Status of Women's Health in South Africa: engagement with DoH, DWYPD & StatsSA

Meeting report

The Chairperson greeted Members on the platform and acknowledged the presence of her former colleague, Ms Faith Muthambi.

Dr Nkosazana Dlamini-Zuma, Minister of Women, Youth and Persons with Disabilities, was present on the platform.

The Chairperson remarked that the day was the last day of Women’s Month and wished everyone a happy Women’s Month. She also acknowledged the presence of Statistics South Africa (StatsSA) , the Department of Women, Youth and Persons with Disabilities (DWYPD) and the Department of Health (DoH) on the platform.

The Caucus recorded the apologies of Ms T Masondo (ANC), Minister Lindiwe Zulu, Deputy Minister N Mafu, Deputy Minister S Tolashe, Ms D Christians (DA, Northern Cape), Ms T Breedt (FF Plus), Ms C Labuschagne (DA, Western Cape), Ms S Boshoff (DA, Mpumalanga), Ms S Lucas (ANC, Northern Cape), Ms C Phiri (ANC), Ms Shabalala (ANC), Ms M Hlengwa (IFP).

Briefing by Statistics SA

Mr Ashwell Jenneker, Deputy Director-General: Statistical Support and Informatics, Statistics South Africa, briefed the Caucus on women’s health in South Africa.

In terms of South Africa’s population, the population of women is slightly higher than men in every province.

South Africa has a fairly young population. Thus, employment and health are instrumental to this population.

The general trend on life expectancy is that women live longer than men.

It was highlighted as a concerning trend that the life expectancy gap for a female living in the Free State is 9.5 years shorter than a female living in the Western Cape.

Mr Jenneker remarked that it was interesting to see that location determines life expectancy.

HIV prevalence is shown to be the highest among sexually active women in the age groups 25-29 and 45-49.

In terms of cancer diagnosis, females were almost twice as high as those among males.

The two leading cancers contributing to female mortality were cervical and breast cancer.

(See presentation attached for further details)

Discussion

The Chairperson appealed to Stats SA that in future, it should make the same presentation as the one sent to Caucus Members. She pointed out that the two presentations were of different versions.

Ms J Mananiso (ANC) requested the presentation to be available for their constituents in indigenous languages because of the informative nature of the presentation.

Ms M Ntuli (ANC) remarked that the statistics showed the worrisome picture that women are at risk and enquired about the actions relevant departments have taken to address what those statistics have revealed.

Ms N Maseko-Jele (ANC) sought clarity on what Stats SA meant by saying “poor reproduction”. 

She noted the high prevalence of HIV amongst women and asked what Stats SA had picked up during the data collection process. Was the high prevalence caused by one man who is HIV positive having multiple sexual partners and thus spreading HIV?

Ms W Newhoudt-Druchen (ANC) noted that access to information on cancer remains a challenge for persons living with disabilities and thus requested a breakdown of statistics with specific categories showing the numbers of the disabled population who have cancer and HIV, respectively.

Ms M Gomba (ANC) described the increasing number of people diagnosed with cancer as concerning and asked Stats SA if there was any measure to address the issue. 

She had reasons to believe that the cancer awareness campaigns in the country are ineffective because otherwise, they would have saved a lot of lives should they be effective. She asked what cancer awareness campaigns were being held throughout the country. What contributed to the shorter life expectancy of men?

Ms N Sharif (DA) asked Stats SA why there was such a delay in the statistics presented to Members as they were not given the most recent 2023 statistics but were rather given 2020 stats.

She agreed with Ms Newhoudt-Druchen that access to cancer information and breast and cervical cancer screening remained key to combating cancer. She wanted more details about DoH’s programmes and people’s access to cancer screening and medical care.

Ms Sharif clarified that a ten-year-old is not a teenager, but rather a child and questioned why they are falling pregnant. She asked about people’s access to contraception and healthcare services.

Lastly, she commented that South Africa still has a long way to go to promote women’s healthcare as a country. She urged the DoH and the Department of Social Development (DSD) to work on strategies to take us forward.

Ms D Mahlangu (ANC, Mpumalanga) emphasised that the Multiparty Women’s Caucus needed to ensure the alignment between Stats SA’s presentation and the Annual Performance Plans (APPs) of various Departments.

Ms Z Majozi (IFP) expressed a concern that programmes on platforms such as MultiChoice, through the sexual content in their programmes, directly exposed teenagers to such behaviours and thus contributed to the rising teenage pregnancy.

Response

Mr Diego Iturralde, Executive Manager: Demographic Analysis, StatsSA, explained to Ms Gomba that shorter male life expectancy is a prevalent global trend. From the age of 45 to 50, the male mortality rate increases and is not specifically correlated to any type of disease. It could be attributed to the high-risk activities which men are often involved in. For instance, men’s occupational activities in mining, etc. could be contributing to a high male mortality rate.

He informed the Caucus that the report presented to the Caucus was prepared during the 2021/22 financial year. The request for more recent data and more disaggregated data for the disabled population, may have to depend on data sources. Stats SA gets its data from a variety of data sources such as the district health information system, Human Science Research Council (HSRC) HIV survey, cancer registry, etc. Those different sources also have different timeframes spread out over time. Stats SA can give a more updated report if those institutions provide it with more recent data because the institution has the statistical infrastructure to update various indicators.

He highlighted that unfortunately, the burden of HIV falls amongst women, both globally and in South Africa. It is ultimately a lifestyle disease. Women from the age of 20 to 49 have the highest rate, which is a reflection of the vulnerability of women in society. Many of them do not have a choice in terms of their sexual activity and that might expose them to danger.

Ms Ramadimetja Matji, Chief Directorate: Cancer Registry, Stats SA, emphasised the importance of reinforcing some key cancer prevention and detection strategies. Those included:

1. Sustaining the rollout of HPV vaccines since HPV causes cervical cancer;
2. Strengthening cancer screening services to ensure early detection of cancer;
3. Health promotion, women needed to be empowered to check their breasts for suspicious lumps and seek care in time

Mr Jenneker remarked that his reference to poor reproduction could be his poor grasp of the English language.

He remarked that it is alarming to see from the statistics that children as young as ten to fourteen are registering for birth at the Department of Home Affairs. The government and the society at large should start to bring perpetrators to account, to have campaigns and shed more light on the issue of teenage pregnancy.

Ms Olga Masebe, Director: Demographic Unit, Stats SA, clarified that the data referred to all the people who had been diagnosed with HIV and cancer which included the disabled population. Since the HSRC provided the data, Stats SA would need to discuss with the HSRC to get more information on the disaggregation of data.

She clarified that the term “poor reproduction” refers to access to reproductive health, contraceptives, and sexual health information.

Minister Dlamini-Zuma opening remarks

Minister Dlamini-Zuma indicated to the Caucus that the DWYPD was starting an important initiative to establish a cooperative bank for women, youth and persons with disabilities. It would like to brief this Caucus on the initiative's progress in due course.

She also said that she appreciated the support that she had been getting from women but indicated that the Department would need more support. To register the bank as a cooperative financial institution, it would need a minimum of 500 people. It currently has 300 or something.

The Department’s presentation would be focusing on the performance of the Sanitary Dignitary programme. However, she clarified that the programme's funding is being designated to provinces and it is ultimately the provinces that spend the funds. Thus, the Department is making a presentation on something of which it is not in control.

Briefing by Department of Women, Youth and Persons with Disabilities on Sanitary Dignity Programme

Mr Sipiwo Matshoba, Chief Director, Social Empowerment and Participation, DWYPD, briefed the Caucus on the Sanitary Dignity Programme.

The Department highlighted some of the challenges it faced in the implementation of the programme:

• Delayed procurement processes;
• Free State Province has not distributed in two years;
• The Eastern Cape Provincial Government was also not delivering on this mandate.

The Department also reported to the Caucus on its interventions as part of its oversight role of the programme.

(See presentation attached for further details)

Discussion

Ms Gomba noted the failure of the Eastern Cape, Free State and KZN to form structures to manage the sanitary dignity programme. She saw it as a defiant act of government’s mandate to address the issues of poverty and inequality. She urged that consequence management measures be instituted against officials of such provinces who refused to carry out the work of the government. The government cannot tolerate such defiance that is affecting poor children on the ground.

Ms Maseko-Jele supported Ms Gomba’s view that it is disturbing to know that some provinces still are not implementing the sanitary dignity programme. In her constituency, she had to personally give sanitary pads to two girls. She thus questioned the efficiency of schools in carrying out the programme.

She wanted to know the procurement policy for sanitary pads. She was resolute that women should produce and distribute those pads since this is one of the few programmes where women were the only beneficiaries. She questioned whether the Directors-General (DGs) at Provincial Departments were complying regarding the procurement policy.

She asked for more information on the composition of those provincial sanitary dignity programme committees, whether they are made of teachers, School Governing Body (SGB) members, etc. As a former teacher herself, she wondered if any teacher was unhappy with performing such responsibilities regularly since their main responsibility was teaching. She believed that the management of those committees should be the responsibility of the DGs and Departments. She sought clarity on who managed the programme at the national level.

Ms Newhoudt-Druchen asked the Department why the programme was not implemented in those three provinces.

She also sought clarity on the line function of the programme. To her knowledge, schools make contact with school districts, so she wanted to know if school districts ensure that schools receive their sanitary products, whether there is cooperation between provincial offices and schools, and whether provincial offices go through school district offices for this programme.

Given that young girls may be shy and many may not want pads given to them by men, she wanted to know how pads were being distributed to girls in schools.

Ms Newhoudt-Druchen asked how Members of Provincial Legislatures (MPLs) could assist in the rollout of the programme for better oversight.

She wanted to know the deadline and progress of the National Plan of Action in assessing the impact of sexual education and whether a report can be sent to Caucus Members. She also wanted to know if disabled children were being included as part of that assessment as well.

She wanted more information about the integrated tools and health programmes and what schools in her constituency are covered. She also wanted to know if special schools were covered during this assessment.

She reported that as an MP, she was prevented from conducting her oversight responsibility at a clinic in Swartland. The staff there told her that she must get permission from the Western Cape MEC on Health before she could conduct her oversight duty. She believed this was not a single incident and MPs continued to face barriers in obtaining information and carrying out their oversight work.

Ms M Semenya (ANC) wanted to know the methods of identifying the indigent, whether it was done by those provincial committees that have been established or the Department of Social Development or ward councillors of those areas. She urged for a collaborative approach for the Department to work with constituency offices, district-level offices, communities, and municipalities to identify those indigents and provide them with the help they needed.

She said that she was looking forward to the Minister’s upcoming briefing to the Caucus on the Women Cooperative Bank which she had mentioned in her opening remark so that Members would be more informed and equipped to communicate that information with their constituencies.

Ms M Mabiletsa (ANC) suggested that sanitary pads be made available at malls, just as the way that condoms are currently being distributed.

Response

Mr Matshob, emphasised the integrated approach that underpins provinces’ sanitary dignity committees that ensure the concerted efforts of different implementing agencies. The Departments of Basic Education, Social Development, Health, Economic Development, Water and Sanitation, Women, Youth and Persons with Disabilities were all part of provincial committees. The programme is convened through the Offices of the Premiers. In other words, the Offices of the DGs should be the convener. The challenge is that some of those meetings are not being attended and some Governmental Departments also defaulted on those meetings, contributing to the non-performance of those three provinces in the programme. In terms of inter-governmental relations, the only consequence management measure or intervention which the Department can do is to highlight those issues to provinces but the Department does not have any power to make further interventions beyond that point. Lastly, he commended KZN for being able to reach its entire beneficiaries, followed by the good performance of the Western Cape and Gauteng, which are also leading provinces on this programme.

He asked Ms Maseko-Jele to provide more clarity on the areas where there was no effective distribution so that the Department could follow up on those areas.

He confirmed that pads are being distributed to all schools including special schools, farm schools and even to primary school learners.

At the level of procurement, Mr Matshoba indicated that the Department does make provisions for enterprises that women, youth and persons with disabilities head. The Department’s analysis shows that provinces have done well in terms of compliance. Mostly, it is the distributors of pads that benefitted the most economically, more than actual local manufacturers. He also pointed out that more capacity building is still needed to assist local manufacturers in making the pads themselves. He informed the Caucus that with the assistance of the Department of Small Business Development, State Information Technology Agency (SITA) and Skills Initiative For Africa (SIFA), the Department is working on ways to create incubation programmes to capacitate women, youth and persons with disabilities to become local manufacturers.

He replied to Ms Newhoudt-Druchen’s questions that the studies that she had referred to would begin in October and be completed by March 2024 and the scope includes special schools as well.

On the Integrated School Health programme, he confirmed that it was implemented under the auspice of the DoH. The programme included Departments of Basic Education, Social Development, Women, Youth and Persons with Disabilities. The Department contributes to issues affecting female learners such as menstrual and reproductive health issues. He is optimistic that it will have a positive impact.

The composition of provincial sanitary dignity programme consists of school principals, SGB members, life orientation teachers, learner support agents, etc. He assured the Caucus that the committee consisted of people that are both inside schools and people from communities. Those committees are linked to district education authorities responsible for taking such information to provinces. In future, it is also envisaged that menstrual products would be available at pick up points such as clinics, malls, post offices, etc.

Briefing by the Department of Health (DoH)

Dr Manala Makua, Chief Director: Women's Health, DoH, briefed the Caucus on women’s health.

The presentation emanated from a background of surging teenage pregnancy, which not only poses challenges to the health and well-being of young girls but also puts them at risk of HIV infection.

The DoH’s Maternal, Newborn and Child Health (MNCH) and the Sexual Reproductive Health and Rights (SRHR) training package policies were provided.

The intervention strategy aims to be patient-oriented.

The DoH has established a digital self-care service that caters for women of childbearing age including adolescent girls, boys and men in the public sector in the country.

The choice for termination of pregnancy service was available to citizens.

(See presentation attached for further details)

Discussion

The Chairperson invited Caucus Members to engage on the presentation but she also provided Members with the option of sending their questions for the Department in writing to the Secretariat.

Ms M Ntuli (ANC) understood the limited time that had been given for the DoH to make its presentation but nevertheless complained about the rushing approach as Members could not make any meaningful engagement given this crucial topic on women and health.

She questioned whether the DOH was doing enough to raise cancer awareness among communities, schools and workplaces and its working relations with sectors.

She enquired about the centralisation process of oncology in government hospitals. Has the DoH tried to find the root cause of the high maternal mortality, as the statistics show? For instance, she used an example of the pre-natal visits which has proven helpful in reducing the maternal mortality rate and questioned patients’ accessibility to those medical services. To access some clinics, people living in rural areas may have to wake up at 3 a.m. to catch transport. Even after they arrive, the visits might not be guaranteed as patients would be put in a waiting line. At some clinics, they may only help fifty patients in a day and the fifty-first patient then would not have a chance to get the treatments that they needed. The entry system prevents people from getting medical attention.

On the issue of HIV/AIDS, she observed that our society has a serious “sugar daddy” issue that can be attributed to the impact of poverty. Sugar daddy refers to older men using their economic advantage to attract younger females into having sexual relations with them. She asked if any of the Department’s integrated programmes has been effective in curbing this trend, given that one sugar daddy who is HIV positive could be infecting more than ten children and thus expand the scale of HIV/AIDS.

Ms Maseko-Jele agreed on the sugar daddy issue. In addition, she highlighted that there were also issues of incest and rape within families that contributed to the expansion of HIV/AIDS. She asked the DoH if its guideline had any binding force. It is unacceptable that the teenage pregnancy rate is rising and no arrests have been made. In those cases, either a parent or the perpetrator should be held accountable and be arrested. Also, she pointed out that if a parent suspects anything unbecoming happened to their children, it is a parent’s responsibility to report such cases, whether the perpetrator is her husband or uncle. Mothers should not leave girl children sleeping under the same blanket with boy children.

She asked about the funding sources that supported the Department's various programmes. She found it unfair that the South African government alone should be funding all those programmes given that many of the current problems which the country faced were not of its people’s making. She questioned whether other countries were assisting South Africa in dealing with those issues and whether big pharmaceutical companies financially benefited from selling their products to the ill and infected.

Ms Newhoudt-Druchen suggested having a more detailed presentation with the DoH on cancer to discuss the available funding for cancer treatments. She recalled that it had been revealed a few years ago that there was insufficient funding for cancer treatment and prevention.

She noted that many clinics and hospitals do not have sign language interpreters for the deaf community. She also asked if DoH was doing free testing during cancer awareness month.

She asked the DoH if the ABC project was still in operation since the number of youth affected by HIV is increasing.

Ms Newhoudt-Druchen noted the horrible attitude nurses at some clinics have shown to pregnant children who went to those facilities seeking abortion. This negative attitude prevents girls from going to clinics for assistance to seek the help they actually need. What can Caucus Members do to assist and bring those rape perpetrators which sometimes include educators, to book.

She asked if social workers check the situations in their communities given the increasing number of teenage pregnancies.

She asked for DoH’s responses to the various figures Statistics South Africa gave.

Response

Dr Makua confirmed that StatsSA obtained all its data from the DoH. Thus, the DoH is very aware of those statistics and it also shares its statistics with other relevant departments.

Dr Makua emphasised the all-society and holistic approach in addressing sexual and reproductive health and assured Members that the DoH has had various cross-departmental interventions with sister Departments in addressing the issue.

She explained that Youth Zone is a safe area for young people to talk about sexual and reproductive health. To create a better experience for young people. The DoH has allocated young health professionals who understand their lingo and behaviours to engage with them. She also guaranteed that DoH is working on addressing the disrespectful behaviour of healthcare workers. Dr Makua explained that B-Wise was a health tech platform where participants could text and interact with health professionals. There are numerous benefits of this platform. For example, it can help inexperienced young people to understand pregnancy and detect early signs of pregnancy.

Dr Makua confirmed that the ABC programme was still operating. The programme also tries to inform people on what they should be doing in scenarios when abstinence is no longer an option and that people still have emergency contraceptives as an option. 

Noting Ms Newhoudt-Druchen, Dr Makua confirmed the input on the special needs of people living with disabilities. She informed the Caucus that the DoH has partnered with health organisations doing mobile screening for particular cohorts of people. She asked for Members’ assistance in identifying a particular place where a reasonable number of people could be gathered together so that the mobile services could assist them with the screening and sign language. Further, she informed the Caucus that the mobile screening service was on the move mainly focusing on cervical cancer screening during September. In addition, the mobile screening services also detect early signs of breast cancer and Prostate Specific Antigens (PSAs) for men.

To raise awareness, the DoH has partnered with different NGOs such as Cancer Alliance, and Pink Drives to increase cancer awareness among the populace.

The mobile screening team is in the Northern Cape to conduct mass screening this month after having conducted its testing in Mpumalanga last month.

In terms of enforcing the DoH’s policy, she highlighted that it is a multi-sectoral and multi-faceted issue and thus has both pros and cons. Although Dr Makua absolutely agreed that arrests should have been made, she also cautioned the need to keep the balance if the DoH oversteps the mark by proactively implementing punitive measures. She explained that should the DoH become too involved in implementing punitive measures, it would be counter-productive and send those pregnant girls who are in need of DoH’s help away.

She explained the meaning of the multi-sectoral approach. At schools, there should be comprehensive sexual education to assist learners in identifying the early signs of pregnancy symptoms and to have available platforms where learners can seek help and support from. The DoH has a role to play in terms of providing health provisions. In terms of enforcing laws, the Department of Justice and Correctional Services as well as the South African Police Service (SAPS) both have a role to play. As for the role of MPs, she believed that Members could assist in carrying out punitive measures to help law enforcement agencies.

Dr Makua attributed the actual causes of maternal mortality to what she called five Hs: hypertension that was associated with lifestyle, haemorrhage that was associated with nutrition, HIV, TB, as well as healthcare workers and the health system.

She noted Ms Maseko-Jele’s input on the limited number of patients clinics could attend to daily. She informed the Caucus that DoH created an ideal clinic realisation programme to address the issues that Members had mentioned. Under the programme, clinics are being evaluated for their compliance, rated according to the ideal model.

Dr Makua informed the Caucus that six months out of a whole year were being dedicated to cancer awareness. For instance, February was dedicated as the cancer period and the months of September, October and November were all cancer months.

Dr Makua highlighted to the Caucus that there is insufficient funding and resources for the DoH to respond to the issue of cancer. More resources need to be mobilised.

Ms Ntuli reminded the DoH to respond to her question on oncology centres in governmental hospitals and how they are being managed and centralised.

She also highlighted the issue of the prolonged waiting period for cancer patients which could be fatal to some patients.

Dr Makua explained to the Caucus the centralisation of oncology in government hospitals. For instance, cervical cancer is one of the few cancers completely preventable since it is caused by papillomavirus virus which is transmitted sexually. Since it is a completely preventable cancer, there is no need to centralise the service at the tertiary institution level where oncology is needed but rather, the focus should be on the strengthening of the prevention component.

She asked Members to bear in mind that Members would not see immediate positive outcomes of the DoH’s programmes dedicated to treating cancer. Since it is slow growing, the return on investment for cancer programmes such as vaccination could take ten to twenty years before Members would be able to see the impact on the ground. In the DoH, the oldest programme is only nine years old.

Because cervical cancer has a pre-cancerous period, which means that the patient has a problem but it is not yet cancer, there is no need for oncology such as radiation or chemotherapy for those patients. Patients in such pre-cancerous periods can be treated at district-level hospitals by trained physicians.

Given that cancer is also staged, regional hospitals can manage the first- and second stages which require surgery. When cancer progresses into the more complicated 2B, third or fourth stage, patients would need more highly sophisticated and specialised equipment and health professionals.

The meaning of centralising is that the issue of cancer should be addressed at every stage so that DoH can avoid dealing with the same crisis that it experienced in 2018, where there was a severe backlog of cancer patients waiting to be treated.

Lastly, she also highlighted the importance of palliative care which is to provide patients with as much comfort as possible and help those patients to remain functional until the end of their lives. At this stage, tertiary-level service is also not required.

The Chairperson said any further questions can be submitted in writing. Previous Caucus minutes were deferred. She thanked Members for their participation.

The Chairperson adjourned the meeting.