Up to half a million African babies die on the day they are born, and every year 1.16 million babies die in the first month of life while another one million babies are stillborn. In addition, about 250 000 women die of pregnancy-related causes every year in Africa. The majority of these deaths are preventable. However due to factors such as critical shortage of health professionals and essential materials and infrastructure, ineffective intervention programmes as well as the impact of the HIV and AIDS epidemic, the Africa continent continues to lose millions of babies and mothers every year. Hence, there is a need to strengthen the health systems in many African countries through effective maternal and child health (MCH) intervention programmes. South Africa, one of the few countries in Africa with a relatively high Gross National Income (GNI) per capita, has reproductive health policies that could be regarded as among the most progressive and comprehensive in the world. Despite government commitment however, maternal and child mortality rates have continued to increase over the past few years. Each year, an estimated 1 400 mothers die, 20 000 babies are stillborn and another 22 000 die before the reach the first month of age, and an additional 60 000 children die before the reach their 5th birthday (Chopra and Lawn, 2009; Department of Health, 2009). According to Chopra and Lawn, South Africa is one of only 12 countries where the under-5 mortality rate is higher than the baseline of 1990. This means, that the country is not only off track for the Millennium Development Goal (MDG) 4, but it is actually going in the wrong direction. Even though the high maternal and child mortality rates in South Africa are closely linked to the high HIV prevalence in the country, most of the deaths could have been prevented with effective MCH services. Thus, it is imperative for health systems strengthening in South Africa to be geared towards the implementation of effective MCH services, particularly at the district level. Adapted from: The Windows of Opportunity Project 2011, Health Systems Trust. 

1.1. Utilise the applicable social determinants of health to describe the reasons for unacceptably high maternal and child mortality rates in Africa.

1.2. There is a need to strengthen the health systems in many African countries through effective maternal and child health (MCH) intervention programmes. Describe the components of a comprehensive maternal and child health program to reduce the burden of disease in these special population groups.

1.3. “ According to Chopra and Lawn, South Africa is one of only 12 countries where the under-5 mortality rate is higher than the baseline of 1990. This means, that the country is not only off track for the Millennium Development Goal (MDG) 4, but it is actually going in the wrong direction.” Describe the extent to which South Africa has achieved MDG.

1.4. Discuss the roles of Primary Health Care in improving Maternal and Child Health Services. 

With the support of European Union Funds for improving Primary Health Care, the NGO Mpilonhle has been working since 2014 with the rural uMkhanyakude District in northern KwaZuluNatal Province to increase the efficiency and effectiveness of the Integrated School Health Programme mobile teams by introducing an electronic medical record and reporting system. The project has also worked to introduce HIV testing into schools for those 12 years and older. Improving health services for youth is one of the pillars of the “Reinventing Primary Health Care” initiative of the Government of South Africa, an initiative that since its inception has received support from the European Union. Improving youth health services has focused on revitalizing school health services though the Government’s new Integrated School Health Programme (ISHP). The ISHP uses mobile teams to take health services to youth in schools. Such a mobile approach is especially important in rural areas, where 40% of South Africa’s population still live, and where it is difficult for youth to access fixed clinics, both because of the distances involved, and because attending clinics requires timeout from school. Nurses form the backbone of the school health programme. Their recruitment, retention and job satisfaction are essential if the ISHP programme is to be a success, and youth are to benefit from these health services. A major tension in the Integrated School Health Programme has been between the need for monitoring performance, versus providing services to the maximum number of youth. The former has required nurses on the mobile health teams to laboriously complete paper forms, and then tabulate and summarize those results, passing them on up the through the clinic and hospital system, where the data has to again be hand tabulated at each step. Health team nurses can spend as much as 50% of their time on paper work, substantially reducing the amount of time they can spend on seeing youth. To increase the efficiency of the programme a grant from the European Union has paired a rural District Health Programme with the NGO Mpilonhle, which has been active in providing health care to youth for over 10 years. Mpilonhle has assisted the ISHP teams in uMkhanyakude District to use an electronic medical record to greatly increase the efficiency and accuracy of both collecting and reporting the results of the health services provided to youth. Sister Sthembile Jele – the ISHP Nurse Team Leader for the mobile clinic at remote Bethesda Hospital – raves about the improvement that the electronic record has made in their ability to provide services. “The use of the electronic application has almost doubled the number of youth that we can see at schools. It lets us focus on the reason were are here – to provide services to youth – and free us up from the burden of paperwork. 

2.1. “Improving health services for youth is one of the pillars of the “Reinventing Primary Health Care” initiative of the Government of South Africa.” Describe the contents of comprehensive health education program for a high school population. 

2.2. Describe, using examples from the case study, some of the innovation in healthcare being deployed by Mpilonhle. 

2.3. “The use of the electronic application has almost doubled the number of youth that we can see at schools. It lets us focus on the reason were are here – to provide services to youth – and free us up from the burden of paperwork.” Justify the value of the electronic health record on human resources for health. 

2.4. List five aspects of work that are improving the quality of work life for the nurses at Mpilohnle. 

2.5. Discuss the approaches to healthcare education, using examples, for the youth in the uMkhanyakude district.