Keypoints:
- Under-five mortality has fallen to 28.6 per 1,000 live births
- Malnutrition remains the biggest threat to progress
- Community health workers are central to prevention efforts
OVER the past two decades, South Africa has achieved a significant public health milestone. Sustained investment in maternal and child health has sharply reduced child mortality, saving thousands of young lives. Yet that progress now faces a serious threat: malnutrition.
According to the Nelson Mandela Children’s Fund Baseline Report, 2025, under-five mortality declined to 28.6 per 1,000 live births in 2024. South Africa’s Child Death Review consistently shows that focused healthcare interventions and social protection policies deliver measurable impact.
This decline has been driven by improvements in healthcare access and quality, expanded vaccination coverage, stronger health information systems, and social support such as the Child Support Grant. Community-based interventions have reinforced these efforts, particularly in underserved and rural areas.
The evidence is clear: sustained commitment works.
A fragile trajectory
In his 2026 State of the Nation Address, President Cyril Ramaphosa recommitted government to ending child stunting by 2030. He highlighted the importance of tackling malnutrition in early childhood and prioritising the first 1,000 days of life, including targeted support for pregnant women and low birth-weight infants.
Early intervention shapes lifelong outcomes.
However, child mortality levels remain too high. Poverty and inequality continue to determine health outcomes long before birth. The lingering effects of Covid-19, alongside preventable conditions such as diarrhoea, pneumonia and HIV-related infections, still threaten young lives. Above all, malnutrition remains the single greatest risk to reversing two decades of progress.
Government and partners are strengthening the prevention and management of Severe Acute Malnutrition. But policy frameworks alone do not save lives. Implementation capacity, community trust and sustained funding do.
The frontline role of community health workers
Through its Child Survival, Development and Thriving programme, the Nelson Mandela Children’s Fund supports pregnant women, infants and children up to five years old. The programme operates at household level, delivering responsive services during the critical first 1,000 days.
Services include growth monitoring, exclusive breastfeeding support, maternal mental health services, nutrition counselling, pre- and post-natal care, and early childhood development guidance. The objective is not merely survival, but long-term wellbeing.
In 2025 alone, more than 15,000 children, mothers and caregivers were reached across five provinces. From farms to rural villages, community health workers ensure immunisations are completed, growth is monitored, and vulnerable children are identified early.
At the centre of this approach are 55 highly trained community healthcare workers. They are trusted members of the communities they serve. By visiting families at home, identifying early warning signs and supporting young mothers directly, they often prevent deterioration before it becomes life-threatening.
Research conducted by the University of Zululand and Humana People to People reinforces the effectiveness of community-based health education, showing improved outcomes and greater accountability at local level.
Scaling what works
Community dialogue remains essential. In Mpumalanga, mothers have engaged in discussions on exclusive breastfeeding. In KwaZulu-Natal, conversations have focused on father involvement in early childhood. A third dialogue on family-level food insecurity brought together nearly 300 participants, informing programme design and strengthening ownership.
Families report improved knowledge on nutrition and early learning, stronger support systems for pregnant women, and more stable caregiving environments. Clinic committees are increasingly engaged. Community safety nets are strengthening.
Over the first five years of its 30-year strategy, the Nelson Mandela Children’s Fund aims to move at least five percent of children below the food and intermediate poverty lines into the upper-bound poverty line. The priorities are clear: reduce child poverty, combat malnutrition, prevent violence, and increase the proportion of healthy children under six.
South Africa has already demonstrated that child mortality can be reduced. The question now is whether the country will act decisively to protect those gains.
Ending child stunting by 2030 will require sustained funding for community health workers, stronger integration of nutrition into economic policy, meaningful father involvement, and a direct confrontation with poverty as a structural driver of ill health.
Children must come first — not as rhetoric, but as measurable national policy.
Shadi Nyokong is the CSDT Programme Manager, Nelson Mandela Children’s Fund
