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ISDS Site: Oliver Thambo District MunicipalityThe OR Tambo District Municipality (ORTDM) is located in the eastern part of the Eastern Cape province, along the scenic Indian Ocean. ORTDM is one of the poorest district municipalities in South Africa and is beset by huge backlogs in infrastructure and problems related to poverty and underdevelopment, inherited from the apartheid era, when the geographical area that now forms the new ORTDM was part of the former Transkei homeland. The ORTDM incorporates seven local municipalities and is subdivided into four health local service areas (LSAs). The population of ORTDM is 1.8 million people, with an average population density of 114 people per square km. Some 65% of the people are unemployed, 49% do not have access to sanitation and 77% do not have a safe water source. Apart from a few facilities in Umtata, all primary health care facilities are provincially run. The majority of health care facilities have no water or electricity. Shortage of doctors is a major problem affecting the quality of care in the district hospitals. The main health problems are TB, HIV/ AIDS, STIs and poor maternal and child health (which includes malnutrition). ISDS interventions in ORTDM include
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