Deputy Speaker, I have already started answering part of this question by mistake. I was saying that in the four negotiated service delivery agreements, this issue of maternal and child mortality is Outcome 2, and a number of measures have already been taken to reduce maternal mortality.
The National Committee on Confidential Enquiries into Maternal Deaths has recently provided the latest triannual report on maternal mortality for the period from 2008 to 2010, which records the number of institutional deaths, causes of mortality, as well as recommendations to reduce mortality in both public and private hospitals in the country. The report found that by far the biggest cause of maternal mortality is HIV/Aids. It is then not by accident that out of the four major announcements made by the President on World Aids Day 2009 on our new approaches to treat HIV/Aids and tuberculosis, three were targeting women and children. This announcement was implemented on 1 April 2010, and we believe that the results will reflect a dramatic change in the number of HIV-positive pregnant women who pass away.
Another major cause of death was found to be obstetric haemorrhage. I am happy to announce that, working with the SA Blood Transfusion Service, all public health facilities that perform Caesarean sections have dedicated fridges for blood installed and managed by the SA Blood Transfusion Service and are now ensuring that blood is easily available when a life-saving transfusion is needed. In addition, working with universities' in-service training programmes, a process called Essential Steps in Managing Obstetric Emergencies, Esmoe, has been initiated. The report further identified 25 districts in the country which carry the highest burden of maternal mortality. The Esmoe process will then be extended to all of these districts in the 2012-13 financial year.
To improve rapid transport of women in labour in emergency situations provinces have purchased and employed obstetric ambulances and to date 105 dedicated obstetric ambulances have been purchased and are in use nationally. In addition, a plan to expand the number of maternity waiting homes has been developed within provinces.
As with interventions to reduce maternal mortality, a number of initiatives have been put in place to reduce infant mortality. The Prevention of Mother- to-Child Transmission programme has already yielded good results, with transmission rates at six weeks post-delivery cut by 50% from 8% to 3,5% nationally. In addition, pneumococcal vaccines and rotavirus vaccines were both introduced in 2008 and accelerated in 2009 as part of our routine immunisation programme. Coverage has improved significantly, and this will reduce deaths in children from pneumonia and diarrhoea.
Research has also found that a large number of children do not survive simply because they are not being breast-fed. This became worse in sub- Saharan Africa because, as part of the fight against HIV and Aids, many women were discouraged from breast-feeding. This was found to have had negative effects on child survival. A national summit on breast-feeding was held last year, and it adopted a declaration on exclusive breast-feeding, at least for the first six months of life. The promotion of exclusive breast-feeding will play a significant role in decreasing infant mortality as well. In this regard, a number of hospitals have already introduced breast milk banks whereby even children whose mothers cannot breast-feed can get breast milk from these banks. Thank you.
Motlatsa Mmusakgotla, ntetle ke leboge Tona ka moo a arabileng ka teng le go tlhalosa. Go bontsha e le ruri gore lefapha la gagwe le na le maikaelelo a le magolo ebile a le mantle go bona gore set?haba se tshela botshelo jo bontle. Ke kopa o tshware ka thata mme fela, ke ne ke kopa go itse Tona gore lefapha le a go dira jang gore maikemisetso le maikaelelo a mantle a o ntse o a tlhalosa, a ya go diragatswa ka dinako tsotlhe? Ke a leboga. (Translation of Setswana paragraph follows.)
[Ms M J SEGALE-DISWAI: Deputy Speaker, please allow me to thank the Minister for his response. It is clear that his department has a huge responsibility in ensuring that we live healthy lifesyles as a nation. Keep on working hard. However, I would like the Minister to tell me how the department will keep its word of fulfilling all these responsibilities at all times? Thank you.]
Deputy Speaker, yes, we are making sure that all of these programmes we are speaking about are reported on in terms of progress in every National Health Council meeting, which is held where MECs and their heads of department sit, where the SA Military Health Service sits, and where Salga sits. We give progress reports about these issues and then interrogate them. We also invite the chief executive officer of the SA National Aids Council to sit there, so that we can assess the progress together. Thank you. [Applause.]
Deputy Speaker and Minister, it seems that we are one of a handful of countries where child and maternal mortality rates are increasing, and it may happen that we do not meet our Millennium Development Goals. Regarding the measures that you have just referred to, we would like to know whether there is going to be regular evaluation of those.
However, I would like to refer to the recent tragic deaths at Baragwanath Hospital, where you gave the personal assurance that you would investigate to ascertain accountability. Did the medical staff adhere to all prescribed medical processes, also to maintain strict hygienic conditions, and was there any indication of negligence with regard to treatment? Have you been able to determine who was accountable for those tragic deaths? Thank you.
Deputy Speaker, to the hon member, yes, we do regular evaluations. As to the report that you are talking about, I haven't yet received the final report. Where there are cases of negligence, you are aware that these are referred to the Health Professions Council of South Africa to determine whether there was any negligence. As I am saying, I am still waiting for the final report on the matter. Thank you.
Deputy Speaker and hon Minister, will the measures to improve the situation at district hospital level be enough to make a significant difference? I refer here to papers produced by Prof Pattinson, director of the Medical Research Council of South Africa's Maternal and Infant Health Care Strategies Research Unit, and his research partners, showing that thousands of deaths of mothers and babies can be prevented at district hospital level, where little has changed since the audit of 34 such facilities five years ago. What are the challenges there?
Deputy Speaker, in trying to deal with the problem the hon member has raised, we have come to the conclusion that because of a lack of senior staff, especially in rural areas where senior people didn't go, we have to embark on the appointment of district specialist teams, where we will have a district obstetrician, a district paediatrician, a district family physician, a district advanced midwife, a district primary health care nurse, and a district paediatric nurse. As I am speaking, these people are being appointed, and they will start on 1 April. The role of these teams is to ensure good clinical governance, to provide training and mentorship, and to ensure clinical guidance and clinical protocols are in place and being used. In some areas, people just ignore protocols.
The guidelines have been produced to assist health professionals - doctors, midwives and nurses - in care for women and infants. These include the reports on obstetric haemorrhage, Caesarean section, hypertension in pregnancy and guidelines for maternity care, and they are being used in community health centres and district hospitals in South Africa. We believe that these measures will go a long way in reducing some of the deaths you have spoken about which are, we agree, actually preventable. Thank you. [Applause.]
Deputy Speaker, to the Minister, there are certain hospitals, for example the East London complex, where infant mortality is high - babies die, and then, after a few years, it happens again. Basically, in hospitals like that, where there has been a repetition, has anybody ever been held accountable for the causes of the deaths in those particular hospitals?
Deputy Speaker, I am not sure which particular hospital in the Eastern Cape the member is referring to, but there is a report that has been released about what actually happened there. We released it publicly; it was in the papers. There was a parliamentary question, and I responded to that question. I am sure you need to refer to that, hon member. Thank you. [Applause.]
Each One Settle One campaign
69. Ms B N Dambuza (ANC) asked the Minister of Human Settlements:
(a) What was the context in which the Each One Settle One campaign was launched and (b) how many people have been drawn into it?