The social security system is failing hundreds of children in one of the poorest regions of South Africa. Children hospitalised for severe malnutrition are being discharged simply to face starvation again as their child support grants fail to materialise, despite several applications being lodged.

The Public Health Programme of the University of the Western Cape (UWC) in collaboration with the Health Systems Trust (HST) have been working in the Mt Frere district in the Eastern Cape (one of the poorest health district in the country) for several years and have successfully implemented the World Health Organisation’€™s 10-Steps treatment guidelines. This has led to a sharp reduction in the number of children dying from severe malnutrition in the hospital wards of the district.

Since implementing the guidelines, a field researcher from the UWC/HST project has been conducting follow-up home visits of those children who were discharged from the hospital wards. The purpose of these visits was to find out what happens to these children and to assess their home and social situation.

Results from the first round of home visits to 30 households suggested that many of the children who have survived the threat of severe malnutrition and have been rehabilitated in hospital, are discharged only to go straight back into an environment of extreme poverty.

The mean household income is R534 per month, usually in the form of an old age pension. None of the children are receiving a child welfare grant, although all qualify.

About 90% of the homes are mud and thatch, 85% use a pond or river for water and 80% don’€™t have a toilet of any type.

Out of 13 staple items expected in a food cupboard, only two were found in more than half of the cupboards at the time of the home visit (mealie meal 80% and tea/coffee 75%). Two families had none of the items. Other staple items on the list include samp, beans, flour, soup, sugar, eggs, rice or milk.

Between 150 and 200 children are being admitted per year for malnutrition at Mary Terese (Mt Frere) and Sipetu hospitals. Between 63% and 75% of these admissions could be directly linked to lack of food in the household and none of these children had a child support grant at the time of admission.

Some of the barriers to accessing the child support grant were:

In some villages government officials have come to help residents to prepare the required documentation ‘€“ however, no one in the village reported having successfully secured a grant. One mother had been waiting for nearly a year.

In some situations, the caregivers were simply unable to pay for the transport to get to the relevant government offices.

Furthermore, on some occasions, having spent money to get to the office, they are then requested to come back another time.

The Child Support Grant was denied because the surname of the child on the Road to Health Card was not the same as the caregiver’€™s, a situation that is common when the primary caregiver is the grandmother.

The Child Support Grant was denied because the child did not have a birth certificate, despite caregivers having applied for it.

Professor David Sanders, head of the Public Health Programme at UWC said “It is clear that these issues have become close to infringing on human rights”.

He said “it is the infringement of the Constitutional rights of children”.

Section 28 (1) of the Constitution provides that a child has the right, among others:

to family care or parental care, or to appropriate alternative care when removed from the family environment;

to basic nutrition, shelter, basic health care services and social services;

to be protected from maltreatment, neglect, abuse or degradation;

to be protected from exploitative labour practices.

Section 27 (1) gives “everyone” the right ” to have access to: (among other rights)

(c) social security, including if they are unable to support themselves and their dependants, appropriate social assistance.”

The Alliance for Children’€™s Entitlement to Social Security (ACESS) confirmed that: “Less than 10% of children who are targeted are receiving grants and this is partly because of documentation problems, difficulty in accessing the system, the offices, the process and so on.”

ACESS spokesperson Teresa Guthrie urged national government to ring-fence the grant budget so it cannot be spent on other things, to increase the allocation, especially to the poorer provinces, to extend coverage to 18 year olds and to increase the amount as R110 is insufficient. “The government has a Constitutional obligation to make the resources available,” she said.