Thank you, Chairperson. The next question, again from the hon D Z Rantho, is about launching an investigation into the deaths of babies after birth in public hospitals in the country, and whether there are preventive measures to deal with that.
Hon members, this is a very complex and painful issue in our country. If there is one issue that is very painful and very close to my heart, regarding which I even signed a performance agreement with the President, it is the issue of maternal mortality - women dying in pregnancy - and infant mortality.
You are aware that internationally the development of a particular country is measured in the way that country performs, among others, in regard to the number of children who die before their first year, which is infant mortality, and those who die before their fifth year, which is child mortality. You are also aware that because of the seriousness of this matter, the United Nations, in the year 2000, when they developed the Millennium Development Goals, made this one of them. Let me remind members that among the eight Millennium Development Goals, Millennium Development Goal No. 4 is about child mortality. No. 5 is about maternal mortality and No. 6 about HIV/Aids.
Having said that, hon member, I am quite aware that because of the media statement there is a temptation generally in the country to regard these deaths of children as isolated incidents, either of malpractice or negligence. When malpractice and negligence, whether they occur with babies or adults or any other person in a hospital where staff might be a bit negligent, come to light, as you know, they are routinely investigated by the Health Professions Council of South Africa.
However, I must confess that what we are seeing with this mortality of children is that we are really in a very bad place in South Africa. We are in a very bad place in regard to infant mortality. It is just out of control and there are quite a number of factors that have led to this, rather than just absolute negligence. I am saying this because the solutions are not going to lie inside the hospital. If we believe the solutions are inside the hospital, we will never defeat this problem.
What am I talking about, Chairperson? If you go back to the graphs that we have, you will realise when this problem became worse.
First and foremost, most of these children who pass away are very premature. The number of premature babies has increased markedly in the country, where we are increasingly seeing children very far below birth weight. A child is usually normal at the birth weight of 2,5 kg to 3,5 kg, but we are seeing them at not only less than 1 kg, but even down to 600 g. There are lots of babies like this.
There was a newspaper statement. Somebody in health in the Eastern Cape asked in the newspaper statement whether we are saying all the premature babies must die and that it is normal. The problem is that when babies are premature they need specialised attention, special paediatricians, advanced midwives, and advanced nurses who specialise in paediatrics. Then they compare the public and the private sectors, and ask why in the public sector the babies die in such numbers and in the private sector they don't.
Firstly, per annum the public sector sees 1,1 million babies. That is per annum. The private sector sees only 110 000. That is a huge gap. Furthermore, in regard to studying and expertise, you know that all the very senior specialists are in the private sector; they are not in the public sector. So you are leaving a few people who are not very highly trained to deal with 1,1 million babies who need special attention because they come into this world very early. What brings about this prematurity? First and foremost, there is the issue of HIV/Aids. Everybody in South Africa knows we are number one in the world regarding HIV and Aids, and a very large number of pre-term babies are such because they are born HIV-positive. If you want me to give you the figure, 70 000 children per annum are born HIV-positive in South Africa. In the whole continent of Africa it is 400 000.
Now, it has been proved that if a child is born HIV-positive, the chance of his or her dying in the first six months increases by 1 500%, even in the best hospitals - in the best public hospitals, let me say. That means they are 15 times more likely to pass away than children who are born HIV- negative. That is why the President specifically instructed us on World Aids Day 2009 that all the children who were born HIV-positive had to be put on treatment, regardless. It was to stop this problem.
Secondly, to prevent them having children who are born HIV-positive, the mothers need to be put on drugs for the prevention of mother-to-child transmission, PMTCT, at 14 weeks. That you do not solve in the hospital; it is in the community. They come to the hospital to deliver. Therefore, we need to know, as we are sitting here, who is pregnant. Have they been tested? Have they saved the baby? If you think the baby will be saved in the hospital at birth, that is too late. That is one of the mistakes that we must never make. That is the issue of the prematurity. When these children are born premature, they very easily die of infection, particularly when there is overcrowding in our hospitals and all that comes with that.
The other area, hon members, is that of abortion. I said this two weeks ago at the nursing summit, and unfortunately people thought I was perhaps callous. However, I want to repeat it. Increasingly young girls in this country are using abortion as a form of contraception. We have young girls who come three times in six months to have an abortion!
There were some happenings that we discovered at the Cecilia Makiwane Hospital during this incentive. [Interjections.] Yes. There is a drug called Misoprostol or Cytotec. It is licensed for ulcers, but people insert it into their vaginas to open the uterus. The law you passed here for the termination of pregnancy provides that an abortion should be before 20 weeks. When women realise it is after 20 weeks, they do the following. I am sure you have seen lots of boards outside here regarding having a quick abortion and they give a phone number. For a quick abortion they just insert Misoprostol and send them to hospital, and the babies are delivered inside the hospital.
In hospitals that are very poorly resourced they are delivered pre-term and left there to die, and the poorly resourced hospital must try their best to make them live. It is a big problem. One of the nurses at Cecilia Makiwane found these tablets in the vaginas of the women.
It usually happens at the beginning of the year, as you have noticed. Why the beginning of the year? It is because people get admitted to university and to colleges, and they suddenly realise that they cannot keep the baby and they dump it in the hospitals.
So we are also looking into this issue. Overall we will be coming up with a strategy which we will unveil in the coming weeks. I will unveil it publicly. It is a strategy of primary health care that starts in the districts, in the municipality wards, in the communities, and at schools. That is where we must fight together with you as leaders and other leaders outside - community leaders - to stop this problem. Otherwise the problem is going to be out of control.
That does not mean we should not improve our hospitals - we are doing so. Just two weeks ago I met with professors and all the experts who deal with this issue of infant mortality. They have given us their inputs on what the government must do in order to reduce the number of children who are dying. If we do it on a hit-and-miss basis - run to one hospital and ask who is wrong and what happened - South Africa will never solve this problem. Thank you.
I do not have a follow-up question, Chairperson.
Thank you.
Thank you, Deputy Chair, and once again thanks to the Minister for his reply.
A short while ago one of the committees from the NCOP, the Select Committee on Women, Children and People with Disabilities, went on an oversight visit, particularly with regard to infant mortality. In the Eastern Cape we came across one or two hospitals where premature babies were sharing an incubator because there weren't enough incubators. What are the Department of Health's comments and the Minister's comments on that? Can't something be done to supply more incubators, just the basics? Thank you very much.
Hon member, that is a new question. Minister, can you answer the next question?
Chair, I am prepared: This is not one hundred per cent new, as it is related. He is right. That is exactly what I was describing. If you suddenly have an avalanche of premature and pre-term babies, they obviously congest the hospitals and the number of incubators that are needed suddenly increases. We are aware of that and we are trying our best to buy and increase the number of them.
If you remember there was the same situation at Charlotte Maxeke Hospital, where six babies died at the same time. We subsequently increased the number of staff, put in more incubators, and built an extra neonatal ward to accommodate the others. We did all those things, and we are doing them all over the country.
What I was describing is that the number of these premature babies is just increasing day by day because of the conditions that I have mentioned here. Thank you.
Assessment undertaken by department to verify whether all public hospitals have functioning generators
41. Ms M G Boroto (ANC) asked the Minister of Health:
Whether his department has undertaken an assessment to verify whether all public hospitals have functioning generators to ensure that they are able to provide health care services in cases of power shortages; if not, why not; if so, (a) how many hospitals in each province do not have functioning generators and (b) what plans is his department putting in place to address this situation?