Academic journal article South African Journal of Psychiatry

Staff and Bed Distribution in Public Sector Mental Health Services in the Eastern Cape Province, South Africa

Academic journal article South African Journal of Psychiatry

Staff and Bed Distribution in Public Sector Mental Health Services in the Eastern Cape Province, South Africa

Article excerpt

The Eastern Cape (EC) Province is located on the southeastern coast of South Africa (SA). The province has an approximate geographical area of 169 580 [km.sup.2], which represents 14% of the country's land area.'11 It was formed by the amalgamation of the two former homelands, Transkei and Ciskei, with the border regions of East London and Port Elizabeth (both former Cape Provincial Administration). At the time of this study (2010), the province was divided into one metropolitan region and six districts with 38 municipalities. [2]

The population of the province at the time of this study was 6 527 747. [1] Black Africans made up the majority of the population (88%), and females constituted 52% of the total population. The high proportion of women is a reflection of the migrant labour system prevalent in this province. A total of 33% of the population was <15 years old, and those [greater than or equal to] 65 years constituted 6%. [1] A Statistics SA report, based on a household survey measuring income and expenditure, ranked the EC as the second poorest province in the country, with a poverty rate of 58%. [3] As early as 2004, it was noted that seven of SA's ten poorest municipalities were located in the EC. The poorest municipality was Ntabankulu, with 85% of its population living below the poverty line. [4] The upper limit of the poverty line was defined as R593/person/month.

In 2006 the Gini co-efficient (a measure of statistical dispersion intended to represent the income distribution of a population; in a situation of perfect equality, the co-efficient would equal zero) for the EC was 0.65. The Western Cape had a co-efficient of 0.58 and the national figure for the same period was 0.64. [5] This demonstrates the vast inequality that exists interprovincially, a remnant of the policies of apartheid. As of the first quarter of 2009, the unemployment rate was 28%, the highest in the country. [2] At the time of the study, 57% of the population were dependent on social grants, [4] and ~73% of the province's children lived in households with an income of

Approximately 90% of the population was dependent on public sector health services. The HIV prevalence rate among antenatal attendees was 29.3% in 2011. [7] The prevalence rate among 15 49-year-olds was recorded at 19% in 2012. [8] The province has the third highest number of new infections in the country, with an estimated annual incidence rate of 1.5%. [9]

The policy of apartheid ensured that health services in SA were segregated by race, and mainly centralised in large urban areas. [10] The homelands were underserviced. The result was an inequitable health system. This is apparent in the EC, where mental health services are disjointed and fragmented. The former homelands have poorer access to public sector mental health facilities and no private facilities. Private sector facilities are only available in the two former nodes of urban growth within apartheid SA, viz. Port Elizabeth and East London.

The province's public sector mental health facilities consist of four psychiatric hospitals (one of which is the only long-stay facility in the province; one other provides medium-to long-stay beds) and six mental health units (attached to tertiary hospitals). There are no public sector community residential psychiatric facilities, and the province has limited primary mental healthcare facilities.

There is no provincial policy on mental health. Mental health is incorporated into the general strategic plan for the entire province. In 2007, the provincial Department of Health (DoH), in filling in the World Health Organization (WHO)'s Assessment Instrument for Mental Systems (WHOAIMS) country report for SA, was unable to provide information in several domains. These included policy and plans, financing of mental health and human rights policies in domain one. In domain four there were errors in reporting of staff numbers. …

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