is maternal mortality in all the countries on the continent and we do not accept that. As to whether, in light of this, we should not be celebrating, I will leave that up to the rest of the leaders on the continent to decide. I don't think it is for me to answer. Thank you.
Query regarding the impact of Dinaledi schools as well as their identification and support
169. Mr D A Kganare (Cope) asked the Minister of Basic Education:
(1) Whether any assessment has been done on the impact of Dinaledi schools; if not, why not; if so, when;
(2) whether she will make the findings available to the public; if not, why not; if so, when;
(3) whether there is a programme to increase the number of Dinaledi schools; if not, what is the position in this regard; if so, which criteria will be applied to determine which schools qualify as Dinaledi schools;
(4) whether provinces play any role in identifying schools; if not, why not; if so, what are the relevant details; and
(5) whether her department or provincial departments provide any support to ensure the success of these schools; if not, why not; if so, what are the relevant details?