Water and sanitation undermines health efforts
South African health officials have failed to advocate for more free water while efforts to improve sanitation have been undermined by lack of funds, resulting in high levels of disease and mortality mainly among the poor.
This is according to Professor David Sanders, head of the School of Public Health at the University of the Western Cape and one of the world’s public health leading experts.
Sanders said that the health department had been notably silent in raising any of these issues, even when the past cholera epidemic or the current food security crisis provided the opportunity.
Municipal environmental health officers that were supposed to facilitate the improvement of conditions were ‘inappropriate’ and had been trained to ‘inspect restaurants in middle-class’ suburbs, he added.
Speaking at this week’s Public Health Association conference in Cape Town, Sanders revealed that almost one out of three (30%) residents in Khayelitsha did not have easy access to water while 80 percent live in shacks.
There is an average of 105 people per toilet in Site B and C in Khayelitsha, or one toilet per seven households where toilets have been provided.
A total of 14 521 households do not have access to water while the sanitation backlog is around 29 811 households.
Sanders showed that the country’s health spending as a percentage of GDP had declined over the years and was set to continue this trend.
South Africa fares dismally when comparing health indicators to other middle and low income countries. In 2002 South Africa had a GDP per capita of U$10 070. Cuba’s was much lower at U$5 259, Brazil U$7 770, Thailand U$7 010 and China U$4 580.
South Africa’s expenditure on public health (as a percentage of GDP) was 3,6% in 2001, compared to 6,2% in Cuba and 3,2% in Brazil.
However, all these countries were getting better health returns on their investments. In 2002 98% of Cuban one-year-olds were fully immunized against Measles. In Brazil it was 93% and in Thailand 94%. At the same time South Africa had immunized 78% of its toddlers.
At birth, a baby in Cuba can expect to live to the healthy age of 76. In Brazil, life expectancy is 68 years, in Thailand 69 years and China 71 years. However, in South Africa it is a mere 47 years. In the other countries life expectancy had increased significantly since the seventies, but in South Africa it had plunged by six years.
By 2002 South Africa’s infant mortality rate was at 52 per 1 000 births. Cuba’s rate was 7, Brazil’s 30, Thailand’s 24 and China’s 31 (down from 85 in 1975). South Africa now one of nine countries with an increasing under five mortality rate.
Sanders said health personnel numbers and skills were key in attempting to turn matters around. He revealed that the overall vacancy rate in the public health sector currently stood at 35 percent ‘ 138 657 posts. The lowest vacancy rate was in the North West at 14% while the highest was in the Eastern Cape (47% – over 30 000 posts), Limpopo (45%) and Free State (41%).
In terms of skills, Sanders said senior managers were poorly oriented to public health care. ‘The health department stresses the ‘public health care package’ and selected activities in HIV/AIDS and TB programmes without corresponding emphasis on the preventative and promotive aspects such as lifeskills for youth, microcredit for women and advocacy for housing.’
Sanders said that even in the best sub-districts such as those in the Western Cape the approach is very selective with emphasis placed on success in antiretroviral therapy and TB programmes but a dismal failure to address sanitation and water.
Human resource development was minimal and that the number of health workers remained totally inadequate in the peripheral areas.