Part 3 covers what might be done and is being done to improve child health outcomes in South Africa.

So now, where would we like to go? Well, if I’ve done my job correctly, you should be able to tell me this. You should be driving us there, itching to move the country on to better outcomes for children.

The vision is big. Turn things on their head; don’t talk of sickness, talk of health. Build, build, promote, promote, prevent, prevent. We have to make children strong; when they are sick, we must get in there early and turn things around. No more HIV; every baby on the breast for at least six months. Join up a primary health care services, clinic with community health centre, community health centre in clinic with district hospital – to provide a more comprehensive service to children, whether parents are cared for. Silos are silly. It just moved to a place where silo-thinking is the subject of ridicule and mirth.
The second thing we want to build a strong in equitable child health system. The blueprint is on the slide. What the data I have shared with you show is that, if we want healthier children who can look forward to a healthy long life, we must take health services to them – this is true for children to a greater extent than it is for adults in our needy communities because their access to all the aspects of health care is utterly dependent on others. We need to improve the way in which primary health care services in districts are supported by people with more specialised child health knowledge and skills. Note that I do not say paediatricians. The paediatrician is just one of the cadres who need to do this job, or be allowed to do this job.
So we can move on to how we get to this wonderful situation of resilient children using resilient health services. I will inform you of a few initiatives that you hope you will support while doing your bit to build resilient children in the health services where you work – in your office and beyond its walls.
National Health Insurance (NHI) is fundamentally about increasing equity and the country’s children more than anyone require greater equity. How we do this cost-wise through NHI I’m not qualified to say, but we must try and all work to make something better happen, I have no doubt in NHI is the chosen vehicle. Access to a qualified medical opinion in primary health care is woefully inadequate for children in South Africa, let alone a specialised opinion. We must increase access: NHI promises this. They just get on board and moulded for the children.
Primary health care re-engineering. These are ministerial initiatives to improve outcomes for pregnant women, newborns and children. While not comprehensive, they do take up some of the themes I have been rehearsing: taking services to children – that’s the Ward-based teams of community workers led by nurses; district clinical specialist teams – a small group of specialised doctors and nurses working in support of the district health system by district or in the catchment area regional hospitals to improve pregnancy care and its associated surgery, to improve neonatal and child outcomes; enhanced school health services aiming to bring services to a captive audience of children and adolescents.
Number three is two sets of recommendations made to the Minister and thus the health systems by two ministerial committee set up to advise on how the country can save children’s lives and improve their health.



Here are those reommendations, made independently but with common elements as highlighted. ‘Regional clinicians’ in this slide links conceptually to the district clinical specialist teams. Note the emphasis on training professionals – that’s a result of the audits that tell us how much morbidity and mortality occurs AFTER professionals have become involved in pregnancy, neonatal and paediatric care. The proposal includes undergraduate and basic nurse training as well as formalising what we teach in terms another young professionals about the care of children. Please read more at the link given here.








This slide precises these approaches in a few words. Focus on the basics. Focus on the potentially severe and damaging conditions. Emergency care and critical care.










This slide can guide individual clinicians on what they can do in everyday practice to protect children and promote their health. The Road to Health Booklet is a marvellous vehicle by which clinicians can travel with their patient through their words written about what they have done and what they have explained to the caregivers or family.
Thank you.