KZN ready for NHI challenge

2012-04-07 15:49

The KwaZulu-Natal government may have bitten off more than it can chew when it volunteered to pilot the National Health Insurance (NHI) scheme in a third district.

Umzinyathi and uMgungundlovu were named by the national health department as KwaZulu-Natal’s NHI pilot districts – and then the provincial government volunteered to pilot a third district, Amajuba, using its own money.

The province’s health MEC, Dr Sibongiseni Dhlomo, said his department was “happy about this challenge, but we are aware that it will not be easy”.

Dhlomo told City Press: “We chose Amajuba district because it is small and we would be able to get the result quickly as to whether the NHI works or not.”

City Press visited the three districts that will pilot the early phases of the NHI in KwaZulu-Natal:

Amajuba is a small district with a population of about 500 000. It is semi-rural, characterised by pockets of extreme poverty, and covers three local municipalities – Newcastle, Utrecht and Dannhauser.

Three hospitals are being renovated in preparation for the National Health Insurance scheme. The district also has 52 clinics.

Despite being a small area with medical specialists in abundance at two of its hospitals, Amajuba’s “health outcomes”, as the department calls them, are poor.

The district’s HIV prevalence last year was 37%, a figure which provincial health department boss Dr Sibongile Zungu said was a major contributor to poor maternal and child health figures.

“Amajuba’s HIV prevalence is way above the national average and maternal and child mortality rates are also not good. What worsens the situation is the sparse settlement pattern which makes it difficult for people to reach health facilities in time,” Zungu said.

“We should have 24-hour clinics that have obstetric units as part of the pilot project,” said Zungu.

UMgungundlovu district has the second-highest HIV prevalence in South Africa: about 40.7% of its residents are HIV positive.

It has a population of 920 000, who live in farming communities, informal rural settlements and upmarket urban areas. The district also has the highest infant mortality rate in KwaZulu-Natal.

Nearly 400 babies below the age of 12 months died while being treated in government facilities in the past year.

UMzinyathi district lies along the main N3 corridor between Durban and Johannesburg, and also runs along KwaZulu-Natal’s East coast. It includes some of the poorest and most underdeveloped rural areas in the province.

More than 80% of the district’s population of about 484 000 live in remote and mountainous rural areas – tricky terrain that makes it difficult for ambulances to reach emergency scenes.

There are four district hospitals in uMzinyathi and 53 clinics.

Dhlomo said despite similar population sizes, uMzinyathi fared far better than neighbouring Amajuba in the health stakes.

“The HIV prevalence in uMzinyathi is lower – 28% – and maternal and child health outcomes are much better in this district,” Dhlomo said.

“In the 2008/09 financial year, this district recorded zero maternal deaths and that is something to be proud of in a country where the number of women who die due to pregnancy- and childbirth-related complications is very high,” he said.

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