Status of Health Systems - Essay Example

Status of Health Systems: Prenatal Care in South Africa Surname, Name Professor Course Institution Date Outline 1.0. Abstract. 2.0. Introduction. 3.0. History of Prenatal Care in South Africa. 4.0. Importance of Prenatal Care in South Africa. 5.0. Current Issues in the Prenatal Health Care Sector of South Africa. 6.0. Reform Drivers In the Prenatal Health Care of South Africa. 7.0. Barriers to Reform. 8.0. Recommendations. 9.0. Conclusion. 1.0. Abstract The health and medical condition of a new born significantly depends on the intensity of care received during pregnancy. Prenatal growth, therefore, has an enormous influence on the child’s development and does not only depend on the quality of prenatal care received, but also the environment exposed during pregnancy. South Africa is among the countries that have been on the edge of a high end revolution, and has had heated debates about the quality of prenatal health care systems. This is also in line with the millennium health care goals of the country, “To have a stable prenatal health care system in South Africa, which will help curb the number of deaths experienced by infants and pregnant mothers.” The country, as a result, has been trying to improve its health care clinics and the whole system at large (Wehby, 2006, pg. 83). This is a process that has brought about a change in the training systems of their doctors, while considering the adoption of high-tech facilities, which will ensure that they achieve their goals. The county, however, has had a series of challenges, among them racism and political disunity that are posing difficulty for the government to carry out radical reforms. 2.0. Introduction It is necessary for pregnant women to make regular visits to a doctor. Prenatal care is the nursing and medical care that is offered to pregnant women. Child bearing, in the African Society, was a great blessing, and; therefore, pregnant mothers had to be given ultimate care in a bid to make sure that the child is delivered safely (Wehby, 2006, pg. 111). However, because of the ad hoc methods that were used, many pregnant women still lost their pregnancies, and some even died during the pregnancies. This means that there was an extremely poor health care system in South Africa, before the modern revolution, and prenatal care was not an exception. Modernity has come along with many changes including medical reforms, which have seen South Africa reconsider their prenatal health care systems, and work towards improving them. This is a comprehensive essay covering the issues prenatal care in the health care systems of South Africa. It exhausts the history of prenatal care in the country and goes further to discuss the importance and current issues in the prenatal health care system of the country, not forgetting to discuss the reform drivers and barriers to reforms. 3.0. History of prenatal care in South Africa Access to maternal health in South Africa before the political transition in 1994 was terribly poor especially for the black communities and the rural areas (Hoque, 2008, pg. 66). It is after the transition that, in South Africa provision of proper and adequate, prenatal care became a core objective of attaining maternal and prenatal health care. This is aligned to the country’s aim to achieve the “Millennium Development Goals”. Primary health care commonly referred to as PHC has been in South Africa since its formal introduction back in 1994; this was a move to enable all South Africans to be able to access primary healthcare (Mutyambizi, 2009, pg. 3). The programme enables all expectant mothers and children below the age of six to receive free medical attention. Its main emphasis is on promoting safe motherhood, immunisation to infants and child health care. To attain this, the programme emphasises on the need for proper improvement of public health clinics. Putting the focus on prenatal care, the programme recommends to all expectant mothers to visit a local clinic or a qualified health practitioner. They are to begin these checkups as early as 12 weeks of pregnancy, where they are to undergo various tests such as HIV, and provide relevant information on their medical history. Since 1998, there have been a number of health care related researches particularly in maternal health. A research by the South African Demographic and Household Survey (SADHS) (Tsoka, Le Seur& Sharp, 2003, pg. 70) gave an indication of approximately 94% of expectant women were utilising prenatal care. Although South Africa’s government move to provide free maternal care is commendable, the quality and access to this service is still questionable. The drive to emphasize on prenatal health care has a lot of emphasis because of the HIV epidemic that was rapidly increasing until 1998. A study in 2006 reveals that the frequency of the deadly virus was now relatively stable among pregnant women because of prenatal health care (SA Department of Health, 2006, pg. 73). 4.0. Importance of Prenatal Care in South Africa There are numerous reasons for explaining the importance of prenatal care in general. Some of the reasons range from maintaining the mother’s health to securing the child’s life from detectable dangers. The essential interventions are identification of obstetric complications and managing them. These complications include tetanus toxoid immunisation, STIs, HIV and preeclampsia (Lincetto, Mothebesoane-Anoh, Gomez &Munjanja, 2011, pg. 51). It is noteworthy as it offers an opportunity to learn about healthy pregnancy behaviours such as early postnatal care lessons, breastfeeding and proper planning for ideal pregnancy spacing. Prenatal care in South Africa is of considerable significance as it coincides with the set millennium goals the country is to achieve. Some include the fourth goal that deals with minimizing child mortality, goal 5, which seeks to improve mothers’ healthcare, and goal 6, which focuses on fighting AIDS and malaria. Another importance of prenatal care in the region is the detection of high-risk pregnancies through this programme leading a high reduction in the number of maternal mortality in some cases up to 60% (SA Department of Health, 2006, pg. 87). This has had a positive impact on the economy because according to World Health Organization (WHO, 2005, pg. 112), for every dollar spent on high-risk women, results to saving over three dollars. This is because of the cost that could end up arising both monetary and social due to the complications arising in instances where high-risk pregnancies are not detected. Prenatal care also enables detection, prevention and treatment of other ailments that may affect the mother or unborn child such as, Down’s syndrome, Malaria and Syphilis (Jamison & World Bank, 2006, pg. 221). The high rate of HIV infection in South Africa is also another tremendously vital aspect as to why a lot of emphasis is on prenatal care. Through prenatal care, there is the antiretroviral treatment for the expectant women and the “Prevention of Mother-to-Child Transmission of HIV (PMTCT)” which are particularly critical factors in curbing the spread of HIV. A study in KwaZulu-Natal (KZN) province, at Empangeni Hospital reveals that 40% of the expectant mothers are HIV positive and over 40% of them transmit it to their children (Hoque, 2008, pg. 69). Such results are what draw more importance on educating and creating awareness of the need to attend prenatal health to all the pregnant women in South Africa. 5.0. Current Issues and Trends in Prenatal Care in South Africa Over the years, there have been substantial awareness campaigns and educational rallies concerning the importance of prenatal care in South Africa. This has contributed to South Africa on average showing a high prenatal coverage of up to 94% of expectant women at least going for one appointment (Day &Gray, 2008, pg. 241). According to a research by the Health Sciences Research Council (HSRC) in 2010, the percentage had gone up to about 97%. The results also reveal that over 71.4% of South African expectant women were going for prenatal services at least five times during their pregnancy (Wehby, 2006, pg. 143).However, after a recent study in Pretoria, Gauteng province and Greytown in KZN province it is evident that larger percentages of the women start their antenatal care in either the second or the third trimester of their pregnancy (Hoque, 2008, pg. 81). In a recent Mother and Child-Care survey, it shows that most South African mothers or mothers to be most seek for information from their mothers (Wehby, 2006, pg. 147). In most cases, they do not rely on speciality doctors or paediatricians. Television, friends, online sources and books are also common sources for their information. They mostly attend prenatal services for screening purposes such as sonograms, glucose tests and blood pressure. Only 51% attend birthing classes, another 54% breastfeeding classes and 49% paid attention to childcare classes (Piper, 2010, pg. 4). The survey also gives rise to another intriguing issue where seven out of every ten women were unsatisfied with the prenatal care. In addition, more than half complain of the hospital not providing support towards breastfeeding, this is alarming given the importance of breastfeeding. Prenatal care is essential in both the medical arena and back at home, as it promotes the future of the children and the new-borns heath (McCray, 2004, pg. 119). A research carried out by Carnegie Mellon University shows that culture plays a substantial role in prenatal care. The survey compares the cultural contribution towards prenatal care in South Africa and United States (Piper, 2010, pg. 7). With references to the research results, it ends up concluding that a regions cultural beliefs and practices play a significant role in prenatal care. It states, “A child’s culture, including foods, socioeconomic status of the mother, prevailing lifestyle, and medical care, begins to affect a child at conception” (Piper, 2010, pg. 13). For South Africa, this is a disadvantage, to a certain degree on prenatal care, basing on the poor socioeconomic, lifestyle and medical care in the rural areas. 6.0. Reform Drivers in the Health Care Sector of South Africa South Africa is experiencing a rigorous revolution and as a result, the government has to be keen to make sure that all sectors are improved. One of the common goals of developed countries is a reliable health care system. In a bid to achieve the millennium goals, which aim at ensuring South Africa is in the first world, the government decide to conduct reforms in the prenatal care system of the country. This is because this was one of the least developed and most ignored sectors, despite being extremely valuable in the growth and development of an infant. In a 20th June 2009, ‘The Weekender’ newspaper article, the article talks about the South Africa’s Health Care Reforms. In the article, it states that according to Olive Sishana’s plans involve putting up a debatable R100 billion per annum outlay in order to accomplish the necessary reforms (Day & Gray, 2004, pg. 394). The plan will certainly put a burden to the few available taxpayers. This is so because South Africa has a vast percentage of its population unemployed leaving together with the minority wealthy citizens. The main threat to South Africa’s health care is the high percentage of HIV infection among its population. Prenatal care, therefore, is also aimed at ensuring that the rate of mother to child HIV transmission is reduced. In a move to curb this pandemic, there are many reforms in the health sector mostly targeting the quality of prenatal care, as statistics still show that there is still a large percentage of mother-to-child transmission (MTCT). From 1994 to 2010, there have been ten notable and effective strategies to reforms in the health sector, which include; the expansion and improvement of clinics around the country. There is the anti-tobacco legislation, free primary health care that was a key first step improvement and the greater equality in district disbursement. There is also the essential drugs programme as well as the community service taken up by health professions after graduation. Another necessary step is the fight to malaria and improvement of the immunisation plan. Hospital revitalisation and choosing of safer pregnancy termination methods have also helped a great deal in shaping up South Africa’s health sector (Harrison, 2010, pg. 8) South Africa has one of the largest economies in Africa, with World Bank putting it as a middle-income country. The country in itself has a two-tier health system, public and private health sectors. The public sector gets its entire funding from taxes while the larger private sector gets most of its primary funding from government tax, individuals and employer insurance (Mutyambizi, 2009, pg. 4). Up to 8.7% of the country’s expenditure goes to the health sector, out of this 3.5% serves the public sector, which comprises of 80% of the population, while the other 5.25% serves private sector (Mutyambizi, 2009, pg. 6). The public sector has a resilient base comprising of community level clinics, central and referral district hospitals. Donor funding has been low over the past years but slowly increasing because of the HIV/AIDS programmes. The Bill of Rights has a provision requiring that all South Africans be able to access health care facilities. 7.0. Barriers to Reforms In a report by the Human Rights Watch (2011, pg 118), it states that there has been a quadruple increase in maternal mortality for the past decade, in SA. This calls for urgent improvement in the health system deficiencies most importantly prenatal health care, as it is an essential factor in this phenomenon. The substandard maternity care including prenatal has been because of health personnel abuses of their obligation. In addition, there is the lack of oversight and responsibility for persistent hitches in the health sector. The Human Rights Watch's report (2011, pg. 121) further states that, failures in maternity care that involve abuse of expectant and maternity mothers by health workers is putting women, as well as their new-born at high risk of injury or death. The South African government itself admits being facing a weighty problem, and it is working hard to do better. Odhiambo a researcher for “Africa Women’s Rights” at Human Rights Watch states that “But for all South Africa’s worthy intentions, policies and plans on paper will not save women’s lives, it requires strong accountability systems to ensure carrying out of the set policies” (Human Rights Watch, 2011, pg 127). With HIV, being a core barrier South Africa is most unlikely to achieve its assurance to attain the UN Millennium Development Goals that are to see it have a 75% reduction in maternal deaths by the year. The UN estimates about 4,500 women are dying in South Africa each year due to pregnancy and childbirth causes that can otherwise preventable or treatable. South Africa can reverse this trend through proper and quality provision of prenatal health care (Human Rights Watch, 2011, pg. 133). The perception of women towards health care centres and personnel is also another barrier towards the reforms in South Africa’s prenatal health care. An interview to a number of women relating to their pregnancy carried by Human Rights Watch (2011) shows most women have a negative perception towards health care nurses and would prefer to stay at home rather than take prenatal visits. Another barrier to reforms in the sector that requires immediate attention is to improve the socio-economic conditions for the rural people, particularly the women (Hoque, 2008, 109). The South African government, in trying to make reforms I the prenatal care systems faces a problem of disunity. The fact that all different government officials have varying suggestions and views about what needs to be done makes it difficult to implement useful ideas and projects. It also means that many hours have to be covered in locked up meeting rooms, trying to agree on simple facts and implementation strategies. The government need to work as one body in order to effectively achieve its goals. Racism in the country has also been another hindrance for reforms in prenatal care systems. South Africa has had a high rate of racism in the recent past. At independence, citizens of South Africa did not have the relevant professional education to take up public offices. The government hence had to import labour from other countries. However, with the high rise of racism in the recent past, many foreigners are developing a negative image about the country, something that keeps of investors and other useful resources. The government hence has to ensure that when they import foreigners to train their citizens. Some politicians have also been witnessed giving racial statements, which discourages foreigners, who could have been of great help in the reform process of the prenatal health care systems in the country. Racism in South Africa has persisted since the colonial era, when apartheid was born. Apartheid brought about four distinct societies, and each one of them worked independently towards ensuring that they achieve the best. The whites dominated over the rest of the races and had the best facilities in the whole country, while Asians engaged into business and setting up industries in the country. Despite the fact the country received its independence in the year 1992, to date; the philosophy of apartheid still exists in the minds of the people living in South Africa (Green, 2008, pg. 127). Africans are mostly bitter since they were the ones who suffered during the apartheid rule. This makes the indigenous South Africans to sometimes go wild and even demonstrate on the streets against foreigners being employed in their country. With this knowledge in mind, it becomes difficult for the government to convince professionals from developed countries to work in South Africa. The South African government is, therefore usually forced to pay high salaries to foreigners who agree to work in the country and help improve their prenatal health care system. It also has to give them security, at some points. 8.0. Recommendations to the Prenatal Care Sector of South Africa South Africa is facing HIV/AIDS, as its main threat with an undesirably high infection rate of mother to child. This is prevalent especially in the rural areas, therefore, the need for an educational programme in the rural areas that seeks to educate the rural women on the importance of antenatal care. This will not only help curb the high spread of HIV but will also help in reduction of deaths relating to other threats such as high-risk pregnancy. In addition, proper advice on feeding pattern, exercise and receive the required vaccination. There is also a need for reforms to nurses that handle and take care of prenatal and prenatal health of the expectant women. This is because of the way many women fear or avoid attending prenatal attention for fear of mistreatment by the nurses at most public health facilities. The rural areas being at a disadvantage, there is, therefore, the need to have more health care facilities to be set up in these areas. As much as this service is free, according to Piper (2010), most women in South Africa especially rural areas face unemployment or are unable to raise enough funds to travel to a health facility regularly. It would be, therefore, recommendable that while putting up the facilities they should be put in an area where they can be accessible to everyone in the community. South Africa forms part of the mot developed African nations (Holtz, 2008, pg. 215). However, it has an enormous disparity between the poor and rich. While the middle class and the high social classes are starting to attach a lot of importance to prenatal care, the low social class still finds it difficult to adopt prenatal care policies. The government should hence consider setting up a pool of funds to help support the poor, so that they too can experience safe delivery and a good health for their new born (Holtz, 2008, pg. 219). Mobile clinics should also be given enough funding by the government so that they can reach out to the interior parts of the country and serve those citizens who do have ready access to good prenatal health care systems. This will be a broad step, towards not only achieving their millennium goals, but also ensuring that more South Africans have access to good prenatal care and that mothers experience safe deliveries. 9.0. Conclusion Prenatal care is a tremendously important aspect of pregnancy, considering the fact that the child’s future life greatly depends on the care given during pregnancy. It is not only influential to the health of the infant, but also that of her mother. Prenatal care ensures that a country has a healthy population. It is, therefore, important for the government and individual citizens to ensure that each expectant mother and her unborn child receive proper medical attention. South Africa since 1994 to this day is continuously progressing in this sector, while fighting the HIV pandemic, at the same time. With the increase in health facilities and free primary health care, there is hope for even a higher percentage of South African women attending prenatal care for at least five times. It is undisputable that the country is doing a lot of reforms in its health care systems, including the prenatal care systems. This means that if the government remains dedicated to achieving its goals, South Africa will be able to have a high end prenatal medical system, which will be commensurate to that of the already developed countries like the US. References Day, C., &Gray, A. (2008).Health and related indicators. South African Health Review (pp.239-396). Durban: Health Systems Trust. Green, C. (2008). Maternal Newborn Nursing Care Plans. London: Cambridge Publishers. Harrison, D. (2010) An Overview of Health and Health care in South Africa 1994 – 2010: Priorities, Progress and Prospects for New Gains 3: 5-26 Holtz, C. (2008). Global Health Care: Issues and Policies. London: Jones & Bartlett Learning. Hoque, M. (2008) Audit of antenatal care in a rural district of KZN, South Africa: SA FamPract; 50(3):66 Jamison, T., & World Bank. (2006). Disease Control Priorities In Developing Countries, Part 611. New York: Oxford University Press. Lincetto, O., Mothebesoane-Anoh, S., Gomez, P. &Munjanja, S. (2011). Antenatal Care: Opportunities for Africa’s Newborns 2(3): pp. 51-62 McCray, T. (2004). An issue of culture: the effects of daily activities on prenatal care utilization6, 2012, from http://www.unicef.org/infobycountry/southafrica_statistics.html Mutyambizi V. (2009) Health insurance in southAfrica: Health care financing in South Africa; (pp. 1-10) Patterns in rural South Africa. Social Science and Medicine, 59, 1843- 1855. Piper, A. (2010).Early Effects of Environment: Humanities and Social Sciences Senior Honors Thesis.Carnegie Mellon University Research Showcase Journal. (pp. 1-58) Tsoka JM, LeSeur D, Sharp BL. (2003). Maternal health services utilization in Ubombo district. South Africa J ObstetGynaecol; 9:70–130. UNICEF - South Africa - Statistics. (2010, March 2). UNICEF - UNICEF Home. Retrieved June Wehby, G. (2006). Prenatal Care Utilization and Its Effects on Infant Health in Samples of Normal Versus Abnormal Births from South America. New York: ProQuest Publishers. World Bank. (2011). World Development Indicators 2010. New York: World Bank Publications. World Health Organization. (2005) Health and the millennium development goals. Geneva: WHO, (530.1). Read More

Since 1998, there have been a number of health care related researches particularly in maternal health. A research by the South African Demographic and Household Survey (SADHS) (Tsoka, Le Seur& Sharp, 2003, pg. 70) gave an indication of approximately 94% of expectant women were utilising prenatal care. Although South Africa’s government move to provide free maternal care is commendable, the quality and access to this service is still questionable. The drive to emphasize on prenatal health care has a lot of emphasis because of the HIV epidemic that was rapidly increasing until 1998.

A study in 2006 reveals that the frequency of the deadly virus was now relatively stable among pregnant women because of prenatal health care (SA Department of Health, 2006, pg. 73). 4.0. Importance of Prenatal Care in South Africa There are numerous reasons for explaining the importance of prenatal care in general. Some of the reasons range from maintaining the mother’s health to securing the child’s life from detectable dangers. The essential interventions are identification of obstetric complications and managing them.

These complications include tetanus toxoid immunisation, STIs, HIV and preeclampsia (Lincetto, Mothebesoane-Anoh, Gomez &Munjanja, 2011, pg. 51). It is noteworthy as it offers an opportunity to learn about healthy pregnancy behaviours such as early postnatal care lessons, breastfeeding and proper planning for ideal pregnancy spacing. Prenatal care in South Africa is of considerable significance as it coincides with the set millennium goals the country is to achieve. Some include the fourth goal that deals with minimizing child mortality, goal 5, which seeks to improve mothers’ healthcare, and goal 6, which focuses on fighting AIDS and malaria.

Another importance of prenatal care in the region is the detection of high-risk pregnancies through this programme leading a high reduction in the number of maternal mortality in some cases up to 60% (SA Department of Health, 2006, pg. 87). This has had a positive impact on the economy because according to World Health Organization (WHO, 2005, pg. 112), for every dollar spent on high-risk women, results to saving over three dollars. This is because of the cost that could end up arising both monetary and social due to the complications arising in instances where high-risk pregnancies are not detected.

Prenatal care also enables detection, prevention and treatment of other ailments that may affect the mother or unborn child such as, Down’s syndrome, Malaria and Syphilis (Jamison & World Bank, 2006, pg. 221). The high rate of HIV infection in South Africa is also another tremendously vital aspect as to why a lot of emphasis is on prenatal care. Through prenatal care, there is the antiretroviral treatment for the expectant women and the “Prevention of Mother-to-Child Transmission of HIV (PMTCT)” which are particularly critical factors in curbing the spread of HIV.

A study in KwaZulu-Natal (KZN) province, at Empangeni Hospital reveals that 40% of the expectant mothers are HIV positive and over 40% of them transmit it to their children (Hoque, 2008, pg. 69). Such results are what draw more importance on educating and creating awareness of the need to attend prenatal health to all the pregnant women in South Africa. 5.0. Current Issues and Trends in Prenatal Care in South Africa Over the years, there have been substantial awareness campaigns and educational rallies concerning the importance of prenatal care in South Africa.

This has contributed to South Africa on average showing a high prenatal coverage of up to 94% of expectant women at least going for one appointment (Day &Gray, 2008, pg. 241). According to a research by the Health Sciences Research Council (HSRC) in 2010, the percentage had gone up to about 97%. The results also reveal that over 71.4% of South African expectant women were going for prenatal services at least five times during their pregnancy (Wehby, 2006, pg. 143).

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