Report on Delivery to Women

9. HEALTH

The goal of the Department of Health is to develop a comprehensive and integrated National Health System which provides accessible health care services for all South Africans. The Department of Health is aware of the inequities which still exist in the provision of health care services in our country. However, a number of strategies that will impact negatively on the health and well being of women are in place to address this and they are:

Internal Achievements

Sexual Assault Care Practice (Forensic Nursing)

• State doctors have received training on use of crime kids and the completion of the J88 forms in the Eastern Cape and the Western Cape:
  • 27 in the Eastern Cape (i.e., 20 in Mdantsane and 7 in Umtata)
  • 100 in the Western Cape and
  • Others have received training on these tools as part of comprehensive training on Sexual Assault Care Practice (Forensic Nursing) in the following provinces.
  • 40 in KwaZulu Natal
  • 30 in the Northern Cape of which 20 are deployed in different district facilities.
  • 544 in the Western Cape
  • Work has commenced on national policy guidelines for the management of survivors of sexual offences and on a Training Manual on Sexual Care Practice. A standard package of interventions is already defined in the primary health care service package
  • The Mental Health Directorate is driving the Victim Empowerment Programme (VEP) in the department and thus far it the directorate has managed to establish 3 VEP centres in Mpumalanga which provide counselling and support services to survivors/victims of violence, including the survivors of gender-based violence.
  • The DoH, through the GFP has been actively involved in the Inter- Departmental Management Team (IDMT) tasked by Cabinet in 2000 to develop strategies to combat rape. Thus far, the team has managed to:
    • Develop an implementation framework for the anti-rape strategies
    • Develop a victim survey and offender analysis (i.e., profiling). The findings of these research initiatives will be utilised in developing inter-departmental and integrated rape strategies.
    • The department participates in programmes of public events during the Sixteen Days of Activism on No Violence against Women (And Children) and the National Women’s Month in August.
    • In terms of the DPSA’s target of 30% female managers in 1999, the DoH has surpassed (i.e., nearly doubled) this goal in all post categories, ranging from Top Management to Low Level Supervision and Production, with an average of 58% female managers in the Department.
    • ‘Women in Partnership Against Aids (WIPAA)’ was established with the aim of uniting women and assessing where they can best participate and drive HIV and AIDS programmes. It also sought to address the needs of women who are infected and affected by the HIV and AIDS epidemic. The WIPAA initiative in provinces aims to build a local platform for decision-making, planning and action.
    • The life skills programme in schools, which forms part of the HIV and AIDS strategy, contains material on gender and is designed to encourage relationships of equality and mutual respect.
    • In line with the Gender Policy Guidelines for the Public Sector (2002), the GFP established the Departmental Gender Forum. The 9 provincial GFPs constitute members of the forum. The forum’s main function is to facilitate and coordinate national and provincial activities on gender mainstreaming in the department. The forum meets on a quarterly basis to discuss, monitor and evaluate progress made regarding the mainstreaming programme in the department.
    • Training of senior and middle managers at both provincial and national level is ongoing. So far, 80 managers and approximately 60 staff members have attended gender sensitisation workshops.
    • 30 internal policies have been analysed to assess the extent to which they are gender sensitive.

Achievements For South African Women

Policies and Legislation

• The Gender Policy Guidelines for the Public Health Sector were finalised and launched in November 2003
• Choice on Termination of Pregnancy Act (1996): allows all women access to termination of pregnancy under certain circumstances. A woman no longer requires the consent of her spouse or male partner for a termination. Termination is now legal up to 12 weeks upon request by pregnant women, and between 13 -20 weeks under certain conditions (socio-economic situation of woman, rape, incest and health risk to woman).
• The Department is developing a model for women-focussed mental health care at primary health level
• New policy guidelines for the provision of contraception are being developed to take into consideration recent developments, in particular the move towards lower dose oral contraceptives and emergency contraception.
• The Sterilisation Act has been amended, particularly in relation to the rights of women with mental illness. The law now requires:
  • The use of the least intrusive form of sterilisation
  • The establishment of panels that include members of the public, in order to limit the abuses such as unjustified hysterectomies performed for the convenience of health workers, especially in the case of women in institutional care.

Programmes and Activities

• Since December 1997, maternal deaths have been notifiable. This means that every maternal death is reported, preventable causes are identified and corrective measures are taken. The statistics and other information will give the Department a more objective picture of problem areas in obstetric care and will therefore lead to improvements in obstetric care.
• Primary Health Care was introduced with major benefits for poor rural women.
• The Community-Based Nutrition Component and Protein Energy and Malnutrition Scheme of government’s Integrated Nutrition Programme assist pregnant women to maintain good levels of nutrition. Breastfeeding is also promoted.
• The Department is distributing female condoms to try and protect women from HIV infection.
• In 1994, the government introduced free health care for pregnant women and children under six at state clinics and hospitals. In 1996, free primary health care was extended to all South Africans.
• Government has embarked on a Clinic Building Programme to try and reach people in rural areas. The programme ensures adequate access to health services in under-served areas.
• Recently built toilets in clinics include baby nappy changing areas.
• Family planning services are available to all women in SA, including women in rural areas.
• Family planning and contraception services are available free of charge at health facilities.
• The District Health System, which is the vehicle for the delivery of primary health care services in the country, is being developed
• A project to rehabilitate hospitals neglected in the past, is underway
• A project for the training of advanced midwives is functioning
• A project for the training of primary health care nurses, is functioning
• Many rural and urban informal settlements have limited access to medical doctors within the public health system. To overcome this problem, the Department of Health has introduced a system of Community Service whereby newly qualified doctors will be required to work in the public service for a period of one year before being allowed to pursue independent practice.
• Another strategy to ensure the availability of doctors in rural and under-served areas is the foreign doctor programmes. The employment of foreign doctors from Cuba, the European Union and the United Nations Volunteer Programme, under government-to-government agreements, addresses one of the government’s immediate priorities in the provision of adequate health services in the most needy areas of our country.

Budget Allocations

• Allocations have been made for maternal and reproductive health and for the Gender Focal Point.