Papers by the author

C hild health promotion activities offer some of the most cost-effective interventions that any government can make. Many child disease prevention activities are affordable, can be delivered effectively and offer decades of good health for a modest investment. This chapter focuses on some key health promotion activities in South Africa including: immunisation, the Integrated Management of Childhood Illness strategy, childhood infection prevention, neonatal health and developmental screening. It highlights accomplishments over the past five years, reviews evidence for intervention effectiveness, describes challenges in implementing and institutionalising the interventions and outlines actions needed to maximise the effectiveness of the interventions in the future. There have been impressive improvements in the delivery of some interventions – such as meeting the 90 per cent under-1 immunisation coverage goal, extension of Integrated Management of Childhood Illness services to all districts in the country and continued decline in the rates of many notifiable diseases. Other interventions have shown modest gains such as the number of birthing centres certified as being 'baby-friendly' in the country and caregivers' use of oral rehydration therapy. Lack of adequate progress is noted for developmental screening and the prevention of mother-to-child transmission of HIV interventions. Failure to achieve targets is most often due to multiple constraints and barriers within broader health care provision, systemic factors limiting the efficient delivery of services, such as staff constraints, inadequate skills and the organisation of service delivery, rather than problems with the individual interventions themselves. There are sound arguments for providing a universal or core programme of preventive health care, accessible to every child in the country. The content of this core in a South African setting has yet to be defined, but many of the activities reviewed in this chapter would form the backbone of such a strategy.