2014 Conference Report

 

The 5th South African Child Health Priorities Conference

Neil McKerrow, Haroon Saloojee, Annalie van der Vyver

The 5th South African (SA) Child Health Priorities Conference was convened by the SA Child Health Priorities Association at the University of the Free Stare in Bloemfontein from 3 to 5 December 2014. Once again the aim of the conference was to review progress in child health in South Africa, reflect on recent achievements, and set priorities for the forthcoming year.

The opening addresses from Drs Sanjana Bhardwaj of UNICEF and Sharon Matela, Provincial Paediatrician in the Free State, reviewed both global and local progress in child survival as the Millennium Development Goals (MDGs) endpoint nears and reflected on the next step. Despite a doubling in the rate of reduction of under-5 mortality more than half of the 62 countdown countries, including South Africa, are unlikely to achieve their targets. They emphasised that to maintain the current momentum ruthless prioritization of appropriate interventions and a sustained focus on maternal and child mortality is required. Fortunately early drafts of the next step, the Sustainable Development Goals (SDGs), retain the health related MDGs as a subset of their proposed health related goals.

The conference theme was “Closing the Gaps – Beyond Child Survival”. Towards this end a well-constructed programme encouraged participants to move away from traditional notions focussed on child survival and the absence of disease towards reflecting on how best to promote the wellbeing, resilience and capability of our children. In the course of the conference three subthemes emerged – taking stock of child survival in South Africa and local initiatives to enhance this; an exploration of early childhood development (ECD); and a long awaited reflection on social, adolescent and mental health.

This 5th conference saw a number of innovations including the return of free papers which were last included in the 2008 conference in Johannesburg. These free papers were aligned to the various subthemes of the conference and reviewed service delivery across various sites including the health service, schools and the home. A longstanding discussion in the Association finally culminated in the inclusion of four skills workshops in this conference. These explored child development, emergency care, nutrition and the post MDG role of non-governmental organisations (NGOs). A highlight for many was the platform provided to two groups of adolescents with chronic diseases, diabetes mellitus and HIV, to discuss the effect of their illnesses on their lives and to answer questions from the audience. Finally, for many participants this was possibly the first conference where they had to sing for their seats when Professor Tony Westwood introduced everyone to the Western Cape pledge to promote the use of the Road to Health Book as a child’s passport to health via a pledge song to the tune of Paul McCartney’s frog song, “We All Stand Together”.

Taking stock of the current position in the country, representatives of the Ministerial committees on perinatal and child mortality presented the committees’ latest reports and South Africa’s child mortality rates. The decline in the under-5 and infant mortality rates continues, albeit at a slower pace, but unfortunately the neonatal mortality rate is unchanged and continues to fluctuate around 12 per 1,000. Dr Sanjana Bhardwaj and Professor Haroon Saloojee provided feedback on the recent UNICEF sponsored Maternal, Newborn, Child and Women’s Health (MNCWH) mid-term review. The findings of the review highlight the need for health workers to know the issues, track responses, be accountable, foster teamwork, get the basics right and connect all components of the health system. Updates were also provided on progress with the roll-out of the District Clinical Specialist Teams (DCST) and implementation of the Integrated School Health Programme (ISHP). Dr Rauf presented the Tshwane experience for community orientated primary care highlighting an expanded role for ward based outreach teams in the future.

Early childhood development (ECD), introduced as a theme in the 2013 conference, was a major focus at this conference. Ms Wiedaad Slemming reviewed the background, develop and future of the ECD policy and plans for the country. She emphasised the central role of ECD in the realisation of the national development plan goal to reduce poverty and inequality in the country and highlighted the five priority areas of the ECD plan. The importance of good nutrition to childhood development and the debilitating impact of stunting were presented alongside the KZN experience in introducing an infant and child feeding policy. Discussions on early child intervention highlighted the powerful effect of early care on the survival, growth and development of children and the importance of shifting the balance from vulnerability to resilience was well illustrated by a case report from Xhariep. The role of screening in child health was considered and despite well considered arguments from advocates of specific screening programmes it was evident that should not occur merely because there is a problem or because there is a suitable test. It must occur within a functional system able to ensure that the benefits of screening outweigh the costs.

The third subtheme of the conference introduced participants to issues related to social, mental and adolescent health. A moving case report from Universitas Hospital highlighted the value of palliative care in the holistic care of children with malignancies. Professor R Nicol and Ms Mabizela, respectively, considered the predisposing factors, context and spectrum of childhood mental disorders as well as an approach to addressing these within the Free State health service. In the final presentation in this theme Dr Helena Rabie used her experience in an adolescent HIV clinic to highlight the complexities, challenges and rewards of caring for adolescent patients.

As 8% of hospital deaths in childhood are due to tuberculosis (TB) two presentations reviewed the challenges of diagnosing and managing childhood TB. A final clinical focus looked at emergency care with presentations on the essentials of a paediatric emergency unit, establishing triage systems and the transport of critically ill children.

The conference once again offered participants an opportunity to engage and debate new initiatives in child health and key issues facing children in the country in an interactive manner, in a stimulating environment, with input and reflections from some of the nation’s leading experts.

The South African Child Health Priorities Association is a child health advocacy group, facilitating the translation of child health knowledge into practice, disseminating skills and knowledge in child health, developing strategies to promote child health, promoting quality of care norms, and providing fora for interaction of child health professionals from a variety of fields (such as health, social development and law). The Association’s goals for the next year include reviewing the training of paediatricians and other child health workers, advocating for the more efficient and effective inclusion of different cadres of staff into child health care provision and exploring the formation of a southern African collaborative child health network.

The next Child Priorities conference is scheduled for Pietermaritzburg in December 2015, with Cape Town being the likely venue in 2016. Visit the Association’s website http://childhealthpriorities.co.za for more detail, and to view key conference activities.

 

Western Cape Department of Health pledge whereby signatories undertake to support and promote the Road to Health Book as a children’s passport to good health.

Western Cape Department of Health pledge whereby signatories undertake to support and promote the Road to Health Book as a children’s passport to good health.