Transcript The District Health Barometer 2006/07

Fiorenza Monticelli
Gauteng District Health Systems Summit
22 August 2008
Presentation Overview
Background
Indicators:
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Per capita Expenditure and Cost per PDE
Nurse clinical workload
Immunisation coverage
HIV prevalence among antenatal clients tested
Proportion antenatal clients tested for HIV
Nevirapine uptake rate among pregnant HIV+ women
PHC utilisation rate
TB cure rate and Smear conversion rate
Rate of children under 5 years not gaining weight
Delivery rate in facility
Gauteng
Perinatal Mortality rate
Overall rankings
Conclusion
Background
• 27 health, socioeconomic and financial indicators
• Up to four years of data for monitoring trends
• Profile for SA, 9 provinces and 52 districts
• CD with full database, resources, references and
original data files used for the report
• A ‘live’ web-enabled GIS maps and indicators
http://webgis.hst.org.za:8081/
Per capita expenditure, 2006/07
SA ave: R256
South Africa
Namakwa
West Coast
City of Cape Town
Xhariep
Eden
Central
City of Tshwane
Bophirima
Southern
Central Karoo
Umkhanyakude
City of Johannesburg
eThekwini
Motheo
Bojanala
Ekurhuleni
Pixley ka Seme
Cape Winelands
Kgalagadi
Sisonke
Amathole
Chris Hani
Frances Baard
Nelson Mandela Bay Metro
Overberg
Mopani
UMgungundlovu
Umzinyathi
Cacadu
Uthungulu
Fezile Dabi
West Rand
Ugu
Zululand
iLembe
Thabo Mofutsanyane
Ukhahlamba
Waterberg
Alfred Nzo
Vhembe
O.R. Tambo
Sedibeng
Nkangala
Uthukela
Lejweleputswa
Capricorn
Gert Sibande
Ehlanzeni
Amajuba
Metsweding
Greater Sekhukhune
Siyanda
R497
R319
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
R167
0
50
100
150
200
250
Rand
300
350
400
450
500
Expenditure by District
Preliminary
Per capita expenditure, 2007/08
SA ave: R303
South Africa
Namakwa
Central Karoo
West Coast
City of Cape Town
City of Tshwane
Sisonke
Eden
Xhariep
Central
Pixley ka Seme
Southern
City of Johannesburg
Cape Winelands
eThekwini
Kgalagadi
Umkhanyakude
Bophirima
Cacadu
Metsweding
Overberg
Ekurhuleni
Motheo
Frances Baard
iLembe
Waterberg
Chris Hani
Amathole
Vhembe
Mopani
Zululand
Ugu
Uthungulu
Nelson Mandela Bay
Bojanala
UMgungundlovu
Uthukela
Umzinyathi
Capricorn
Ehlanzeni
Sedibeng
Ukhahlamba
West Rand
Fezile Dabi
O.R. Tambo
Amajuba
Nkangala
Greater Sekhukhune
Gert Sibande
Thabo Mofutsanyane
Siyanda
Alfred Nzo
Lejweleputswa
R634
R418
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
R233
0
50
100
150
200
250
300
Rand
350
400
450
500
550
Cost per PDE (all bed categories), 2006/07
SA ave: R954
South Africa
Namakwa
Frances Baard
Pixley ka Seme
Nelson Mandela Bay Metro
City of Tshwane
Nkangala
Amajuba
Ekurhuleni
Waterberg
Southern
Greater Sekhukhune
iLembe
Umkhanyakude
Ehlanzeni
Capricorn
Central
Central Karoo
Zululand
Thabo Mofutsanyane
Cacadu
Vhembe
West Coast
Sedibeng
West Rand
Gert Sibande
Lejweleputswa
Uthukela
City of Johannesburg
Xhariep
Mopani
O.R. Tambo
Eden
Sisonke
Uthungulu
eThekwini
Motheo
Umzinyathi
Overberg
Siyanda
Bojanala
Alfred Nzo
Amathole
Fezile Dabi
Ugu
Bophirima
City of Cape Town
UMgungundlovu
Chris Hani
Cape Winelands
Ukhahlamba
Kgalagadi
Metsweding
3 790
2 171
1 881
R1 390
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
R952
No district hospitals
0
200
400
600
800
1000
1200
1400
Rand per patient day equivalent
1600
Nurse clinical workload, 2006/07
SA ave: 27
South Africa
City of Cape Town
West Coast
Nelson Mandela Bay
Fezile Dabi
Cacadu
Eden
Central Karoo
Thabo Mofutsanyane
Southern
West Rand
Lejweleputswa
Gert Sibande
Kgalagadi
Namakwa
Ekurhuleni
Overberg
Siyanda
Xhariep
City of Tshwane
Frances Baard
Motheo
Nkangala
Pixley ka Seme
eThekwini
Ukhahlamba
Cape Winelands
Central
Umkhanyakude
Sedibeng
Chris Hani
O.R. Tambo
iLembe
Amathole
Vhembe
Bophirima
City of Johannesburg
Uthukela
UMgungundlovu
Ugu
Amajuba
Uthungulu
Bojanala
Zululand
Mopani
Umzinyathi
Metsweding
Alfred Nzo
Ehlanzeni
Sisonke
Capricorn
Greater Sekhukhune
Waterberg
38.2
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
19.8
0
10
20
30
40
50
Patients per nurse clinical work day
60
Nurse Clinical Workload 2003/04 to 2006/07
55.0
50.0
South Africa
45.0
40.0
Patients per day
West Rand
Ekurhuleni
City of Tshwane
35.0
30.0
Gauteng
25.0
Gauteng
Gauteng
Gauteng
Sedibeng
City of
Johannesburg
20.0
Metsweding
15.0
10.0
5.0
2003/04
2004/05
2005/06
2006/07
Immunisation coverage, 2006/07
*
SA ave: 85%
South Africa
Pixley ka Seme
Eden
Frances Baard
West Coast
Lejweleputswa
101%
Central Karoo
Cape Winelands
City of Tshwane
Uthukela
Metsweding
Sisonke
UMgungundlovu
Kgalagadi
City of Cape Town
Ekurhuleni
Uthungulu
Xhariep
Ugu
City of Johannesburg
Overberg
Vhembe
West Rand
Gert Sibande
EC
O.R. Tambo
FS
GP
Fezile Dabi
KZN
Greater Sekhukhune
LP
MP
Umkhanyakude
NC
Thabo Mofutsanyane
NW
Zululand
WC
83%
Capricorn
Nkangala
SA
Sedibeng
Chris Hani
Motheo
Ehlanzeni
Mopani
Amajuba
Siyanda
Central
Umzinyathi
eThekwini
Bophirima
Alfred Nzo
Cacadu
Waterberg
Ukhahlamba
Nelson Mandela Bay Metro
Namakwa
iLembe
Southern
Bojanala
Amathole
0
20
40
60
Percentage
80
100
120
*Proxy for MDGs
HIV prevalence antenatal survey (NDoH), 2006
SA ave: 29.1%
South Africa
Metsweding
Namakwa
West Coast
Central Karoo
Pixley ka Seme
Eden
Siyanda
Overberg
Cape Winelands
Vhembe
Greater Sekhukhune
City of Cape Town
Kgalagadi
Xhariep
Bophirima
Frances Baard
Cacadu
Central
Capricorn
Mopani
Alfred Nzo
City of Tshwane
Nkangala
Chris Hani
Waterberg
Umzinyathi
Ukhahlamba
Amathole
Fezile Dabi
O.R. Tambo
Motheo
City of Johannesburg
Southern
Sisonke
Nelson Mandela Bay
Ehlanzeni
Thabo Mofutsanyane
Ekurhuleni
Bojanala
Lejweleputswa
West Rand
Uthungulu
Sedibeng
Uthukela
Umkhanyakude
Zululand
Ugu
Gert Sibande
iLembe
eThekwini
UMgungundlovu
Amajuba
No data
26.5%
34.6%
0
10
20
30
Percentage
40
50
60
Proportion antenatal clients tested for HIV, 2006/07
SA ave: 67.9%
South Africa
Southern
Central Karoo
Overberg
West Coast
Cape Winelands
Eden
Metsweding
Sedibeng
Pixley ka Seme
Waterberg
Uthukela
Vhembe
City of Cape Town
Sisonke
Fezile Dabi
Central
Umzinyathi
Bophirima
Namakwa
Alfred Nzo
O.R. Tambo
Capricorn
Siyanda
Xhariep
Umkhanyakude
Kgalagadi
Nelson Mandela Bay
Ukhahlamba
Chris Hani
Frances Baard
Amathole
iLembe
Motheo
Greater Sekhukhune
Zululand
City of Johannesburg
Ehlanzeni
Mopani
Amajuba
Thabo Mofutsanyane
Cacadu
West Rand
Ugu
Bojanala
Nkangala
City of Tshwane
Lejweleputswa
Ekurhuleni
Gert Sibande
UMgungundlovu
Uthungulu
eThekwini
115.0
95.2
93.9
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
48.6%
0
10
20
30
40
50
60
Pe rce ntage
70
80
90
100
Nevirapine uptake rate among pregnant HIV+ve women, 2006/07
*
SA ave: 61.1%
South Africa
Metsweding
Cacadu
Umkhanyakude
City of Johannesburg
West Rand
Zululand
Pixley ka Seme
Uthukela
Sedibeng
Gert Sibande
Ekurhuleni
Ehlanzeni
eThekwini
City of Cape Town
City of Tshwane
Eden
West Coast
Kgalagadi
Sisonke
Vhembe
iLembe
Frances Baard
Umzinyathi
UMgungundlovu
Central Karoo
Waterberg
Southern
Central
Cape Winelands
Overberg
Nkangala
Greater Sekhukhune
Nelson Mandela Bay
Ugu
Mopani
Uthungulu
Capricorn
Siyanda
Bophirima
Chris Hani
Bojanala
Ukhahlamba
Amathole
Namakwa
Amajuba
O.R. Tambo
Motheo
Thabo Mofutsanyane
Fezile Dabi
Alfred Nzo
Lejweleputswa
Xhariep
91.3%
66.8%
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
0
10
20
30
40
50
60
Percentage
70
80
90
100
*Proxy for MDGs
PHC utilisation rate, 2006/07
South Af rica
Central Karoo
Vhembe
Central
Eden
West Coast
Mopani
Cacadu
Overberg
Nelson Mandela Bay Metro
Southern
Namakw a
Pixley ka Seme
Cape Winelands
Bophirima
Frances Baard
Siyanda
Bojanala
Xhariep
City of Cape Tow n
Thabo Mof utsanyane
Umkhanyakude
Chris Hani
Ehlanzeni
Amathole
UMgungundlovu
Ugu
Sisonke
eThekw ini
Uthungulu
Kgalagadi
City of Tshw ane
Fezile Dabi
Capricorn
iLembe
Umzinyathi
Zululand
Uthukela
Ukhahlamba
O.R. Tambo
Gert Sibande
City of Johannesburg
Motheo
Nkangala
Waterberg
Amajuba
Alf red Nzo
Lejw eleputsw a
West Rand
Sedibeng
Ekurhuleni
Greater Sekhukhune
Metsw eding
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
0
1
2
3
4
Average number of visits per person
5
TB Cure rate, 2005
South Africa
Overberg
Eden
West Coast
Bohlabela
Vhembe
Chris Hani
Cape Winelands
Central Karoo
West Rand
Thabo Mofutsanyane
Xhariep
City of Cape Town
City of Johannesburg
Lejweleputswa
Capricorn
Kgalagadi
Motheo
Zululand
Umzinyathi
Central
Amajuba
City of Tshwane
Ekurhuleni
Bophirima
Ehlanzeni
O.R. Tambo
Fezile Dabi
Metsweding
Cacadu
iLembe
Mopani
Ukhahlamba
Namakwa
Sedibeng
Pixley ka Seme
Greater Sekhukhune
Bojanala
Siyanda
Nelson Mandela Bay Metro
Southern
Sisonke
Alfred Nzo
Gert Sibande
Uthukela
Uthungulu
Umkhanyakude
eThekwini
Waterberg
Frances Baard
UMgungundlovu
Ugu
Amathole
Nkangala
* SA ave: 57.6%
70.6%
EC
FS
GP
KZN
LP
MP
NC
NW
57.8%
WC
SA
0
10
20
30
40
50
60
Pe rce ntage
70
80
90
100
*Proxy for MDGs
TB cure rate 2003-2005
80
2003
2004
2005
West Rand
City of
Johannesburg
City of
Tshwane
Percentage
70
Ekurhuleni
Metsweding
60
Sedibeng
50
40
30
Sedibeng
Ekurhuleni
Gauteng
2003
Metsweding
2004
City of Johannesburg
West Rand
2005
City of Tshwane
TB cure rate per province
*
Province
EC
2003
50.7
2004
40.8
2005
53.7
FS
GP
KZN
LP
64.8
61.3
44.0
53.6
67.2
62.6
34.8
69.5
67.5
66.7
45.2
60.8
MP
NC
NW
43.7
64.6
59.8
32.0
38.3
56.6
51.8
50.1
57.6
WC
SA
71.9
56.7
70.1
50.8
71.9
57.6
*Proxy for MDGs
Smear conversion rate per province *
Province
EC
2004
37.3
2005
41.8
2006
49.9
FS
GP
KZN
LP
58.5
57.8
38.7
43.2
61.1
62.2
40.4
62.0
67.2
69.2
48.4
54.3
MP
NC
NW
34.2
31.8
48.4
35.6
40.5
47.7
44.4
48.4
48.1
WC
SA
58.0
46.6
60.7
50.5
66.9
55.8
*Proxy for MDGs
(Under 5 years) Not gaining weight rate, 2006/07
South Af rica
City of Johannesburg
Vhembe
Capricorn
Umzinyathi
O.R. Tambo
Mopani
West Rand
City of Tshw ane
Nelson Mandela Bay Metro
Zululand
Alf red Nzo
Bojanala
Amathole
Ehlanzeni
UMgungundlovu
Sedibeng
Ekurhuleni
eThekw ini
iLembe
Cape Winelands
Sisonke
Bophirima
Metsw eding
Nkangala
City of Cape Tow n
Waterberg
Uthungulu
West Coast
Ukhahlamba
Gert Sibande
Umkhanyakude
Southern
Amajuba
Ugu
Overberg
Chris Hani
Central Karoo
Motheo
Frances Baard
Central
Xhariep
Kgalagadi
Pixley ka Seme
Cacadu
Greater Sekhukhune
Eden
Siyanda
Thabo Mof utsanyane
Fezile Dabi
Lejw eleputsw a
Uthukela
Namakw a
*
SA ave: 1.3%
0.3%
1.3%
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
0
2
4
Percentage
6
*Proxy for MDGs
C
ity
R
2005/06
e
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P
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fri
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R
D
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M
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bu
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th
of
ha
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2004/05
S
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Jo
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tR
an
2003/04
C
of
E
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in
g
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sw
ed
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ib
W
es
M
et
S
Percentage of children weighed
Rate of children under 5 years not gaining weight 2003/4 2006/7
2.5
2006/07
2.0
1.5
1.0
0.5
0.0
Delivery rate in facility, 2006/07
SA ave: 77.7%
South Af rica
Eden
Cape Winelands
Kgalagadi
Sisonke
Frances Baard
West Coast
Pixley ka Seme
Greater Sekhukhune
Lejw eleputsw a
City of Cape Tow n
Uthukela
Ekurhuleni
Central Karoo
Ehlanzeni
UMgungundlovu
Umzinyathi
Waterberg
Vhembe
Capricorn
Sedibeng
West Rand
Uthungulu
Mopani
Motheo
Central
Ugu
Nelson Mandela Bay
Gert Sibande
Southern
Thabo Mof utsanyane
eThekw ini
Nkangala
Bojanala
Fezile Dabi
Umkhanyakude
City of Tshw ane
Cacadu
O.R. Tambo
Siyanda
Overberg
Bophirima
Ukhahlamba
City of
Xhariep
Chris Hani
Amajuba
Amathole
iLembe
Zululand
Namakw a
Alf red Nzo
Metsw eding
120.8
115.2
107.1
105.4
103.9
100.2
88.6%
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
66.5%
No district hospitals
0
10
20
30
40
50
60
Percentage
70
80
90
100
Perinatal mortality rate, 2006/07
South Africa
Metsweding
Cape Winelands
Overberg
West Rand
Vhembe
Eden
City of Johannesburg
Ekurhuleni
City of Cape Town
City of Tshwane
Zululand
Sisonke
Chris Hani
Mopani
West Coast
Umkhanyakude
Gert Sibande
Ehlanzeni
Fezile Dabi
Xhariep
Frances Baard
Pixley ka Seme
Nkangala
Uthukela
Alfred Nzo
Ugu
Southern
Bojanala
Central
Cacadu
Siyanda
Sedibeng
Waterberg
Capricorn
Amathole
Umzinyathi
Thabo Mofutsanyane
Greater Sekhukhune
UMgungundlovu
Motheo
Lejweleputswa
Nelson Mandela Bay Metro
Ukhahlamba
Bophirima
eThekwini
Uthungulu
iLembe
Central Karoo
Kgalagadi
O.R. Tambo
Amajuba
Namakwa
*
No district hospitals
EC
FS
GP
KZN
LP
MP
NC
NW
WC
SA
0
20
40
60
80
Deaths per 1000 births
100
120
*Proxy for MDGs
Spider graph illustrating rankings in 2006/07
Sedibeng
Access to piped water (%)
Perinatal mortality rate
Stillbirth rate
Delivery rate
60
Deprivation index
PHC expenditure per capita
50
40
Average length of stay
30
Not gaining weight under 5 years
Useable bed utilisation rate
20
10
Diarrhoea incidence under 5 years
Male condom distribution rate
0
TB smear conversion rate
Immunisation coverage < 1 year
TB cure rate
Immunisation drop out rate (DTP1-3)
Incidence of STI treated - new
Proportion ANC clients tested for HIV
Utilisation rate
Nevirapine uptake women
HIV prevalence among ANC clients tested
Nevirapine uptake babies
District Rank
Average
Spider graph illustrating rankings in 2006/07
City of Johannesburg
Access to piped water (%)
60
Perinatal mortality rate
Deprivation index
Stillbirth rate
Delivery rate
PHC expenditure per capita
50
40
Average length of stay
30
Not gaining weight under 5 years
Useable bed utilisation rate
20
10
Diarrhoea incidence under 5 years
Male condom distribution rate
0
TB smear conversion rate
Immunisation coverage < 1 year
TB cure rate
Immunisation drop out rate (DTP1-3)
Incidence of STI treated - new
Utilisation rate
Nevirapine uptake women
Proportion ANC clients tested for HIV
HIV prevalence among ANC clients tested
Nevirapine uptake babies
District Rank
Average
Performance/Overall rankings
District
Smear
conversion rate
TB Cure rate
Immunisation
coverage
< 1 year
Non-Hosp PHC
exp per capita
Clinic
supervision
rate
Nevirapine
uptake rate
among
pregnant
HIV+
women
Not gaining
weight under 5
years rate
Perinatal
mortality rate
in facility (per
1000 births)
2006/07
200
4/05
200
5/06
200
6/07
200
4/0
5
200
5/0
6
200
6/0
7
5
4
2
0
0
4
20
05
2002
2006
2007
2006
2007
2006/07
2005/
06
2003
200
4
2005
20
03
Sedibeng
25
21
34
3
2
1
13
39
42
4
2
5
28
9
16
19
16
5
Metsweding
33
9
28
1
5
2
22
36
50
1
1
6
38
1
7
7
23
-
West Rand
5
7
9
6
6
6
19
19
32
2
3
4
46
5
15
11
7
4
3
2
Ekurhuleni
21
27
23
5
1
3
1
17
16
6
4
3
37
11
10
18
17
3
4
5
Johannesburg
22
19
13
4
3
5
4
7
12
5
5
2
34
4
4
1
1
1
1
1
Tshwane
27
18
22
2
4
4
15
18
7
3
6
1
42
15
21
26
8
6
6
3
-
-
Performance/rankings
Proportion ANC clients
tested for HIV
HIV prevalence
among ANC
clients tested
(National
survey)
Utilisation rate
2004/05
2005/06
2006/07
Rank 2006/07
2004/
05
2005/06
2006/07
2004/05
2005/06
2006/07
Sedibeng
12
10
8
42
47
48
49
14
18
20
Metsweding
27
30
7
-
53
53
52
-
-
52
West Rand
33
40
42
40
51
51
48
8
8
21
Ekurhuleni
38
48
48
37
52
52
50
11
10
12
Johannesburg
13
12
36
31
48
46
41
29
34
43
Tshwane
28
32
46
21
50
50
31
19
28
36
District
Delivery rate in facility
Conclusion
 More must be done to improve the following:
•
•
•
•
•
•
Proportion of antenatal clients tested for HIV,
Nevirapine uptake rate among pregnant HIV+ve women
HIV prevalence among ANC clients tested,
Delivery rate in facility,
PHC utilisation rate
TB cure rate
 About 60% of the information in the DHB relies on data extracted from
the DHIS. The quality of this data affects what you see in the District
Health Barometer publication and also the managerial decisions
informed by this data.
 Where DHIS data differs with what districts have, is often an indication
of a need for sub-district and facility level support.
 Improving the quality of data may cause the district raking to
deteriorate initially, however, the districts will then have accurate and
reliable data to base decisions on and can begin to see a true
improvement.
THANK YOU!
We acknowledge the National Department of Health,
Treasury and all other providers for access to and use of
their data for this publication and Atlantic
Philanthropies for funding the project.
For more information, contact
Fiorenza Monticelli at [email protected]
Or Elliot Sello at [email protected]
Telephone: (031) 307 2954