Chapter 5 Methodology Methodology
5.1. Study Location
Chapter 5
District population by municipality. This district comprises the following five local municipalities: Ingwe, Ubuhlebezwe, Greater Kokstad, Kwa Sani and Umzimkhulu.
Figure 5.1 below provides a visual map of Sisonke District. The majority of this district’s population, about 96.7%, using classification according to historical population group, are black Africans. Table 5.1 provides a detailed population breakdown of this district, by municipality, as adapted from Statistics South Africa (2011b). Statistics further indicate that 62.7% of Sisonke District’s population speaks isiZulu as their first language, followed by those who speak isiXhosa (28.6%), English (3.2%), Afrikaans (1.3%) and Other (4.8%) (Statistics South Africa, 2011a).
Table 5.1: Population estimates of Sisonke District by municipalities Municipalities Population Estimate %
1. Umzimkhulu 180 302 39.1%
2. Ingwe 100 548 21.8%
3. Ubuhlebezwe 101 691 22.0%
4. Greater Kokstad 65 981 14.3%
5. Kwa Sani 12 898 2.8%
Total 461 420 100%
Source: Harry Gwala District Municipality (2016)
Figure 5.1: A map of Sisonke District
Source: Harry Gwala District Municipality (2016)
Sisonke District is predominantly a rural area characterised by a high unemployment rate, agriculture forms the bedrock of its economy, and the most prominent employment sectors are agriculture, construction and small-scale farming (The Local Government Handbook, 2015). The district’s Health Development Plan states that the unemployment rate, in 2014, was at 36% and the majority of people earned below R283 per month (Harry Gwala Health District Plan, 2014). The unemployment rate in this district is particularly high among youth (those between the ages of 15 – 34). However, the Sisonke District Municipality (2014) reports that the district has embarked on a number of programmes to alleviate this situation. For example, the district has offered bursaries to needy students for them to be able to attend tertiary institutions and has encouraged learners to pay more attention to scarce skills like engineering. In 2013 a significant number of students from the district were sent to Cuba to study medicine. According to the Harry Gwala Health District Plan (2014), the majority of those people who are employed in Sisonke District are employed in farms, sugar plantations and supermarkets, and those who qualify for social grants are able to complement their low wages. A large number of the district’s settlements have no adequate access to basic services. There are only two general hospitals in Sisonke District situated at Greater Kokstad (E.G. Usher Memorial Hospital) and Ingwe (St Apollinaris District Hospital) Municipalities, and one psychiatric hospital (Umzimkhulu Psychiatric Hospital) located at Umzimkhulu Municipality. A few clinics and mobile teams also provide health services in this district. However, of note is that prior to having a designated psychiatric hospital in Sisonke District, mental health services were provided by psychologists and psychiatrists who visited once or twice a month from other districts. Intermittently there have been clinical psychology services provided at Usher Memorial Hospital.
5.1.1.1. Greater Kokstad Municipality.
The sample for this study was drawn from only two municipalities within Sisonke District namely, the Greater Kokstad and Kwa Sani Municipalities.
Information from Statistics South Africa (2011b) indicates that Kokstad lies on the south-west tip of KwaZulu-Natal and is bordered by Matatiele Local Municipality on the west, and Lesotho and part of the Eastern Cape on the north-west. This municipality is considered to be the commercial centre in the Sisonke District. The then Mayor of Greater Kokstad Municipality acknowledged in the Reviewed
Integrated Development plan of 2008/2009 that this municipality was faced with numerous challenges such as a high percentage of low income earning households, service backlogs in the provision of water and sanitation, and housing demand for formal housing, to mention only a few (Greater Kokstad Municipality, 2008). Although in a subsequent review of 2012 – 2017 problems such as unemployment, challenges of the provision of water and sanitation, and the high percentage of low income earning households were still a concern, an increase in availability of and access to high quality amenities such as education, training, medical, recreational and cultural facilities was reported (Greater Kokstad Municipality, 2012). Statistics South Africa (2011b) reported an improved scenario whereby the majority of households (85%) in Greater Kokstad Municipality reside in formal dwellings and approximately 36% of residences are owned and fully paid off. However, the Harry Gwala Health District Plan (2014) shows that these dwellings are mainly composed of low cost houses. Approximately 98% of households have access to piped water from either inside the dwelling, inside the yard or from water supplied on a community stand. Only 7.4% of the population in Greater Kokstad Municipality is reported to speak isiZulu as their first language while the majority of the population speaks isiXhosa (69.5%), followed by those who speak English (8.6%), Afrikaans (6.1%), Sesotho (4.2%) and those who speak other languages (4.2%) (Statistics South Africa, 2011b).
5.1.1.2. Kwa Sani Municipality.
According to Statistics South Africa (2011b), Kwa Sani Municipality is located at the foothills of the southern Drakensburg, and is bordered by Umkomazi Wilderness area to the west, Greater Kokstad to the south-west, Ingwe Local Municipality to the east, and Impendle Local Municipality to the north. This municipality has the smallest population in Sisonke District, and the residents of the district live in both rural and farm areas (Harry Gwala Health District Plan, 2014).
About 67.5% of households in this municipality live in formal dwellings and only 37.9% of dwellings are owned and fully paid off. This district is characterised by high levels of illiteracy and unemployment, poor condition of school buildings and limited access to water and sanitation. Regarding education, approximately 13%
of the Kwa Sani population have no formal schooling, 35% have some primary schooling, 29% have some secondary schooling, 17% obtained their grade 12 certificate and only 6% have attained a tertiary level of education (Kwa Sani
Municipality, 2011). Only 41% of the Kwa Sani population is employed, and of those that are employed 17% earn less than R400 per month, and 6% earn between R400 and R800 per month (Kwa Sani Municipality, 2016). The agriculture and tourism sectors are the major economic drivers of Kwa Sani Municipality. To promote agriculture and tourism, the municipality has initiated the following programmes:
support of commercial production of vegetables; livestock owners’ day celebration; tourism month flagship programme; Duzi 2 Sani 4X4 Expedition; Kwa Sani intercultural food tasting expo; handcraft promotion, as well as other efforts geared towards the improvement of informal trade (Kwa Sani Municipality, 2016).
Statistics South Africa (2011b) also indicates that in Kwa Sani Municipality less than 42.9% of households have access to piped water from inside the dwelling, inside the yard or from a community stand and, according to The Local Government Handbook (2015), approximately 44% of households are headed by females. About 75% of the community has access to electricity and 43% have access to refuse removal services (Kwa Sani Municipality, 2016). Regarding first language spoken at Kwa Sani Municipality, 79.3% of the population speaks isiZulu followed by English (10.2%), isiXhosa (2.3%), Sesotho (1.6%) and 6.6% is accounted for by other languages (Statistics South Africa, 2011b). According to the Harry Gwala Health District Plan (2014), this municipality does not have a hospital or community health clinic (CHC) but has two smaller clinics, Underberg Clinic and Tsatsi Memorial Clinic. These clinics are situated in Underberg and Mqatsheni, respectively. The Underberg Clinic has a maternal and obstetric unit and its location makes it possible to attract a high volume of patients as it is situated close to the taxi rank. People residing in the far rural areas of this district have difficulties in accessing clinic services due to the lack of transport facilities, and those who reside in the northern region of the municipality use the clinic in Impendle Municipality as it is closer to them than Underberg (Kwa Sani Municipality, 2016).
There are, however, no specialised mental health services offered in this municipality.