The State of the World's Children 1998: Focus on Nutrition

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Panel 21

Child nutrition a priority for the new South Africa

Photo: In South Africa, community health workers weigh children and discuss growth promotion with their families.

Under apartheid, South Africa had a highly sophisticated medical research infrastructure that served the white minority, pioneering heart transplants, for example. Yet the majority of the people were left with poor health and nutrition care. The advent of demo cratic rule in 1994, however, changed all that. The Government is now reorienting the health system to the needs of the majority, and child nutrition is a priority.

Establishing a community-level nutrition monitoring system is an important part of this effort, and one area where this approach is taking shape is the Bergville district of KwaZulu-Natal Province. Child health and nutrition problems in the prov ince are among the most challenging in the country. Over half the children live in poverty, nearly 40 per cent have vitamin A deficiency, up to one quarter of the children in rural areas are stunted, and iodine deficiency is a problem in mountainous areas. Ten per cent of children ages six months to five years suffer from anaemia, which is also prevalant among pregnant women, and low birthweight is common.

In the Bergville district, with a population of 120,000, a network of community health workers and health assistants is being trained as part of the new Child Survival Pro gramme. The approach, based on regular weigh ing of young children in their homes to monitor growth, is similar to that used successfully in other developing countries during the past decade. Health workers will use the weighing sessions to discuss children's growth with their families, reinforcing positive trends and ex ploring reasons behind faltering growth to devise solutions. To carry out the programme, the number of community health workers in the district will be expanded significantly. The main objective is to cover all families, including the poorest and most marginalized.

Community participation in planning and operating health services is at the core of the programme. Com munity members formed a health forum in 1994, which serves as the steering committee of the Child Sur vival Programme. The group has helped establish a district hospital board and local committees to su pervise health workers and has or ganized workshops on the new programme.

Since 1996, resources for health care have been channelled more equitably to disadvantaged provinces such as KwaZulu-Natal, and this will help finance the improved health services. The University of Natal in Pietermaritzburg is taking a leading role in supporting child growth monitoring in the Bergville district. In addition, World Vision of South Africa, an NGO which has been active in the district since 1980, has helped lay the groundwork for the programme through various community development projects. These include local leadership training, skills training for women's groups, support for a pre-school and cräche programme and cooperation with the health service in addressing malnutrition.

The new system for monitoring growth is sorely needed, according to a recent survey, which found that while most mothers had a health ser vices card for monitoring child growth, many of the cards were either left blank or were incomplete. The survey also found that very little nutritional counselling had accompanied growth monitoring.

The new programme faces many difficulties: Resources are stretched, personnel must be trained and there must be outreach into communities. None the less, the new partnerships being forged between government, the university, NGOs and communities represent an approach that holds promise for the future.

A major effort to tackle vitamin A deficiency is also under way. Within months after the new Gov ernment took office, the South African Vitamin A Consultative Group launched the country's largest-ever nutrition survey, covering nearly 20,000 households. The survey found that one third of children ages six months to five years are vitamin A deficient or on the borderline. The Government and non-governmental partners are gearing up to address the prob lem. Steps planned include giving vitamin A supplements to young children and to mothers shortly after giving birth, fortifying staple foods with vitamin A and encouraging the production and consumption of vitamin A-rich foods.

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