Twenty years on – have we made progress in service delivery?

An overview of relevant data

Lizette BerrySenior Researcher

Children’s Institute (UCT)

ECD Knowledge Building Seminar5 December 2014

Acknowledgements: L Biersteker, A Dawes, K Hall and W Sambu

Introduction

Child-centred data is useful and necessary for evidence-based planning

It helps with measuring and monitoring progress against objectives

Data tells us about: children’s environments and living

conditions Access to resources, services and support Gaps and inadequacies, enabling action

Providing services across the developmental continuum

Adapted from Richter L, Biersteker L, Burns J, Desmond C, Feza N, Harrison D, Martin P, SaloojeeH & Slemming W (2012) Diagnostic Review of Early Childhood Development. Pretoria: Department of Performance, Monitoring and Evaluation & Inter-Departmental Steering Committee on ECD.

Essential services for young children

Young children’s needs are multi-faceted + interdependent

Priority services include: health + nutrition early learning caregiver support social services

The proposed package draws on the work of Ilifa Labantwana, a multi-donor partnership which supports integrated ECD in South Africa.

Then and now….

1994: advent of democracy Limited and fragmented attempts to monitor

child well-being Availability and quality of data was a challenge Focus was largely on maternal and child health Overwhelming attention on child survival Child-centred data not readily available

Then and now….

Present context – Wider variety of data sources allows for

deeper and diverse analysis Growing understanding of developmental

stages and the need to differentiate ages Greater number of actors and systems

performing monitoring functions Gradual acknowledgment that moving beyond

child survival/curative approach to a developmental and holistic approach is essential

The young child population

4,443,6215,685,452

4,668,722

4,819,751

1996 2011

5-9 years

0-4 years

Number of young children aged 0-9 years, 1996 and 2011

9.1 million

10.5 million

Source: Statistics South Africa 1998, 2012. Census 1996 and 2011.

Child health and mortality

Provision of public health services has improved significantly since 1994

Sector’s most profound success is the reduction in child mortality – from 58.5 in 1994 to 41 per 1,000 live births in 2012

Mostly due to improved access and take-up of HIV prevention and treatment programmes

Existing public health infrastructure enables regular contact and reach of services to young children

Sources: 1994 U5MR - Estimates generated by the UN Inter-agency Group for Child Mortality Estimation (IGME) in 2013; U5MR 2012 - MRC, Rapid mortality surveillance report, adjustments 2012.

Child health and mortality [2]

SA EC FS GT KZN LM MP NW NC WC

3.2 mil  410, 698 158, 963 641, 935 643, 703 397, 339 269, 758 238, 336 69, 499 332, 216

Children 0 – 2 years by province

Service Measure Access, equity and quality

Maternal and child health

Antenatal care • Overall coverage is high, at over 90%• In 2011, 40% of pregnant women attended antenatal

visits before 20 weeks• Women attending antenatal care attend three visits

on average

Immunisation • In 2012, 94% of 1-year-olds were fully immunised• Significant provincial and district disparities exist

HIV testing • In 2012, 79% of HIV-exposed infants received a PCR test at eight weeks. Infants living in rural districts are less likely to get tested.

Sources: SAHR 2012/13 & 2013/14; GHS 2012; DHIS 2012

Child nutrition

6m - 6 years (1994)%

1 - 6 years (1999)%

0-5 years (2012)%

Stunting 23 24 22Wasting 3 4 3Underweight 9 11 5

• 27% of 0–2 year-olds remain stunted

• Severe acute malnutrition in children younger than 12 months appears to be increasing

40%

29%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1993 2008

Stunting rates among the poorest 20% of children under 5 years

Sources: SAVACG survey 1995; Food Consumption Survey 1999; PSLSD 1993 & NIDS wave 1 2008 (SALDRU) Children’s Institute analysis; SANHANES-1 2012

Child nutrition [2]

SA EC FS GT KZN LM MP NW NC WC

44%  ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Vitamin A deficiency in children under 5 years

Sources: SANHANES-1 2012; SADHS 2003; The health of our children 2008; HST review of public health facilities 2011; DHIS 2012

Service Measure Access, equity and qualityNutrition Breastfeeding

rates• In 2003, 8% of infants were exclusively breastfed for the

first six months • A 2008 survey suggested 26%, but the sample was very

small • A 2010 survey found that 28% of infants were exclusively

breastfed at 4-8 weeks

Vitamin A coverage

• In 2012, 43% of children 1 – 5 years received vitamin A supplements

• Provincial variation is a concern, and malnutrition is highest in rural and urban-informal areas

Stimulation for early learning

Since 1994 there has been a significant increase in access to centre-based care

In 2001, over 1 million learners (0 – 7 years) were enrolled in over 23,000 audited ECD sites

Enrolment in Grade R has more than doubled between 2003 and 2011 and is near universal access

By 2012, 88% of learners in Grade 1 in public schools had attended Grade R

Sources: Nationwide ECD audit 2001; 20 year review, South Africa 2014

Stimulation for early learning [2]

SA EC FS GT KZN LM MP NW NC WC

3.2 mil  487, 003 171, 525 595, 528 680, 205 369, 561 259, 647 237, 751 78, 687 310, 183

Children 3 – 5 years by province

Sources: GHS 2012; National DSD data

67%73% 75% 76%

53%

74%

61%66%

54%

63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

SA EC FS GT KZN LP MP NW NC WC

Attendance of early learning group programmes, 3-5 year olds

• In 2012, 486,000 children under 5 years received a subsidy

• An estimated 16% of poor children was covered by the subsidy in 2013/14

• There are age, geographic, race and income disparities

Stimulation for early learning [3]

Caregiver support

Since 1994, there has been a focus on transforming social welfare services by deracialising access and promoting a developmental approach

Family and parental support are included in the ambit of designated welfare services and recognised in several policies

Parenting support offers a strong preventive and protective function and has been shown to produce good child outcomes when implemented effectively

Sources: Twenty year review, South Africa 2014

• Antenatal visits are a good place to start • Postnatal care is improving: in 2009, 5% of women

received follow-up, while 53% received care in 2012• An estimated one-third of mothers suffer from post-

natal depression

Caregiver support [2]

Sources: GHS 2011; DHIS 2012

0%10%20%30%40%50%60%70%80%90%

100%

0-2 yrs 3-4 yrs 5-6 yrs 7-9 yrs

Young children living with their mothers

Mother only Both

Social services and income support

The CSG has enjoyed tremendous success: 22,000 recipients in 1998 11,3 million in 2013

Its benefits are well documented, including improving child nutrition, health and educational outcomes

An estimated 76% of eligible children currently receiving the grant

Birth registration is another service area where South Africa boasts large improvements in service delivery over the past decade

Sources: Twenty year review, South Africa 2014; Stats SA mid year population estimates 2011, Children’s Institute analysis

Social services and income support

Take-up is lower for younger children

This indicates barriers in access to the grant in the first year of life

This is the period when children are arguably most in need of nutritional foods, access to health care and other forms of support

There are no reliable statistics on the need for social services, or on the extent of delivery

South African Child Gauge 2013