South Africa

ASSET works on the maternal care platform will focus on 12 public sector Midwife Obstetric Units (MOU) in Cape Town Metropolitan Area. The same Area will most likely be the focus for the Palliative Care Integrated Primary Health Care platform.

The total population of Cape Town Metropolitan Area is four million of whom just over half are female. A quarter of the population is under the age of 15, while 6% is 65 or older. 45.4% of the population describe themselves as “Coloured”, 42.7% as “White”, 8.6% as “Black African”, and 1.4% as “Indian or Asian”. Although the literacy rate is 91%, less than half the population has completed secondary schooling. The Gini index rose from 0.59 in 2007 to 0.67 by 2011/12. Wealthy areas of Cape Town are clustered around Table Mountain and the Atlantic seaboard, and contrast with areas of the Cape Flats, such as Khayelitsha, where most residents live.

The Midwife Obstetric Units are staffed by midwives and nurses and some have on call doctors. Cape Town Metropolitan area has 158 public primary healthcare facilities. Most of these PHC facilities are staffed by nurses (and over 90% of PHC in South Africa is nurse led), with occasional visits by doctors for specific clinics.

Public healthcare in South Africa requires out-of-pocket payments, which are means tested, such that below a certain poverty threshold, there is no charge. The state contributes about 40% of all expenditure on health, for the 80% of the population that relies on public healthcare.

ASSET works on tuberculosis (TB) care (Integrated Primary Health Care platform) in South Africa will be based in the Nkomazi Local Municipality in the eastern part of the Ehlanzeni District Municipality of the Mpumalanga Province, on the southern border of the Kruger National Park. The total population is 393 030 (2011 Census), of which 98% are black African and speak SiSwati. This is a predominately rural sub-district. Children aged 1 years or under make up 35% and working age adults 60% of the population. Only 13% have completed secondary education.

Nkomazi is served by 8 district hospitals, 2 TB hospitals, 2 regional hospitals and 1 tertiary hospital. Nkomazi itself has four Community Health Centres and 28 Primary Health Care Clinics. Most clinics are fixed structures in reasonable to good condition. Many have containers on the property for overflow of patients, and often TB services are conducted in containers to limit exposure of TB to patients and staff in other areas of the clinics. Very few, if any, clinics are fitted with structures to reduce risk of TB infection, including adequate ventilation, laminar flow and UV lights.

Primary healthcare and medication is free to all. For secondary level care, patients are classified and payment influenced by work and household income on a sliding scale system, although most patients are too poor to be charged for these services. Mental Health Care Users, pensioners, and those with other form of declared disabilities do not pay, as well as those with household income below a certain threshold.