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State of Cape Town Report 2016
Introduction
Social
Document navigation
Economy
shortcuts
• Entries on the contents About this report
page link to the
relevant page. The State of Cape Town report is countries all over the world in
a biennial publication produced the next 15 years. Importantly
• The tabs on the
by the Development Information for cities, an urban sustainable
Make cities inclusive,
right-hand pages
and GIS Department of the City development goal has been safe, resilient and
link to the first page
of each section.
of Cape Town. The 2016 edition developed and introduced as sustainable.
Natural wealth
is the sixth, following on similar Goal 11, “Make cities inclusive,
• The title in the footer reports produced in 2006, 2008, safe, resilient and sustainable” (or
of each page links to 2010, 2012 and 2014. The report is “the urban goal”). This is highly
the first contents page designed to provide an overview significant, as it highlights and themes, namely social, economic,
of the section. of the city’s development status at embeds the importance of cities natural wealth, urban growth and
a particular point in time by giving and urban areas in the flagship form, and urban governance.
an updated snapshot of the most UN sustainable development and Additional inclusions are two
pertinent issues influencing the state international agenda, and is the short specialist inputs that are of
of Cape Town. The report highlights first time that subnational units particular importance for the City of
opportunities and challenges that feature in this way. Cape Town, namely on transversal
Urban growth
the City of Cape Town administration management and resource
• The New Urban Agenda – the
(hereinafter the City) faces, efficiency. The former supports
outcome document of the
contextualised within a broader integrated planning, alignment and
UN Habitat III conference on
context, and gives a real and current collaboration within the City, while
housing and sustainable urban
sense of the city and its inhabitants. the latter reflects the current status
development in Quito, Ecuador
of sustainability in the city. Case
The production of this report was – will be officially launched in
studies that outline cross-cutting
informed by two key contextual October 2016. It will guide a
urban development programmes
factors important to urban wide range of organisations and
and projects, as well as the
Urban governance
development in 2016: stakeholders’ efforts around
supportive tools and processes,
urbanisation over the next 20
• This is the first year in which the are presented throughout
years and will also serve as the
United Nations (UN) Sustainable the report.
foundation for policies and
Development Goals (SDGs) will
approaches that will affect urban
be officially implemented. The
areas and those active in them
SDGs follow on the Millennium For an extract of key selected
far into the future.
Development Goals (MDGs), statistics from this report,
which lapsed in 2015. The SDGs This report presents information see the accompanying
comprise 17 goals with a total and analyses on Cape Town’s overview document.
of 169 targets to be achieved by developmental context across five
Conclusion
State of Cape Town Report 2016 3
Introduction
Table of contents
About this report 3 Chapter 2: Economy 41 4. Energy 74 5.1 Access to services 102
List of figures and tables 6 4.1 Key issues 74 5.2 Urban mobility – transport in Cape Town 112
List of acronyms 8 4.2 Data, trends and analysis 75 6. Implications for Cape Town’s urban form 117
Foreword by the City Manager 10 4.3 Cape Town’s energy breakdown by sector, 2012 77 7. Future Cape Town and the New Urban Agenda 117
Acknowledgements 11 5. Biodiversity 78 8. Conclusion 118
Disclaimer/Exclusion of Claims 11 5.1 Key issues 78 Chapter 4: Urban growth and form reference list 122
5.2 Data, trends and analysis 78 Case study 124
Social
Introduction 13 6. Water quality 82
Chapter 1: Social 15 1. Introduction 42
6.1 Coastal water quality 82
Chapter 5: Urban governance 127
6.2 Inland water quality 84
2. Global trends: Headwinds for emerging economies 42
6.3 Drinking water quality 85
3. The power and responsibility of cities 43
7. Water resources and use 86
4. Cape Town’s economic growth performance 44
7.1 Key issues 86
5. The sectoral drivers of Cape Town’s economy 46
7.2 Data, trends and analysis 87
Economy
5.1 Sectors attracting the most foreign direct
8. Solid waste management 87
investment 46
8.1 Key issues 87
6. Cape Town’s labour market 48
8.2 Data, trends and analysis 88
6.1 A disproportionately low number of discouraged
work seekers in Cape Town 49 9. Future Cape Town 90 1. Introduction 128
1. Introduction 16
6.2 Youth unemployment in Cape Town 50 9.1 The future outlook for air quality 90 1.1 What is “urban governance”? 128
2. Demographic trends 17
6.3 Employment-creating sectors 52 9.2 The future outlook for energy 91 1.2 Governance within the New Urban Agenda 128
2.1 Population 17
7. Size and impact of the informal sector in Cape Town 52 9.3 The future outlook for biodiversity 91 2. Urban governance in South Africa: A high-level
Natural wealth
2.2 Households 17
9.4 The future outlook for water quality (including overview 129
2.3 Age 18 8. Leveraging strategic infrastructural assets 53
coastal water quality, inland water quality and 2.1 Driving local government transformation,
3. Health trends 19 8.1 The Port of Cape Town 54
drinking water) 91 1996 to 2016 129
3.1 Health trends in Cape Town 19 8.2 Cape Town International Airport 56
9.5 The future outlook for water resources and use 92 2.2 Evolving municipal mandates globally
3.2 Foetal alcohol spectrum disorder 24 9. Spatial characteristics of Cape Town’s economy 57 and locally 130
9.6 The future outlook for solid waste management 92
4. Education 24 9.1 Inward growth 60 3. Emerging perspectives on urban governance in
9.7 Summary 93
4.1 Literacy 25 9.2 Land value gradients and congestion 60 South Africa 131
Chapter 3: Natural wealth reference list 93
4.2 Adult education 25 9.3 What to expect up until 2020 63 4. Configuring local government in Cape Town,
Specialist analysis 94
2000 and since 132
Urban growth
4.3 Youth education 25 10. Economic outlook for Cape Town: Key emerging
Case study 96
trends 63 4.1 Internal structures, external partnerships and
5. Poverty and food security 26
10.1 Short-term outlook 63 ways of working 132
5.1 Poverty and inequality 26
5.2 Food security 28
10.2 Beyond the short term – key trends that will affect Chapter 4: Urban growth 4.2 Local government planning, policies and
implementation tools 136
6. Crime 30
industries in Cape Town 65
and form 99 4.3 Tools for improving the City’s effectiveness
Chapter 2: Economy reference list 67
6.1 Murder 31 and responsiveness 137
Case study 68
6.2 Total sexual crime 31 5. Building urban governance practice for the future 139
Urban governance
6.3 Driving under the influence of alcohol or drugs 32 6. Conclusion 142
6.4 Substance abuse 32 Chapter 3: Natural wealth 71 Chapter 5: Urban governance reference list 142
7. Future Cape Town 34
Chapter 1: Social reference list 36 Conclusion 145
Case study 38 Social 145
Economy 146
1. Introduction 100 Natural wealth 146
2. The urbanisation challenge and the role of cities 100 Urban growth and form 147
3. Sustainable urban development in South Africa 100 Urban governance 147
Conclusion
4. The Cape Town context – urban development Summary 148
1. Introduction 72 policy and strategies 101 Conclusion reference list 148
2. Cape Town’s environmental challenges 72 5. Urban growth in Cape Town – access to services Specialist analysis 150
3. Air quality 73 and urban mobility 101
Case study 152
3.1 Key issues 73
3.2 Data, trends and analysis 73
4 Table of contents State of Cape Town Report 2016 5
Introduction
List of figures
Figure 1.1: Rate of urbanisation by major area, Figure 2.10: Discouraged work seekers as a proportion of Figure 3.11: Daily water use per capita (in litres) in Figure 4.3: Household access to types of housing in
1950 to 2050 16 the broadly unemployed in South African metros, 2015 50 Cape Town, 1996 to 2015 87 Cape Town, 1996 to 2014 112
Figure 1.2: Average household size in Cape Town, Figure 2.11: Broad rate of unemployment and proportion Figure 3.12: Total waste disposed (tonnes) in Cape Town, Figure 4.4: Transport modes to travel to and from
1996 to 2011 18 of NEET (not in education, employment or training) among 2006 to 2015 88 work in Cape Town, 2009 to 2014 113
Figure 1.3: Cape Town population by age, 2002 to 2015 19 those aged 15 to 24 50
Figure 3.13: Waste minimisation (%) in Cape Town, Figure 4.5: Travel time to work* in Cape Town,
Figure 1.4: Infant mortality rate in South Africa, Figure 2.12: Sectoral employment levels in Cape Town, 2006 to 2015 91 2009 to 2014 114
2009 to 2014 20 2013 to 2015 52
Figure 4.1: Household access to basic services in Figure 4.6: Transport mode to travel to work,
Social
Figure 1.5: Causes of child death in Cape Town, 2010 20 Figure 2.13: Total containers handled (20 ft.-equivalent Cape Town, 1996, 2001, 2011 to 2014 102 by population group, 2014 114
units) in South Africa and the ports of Ngqura, Durban and
Figure 1.6: All Cape Town TB cases per 100 000 Figure 4.2: Cape Town household access to
Cape Town, 2012 to 2015 54
population, 1997 to 2014 22 telephones, 2014 106
Figure 2.14: Total passengers at South Africa’s major
Figure 1.7: Drug-resistant TB cases in Cape Town,
international airports, 2012 to 2015 56
2010 to 2013 22
Figure 2.15: Freight movement between business List of case study figures
Figure 1.8: Cape Town HIV prevalence trend, 2001 to 201323
nodes in Cape Town 57
Figure 1: Design process for City’s UN Safe City Figure 3: Screenshot of the CityMap viewer showing
Figure 1.9: Number of ART clients registered for
Figure 2.16: Employment densities in Cape Town, 2015 58 programme M&E baseline survey 39 some of the spatial tools available to all staff members 97
Economy
treatment in Cape Town 23
Figure 2.17: Building activity and gross value added Figure 1: Resource efficiency – Cape Town, 2005 to 2015 94 Figure 4: Corporate GIS vision 97
Figure 1.10: Causes of death (per 100 000 population),
in Cape Town, 2005 to 2015 58
Cape Town, 2010 24 Figure 2: Transport in Cape Town, 2012 95 Figure 1: Various stages of building developments in
Figure 2.18: Business nodal performance in Cape Town, Cape Town CBD (green: completed, yellow: under
Figure 1.11: Cape Town’s Gini coefficient, 2001 to 2014 28 Figure 3: Annual land consumption in Cape Town
2005 to 2015 59 construction, red: in planning, orange: proposed) 124
1652 to 2032 95
Figure 1.12: South Africa’s HDI trends, 1980 to 2014 28
Figure 2.19: Location potential of businesses in Cape Town, Figure 2: Visualisation of zoning rights vs. existing
Figure 1: Knowledge generation, sharing and utilisation
Figure 1.13: Food security among adults in Cape Town, 2015 59 buildings – Blouberg beachfront 125
via the Development Information Resource Centre on the
2005 to 2014 30
Figure 2.20: Industrial location potential in Cape Town, 2015 City’s Intranet (Cityweb) 96 Figure 1: The City’s transversal management system
Natural wealth
Figure 1.14: Food security among children in Cape Town, 61 structure 151
Figure 2: Role players in the City’s eGIS, at a glance 97
2005 to 2014 30
Figure 2.21: Nodal growth in Cape Town: Mixed-use, Figure 1: A screenshot of the City’s open-data portal 153
Figure 1.15: Crime rate – all reported crimes in Cape Town, commercial and industrial, 2005 to 2015 61
and trend for South Africa, 2005/6 to 2014/15 31
Figure 2.22: Nodal regeneration – redevelopment and flats
Figure 1.16: Murder rate (per 100 000) for Cape Town in Cape Town, 2005 to 2015 62 List of tables
and South Africa, 2005/6 to 2014/15 32
Figure 2.23: Urban land values and congestion in Table 1.1: Households in Cape Town, 1996 to 2011 17 Table 3.3: Breakdown of results of Cape Town beaches
Figure 1.17: Total sexual crime rate (per 100 000) for Cape Cape Town 62 meeting the 80th-percentile guideline, 2012 to 2015 82
Town, Western Cape and South Africa, 2005/6 to 2014/15 32 Table 1.2: Labour absorption rate of Cape Town’s
Figure 2.24: Expected changes to density, 2015 to 2020 64 economically active population, 2008 to 2015 19 Table 3.4: Drinking water quality in Cape Town,
Figure 1.18: Rate of driving under the influence of alcohol
Urban growth
Figure 3.1: PM10 exceedances in Cape Town following 2009 to 2015 (SANS 241 requirements per population size;
or drugs (per 100 000) for Cape Town and South Africa, Table 1.3: Cape Town infant mortality rate (IMR) trends
the United Kingdom guideline, 1995 to 2015 74 one sample: 20 000 population) 86
2005/6 to 2014/15 33 (per 1 000 live births), 2003 to 2012 20
Figure 3.2: PM10 exceedances in Cape Town following the Table 3.5: City of Cape Town major dam levels
Figure 1.19: Drug-related crime rates in Cape Town, Table 1.4: Skills needed in the 21st century 25
South African standard, 1995 to 2015 75 (in million kℓ), 2012 to 2016 87
and trend line for South Africa, 2005/6 to 2014/15 33 Table 1.5: Adult literacy levels in Cape Town, 2011
Figure 3.3: Electricity consumption in Cape Town, 2013 76 Table 4.1: Household access to piped water in
Figure 2.1: Economic growth trends in developed to 2014 25
Cape Town, 1996, 2001, 2011 to 2014 104
economies, 2008 to 2015 43 Figure 3.4: Cape Town’s economy vs electricity sales Table 1.6: Learner enrolment numbers (Grade 7, 10 and 12)
growth, 1996 to 2012 76 Table 4.2: Household access to toilet facilities in
Figure 2.2: Economic growth trends in developing in ordinary public schools in Cape Town, 1995 to 2015 26
Cape Town, 1996, 2001, 2011 to 2014 104
Urban governance
economies, 2008 to 2015 43 Figure 3.5: Energy use by sector, 2012 78 Table 1.7: Impact of rebased food, lower-bound and
Table 4.3: Household access to energy in Cape Town,
Figure 2.3: GDP annual growth rates for Cape Town and Figure 3.6: C02 emissions by sector, 2012 78 upper-bound poverty lines on poverty estimates in
1996, 2001, 2011 to 2014 104
South Africa, 1997 to 2014 44 South Africa, 2011 27
Figure 3.7: Biodiversity and city development for Table 4.4: Household access to refuse removal in
Figure 2.4: Comparison of GDP contributions of Cape Town Cape Town 81 Table 1.8: Households living in poverty in Cape Town,
Cape Town, 1996, 2001, 2011 to 2014 105
and other South African metros, 2004 and 2014 45 2012 to 2014 27
Figure 3.8: Results meeting the Department of Water Table 4.5: Cape Town household access to the
Figure 2.5: GDP per capita and GDP per-capita growth rates and Sanitation’s 80th-percentile coastal recreational Table 1.9: Indigent households in Cape Town,
internet, 2014 107
for Cape Town and South Africa, 2004 to 2014 45 guideline for Cape Town’s False Bay and Atlantic 2003 to 2015 27
coastline beaches, 1992 to 2015 82 Table 4.6: City sports and recreational facilities
Figure 2.6: Sectoral contributions to GVA growth in Table 2.1: Metro comparison of strict (official) and expanded
by type, 2016 108
Cape Town, 2005 to 2014 46 Figure 3.9: Percentage results meeting the Department of (broad) unemployment rates 50
Water and Sanitation’s intermediate-contact recreational Table 4.7: City public open spaces by type, 2014 109
Conclusion
Figure 2.7: FDI distribution by industry in Cape Town, Table 2.2: Employment and wage estimates for the informal
2003 to 2015 48 guideline for all inland aquatic systems: Annual medians sector in Cape Town 53 Table 4.8: City and provincial health-care facilities in
2000 to 2015 84 Cape Town, 2015/16 109
Figure 2.8: Employment levels in Cape Town, Table 2.3: Ranking of international flight routes by total
2008 to 2015 49 Figure 3.10(a): Total phosphorus (annual median) passenger movements 56 Table 4.9: City and provincial health-care facilities in
measured in various Cape Town wetlands, 2010 to 2015 84 Cape Town, 2015/16 110
Figure 2.9: A comparison of the strict and broad rate Table 3.1: Remaining natural vegetation in Cape Town,
of unemployment for Cape Town and South Africa, Figure 3.10(b): Total phosphorus (annual median) by type, 2015 80 Table 5.1: Number of ward councillors by term of office 132
2008 to 2015 49 measured in various Cape Town rivers, 2010 to 2015 85
Table 3.2: Breakdown of conserved land in Cape Town 81 Table 5.2: Number of subcouncils in Cape Town 133
6 List of tables and figures State of Cape Town Report 2016 7
Introduction
List of acronyms
3D three-dimensional ICDG Integrated City Development Grant (of SEZ special economic zone Development
3DCIM three-dimensional city information National Treasury) SO2 sulphur dioxide UNESCO United Nations Educational, Scientific
model ICT information and communications SPELUM Spatial Planning, Environment and Land and Cultural Organization
ACSA Airports Company South Africa technology Use Management Committee USDG Urban Settlements Development Grant
ART antiretroviral therapy ICT4D information and communications SPU Strategic Policy Unit VU vulnerable
BEPP Built Environment Performance Plan technology for development SRA special rating area WCWDM water conservation and water demand
BioNet biodiversity network IDP Integrated Development Plan Stats SA Statistics South Africa management
BPO business process outsourcing IDZ industrial development zone TB tuberculosis WCWSS Western Cape water supply system
Social
BRIC Brazil, Russia, India and China IHSF Integrated Human Settlements TCT Transport for Cape Town WDM water demand management
BRT bus rapid transit Framework TMS transversal management system WEF World Economic Forum
CBD central business district IMEP Integrated Metropolitan Environmental TOD transit-oriented development WHO World Health Organization
CCCC Century City Conference Centre Policy ToO term-of-office (plan) WMA water management area
CDS City Development Strategy IMF International Monetary Fund UCLG United Cities and Local Governments WISP Western Cape Industrial Symbiosis
CFR Cape Floristic Region IMR infant mortality rate UN United Nations Programme
CHC community health centre IPTN Integrated Public Transport Network UBPL upper-bound poverty line XDR-TB extensively drug-resistant tuberculosis
CID city improvement district IRT integrated rapid transit UNCTAD United Nations Conference on Trade and
City City of Cape Town administration IT information technology
Economy
CO2 carbon dioxide ITP Integrated Transport Plan
COGTA (National Department of) Cooperative IUDF Integrated Urban Development
Governance and Traditional Affairs Framework
Convenco Cape Town Convention Centre Company IWEX Integrated Waste Exchange
(Pty) Ltd IWM integrated waste management
CPI consumer price index LBPL lower-bound poverty line
CPMS Capital Programme Monitoring Support LPG liquid petroleum gas
(Unit) LT least threatened
Natural wealth
CR critically endangered Mayco Mayoral Committee
CSIR Council for Scientific and Industrial MDGs Millennium Development Goals
Research MDR-TB multidrug-resistant tuberculosis
CSP Cities Support Programme (of National M&E monitoring and evaluation
Treasury) MIG Municipal Infrastructure Grant
CTICC Cape Town International Convention MRC Medical Research Council
Centre MTREF Medium-Term Revenue and Expenditure
CTSDF Cape Town Spatial Development Framework
Framework NDP National Development Plan
DI&GIS Development Information & Geographic NEET not in education, employment or training
Urban growth
Information Systems (Department) NGO non-governmental organisation
DWI driving while intoxicated NMT non-motorised transport
DWS (National) Department of Water and NO2 nitrogen dioxide
Sanitation ODTP Organisational Development and
ECD early childhood development Transformation Plan
eGIS enterprise geographic information PEPFAR United States President’s Emergency
system Plan For Aids Relief
EN endangered PHASA Public Health Association of South Africa
EPWP Expanded Public Works Programme PHC primary health care
Urban governance
FASD foetal alcohol spectrum disorders PM10 particulate matter smaller than ten
FDI foreign direct investment microns in size
FNB First National Bank PMTCT prevention of mother-to-child
FPL food poverty line transmission of HIV
GDP gross domestic product PR proportional representation (councillor)
GGP gross geographic product PRASA Passenger Rail Agency of South Africa
GHS General Household Survey (conducted Province Western Cape Provincial Government
by Statistics South Africa) PV photovoltaic
GJ gigajoule QLFS Quarterly Labour Force Survey
GIS geographic information systems (conducted by Stats SA)
GNI gross national income REI4P Renewable Energy Independent Power
Conclusion
GVA gross value added Producer Procurement Programme
GWh gigawatt per hour SAPS South African Police Service
HCT HIV counselling and testing SDGs Sustainable Development Goals (of the
HDI human development index United Nations)
HIV human immunodeficiency virus SESE Survey of Employers and the Self-
HSRC Human Sciences Research Council Employed (conducted by Stats SA)
8 List of acronyms State of Cape Town Report 2016 9
Introduction
Acknowledgements
Foreword by the City Manager This State of Cape Town 2016 Management; Othelie Muller • Carol Wright on monitoring and
report was compiled by the from Solid Waste Management; evaluation support
It is my privilege to present As the City nears the completion Development Information and Jaco de Bruyn from Water and • Natasha Primo on the City of
the sixth edition of the City of its Integrated Development Geographic Information Systems Sanitation; Candice Haskins from Cape Town’s Urban Development
of Cape Town’s biennial State Plan (IDP) for the 2012-2017 (DI&GIS) Department of the City of the Stormwater & Sustainability Indicator Framework
of Cape Town report. The key term of office and prepares Cape Town and is stronger for the Branch (Transport for Cape Town), • Mark van der Merwe on the City’s
objective of this 2016 edition, for the development of a new various contributors. and Ian Gildenhuys from City spatial information portal
similar to past reports, is to five-year IDP, it is encouraging Health. Production of the chapter
Social
• Thomas Reiner on the
provide a snapshot of the city, to note positive progress as Carol Wright, Natasha Primo and was coordinated by Maxine three-dimensional city
with up-to-date information and the City provides an enabling Ameen Benjamin reviewed and Newman and Ameen Benjamin information model
analyses of the most pertinent environment for economic provided editorial input to earlier in the DI&GIS Department. • Neil Hoorn on the City’s Open
issues influencing Cape Town, growth and job creation, and drafts of the chapters and case • Chapters on the social issues
Data project
its residents and businesses. It the great strides made with key studies. Ameen Benjamin was also and concerns, the urban
highlights the opportunities and enablers such as broadband and responsible for overall project form and growth, and urban
We also thank the following City
challenges facing the city and energy management. The City’s management of the report. governance in Cape Town were
colleagues for the production of the
helps inform a range of activities transversal management system written by DI&GIS officials
two “think pieces”:
in relation to urban development supports improved delivery The DI&GIS Department would Ameen Benjamin, Sivuyile Vuyo
Economy
• Claus Rabe in Spatial Planning
for the administration, its across a range of services, like to thank the following City of Rilityane and Natasha Primo
and Urban Design for the
partners and stakeholders. including joint planning for short, Cape Town colleagues who took respectively.
specialist analysis of urban
medium and longer-term outputs of work and public housing. responsibility for the production
This report provides an overview and outcomes. This has already Through ensuring that new of the main chapters of the report: Numerous City colleagues and resource efficiency
of current urban development yielded improvements, which will integrated human settlements • Chapter on the Cape Town others also assisted in providing
• Kathryn Schneider in the Strategic
– its challenges as well as be further enhanced in the future. are located near public transport economy: Paul Court, Meagan updated and historical data or Policy Unit for an abbreviated
opportunities – in Cape Town and/or economic hubs, the City Jooste and Timothy Hadingham inputs for the various chapters – their overview of the City’s transversal
and for the City of Cape Town as In the context of rapid will continue to pursue a more in Trade and Investment; Claus contributions are all acknowledged. management system
Natural wealth
an organisation. This is viewed urbanisation, the trends revealed inclusive Cape Town. Rabe in Spatial Planning and
through the lens of population in the State of Cape Town 2016 Urban Design In addition, we acknowledge the Finally, we acknowledge the various
and social development issues, report highlight the need for Cape Town is a special place, and • Chapter on Cape Town’s natural following authors for showcasing other supportive contributions
the Cape Town economy, the city’s continued investment in key I am confident that its residents wealth: Updated inputs from specific DI&GIS initiatives and how by colleagues in the DI&GIS
natural wealth, urban growth and enabling infrastructure, and to and businesses will continue Amy Davison and Patricia Holmes these support transversal work Department and the rest of the
form, as well as urban governance, continue to work hard and ensure their hard work to together from Environmental Resource in the City: City of Cape Town.
with the theme chapters, case that its services are provided ensure that good progress
studies and specialist analyses efficiently and effectively. continues to be made to make it
offering informative insights. Critical to the sustainable a better place for all who live and Author:
development of Cape Town work here. Department of Development Disclaimer/Exclusion of Claims
Urban growth
Cape Town continues to be one will be the deepening of the Information and Geographic
Information Systems,
of the top-performing cities in transit-oriented development All efforts and due care have been including elected councillors,
Development Information Branch
South Africa and Africa. However, approach, which aims to lower taken to ensure the accuracy in the responsible for the development and
the City continues to review its travel costs and address the Photography: assembly, analysis and compilation local administration of the city.
context to find ways of improving worsening road congestion Bruce Sutherland, of data and information in this report.
Integrated Strategic Communications,
and innovating in managing along the city’s main transport Achmat Ebrahim However, the City of Cape Town is The “city” refers to the geographical
Branding and Marketing,
the persistent challenges of routes. This will be done through City Manager unable to warrant the accuracy of area that is administered by the City
City of Cape Town
unemployment, poverty, a the provision of safe and reliable the data and information, analysis of Cape Town, its physical elements,
relatively high incidence of public transport infrastructure Design and layout: and compilations contained in this as well as all the people living in and
Urban governance
HIV/Aids, and crime. and services closer to places Arc Cape Town report. Readers of this publication active within the area.
Production: are deemed to have waived and
Publication Unit, renounced all rights to any claim For readers’ convenience,
Integrated Strategic Communications, against the City of Cape Town complete source references are
Branding and Marketing Council, its officers, servants or indicated in footnotes in the
Published by:
agents for any loss or damage of chapter summaries. Thereafter,
Integrated Strategic Communications, any nature whatsoever arising from footnote references appear in a
Branding and Marketing Department any use or reliance upon such data, shortened form, accompanied by a
information, analysis or compilations. complete reference list at the end of
This document should be referenced
each chapter.
as: City of Cape Town (2016),
Information is presented at the time
Conclusion
State of Cape Town Report 2016.
of writing (May 2016), with updates © City of Cape Town 2016
Any feedback, comments or where possible.
suggestions on the report are
welcomed and can be e-mailed to
In this report, the “City” refers to the
devinfo@capetown.gov.za.
City of Cape Town administration,
10 Foreword State of Cape Town Report 2016 11
Introduction
Introduction
Cities are hubs for ideas, commerce, development and international themes of social, the economy,
culture, science, productivity, social agenda, and is the first time that natural wealth, urban growth and
development and more. There are subnational units feature in this way. form (which focuses on infrastructure
however challenges in developing and services), and urban
and maintaining cities in a way In addition, the New Urban Agenda – governance. Each thematic chapter
that continues to create jobs and being the official outcome document contains a review of the national
prosperity, without straining land of the UN Habitat III conference and local development shifts, an
and resources. Cities can overcome on housing and sustainable urban overview of the current context and
Social
their challenges and continue to development in Quito, Ecuador – will trends, and where possible, some of
thrive and grow, while improving be officially introduced in October the emerging trends, opportunities
resource use and reducing pollution 2016. It will guide a wide range of and challenges for the future.
and poverty.1 organisations and stakeholders’
efforts around urbanisation over the
This State of Cape Town 2016 report next 20 years and will also provide
is the sixth in a series produced the foundation for policies and
The purpose of this
biennially by the City of Cape Town. approaches that will still affect urban report is to outline
It seeks to provide information on, areas and those active in them far the current context
Economy
and evidence-based analysis of, the into the future. 2
current urban opportunities and of Cape Town,
challenges facing Cape Town, while This report objectively assesses providing a snapshot
also highlighting issues that need the state of development in Cape
to be kept track of and attended to Town and among its people,
of its profile and the
as the city moves forward, into the using National Census and issues, key challenges
future. The purpose of the report General Household Survey data, and opportunities
is to outline the current context of economic data from the Economic
facing the city and
Natural wealth
Cape Town, providing a snapshot Performance Indicators for Cape
of its profile and the issues, key Town (EPIC) document, the City’s its stakeholders.
challenges and opportunities facing planning, service and administrative
the city and its stakeholders. data, supplemented by other
relevant data sources. It is aimed
The production of this State of Cape at policymakers and decision- The report does not purport to
Town report was edified by key makers, senior managers and other be a comprehensive overview of
urban development informants. The stakeholders, as well as researchers all the possible components and
year 2016 is the first year in which and ordinary residents who seek aspects that may shape the future
the United Nations (UN) Sustainable information on Cape Town and Cape Town, but rather touches
Urban growth
Development Goals (SDGs) will its diverse set of development on the issues most pertinent to
be officially implemented. The opportunities and challenges. increasing economic growth and
SDGs follow on the Millennium development, advancing social
Development Goals (MDGs), which The content of this 2016 edition can inclusion and cohesion, building
lapsed in 2015. The SDGs comprise be divided into three categories: the city’s resilience and supporting
17 goals with a total of 169 targets analytical chapters covering five sustainable development. Cape
to be achieved by countries all themes, two think pieces, and case Town’s growth and change is both
over the world in the next 15 years. studies of specialised tools and a challenge and an opportunity for
Importantly for cities, an urban processes that support transversal social, institutional and economic
Urban governance
sustainable development goal has management work and activities in innovation. An attempt is made to
been developed and introduced the City. The latter two are linked to provide data for 2015 and 2016;
as Goal 11, “Make cities inclusive, the respective chapter themes. however, where 2015 and 2016
safe, resilient and sustainable” data were not available, the most
(or “the urban goal”). This is This 2016 issue builds on the 2014 recent available data were used and
highly significant, as it embeds edition, again covering the five referenced appropriately.
the importance of urban areas
in the flagship UN sustainable 2 For more information on the purpose and
proposed ideas for the New Urban Agenda, For an extract of key selected
please see UN-Habitat, 2016, World Cities
statistics from this report,
1 http://www.un.org/sustainabledevelopment/ Report 2016: Urbanization and Development –
see the accompanying
Conclusion
cities/. Emerging Futures, UN-Habitat: Nairobi.
overview document.
12 State of Cape Town Report 2016 13
Introduction
Social
Chapter 1: Social
Economy
1. Introduction 16
2. Demographic trends 17
2.1 Population 17
2.2 Households 17
2.3 Age 18
Natural wealth
3. Health trends 19
3.1 Health trends in Cape Town 19
3.2 Foetal alcohol spectrum disorder 24
4. Education 24
4.1 Literacy 25
4.2 Adult education 25
4.3 Youth education 25
26
Urban growth
5. Poverty and food security
5.1 Poverty and inequality 26
5.2 Food security 28
6. Crime 30
6.1 Murder 31
6.2 Total sexual crime 31
6.3 Driving under the influence of alcohol or drugs 32
6.4 Substance abuse 32
Urban governance
7. Future Cape Town 34
Chapter 1: Social reference list 36
Case study 38
Conclusion
14 State of Cape Town Report 2016 15
Introduction
“Cities of the developing Table 1.1: Households in Cape Town, 1996 to 2011
world will absorb
roughly 95% of the Population 1996 2001 2011
total population growth group Number % Number % Number %
expected worldwide in the Black African 168 000 25,7 251 125 32,3 444 781 41,6
next two decades.” Coloured 259 982 39,8 310 465 39,9 358 629 33,6
(United Nations, 2015) Asian 8 742 1,3 10 065 1,3 14 267 1,3
White 195 011 29,9 205 734 26,5 232 826 21,8
Other 21 350 3,3 0 0,0 18 069 1,7
Social
Total 653 085 100,0 777 389 100,0 1 068 572 100,0
Source: City of Cape Town DI&GIS Department, using all available Census data.
In the State of Cape Town 2014
report, a 20-year trend analysis
2. Demographic trends estimated at 4 004 79318.
was presented to determine 2.2 Households
1. Introduction urbanisation developments since
2.1 Population
the dawn of democracy in South The family and the household are
The South African nation comes
Economy
Historically, cities have always been the most basic socio-economic
Africa. The social inequalities from diverse cultural and ethnic
strategic sites to explore major Figure 1.1: Rate of urbanisation by major area, 1950 to 2050 institutions in society. Traditionally in
inherited from the pre-democratic backgrounds and has 11 official
issues confronting society. In the most cultures, the primary role of the
South Africa formed the baseline languages. This diverse population
21st century, the city is once again Africa Asia Europe Latin America and the Caribbean family is to raise and care for children,
for this analysis. This chapter will is characterised by eight distinct
emerging as a strategic site for Northern America Oceania and to support the ill and elderly. The
consider the latest developments factors, namely race (population
understanding some of the pertinent 3,5% role of the household and residential
since the 2014 analysis to continue group), culture, ethnicity, language,
new trends influencing the global family is also central in economic
to reflect on changes in Cape Town’s religion, class, education and
and local social order. 3 analyses, because these units are
3% demographic, health, education, politics.12 This section will reflect on
poverty, inequality and crime trends. usually the locus of joint decisions
The importance of the social the demographics of Cape Town,
Natural wealth
regarding consumption, production,
component of cities cannot be 2,5% highlighting where trends may differ
This chapter is structured as follows: labour force participation, savings
overstated. Indeed, cities cannot across population groups. Later in
and capital formation.19
succeed without the energy and 2% • Demographic trends the chapter, discussions will centre
investment of their citizens. Cities’ −− Population on education and class within the The total number of households in
success stems from their unique 1,5% −− Households context of poverty. Cape Town grew from 653 085 in
capacity to bring together a critical −− Age 1996 to 1 068 572 in 2011, 20 which
mass of social and cultural diversity.4 The South African population in
1% represents an increase of 63,6%. 21
• Health trends 2015 was estimated at 54 956 900
There seems to be a trend towards
Contrary to popular belief, global −− Health trends in Cape Town people, of whom approximately 51%
smaller household units across all
urbanisation5 and urban growth 0,5% −− Foetal alcohol spectrum (some 28,07 million) were female.13
Urban growth
population groups. In 1996, the
rates have been declining for disorders The Western Cape population in
average household in Cape Town
some time (figure 1.1). However, 0% 2015 was estimated at 6 200 100,
• Education had 3,92 members, which declined
the number of people added which constituted 11,3% of the
2015
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2020
2025
2030
2035
2040
2045
2050
−− Literacy to 3,50 in 2011 (refer figure 1.2).
to the world’s urban population country’s total population,14 having
−− Adult education
annually has been increasing Year declined slightly since 2014 when it Fertility, mean age at marriage,
Source: United Nations, 2015c: 11. −− Youth education
steadily and is expected to peak constituted 11,4% of the total South and divorce are the three main
at more than 70 million during this • Poverty and food security African population.15 The female demographic determinants
decade. 6 By 2030, about 84,6% of −− Poverty and inequality population in the province is slightly influencing household size.
growth expected worldwide in the world’s urban population.9
Urban governance
the global population will live in −− Food security higher, comprising 50,73% of the Households become less extended,
less-developed countries.7 Cities next two decades. 8 Cities are thus total population.16 The Western more nuclear and smaller as
In the early 1990s, South Africa
of the developing world will absorb vital to bring about social upliftment • Crime Cape’s population is predominantly societies industrialise and urbanise. 22
reached the urban tipping point
roughly 95% of the total population and sustainable development. −− Murder urban, mainly as Cape Town’s The Human Sciences Research
where 52% of the country’s
−− Total sexual crime population makes up a significant Council (HSRC) reviewed the factors
The pace of urbanisation in Africa population were urban. This
−− Driving under the influence of portion of the provincial population.
3 Saskia, 2010. has recently accelerated (figure 1.1). increased to 64% in 2014, and by
alcohol
4 Republic of South Africa, 2014a: 75. Although this is expected to again 2050, it is projected that 77% of Cape Town is ranked as the tenth 18 City of Cape Town, DI&GIS Department, using
5 Although there are different definitions for −− Substance abuse StatsSA 2016 Community Survey data.
urbanisation, it is generally accepted to
decrease gradually in the coming the population will be urban.10 The most-populous city in Africa.17 19 Bongaarts, 2001.
involve a shift in population from rural to decades, Africa is expected to be advent of South Africa’s democracy • Future Cape Town In 2016, the city’s population was 20 Stats SA defines a household as “a group
urban settlements. From a demographic the fastest-urbanising region from in 1994 saw the end of the repressive of persons who live together and provide
perspective, the urbanisation level is best
2020 to 2050. By 2050, the urban apartheid control policies, which themselves jointly with food or other
Conclusion
measured by the urban population share essentials for living, or a single person who
(of total population), while the urbanisation
population of Africa will have likely facilitated a recovery in the rate
12 Benjamin, 2014. lives alone”.
rate represents the rate at which that share is tripled to account for 21% of the of urbanisation.11 13 Stats SA, 2015b. 21 The Stats SA Community Survey 2016 was
growing. See McGranahan and Satterthwaite, 14 Ibid. being conducted at the time of writing. When
2014. 9 United Nations, 2015c. 15 City of Cape Town, 2014. available, the results will allow the number of
6 McGranahan and Satterthwaite, 2014. 10 Ibid. 16 City of Cape Town, 2015. DI & GIS households and average household size in
7 United Nations, 2015a. 8 United Nations, 2015b. 11 Turok, 2012 Department, using StatsSA data Cape Town to be updated.
17 UN-Habitat, 2014. 22 Bongaarts, 2001.
16 Chapter 1: Social State of Cape Town Report 2016 17
Introduction
responsible for the reduction in Table 1.2: Labour absorption rate of Cape Town’s economically active population, 2008 to 2015
household sizes throughout South Figure 1.2: Average household size in Cape Town, 1996 to 2011
Africa. Their review revealed that a B lack Coloured Asian White Other Total 2008 2009 2010 2011 2012 2013 2014 2015
African Labour
combination of interrelated legal, 54,20% 52,50% 50,80% 51,80% 51,30% 50,80% 51,70% 53,30%
6 absorption rate
economic and social processes have
contributed towards this trend since Source: Stats SA Quarterly Labour Force Survey, 2008 to 2015.
1994. These involve greater legal 5
protection and social acceptance active population. However, it also
of youth and women claiming displays the impact of the economic Figure 1.3: Cape Town population by age, 2002 to 2015
4
rights to housing, the emergence recession from late 2008 to the
Household size
of a powerful youth culture driving
Social
end of 2009 on the economy, and a 0-14 15-64 65+ Total
modern aspirations, the cumulative 3 degree of recovery since then. 4,500,000
effects of high unemployment, and
women’s earning power eroding The high ratio of potential workers to 4,000,000
2
patriarchal values and changing the dependants holds possible benefits
for Cape Town’s economy – a so- 3,500,000
nature of the institution of marriage. 23
called “window of opportunity”
Population numbers
1
3,000,000
Cape Town’s average household for accelerated economic
size (figure 1.2) is below that of development. 31 If the population 2,500,000
0
developing countries (five members) continues to age, however, there will
Economy
1996 2001 2011
and is moving closer to that of many be a negative impact not only on the 2,000,000
Census years
developed countries (two to three Source: City of Cape Town DI&GIS Department, using all available economy, government and pension 1,500,000
members). This is already the case in Census data. expenditure, but also on health care,
certain population groups, notably the social services, housing and the 1,000,000
white and black African groups (with family32 – especially for low-income
baby boomer generation redefines 25
500,000
the former averaging at around 2,5 and indigent families who depend
what it means to grow older. Coupled
and the latter at 3,25 in 2011).
with the younger generation’s Cape Town’s on the state for support. 0
obsession with body image, 26 this average household
Although the trend of smaller
3. Health trends
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Natural wealth
renewed interest in living better
household sizes may be viewed
(and perhaps longer – see discussion
size is below that of
as positive, it does pose certain South Africa’s health profile Source: Stats SA mid-year estimates, 2002 to 2015.
challenges to Cape Town, as to on life expectancy under section 3 developing countries
reflects the historical challenges
other South African metros and below) may change the age profile in (five members) associated with its economic and
developing-country cities. These the decades to come. 3.1 Health trends from 25,2 to 16,4 (per 1 000 live
include the increased demand for
and is moving geographical disparities. South
in Cape Town births) (refer table 1.3).
The demographic trend for South Africans experience an increasing
housing supply to accommodate
Africa and the Western Cape
closer to that of number of non-communicable Areas with low socio-economic status
a) Infant mortality rate in
the trend, with the consequent
indicates an ageing population27 many developed diseases associated with age and
Cape Town 36
display a higher IMR than those with
increase in housing prices; increased lifestyle, while communicable high socio-economic status, 38 which
competition for scarce urban land
across all population groups. 28 This countries (two to The infant mortality rate (IMR) 37 confirms that socio-economic and
Urban growth
pattern is also evident in Cape Town. diseases (mainly the Human
for new housing developments, three members). Immunodeficiency Virus (HIV) and is a key indicator of health environmental factors contribute
and the breakdown of the extended The proportion of children (0 to 14 Tuberculosis (TB)) also remain and development in a society. to the root causes of infant deaths.
family, which is often considered a years) in Cape Town decreased from paramount concerns. 33 It is associated with a broad Gastroenteritis and pneumonia are
powerful social support network. 29,10% in 2002 to 26,18% in 2015 Town decreased during this period range of social, economic and common causes of infant deaths,
(see figure 1.3). In the same period, from 0,50 to 0,48. Life expectancy at birth in South environmental factors, which are particularly among the black African
2.3 Age the percentage of the population Africa increased from 61,2 years in also indicative of the health status and coloured population groups.
who are economically active (15 to According to the UN classification, 2012, to 62,2 years in 2013, to 62,9 of the broader population. Many infant deaths are directly
Ageing is not what it used to be. 64 years) increased from 66,58% to Cape Town’s population has moved years in 2015,34 which represents an attributable to the effects of bad
Emerging movements such as “slow towards the upper end of a mature annual rate of increase of 0,57 years. The IMR in South Africa significantly
67,73%, while the aged population
Urban governance
sanitation, poor nutrition, inadequate
living” and “ageing reinvented” are or intermediate-aged population. A At this rate, the National Development reduced from 2009 (39,0) up to 2012
(65 years and above) grew from water supply, poor housing,
new societal trends that will redefine population is considered mature or Plan (NDP) vision of 70 years for life (27,0), but had increased slightly
4,31% to 6,09%. However, the total overcrowding and poverty. 39 A key
the way we live, work and play. 24 of intermediate age if 4 to 7% of the expectancy by 2030 is very likely to by 2014 (28,0), although it was still
age dependency ratio29 for Cape factor in the significant reduction
“Slow living” advocates a cultural population are aged 65 and above. be achieved. The Western Cape has significantly lower than in 2009
in the IMR, especially in areas of
shift towards slowing down in a the highest life expectancy at birth (figure 1.4). This downward trend is
25 The baby boomers are those born during
Of the economically active (15 to low socio-economic status, is the
fast-living culture. This movement the post-World War II baby boom, between
(68 years),35 which is very close to also seen in Cape Town, where there
64 years), 53,30% were absorbed improvements in basic service
is associated with a desire to lead approximately 1946 and 1964. In 2016, this
achieving the NDP 2030 vision. was a clear trend towards a decrease
would include those between 52 and 70 years into the economy in 2015. Although delivery to these areas.
healthier lives and explore healthier in the IMR in the Cape metro
of age. See Wikipedia, 2016.
ways of eating, living and consuming 26 Ngubane et al., 2016.
this increased from 2009, when the between 2003 and 2012, dropping Exclusive breastfeeding in the first six
products that relieve modern man 27 Population ageing refers to declining labour absorption rate30 was 52,50%, months of an infant’s life provides all
from the relentless pace of busy lives proportions and numbers of children, it has still not recovered to the 2008 36 IMR and causes-of-death data cannot be
the nutrients that they need to grow,
Conclusion
increasing proportions and numbers of older updated due to the Medical Research Council’s
and fast-evolving technology. In the level of 54,20% (refer table 1.2). This and further strengthens their immune
persons, and rising median ages. inability to access death certificates, as
reinvention of ageing, in turn, the 28 City of Cape Town, 2014.
reflects that Cape Town’s economy explained under paragraph (b), “Child deaths”. systems. However, modern lifestyles,
29 The World Bank defines the age dependency is not growing fast enough to 31 Haldenwang, 2011. 37 The IMR is defined as the probability of dying with many mothers pursuing careers,
ratio as the ratio of dependants (people younger support the increasing economically 32 Roux, 2013. within the first year of life. It refers to the
than 15 or older than 64) to the working-age 33 Republic of South Africa, 2016. number of babies below 12 months of age who
23 Cross et al., 2005. population (those aged 15 to 64). http://data. 30 This is the percentage of the working-age 34 Republic of South Africa, 2015, 2016. die within a year, per 1 000 live births during 38 See City of Cape Town, 2014.
24 O’Brien, 2016. worldbank.org/indicator/SP.POP.DPND. population in employment. 35 Republic of South Africa, 2016. the same year. See Nannan and Hall, 2014. 39 Chetty, 2003.
18 Chapter 1: Social State of Cape Town Report 2016 19Introduction
Table 1.3: Cape Town infant Most child deaths are
mortality rate (IMR) trends (per Figure 1.4: Infant mortality rate in South Africa, 2009 to 2014
caused by diseases that
1 000 live births), 2003 to 2012 45
are readily preventable
Year Cape Town IMR 40 or treatable.
2003 25,2 35
2004 23,7
30
Infant Mortality Rate
2005 22,3
2006 21,4 25
2007 20,0
Social
2008 19,8 20
2009 20,8 15
2010 20,1
10
2011 15,6
2012 16,4 5
Source: Medical Research Council 0
(MRC), 2013.
2009
2010
2011
2012
2013
2014
Economy
do not always allow for breastfeeding. Year
Infant formula as a substitute does Source: Dorrington et al., 2015.
however not contain all the essential
nutrients or antibodies to protect
children from diarrhoea, pneumonia or Figure 1.5: Causes of child death in Cape Town, 2010
malnutrition. Many maternity facilities Diarrhoea 13%
across Cape Town provide antenatal
workshops where breastfeeding
Deaths before
is encouraged as a first choice. In
age 1 month
Natural wealth
addition, health practitioners also
34% Pneumonia 10%
encourage breastfeeding among
their antenatal patients.
b) Child deaths HIV/Aids 4%
Most child deaths are caused by
Septicaemia 2%
diseases that are readily preventable
Meningitis 2%
or treatable. Globally, infectious Tuberculosis 1%
diseases and neonatal complications
are responsible for the vast majority
Urban growth
Neonatal conditions Injuries 10%
of deaths below the age of 5.40 > 1 m 8%
Internationally, there has been Congenital 3%
steady progress in reducing the Malnutrition 2% Other 11%
under-5 mortality rate, with the
Source: MRC, 2013.
annual rate of reduction having
increased from 1,8% in the period
1990-2000 to 3,9% in the period 10,3% between 2006 and 2011 (the The main causes of child deaths
2000-2015. Sub-Saharan Africa, fourth fastest rate of decline globally). during 2010 in Cape Town (figure
Urban governance
the region with the highest under-5 1.5) include diarrhoea (13%), other
This decline is largely attributed to
mortality rate in the world, also saw illnesses (11%), pneumonia (10%) and
the programme for the prevention of
a significant improvement in the rate injuries (10%).44 The data for causes
mother-to-child transmission (PMTCT)
of reduction from 1,6% in the 1990s of child deaths in Cape Town were
of HIV, improved immunisation
to 4,1% in the period 2000-2015.41 previously generated by the Medical
rates to protect children against
Research Council (MRC). However,
Although South Africa did not meet vaccine-preventable diseases such
the National Department of Home
its MDG target of reducing deaths per as diarrhoea and pneumonia, and
Affairs has introduced certain law
1 000 live births to 20 by 2015 (based vitamin A supplementation, which
on projections),42 it has however has decreased vitamin A deficiencies.
significantly improved its child health South Africa is one of only a few
countries that have introduced
Conclusion
and under-5 mortality rate. The latter
declined by an annual average of rotavirus and pneumococcus vaccines
to reduce the incidence of, and death
due to, diarrhoea and pneumonia
40 UN IGME, 2015.
41 Ibid.
in children.43 44 Death before the age of one month as a
42 Haldenwang, 2015. The author used 2013 data category, although the highest proportion in
for her 2015 projection. 43 Republic of South Africa, 2014b. the graph, is not a cause of death in itself.
20 Chapter 1: Social State of Cape Town Report 2016 21Introduction
amendments,45 which now prohibit HIV/Aids is the leading cause of
access to medical certificates, except Figure 1.6: All Cape Town TB cases per 100 000 population, 1997 to 2014 Figure 1.8: Cape Town HIV prevalence trend, 2001 to 2013 premature mortality in Cape Town. 53
for Stats SA. Therefore, the MRC 900 According to the annual antenatal
25%
was unable to generate more recent survey, overall HIV prevalence in
877
874
868
800
848
835
data. Stats SA’s report on mortality Cape Town is plateauing, although in
815
673
800
638
and causes of death only presents 700 some areas, this still occurs at a very
752
20%
581
706
a national overview of the causes of high level. The 2013 antenatal survey
562
530
HIV prevalence (%)
663
600
520
521
Number of cases
death for the under-5 group. showed an HIV prevalence of 19,7%
631
500 15% in the city (figure 1.8).
c) Tuberculosis
There was a general increase in 400 The significant increase in HIV
Social
TB cases and incidence from 1997 prevalence up to 2011 was in part
10%
to 2014 in Cape Town (figure 1.6). 300 due to the large number of people
From 2010 to 2014, however, a receiving antiretroviral therapy
200
downward trend started to emerge. (ART) (figure 1.9), enabling them to
5%
This downward trend is consistent 100 live longer with the virus, thereby
with global and national TB trends. increasing the total number of
0 people living with HIV. Access
In Cape Town, data reveal that the 0%
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
number of HIV-positive TB cases, to ART has continued to expand.
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
which previously increased, is now The eligibility criteria for ART
Economy
Year commencement have become
falling. Substantial improvements in Year
Source: City of Cape Town, Health Directorate, 2016. increasingly inclusive, and the latest
TB outcomes have been achieved in Source: South African National Department of Health, 2015.
the past number of years. guidelines released in 2015 have
expanded access to HIV-positive
In spite of these improvements, Figure 1.7: Drug-resistant TB cases in Cape Town, 2010 to 2013 Figure 1.9: Number of ART clients registered for treatment in Cape Town persons with a CD454 count of below
however, the following factors continue MDR XDR 120 000 500, women with HIV within one
to fuel the TB epidemic in Cape Town: 1400 year post-partum, regardless of
infant feeding choice, as well as HIV-
• Poverty 100 000
infected partners in serodiscordant 55
Natural wealth
1200
Urbanisation, with resultant
Total number of ART clients
•
159 122 couples. However, maintaining an
overcrowding
1000 151 178 80 000 increasingly large number of people
• Damp, poorly ventilated houses/
on lifelong ART does pose certain
Number of cases
shacks
800 challenges, with available staff and
• High HIV prevalence 60 000
infrastructure struggling to cope.
• Clients presenting or being
identified late in the course of 600
40 000
Strategies that address the HIV
the disease (having potentially 898 901 987 1006 epidemic need to consider
infected many others before 400 the broader issues of poverty,
treatment starts) 20 000 discrimination, alienation, the
Urban growth
• Some clients never starting 200 separation from the family, and
treatment, or interrupting the breakdown of established
0
treatment (defaulters) 0 community and social networks,
2010 2012 2011 2013
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
• Substance abuse Year along with the broader goal of
• Smoking Source: City of Cape Town, Health Directorate, 2016. building social capital.
Year
Particular challenges are Source: City of Cape Town Health Directorate, 2016. City Health, along with the national
experienced in areas with high throughout the city, but also to TB and requires the use of second- and provincial departments of health
case loads and high dual infection develop enhanced responses in the line anti-TB drugs, which are and the United States President’s
d) HIV/Aids Historically, the Western Cape
Urban governance
rates, such as Khayelitsha and parts high-burden areas. New challenges more expensive and have more Emergency Plan For AIDS Relief
Although South Africa has more has always been the province with
of the Klipfontein, Eastern and have also arisen with the emergence side effects.46 The diagnosis of (PEPFAR), is currently in the planning
people living with HIV than any other the lowest prevalence rates in the
Mitchells Plain health sub-districts. of drug-resistant strains (multidrug- drug-sensitive and drug-resistant stages of implementing the UNAIDS
country, the number of new infections country.51 In 2005, the Western Cape
In Khayelitsha, the TB incidence resistant (MDR) and extensively TB has been enhanced by the strategy of “90-90-90”. UNAIDS
almost halved from 0,6 million in passed the early phase of the HIV
is a high 1 165 per 100 000. The drug-resistant (XDR) – refer figure roll-out of a new diagnostic test postulates that if by 2020, 90% of
2000 to 0,34 million in 2014, thereby epidemic, which was characterised by
challenge is not only to maintain 1.7), which poses difficulties in called GeneXpert.47 GeneXpert those with HIV are diagnosed, 90%
meeting the MDG target. However, an exponential growth in prevalence.
efforts to combat the TB epidemic service delivery as well as clinical is a molecular test for TB that of these are retained in care on ART,
South Africa still has the fourth Thereafter, prevalence rates began to
and ethical issues. The treatment diagnoses the disease by detecting and 90% of these are on effective
45 The registration of deaths in South Africa highest HIV prevalence rate49 in the stabilise, with a slight decrease in 2012
falls under the mandate of the Department of and management of patients the presence of TB bacteria as compared to 2011 figures. The 2013
world, having increased from 15,6%
Home Affairs and is governed by the Births with drug-resistant TB has been well as testing for resistance to the HIV prevalence rate for the province
53 Medical Research Council’s Western Cape
in 2002 to 18,8% in 2013, which failed Mortality Profile 2011, referenced in City
and Deaths Registration Act 51 of 1992. decentralised to primary health-care commonly used drug Rifampicin.48
Conclusion
Although the act itself was last amended in to meet the MDG target.50 was 17,1%, 52 which was lower than of Cape Town, 2015b.
2010, its accompanying regulations were
level since 2010. the 2010 rate of 17,3% and suggests a 54 CD4 cells (sometimes called T-cells,
T-lymphocytes, or helper cells) are white blood
revised in 2014. The death notification form
The treatment of both MDR- and downward trend.
used to register deaths in South Africa 49 The HIV prevalence rate in selected cells that play an important role in the immune
provides legal evidence of death and is used XDR-TB takes substantially longer 46 WHO, 2012. populations refers to the percentage of system. See Carter and Hughson, 2014.
to compile national statistics on mortality and than ordinary (drug-susceptible) 47 City of Cape Town, 2015b. people tested in each group who were found 51 See City of Cape Town, 2014. 55 Also known as magnetic or mixed-status,
causes of death. See Stats SA, 2014. 48 Kanabus, 2016. to be HIV-positive. 52 South African National Department of Health, “serodiscordant” refers to a couple of which
50 Haldenwang, 2015. 2015. one partner is HIV-positive and the other is not.
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