amajuba district district health plan 2018/19 - 2020/21€¦ · amajuba district health plan...

AMAJUBA DISTRICT

DISTRICT HEALTH PLAN

2018/19 - 2020/21

KWAZULU-NATAL

Amajuba District Health Plan 2018/19 – 2020/21

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1. EXECUTIVE SUMMARY BY THE DISTRICT MANAGER

Strategic overview

Vision

Optimum health for all people of Amajuba District and beyond

Mission

To develop and implement a sustainable, coordinated, integrated and

comprehensive health system at all levels, based on the Primary Health Care

approach through the District Health System, to ensure universal access to health

care.

Position Statement

Amajuba District Department of Health is a learning organisation striving for

continuous quality improvement.

Core Values

Legacy Value

• Leading in District Health Services, professionalism, accountability and

commitment to excellence

Foundation Values

• Respect, trustworthiness, honesty and integrity, open communication,

transparency and consultation, loyalty and compassion

Service Value

• Efficiency, Flexibility, Reconciliation, Courage, continuous learning, amenable to

change and innovation.

Resultant Benefit Values

• Empowerment, Skills Development, Poverty Alleviation, Role Model

District Priorities

The burden of disease that affects the Amajuba citizens is mainly in the following four

(4) areas: HIV and TB, Maternal and Child morbidity and mortality, NCDs, Trauma

and injuries. Over the next years the Amajuba district health programmes aim to

address this burden of disease as well as other health priorities, through;

Implementation of the robust 90-90-90 strategy phase 3

Focus on prevention and management of chronic disease especially Diabetes

and improve access to mental health


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Provision of differentiated care through Central Chronic Medication Distribution

and Dispensing (CCMDD)

Improving quality through monitoring the NCS in all facilities.

Scale-up Ideal Clinic Realization and Maintenance (ICRM)

Collection of municipal ward based health data at Primary Health Care level

Strengthening community based primary health care service with emphasis on

health promotion and disease prevention

Primary Healthcare & Universal Coverage

The majority of the citizens in Amajuba district are solely reliant on the public sector

services, mainly delivered through the Primary Healthcare (PHC) services. Of the

total population 90.6% of the citizens are not medically insured leaving only 9.4% with

medical or health insurance. Our primary healthcare services are delivered through

8 mobile services, within our 25 fixed PHC facilities and 1 CHC. We will work to:

promote health, prevent illness and injury, and influence our stakeholders on the

change towards improving the social determinants that affect health. Our success in

achieving better health outcomes as Amajuba district depends on our collective

ability to build relationships and work across sectors to create cohesive communities

and enabling environments that promote health. Few other challenges relates to

human resources for health and physical infrastructure, with the high burden of

disease resulting in immense strain on the health system. We remain committed to

forge ahead with the implementation of the National Health Insurance (NHI)

initiatives. In order to progress towards the accreditation of facilities to implement

NHI in Amajuba district a concerted effort is required to understand population

health, increase responsiveness to community needs, improve the quality of services

provided, and to work collaboratively with the community served.

Service Delivery through Strategic Health Programmes (SHP)

HIV

The district has had significant strides in improving access to treatment and reducing

mother to child transmission, however this scourge is a serious concern. There have

been and still are successes with regard to ART initiations with a total of 53 646 clients

remaining on ART at the end of the financial year 2016/17. The district did not do well

with regard to HIV prevention interventions, both male and female condom

distribution and Male Medical Circumcision (MMC), with the latter recording only 4

471 males circumcised. This is a challenge as it hampers efforts and interventions

towards reducing HIV incidence. It is estimated that a total of 88 000 citizens in

Amajuba are People Living with HIV (PLHIV), HIV Tembisa Estimates; 2016.

Tuberculosis (TB)

Tuberculosis (TB) continues to be the leading cause of deaths affecting the citizens

of Amajuba district and also contributes to maternal deaths. Despite the efforts and


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resources injected towards fighting TB, declining treatment success rate from 77.8%

to 77.6% that was achieved in 2015/16 is a worrying concern. It is estimated that

more than 4000 people had TB in Amajuba in 2017 (WHO TB estimates). This places TB

at the top of public health problems in Amajuba. Renewed focus will be directed

towards reducing the detrimental impact that the disease has on many

communities within our boarders.

Maternal, Neonatal, Child & Women’s Health and Nutrition

Maternal deaths remain a concern for Amajuba district with the previous financial

year recording 11 maternal deaths i.e. 130.3/100 000 live births in 2016/17 Financial

Year. This affects our progress toward the Sustainable Development Goals (SDGs)

which envisions the reduction of Maternal mortality Rate (MMR) to less than 70/100

000 live births. Child health is another area of service delivery concern includes the

challenge to deal adequately with malnutrition, which along with other related

diseases like, HIV and Diarrhoeal Diseases (DD) make-up child morbidity and

mortality concerns. The uptake of vaccines is not as high as it should be to a need to

improve our mass immunisation campaign to reach as many children as possible.

Improve health by reducing preventable diseases and injuries are another strategic

area of focus in the current strategic term.

Non-communicable Diseases (NCDs)

The NCDs are becoming a global threat. The success of HIV treatment also

contributes to people living longer some eventually developing NCDs. The Amajuba

district citizens are not immune to the burden posed by the diseases of lifestyle.

Among these, Diabetes has since been among the top four (4) leading causes of

deaths in Amajuba District. There are however worrying signs of the dangers posed

by these global threats, the increasing incidence and the number of amputations

that were performed as a result of complications. We will need to be instrumental in

promoting healthy lifestyle and health seeking behaviour in order to have healthy

communities. We will adopt a Life Course approach in dealing with all the risks and

our interventions will have to cover everything from pre-natal and post-natal care

services that promote healthy lifestyle, eating and encourage active living. Palliative

care will be an integral part of the management of the NCDs.

e-Health Technology

Despite numerous IT related challenges the district has achieved 100% in network

connectivity and has taken an initiative to have all fixed PHC facilities connected or

having access to the internet. This therefore allows seamless capturing of data on

webDHIS and will therefore support real-time access to data. These initiatives are

however hampered by the problematic Health Patient Registration System (HPRS)

which has numerous technical challenges and longer tur-around time in resolving

these challenges. Our focus will be on making the system work to our advantage,

reduce patient waiting times and thus contribute to patient delight.


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Monitoring and Evaluation

Data inaccuracy and quality remains a challenge. Targeted interventions will be

implemented in order to inculcate the culture of using information for action. The

annual Operational plan will be developed based on this 3 year District Health Plan

and set targets and indicators will be used to monitor progress towards the

implementation of this plan. Both monitoring and evaluation will remain a collective

responsibility in all levels of health care system to enable responsibility and

accountability for the implementation of the Amajuba District health Plan. The

quarterly reports through the District Operational Plan will be used as a basis for

monitoring and evaluation of programmes. The quarterly reports will be used for

monitoring and evaluation of programmes based on the District Operational Plan.

Conclusion

Despite the limited funding and the shrinking envelope, the district will continue with

the implementation of this plan and remain committed to the delivery of DHS

through the PHC approach. This approach is seen as the most appropriate in

responding to the burden of disease thus enabling a long and healthy life for all

citizens in Amajuba district and beyond. The district of Amajuba commits through

this plan to render services that are efficient, effective, accessible, acceptable and

client-centred, equitable and free from harm to the users.

I call upon all our health workers together with the District Health Management Team

(DHMT) to combine our efforts and play our part in implementing this plan and move

the district towards realizing the vision of Optimum health for all the citizens in

Amajuba and beyond.


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2. ACKNOWLEDGEMENTS

The Amajuba District Health Plan (DHP) 2018/19 – 2020/21 was developed by the

Amajuba District Health Management Team, supported by the provincial Strategic

Planning Unit, M & E and NCD programme. Primary acknowledgement is due to the

dedicated Amajuba District Planning, Monitoring and Evaluation Team who were the

principal collators of the Amajuba District Health Plan 2018/19 – 2020/21. This team

included the following officials:

Nzuza MS : Deputy Director DHS Planning

Khanyi BF : District Information Officer

Mpungose BM : Assistant Manager M & E

Special acknowledgement extended to several Managers who provided detailed

inputs and feedback to the draft versions of the Amajuba DHP 2017-18. Their feedback

and comments have been integrated into the current version and their contributions are

duly acknowledged. This team includes the following managers:

Tshabalala AMET : Amajuba District Director

Khumalo CM : Deputy Director Clinical Programs

Le Roux HP : Deputy Director Finance

Cassim AS : Deputy Director Pharmaceutical Services

Buthelezi GC : Acting Deputy Director Human Resource

Ntuli AN : District Clinical Specialist Advanced Midwifery

Langa MP : District Clinical Specialist PHC

Nyaba TLF : District Clinical Specialist (Paeds)

Hlela HA, Dr : Act CEO/Medical Manager Madadeni Hospital

Gumede Z : Nursing Manager Madadeni Hospital

Nkosi GN : Nursing Manager Niemeyer Hospital

Sakyi TBT : CEO Newcastle Regional Hospital

Ndumo DM : Nursing Manager Newcastle Hospital

Nkosi SB, Dr : CEO Niemeyer Memorial Hospital

Shezi WT : EMS Manager Amajuba District

Xaba SK : District QA

Finance and HR Managers

M&E Managers

Program Managers

PHC Managers

Systems Managers


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3. OFFICIAL SIGN OFF

It is hereby certified that this District Health Plan:

Was developed by the district management team of Amajuba District with the

technical support from the district health services and the strategic planning Units

at the Provincial head office.

Was prepared in line with the current Strategic Plan and Annual Performance

Plan of the KwaZulu Natal Department of Health.

_________________________

Dr AMET Tshabalala Date

District Director


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4. EPIDEMIOLOGICAL PROFILE

District Map & Demarcation (Wards)

The Amajuba District Municipality is located in the north-western corner of KwaZulu-

Natal, bordering on the Free State Province and Mpumalanga. It is one of the

smallest districts in the province, making up only 8% of its geographical area. The

municipality comprises three local municipalities: Newcastle (31 wards),

Emadlangeni (6 wards) and Dannhauser (11 wards). The main transportation routes

linking the district to its surrounds are the N11, which is the alternative route to

Johannesburg from Durban, and the rail line, which is the main line from the Durban

harbour to Gauteng. The R34 also bisects the district in an east-west direction and

provides a linkage from the port city of Richards Bay to the interior.

Area: 7 102km² (3 539km2; 1 707 km2 and 1 856 km2)

Cities/Towns: Charlestown, Dannhauser, Hattingspruit, Newcastle, Utrecht

Population distribution and population pyramid

It is estimated that there is a total of 565 227 people living in Amajuba District (Stats SA

Mid-Year population estimates, 2016). The population growth is estimated to grow to

595 573 by 2020, an estimated average growth of 15 173. The following pyramid depicts

the population distribution across different ages categorized in 5 year cohorts.

Population category 2016 2017 2018 2019 2020

under 1 year 14 207 14 556 14 917 15 231 15 421

under 5 years 72 717 73 293 73 900 74 479 74 981


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05-09 years 71 778 72 416 72 806 73 087 73 474

10-14 years 64 637 66 904 68 968 70 732 72 117

15-19 years 54 691 55 255 56 965 59 358 62 072

20-24 years 56 751 55 828 54 635 53 420 52 739

25-29 years 53 152 54 020 54 606 55 044 55 041

30-34 years 42 295 44 501 46 635 48 764 50 956

35-39 years 32 699 34 428 36 029 37 436 38 535

40-44 years 23 813 24 908 26 121 27 441 28 855

45-49 years 18 604 19 014 19 521 20 141 20 886

50-54 years 16 091 16 076 16 136 16 257 16 443

55-59 years 15 012 14 857 14 636 14 411 14 238

60-64 years 12 350 12 521 12 668 12 769 12 794

65-69 years 9 072 9 252 9 429 9 595 9 745

70-74 years 6 101 6 218 6 325 6 435 6 553

75-79 years 3 449 3 564 3 673 3 766 3 844

80 years and older 2 131 2 170 2 211 2 257 2 306

Total 555 347 565 227 575 265 585 389 595 573

Estimated pregnant women* 15 201 15 575 15 961 16 297 16 500

Source: Stats SA Mid-Year population Estimates, 2016

under 1 year

5-9 yrs

10-14 yrs

15-19 yrs

20-24 yrs

25-29 yrs

30-34 yrs

35-39 yrs

40-44 yrs

45-49 yrs

50-54 yrs

55-59 yrs

60-64 yrs

65-69 yrs

70-74 yrs

75-79 yrs

80 + yrs

under 1 year

5-9 yrs

10-14 yrs

15-19 yrs

20-24 yrs

25-29 yrs

30-34 yrs

35-39 yrs

40-44 yrs

45-49 yrs

50-54 yrs

55-59 yrs

60-64 yrs

65-69 yrs

70-74 yrs

75-79 yrs

80 + yrs

40 000 30 000 20 000 10 000 0 10 000 20 000 30 000 40 000 50 000

Population Pyramid for Amajuba District - 2017


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Social Determinants of Health – Amajuba District

Unemployment ratea 39.1%

Youth unemployment rate (15-34 years)a 50.3%

No schooling 6.1%

Matric 36.6%

Higher education 9.0%

Households 117256

Female headed households 48.4%

Formal dwellings 84.4%

Flush toilet connected to sewerage 52.0%

Weekly refuge removal 53.8%

Piped water inside dwellings 37.3%

Electricity for lighting 92.0%

Blue drop water score 58.2%

Source: Blue Drop Report, Stats SA, 2014

Unemployment is a major problem in Amajuba District. It does not only affects an

individual’s living standards but it cripples the economic growth of the country and is a

major social determinant for health that has a negative impact on the lives of the

citizens within Amajuba. It contributes to the quick loss of skills and knowledge through

disuse; it is also a contributing factor in inequality of income distribution. People without

pipe water use boreholes or services provided by both local municipalities and the

Amajuba District Municipality by the water tanker service. From the figures below it is

evident that there is progress in terms on ensuring that water is accessible to the

communities.

Causes of Mortality

Source: Stats SA – mortality report, 2013

10.4

9.1

8.4

6.4

6

5.5

5.4

5.3

4.7

4.3

3.4

0 2 4 6 8 10 12

Tuberculosis

HIV

Non-natural causes

Heart Diseases

Cerebrovascular…

Other viral diseases

Influenza &…

Diabetes Mellitus

Hypertension

Intestinal infestious…

Other Acute LRTI

Deaths by Broad causes - Amajuba District - 2013


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Tuberculosis was the leading cause of death during the three years, averaging at

least 9.4% of all deaths each year in 2013; 2014 and 2015. This indicates the

increasing proportion of deaths due to tuberculosis over the years. Diabetes mellitus

assuming a higher rank than Hypertension and there has been a notable constant

rise over the past three years. Advances in HIV management and treatment has

seen the disease being displaced further out of the top five (5) leading causes of

deaths in Amajuba.

8.9%

6.7%

6.4%

6.2%

5.3%

5.1%

4.0%

3.1%

2.7%

2.5%

14.6%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

Tuberculosis

Cerebrovascular diseases

Other forms of heart diseases

Influenza & Pneumonia

Diabetes Mellitus

Hypertension

Intestinal infestious diseases

Other Acute LRTI

HIV related


Non-natural causes


9.0%

6.5%

6.4%

6.4%

6.2%

6.0%

4.9%

4.7%

3.6%

2.8%

9.9%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

Tuberculosis

Other forms of heart diseases

Cerebrovascular Diseases

Diabetes Mellitus


HIV related

Hypetensive diseases

Influenza and pneumonia

Other Acute LRTI

Intestinal Infectious diseases

Non-natural causes



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5. SERVICE DELIVERY PLATFORM AND MANAGEMENT

Number of facilities per sub-district

Wa

rd b

ase

d

ou

tre

ac

h

tea

ms

Clin

ic

CH

C

Dis

tric

t

Ho

spita

l

Re

gio

na

l

Ho

spita

l

Ce

ntr

al/

Tert

iary

Ho

spita

ls

Oth

er

Ho

spita

ls

Dannhauser SD 5 10 1 0 0 0 0

Emadlangeni SD 2 2 0 1 0 0 0

Newcastle SD 5 14 0 0 2 0 1

Amajuba 12 26 1 1 2 0 1

The status of health facilities remained the same and there are no plans for expansion in

the upcoming financial years leading to the end of the 3 year term of the DHP. The other

hospital that exists in Newcastle sub-district represents Medi clinic which is a 130 bed

private health facility. Status remained for the WBOTs, though the teams are currently not

complete with many being led by the Enrolled Nurses instead of Professional Nurses.

Plans are in place for their replacement.

List of fixed PHC facilities per sub-district

Dannhauser sub-district Emadlangeni sub-district Newcastle sub-district

1) Durnacol Clinic

2) Thandanani Clinic

3) Verdriet Clinic

4) Ladybank Clinic

5) Nelliesfarm Clinic

6) Sukumani Clinic

7) Thembalihle Clinic

8) Greenock Clinic

9) Naasfarm Clinic

10) Emfundweni Clinic

11) Dannhauser CHC

1) Groenvlei Clinic

2) Niemeyer Gateway

1) Charlestown Clinic

2) Ingogo Clinic

3) Newcastle PHC

4) Madadeni 1 Clinic



7) Madadeni Gateway

8) Stafford Clinic

9) Rosary Clinic

10) Osizweni 1 Clinic



13) Mndozo Clinic

Human Resources for Health (filled posts)

Co

mm

un

ity

He

alth

Wo

rke

rs

Nu

rsin

g

ass

ista

nts

En

rolle

d

nu

rse

Pro

fess

ion

al

nu

rse

Me

dic

al

pra

ctitio

ne

rs

Ph

arm

ac

ists

De

nta

l

pra

ctitio

ne

rs

Oc

cu

pa

tio

na

l th

era

py

Ph

ysi

oth

era

p

y

Sp

ee

ch

The

rap

y a

nd

Au

dio

log

y

Amajuba District - Total 560 361 347 620 94 24 07 8 16 4

Source: Persal


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6. QUALITY OF CARE

Ideal Clinic worst performing

elements

NCS (Hospitals) worst performing

elements

Patient surveys top 5 challenges

reported by patients

i. Sign indicating NO

WEAPONS, NO SMOKING,

NO ANIMALS (except for

service animals), NO

LITTERING and NO

HAWKERS

ii. Patient record content

adheres to ICSM

prescripts

iii. Patient are consulted,

examined and

counselled in privacy

iv. TB treatment success rate

is at least 85% or has

increased by at least 5%

from the previous year

v. Immunisation coverage

under one year

(annualised) is at least

87% or has increased by

at least 5% from the

previous year

vi. Quality Improvements

plans are signed off by

the facility manager and

updated quarterly

vii. Adolescent and youth

friendly services are

provided

viii. 80% of professional nurses

have been trained on

Basic Life Support

ix. The patient safety

incident records show

compliance to the

National Guideline for

Patient Safety Incident

Reporting

x. The National Clinical

Audit guideline is

available

xi. The National Policy for

The Management Of

Waiting Times is available

xii. The National Patient

Experience of Care

Guideline is available

xiii. Medicine

room/dispensary is neat

and medicines are stored

to maintain quality

xiv. The laboratory results are

received from the

i. Security measures are

adequate to safeguard

new born and

unaccompanied children.

ii. Emergency trolleys are

standardised/

appropriately stocked and

regularly checked

iii. Appropriate isolation

accommodation exists for

patients with

communicable diseases

iv. Appropriate isolation

accommodation exists for

patients with

communicable diseases -

as a minimum for viral

haemorrhagic disease.

v. A report (from within the

last 12 months) shows that

adverse events involving

medical equipment are

reported

vi. All sterilisation equipment is

validated / licensed

vii. Random selected scripts in

pharmacy are correlated

with medication dispensed

viii. With respect to 72 hour

observation of patients /

the required criteria are

met

ix. Minutes of the forum

reviewing infection control

(from within the last

quarter) indicate that

infection control

surveillance data and

control measures are

regularly discussed

x. A random selection of 3

prescriptions audited shows

that prescribing is done to

facilitate rational use of

medicine and in

accordance with

prescribing guidelines and

policies

xi. Staff members interviewed

are able to explain how the

cold chain is ensured for all

blood products including

ordering / storage / issuing

i. Long waiting time

ii. Non availability of

handwashing soap

iii. Non availability of

medicines

iv. Loss of medical records

v. Poor quality of food


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elements


elements



laboratory within the

specified turnaround

times

xv. Staffing is in line with WISN

xvi. Staff satisfaction survey is

conducted annually

xvii. Disinfectant, cleaning

materials and equipment

are available

xviii. There is a standard

security guard room OR

the facility has an alarm

system linked to armed

response

xix. There is access for people

in wheelchairs

xx. There is a functional

clinic committee

xii. There is a system in place to

monitor that items requiring

replacement or ordering

are received within 3

months

xiii. Up to date records within

the last 12 months show

that the equipment listed

has been maintained

according to a planned

schedule or manufacturer

instruction

xiv. A report (from within the

last 12 months) shows that

adverse events involving

medical equipment are

reported

xv. Staff- patient ratios in key

areas are in accordance

with the approved staffing

plan for emergency unit /

outpatients / medical/

surgical / paediatrics / ICU

wards as applicable

xvi. Minutes of the

occupational health and

safety committee / forum

(from within the last 6

months) indicate that

occupational risks are

regularly discussed

xvii. Evidence shows that

medical examinations are

performed for all health

care workers who are

exposed to potential

occupational hazards

when performing their

duties (e.g. radiation /

infectious diseases

including TB/ chemicals)

xviii. There is a security system

documented in the security

policy and in place in the

establishment that covers

the buildings and

premises/grounds

xix. Security systems are

positioned at vulnerable

patient areas such as

maternity / paediatric /

psychiatric and emergency

units and access and

egress points

xx. There is evidence that exit

interviews are conducted

with all managers who


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elements


elements



have resigned and action

plans are put in place that

address issues raised

7. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT

TEAM

The district organizational structure depicts a number of critical posts that are vacant

that could not be filled in the financial year 2017/18 due to moratoriums and

freezing of posts. These posts are critical for the functioning of the organization, in

particular the Human Resource component. These will be prioritized, and have been

submitted in the minimum post establishment.


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8. DISTRICT HEALTH EXPENDITURE

Sub-Programme Budget: Adjusted Appropriation Expenditure TOTAL % Overspent

(Underspent)

Province Transfer to

LG *

LG Own Province Transfer to

LG

LG Own Budget Expendi

ture

2.1 District Management 24 198 000 0.00 0.00 24 028 495 0.00 0.00 24 198 000 24 028 495 0.8%

2.2 Clinics 191 202 000 0.00 0.00 190 568 014 0.00 0.00 191 202 000 190 568 014 0.1%

2.3 Community Health Centres 35 439 000 0.00 0.00 34 810 099 0.00 0.00 35 439 000 34 810 099 1.8%

2.4 Community Services (incl. PAH) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%

2.5 Other Community Services 60 563 000 0.00 0.00 56 881 045 0.00 0.00 60 563 000 56 881 045 6.1%

2.6 HIV/AIDS 148 265 000 0.00 0.00 142 912 590 0.00 0.00 148 265 000 142 912 590 3.6%

2.7 Nutrition 2 800 000 0.00 0.00 2 450 476 0.00 0.00 2 800 000 2 450 476 12.5%

2.9 District Hospitals 67 892 000 0.00 0.00 68 012 181 0.00 0.00 67 892 000 68 012 181 -0.2%

2.12 Other Donor Funding 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%

TOTAL DISTRICT 530 359 000 0.00 0.00 519 662 900 0.00 0.00 530 359 000 519 662 900 2.0%

Source: District Health Expenditure Review (2016/17) or BAS

Slight underspending under sub-programme 2.1 was due to terminations of services by the DD: P, M & E, ASD: HRD, resignations and

the transfer of DD: HR. PHC facilities were unable to fill posts due to moratorium. Underspending on HIV/AIDS was due to resignation

of two (2) doctors from the roving team, though overspending was noted on ARV budget. Underspending on sub-programme 2.6

was due to resignation of two (2) doctors from the roving team and incorrect linking of CCGs under voted funds instead of

conditional grant. UTT impact initiative also resulted in fewer clients with less body mass index and terminally ill. Overspending was

noted on ARV budget which could be attributed to implementation of differentiated models of care: Adherence clubs, spaced


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fast lane and CCMDD Medipost clients for review on their six monthly basis and others that sometimes don’t get their medication

on the specified pick-up points. Overspending on sub-programme 2.6 was also incurred due to the assignment of VMMC Doctor

as Chief Medical Officer as well as appointment of HAST Finance Manager, HAST Facility Information Officer and seven (7) data

capturers linked to facilities.

9. DISTRICT ASPIRATIONS

# District Aspiration Provincial Strategic Plan 2015-2020 Goal(s)

1. Reduced maternal deaths and improved women health Reduce the burden of disease

2. Reduce child under 1 year mortality rate Reduce the burden of disease

3. Reduce HIV incidence Reduce the burden of disease

4. Reduced mortality due to TB Reduce the burden of disease

5. Reduced diabetes and hypertension incidence Reduce the burden of disease

7. Increase the number of WBOTs Strengthen health systems effectiveness

8. Reduced expenditure per PDE – Niemeyer Hospital Strengthen health systems effectiveness

9. Increase clinical workforce Strengthen human resources for health

10. Improved compliance to ICRM and NCS Improved quality of health care


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9.1 KEY INTERVENTIONS

District Aspiration #1: Reduced maternal deaths and Improved women health

Life Course Group (Sub-district/Ward)** Bottlenecks / Challenges Root Cause

Public Health Intervention

Key Intervention

(Specify targeted population)***

Dimension

(Clinical/

Community/

Systems)

Pregnant women and

women of child bearing

age

Newcastle and

Dannhauser sub-

districts

High number of unplanned

pregnancies associated with poor

uptake of contraceptive methods

Poor integration of services Strengthen sexual and

reproductive services

Clinical

Limited health promotion on Sexual

and Reproductive health services

Poor linkage of pregnant

women pre and post- delivery

to PHC facilities/CCGs /WBOTS

Early diagnosis of pregnancy and

initiation of antenatal care

services

Systems

Increased burden of HIV and TB

among pregnant women

Late presentation of clients to

health care facilities due to

socio economic factors

Increase access to health

services

Systems

Targets for all Theory of Change (impact, outcome and output) indicators for District aspirations, to reach health outcomes

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Imp

ac

t

Maternal mortality IN FACILITY

ratio (per 100 000)

143.2 161.7 130.3 113.9 77.5 70.6 50.5

Maternal death in facility 20 14 11 10 7 7 5

Live birth in facility plus Born alive 13 965 8 660 8 875 8 774 9 029 9 920 9 906


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Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

before arrival at facility

Ou

tco

me

Antenatal client initiated on ART

rate (%)

94.2% 92.6% 94.0% 96.1% 94% 94% 96%

Antenatal client start on ART 2 370 1 875 1 685 1 450 1 837 2 002 2 229

Antenatal client known HIV positive

but not on ART at 1st visit

2 516 2 024 1 793 1 508 1 954 2 130 2 322

Ou

tco

me

Delivery in 10 to 19 years in

facility rate (%)

8.9% 8.3% 8.1% 12.9% 10.3% 8.1% 6.8%

Delivery 10 to 19 years in facility 1 250 726 691 1 112 951 808 722

Delivery in facility - total 14 089 8 745 8 495 8 602 9 228 10 024 10 687

Ou

tpu

t

Antenatal 1st visit before 20

weeks rate (%)

52.8% 58.8% 70.2% 70% 70.3% 70.5% 70.6%

Antenatal 1st visit before 20 weeks 5 615 5 408 6 361 6 760 6 983 7 668 8 421

Antenatal 1st visit total 10 636 9 200 9 066 9 696 9 930 10 882 11 931

Ou

tpu

t

Cervical screening coverage

(%)

62.8% 57.8% 89.0% 89.5% 90% 91% 92%

Cervical cancer screening in woman

30 years and older

6 599 6 201 9 830 9 858 10 026 10 227 10 431

Population 30 years and older

female/10

15 326 10 722 10 975 11 015 11 085 11 195 11 307

O u t p u t Couple year protection rate (%) 51.9% 52.7% 52.3% 53% 54% 55.3% 57%


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Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Couple year protection 73 957 76 070 77 482 79 339 82 449 85 398 89 371

Population 15-49 years females 141 827 144 261 146 806 149 696 152 683 154 427 156 791

Ou

tpu

t

Mother postnatal visit within 6

days rate (%)

75.9% 71.9% 66.9% 72.2% 66% 69.5% 71.8%

Mother postnatal visit within 6 days

after delivery

7 057 6 289 5 684 6 336 6 090 6 965 7 717

Delivery in facility total 9 300 8 745 8 495 8 774 9 228 10 025 10 750

Identified Risks Mitigation Strategy

Increased removal of long term reversible contraceptives e.g. implants Improved training and supervision of Professional Nurses (PHC level) on Family Planning


District Aspiration #2: Reduced child under 1 year mortality



Key Intervention


Dimension

(Clinical/

Community/

Systems)

Early life (0-28 days) Newcastle Extreme prematurity resulting from

poor service delivery at PHC

Negative attitude by health

workers, community and Faith

Based Organizations on CTOP

due to personal beliefs

Value clarification to all

stakeholders bi-annually

Systems


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Key Intervention


Dimension

(Clinical/

Community/

Systems)

Poor accountability by OM

facility, PHC supervisor and

district on implementation of

BANC plus

Monthly reporting at PHC

management meeting every

second week of the month after

nerve centre meeting

Clinical

Child under 1 year All three (3) sub-

districts

Children left under the care of

elderly parents

Children under 1 year not

brought for immunization

Strengthen universal health

coverage by reaching all people

in the population with essential

services and protecting them

from financial hardship owing to

the cost of these services

Systems

Child Health Theory of Change (impact, outcome and output) indicators for District aspirations, to reach health outcomes

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Imp

ac

t

Death in facility under

1 year rate

(annualized)

9.0% 6.6% 5.8% 5.8% 5% 4% 3%

Death in facility under 1

year total

180 144 140 114 120 103 89

Inpatient separations

under 1 year

1 990 2 190 2 345 1 970 2 533 2 735 2 954

I m p a c t Neonatal death rate 10.1% 13.6% 13.9% 10.5% 7.0% 7.3% 7.0%


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Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

per 1K

Neonatal 0-28 days death

in facility

96 118 117 88 63 72 69

Live birth in facility 13 965 8 660 8 440 8 308 9 029 9 920 9 906

Ou

tpu

t

Infant 1st PCR test

positive around 10

weeks rate (%)

1.0% 1.9% 1.0% 0.8% 0.5% 0.3% 0.3%

Infant PCR test positive

around 10 weeks

32 40 21 16 12 9 7

Infant PCR test around 10

weeks

3 079 2 082 3 301 2 042 2 450 2 940 2 528

Ou

tpu

t

Immunization

coverage under 1 year

(%)

79.2% 81.6% 76.6% 66% 78.3% 80.9% 84.3%

Immunised fully under 1

year new

9 265 9 957 9 723 9 584 11 680 12 321 12 999

Population under 1 year 11 699 12 200 14 207 14 556 14 917 15 231 15 421


Poor infrastructure preventing optimal neonatal care Closer collaboration between Provincial Infrastructure and Department of Public Works


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District Aspiration #3: Reduced HIV incidence



Key Intervention


Dimension

(Clinical/

Community/

Systems)

15-49 years All sub-districts Myths and misconceptions around

MMC and fear of HTS during MMC

Communication barrier Appoint MMC champions on the

same age group as target

population

Community

HIV - Theory of Change (impact, outcome and output) indicators for District aspirations, to reach health outcomes

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Ou

tco

me

Proportion of viral load

suppressed (%)

- - - - 90.4% 91.5% 95.2%

Numerator - - - - - - -

Denominator - - - - - - -

Ou

tco

me

Proportion of viral load

done (%)

- - - - 80.6% 72.2% 81.2

Numerator - - - - - - -

Denominator - - - - - - -

O u t p u t Total remaining on ART 41 272 46 388 48 846 59 466 66 171 74 290 76 048


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Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

- Adult

Total remaining on ART

- child

2 261 2 134 1 948 2 172 2 372 2 660 3 005

Ou

tpu

t Medical Male

Circumcision

performed

8 664 6 332 4 471 6 584 7 002 5 137 4 022

Ou

tpu

t

Male condom

distribution coverage

65.3 68.9 62.6 41.2 68.0 64.8 62.9

Numerator 8 406 885 9 057 802 8 419 270 5 664 000 9 592 080 9 435 000 9 400 000

Denominator 128 636 131 392 134 442 137 527 140 956 145 436 149 385


Failing HIV prevention efforts to reduce new infections Intensified focus on Condom distribution and MMC

Linking of newly diagnosed patients to Palliative Care service package Implementation of Palliative Care package at all levels of health care


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District Aspiration #4: Reduced mortality due to TB



Key Intervention


Dimension

(Clinical/

Community/

Systems)

Adult males and females

(24 years and older)

All sub-districts Late presentation of patients for

initiation on TB treatment and

defaulting while on treatment

Poor health seeking behaviour

by patients

Improve access to health

services at all levels

Systems

TB - Theory of Change (impact, outcome and output) indicators for District aspirations, to reach health outcomes

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Imp

ac

t

TB death rate (%) 5.4% 13.7% 11.5% 10.6% 6.4% 4.7% 4.0%

Numerator 156 336 263 238 168 140 136

Denominator 2 881 2 435 2 285 2 238 2 605 2 970 3 385

Ou

tco

me

TB treatment success

rate (%)

79.4% 79.4% 82.7% 74% 81% 80% 82%

Numerator 2 277 2 279 1 896 1 660 2 105 2 376 2 776

Denominator 2 881 2 435 2 285 2 238 2 605 2 970 3 385

Ou

t

co

me

TB client loss to follow-

up rate (%)

6.5% 5% 5.4% 6.8% 5% 5% 4%


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Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Numerator 190 143 123 152 129 135 142

Denominator 2 881 2 435 2 285 2 238 2 605 2 970 3 385

Ou

tpu

t

TB client initiated on

treatment rate (%)

97.4% 95.6% 97% 97.6% 98% 99.1% 99.4%

Numerator 2 881 2 329 2 212 2 184 2 543 2 925 3 364

Denominator 2 959 2 435 2 285 2 238 2 605 2 970 3 385


District Aspiration #5: Reduced Diabetes and Hypertension incidence



Key Intervention


Dimension

(Clinical/

Community/

Systems)

Adult males and females

(40yrs and older)

All three (3) sub-

districts

Unhealthy lifestyle including

sedentary lifestyle

Lack of awareness campaigns

to targeted population

Coordinate social mobilization &

community awareness on the

dangers of sedentary lifestyle

Community


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NCD - Theory of Change (impact, outcome and output) indicators for District aspirations, to reach health outcomes

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Type

Ou

tco

me

Diabetes incidence

per 1K

0.8 0.9 1.3 0.9 1.0 1.2 1.2

Numerator 370 467 676 517 574 637 714

Denominator 514 977 522 642 530 477 566 862 576 906 585 389 595 573

Ou

tco

me

Hypertension

incidence per 1K

14.9 13.6 26.9 9.8 10.9 38.2 37.4

Numerator 1 692 1 593 2 875 1 096 1 243 1 330 1 306

Denominator 514 977 522 642 106 623 110 720 113 072 115 664 118 781


Limited Community Resources to support physical exercise programmes Mobilize community resources

Lost focus on NCD for improved chronic patient outcomes Promote self-management and prevention


of 63

ANNEXURE A – CUSTOMISED INDICATOR TABLES ALIGNED TO APP (2018/19 – 2020/21)

Table 1: (DHS3) Strategic Objectives, Indicators & Targets

Strategic

Objective

Statement

Indicator Source Frequency/

Type

Audited/ Actual Performance Estimated

Performance

2017/18

Medium Term Targets Strategic

Plan Target

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Strategic Objective: Scale up implementation of Operation Phakisa ICRM

100% Provincial

fixed PHC

facilities score

above 70% on

the Ideal Clinic

Dashboard by

March 2021

1. Ideal clinic status

rate

Assessment

records; Ideal

Clinic

dashboard;

DHIS

Annual

%

Not reported 38% 100% 100% 100% 100% 100% -

Ideal clinic status Assessment

records; DHIS

No - 10 26 26 26 26 26

Fixed clinics plus fixed

CHCs/CDCs

DHIS No - 26 26 26 26 26 26

Strategic Objective: Accelerate implementation of PHC re-engineering

PHC utilisation

rate of at least

2.2 visits per

person per year

by March 2021

2. PHC utilization rate

- total (annualized)

DHIS Quarterly

No

2.4 2.6 2.2 2.3 2.2 2.2 2.2

PHC headcount total DHIS/ PHC

tick register

No 1 217 741 1 219 715 1 118 515 1 198 566 1 260 000 1 265 000 1 268 075

Population total DHIS/ Stats SA

Population 507 468 514 976 522 638 530 449 566 862 576 906 587 035

Strategic Objective: Improve compliance to the Ideal Clinic and National Core Standards

Increase

complaint

resolution within

25 working days

rate to 95% (or

more) in all

public health

3. Complaint

resolution within 25

working days rate

(PHC)

Complaints

register; DHIS

Quarterly

%

75.5% 96.5% 96.5% 89.5% 90% 95% 95% -

Complaint resolved

within 25 working

days

Complaints

Register

No 172 108 112 120 115 121 119


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Strategic

Objective

Statement


Type


Performance

2017/18


Plan Target

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

(PHC) facilities

by March 2021 Complaint resolved Complaints

Register

No 228 112 116 134 128 127 126


Increase

complaint

resolution to

90% (or more) in

all (PHC)

facilities by

March 2021

4. Complaint

resolution rate

(PHC)

Complaints

register; DHIS

Quarterly

%

90% 66.9% 67% 77% 80% 85% 90%

Complaint resolved Complaints

register

No 178 116 116 134 128 127 126

Complaint received Complaints

register

No 197 174 174 174 160 150 140


Maintain PHC

under 5years

utilisation rate

of at least 3.3

visits per child

per year

5. PHC utilisation rate

under 5 years

(annualised)

PHC register;

DHIS

Quarterly

No

3.3 3.4 3.3 3.4 2.9 3.1 3.3 3.3

PHC headcount under

5 years

PHC register;

DHIS

No 198 373 172 453 194 881 202 662 215 798 231 492 244 240

Population under 5

years

Stats SA; DHIS No 57 047 57 832 58 834 59 944 73 334 73 933 74 494

Increase the

expenditure per

PHC

headcount to

R 328 by March

2021

6. Expenditure per

PHC headcount

DHIS; BAS Quarterly

R

110 267.7 341.6 300 308 315 328 -

Total expenditure

PHC (Sub-

Programmes 2.2-

2.7)

BAS R’000 140 000 000 326 486 015 382 055 736 359 569 800 388 000 000 398 475 000 415 164 750

PHC headcount

total

DHIS No 1 250 000 1 219 715 1 118 515 1 198 566 1 260 000 1 265 000 1 268 075

Increase School

Health Teams to

15 by March

2021

7. Number of school

health teams

(cumulative)

Persal; BAS Annual

No

12 12 12 8 12 14 15 -


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Strategic

Objective

Statement


Type


Performance

2017/18


Plan Target

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Increase the

number of

ward based

outreach teams

to 13 by March

2021

8. Number of ward

based outreach

teams 1

(cumulative)

Persal; BAS Annual

No

11 9 9 12 12 12 13 -

Increase the

accredited

Health

Promoting

Schools to 56

(or more) by

March 2021

9. Number of

accredited health

promoting schools

(cumulative)

Accreditation

Certificate;

Health

Promotion

database

Annual

No

13 15 15 53 54 55 56 -

Accelerate

implementation

of PHC re-

engineering by

increasing

household

registration

coverage to at

least 6.9% per

annum

10. Outreach

household

registration visit

coverage

(annualised)

Outreach

registers; DHIS

Quarterly

%

New

indicator

New

indicator

New

indicator

4.5% 5.2% 6% 6.9%

Outreach households

registration visit

Outreach

Registers

No - - - 4 894 6 215 7 315 8 580

Households in the

population

Stats SA No - - 110 963 117 181 119 524 121 914 124 352

1The 2 (Emadlangeni sub-district) wards worst affected by poverty is targeted as part of the Poverty Eradication Master Plan


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Table 3: Strategic Objectives, Indicators and Targets – District hospitals

Strategic

Objective

Statement

Performance

Indicators Data Source

Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21


100% public

health hospitals

achieved 75%

and more on

the National

Core Standards

self-assessment

rate by March

2021

1. Hospital

achieved 75%

and more on

National Core

Standards self-

assessment rate

(District Hospitals)

Self-assessment

records; QA

records; DHIS

Quarterly

%

Not reported Not reported Not reported 100% 100% 100% 100% 100%

Hospital achieved

75% and more on

National Core

Standards self-

assessment

NCS

Assessment

records

No - - - 1 1 1 1

National Core

Standards self-

assessment

NCS

Assessment

records

No - - - 1 1 1 1

Strategic Objective: Improve hospital efficiencies

Improve

hospital

efficiencies by

reducing the

average length

of stay to 4.5

days (District

Hospital) by

March 2021

2. Average length

of stay - total

DHIS Quarterly

Days

3.7 4.8 4.4 4.5 4.5 4.5 4.5 -

In-patient days - total Midnight

census

No 9 040 11 452 11 300 12 578 12 626 13 257 13 920

½ Day patients Admission/

Discharge

Register

No 420 856 492 838 944 991 1 041

Inpatient separations Admission/

Discharge

Register

No 2 904 2 456 2 625 2 726 2 672 2 787 2 907

Increase bed

utilisation rate

to 70% (or

3. Inpatient bed

utilization rate -

total

DHIS Quarterly

%

44.3% 62.6% 60.8% 62% 70% 70% 70%


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

more) by

March 2021 In-patient days - total Midnight

census

No 9 040 11 452 11 300 12 578 12 626 13 257 13 920

½ Day patients Admission/

Discharge

Register

No 420 856 492 838 944 991 1041

Inpatient bed days

available

DHIS No 52 624 624 624 624 624 624


Maintain

expenditure per

PDE within the

provincial

norms

4. Expenditure per

patient day

equivalent (PDE)

BAS; DHIS Quarterly

R

1 981.2 2 046 2 283 2 203 2 126 2 252 2 295 -

Expenditure total BAS R’000 68 259 505 68 937 966 63 347 394 69 682 133 76 650 347 82 069 815 86 994 000

Patient day

equivalent

DHIS No 34 454 33 693 27 748 31 633 36 061 36 442 37 900


Sustain a

complaint

resolution within

25 working days

rate of 100% in

all public health

facilities from

March 2019

onwards

5. Complaint

resolution within

25 working days

rate

DHIS/ QA

database

Quarterly

%

88.2% 100% 100% 100% 100% 100% 100% -

Complaints resolved

within 25 working days

Complaints

Register

No 15 14 32 70 75 78 80

Complaints resolved Complaints

Register

No 17 14 32 70 75 78 80

Sustain

complaint

resolution rate

of 100% in all

public health

facilities from

March 2019

onwards

6. Complaints

resolution rate

DHIS/ QA

database

Quarterly

%

86% 100% 48.5% 85% 100% 100% 100%

Complaints resolved Complaints

Register

No 19 14 32 70 75 78 80

Complaints received Complaints

Register

No 22 14 66 82 75 78 80


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Strategic Objective: Reduce maternal mortality

Reduce the

caesarean

section rate to

25% (District),

40% (Regional),

March 2021

7. Delivery by

caesarean

section rate

DHIS Quarterly

%

23% 28.9% 29.4% 30% 25% 25% 25% -

Delivery by caesarean

section

Delivery&

Theatre

registers

No 157 165 171 192 148 151 154

Delivery in facility total Delivery

register

No 685 571 582 636 594 605 617


Reduce the un-

referred

outpatient

department

(OPD)

headcounts

with at least 7%

per annum

8. OPD headcount-

total

DHIS/ OPD tick

register

Quarterly

No

62 273 44 727 23 270 58 000 26 000 26 496 27 000 -

9. OPD headcount

not referred new

DHIS/ OPD tick

register

Quarterly

No

6 312 3 643 2 768 3 355 2 355 1 850 1 890 -


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Table5: Strategic Objectives, Indicators and Targets

Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18

Medium Term Targets Strategic Plan

Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Strategic Objective: Manage HIV prevalence

Increase the

number of

patients on ART

to at least

76 000 by

March 2021

(cumulative)

1. ART client remain

on ART end of

month - total

DHIS/ ART

Register

Quarterly

No

41 272 48 522 48 830 57 750 62 472 69 672 76 000

2. TB/ HIV co-

infected clients

on ART rate

ART register;

TIER.Net;

DHIS

Quarterly

%

73.2% 81.2% 90% 82% 90% 90% 90% -

TB/HIV co-infected

clients on ART

ART Register;

ETR.Net

No 667 1 375 1 914 1 625 1 653 1 691 1 703

HIV positive TB client ART Register;

ETR.Net

No 911 1 694 2 015 1 979 1 837 1 879 1 892

Strategic Objective: Reduce HIV Incidence

Test at least 159

922 people for

HIV by March

2019

(cumulative)

3. HIV test done -

total

DHIS/ HIV

Register

Quarterly

No

155 515 141 189 167 608 121 478 159 922 114 193 116 900

Increase the

male condom

distribution to

9 952 080 by

March 2021

4. Male condoms

distributed

Stock/ Bin

Cards

No 8 406 885 9 057 802 9 038 166 9 500 000 9 592 080 10 076 100 10 310 700 -

Increase the

medical male

circumcisions by

circumcising

19 341 males by

March 2021

(cumulative)

5. Medical male

circumcision –

total

MMC

Register;

Theatre

register; DHIS

Quarterly

No

8 644 6 332 6 230 5 008 7 002 6 556 5 783 -

Strategic Objective 2.4: Improve TB outcomes


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Increase the TB

clients 5 years

and older start

on treatment to

99% by March

2021

6. TB 5 years and

older start on

treatment rate

TB/HIV

Registers;

TIER.Net;

Quarterly

%

New

indicator

New

indicator

New

indicator

99.7% 99.5% 99.5% 99% -

TB client 5 years and

older start on

treatment

TB/HIV

Registers;

TIER.Net

No - - - 2 450 2165 2 058 2 254

TB symptomatic client

5 years and older

tested positive

TB/HIV

Registers;

TIER.Net;

No - - - 2 455 2 175 2 069 2 262

Increase the TB

client treatment

success rate to

88% (or more)

by March 2021

7. TB client

treatment

success rate

TB register;

ETR.Net

Quarterly

%

79.4% 79.4% 80% 85% 85% 87% 88% 90% or more

TB client successfully

completed

treatment

TB Register No 2 277 2 279 1 960 801 2 508 2 644 2 754

TB client start on

treatment

TB Register No 2 869 2 870 2 450 942 2 951 3 040 3 130

Decrease TB

client lost to

follow up to 5%

(or less) by

March 2021

8. TB client lost to

follow up rate

TB register;

ETR.Net

Quarterly

%

5% 5% 5% 4.6% <4% <4% 4% -

TB client on treatment

lost to follow up

TB Register No 143 143

123 43 106 106 125

TB client start on

treatment


2 870

2 450 942 2 951 3 040 3 130

Decrease TB

death rate to

5% by March

2021

9. TB client death

rate

ETR.Net Annual

%

11.7% 11.6% 11% 5.5% 5% 5% 5% 5%

TB client death during

treatment

TB Register No 336

336

269 52 147 152 157

TB client start on

treatment


2 870

2 450 942 2 951 3 040 3 130


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Increase the

MDR-TB

treatment

success rate to

75% (or more)

by March 2021

10. TB MDR

treatment

success rate

MDR

register; EDR

Web

Annual

%

Not reported Not reported Not reported 50% 62.7% 70% 75% 62% or more

TB MDR client

successfully

completing treatment

MDR

Register

No - - - 59 96 122 143

TB MDR confirmed

client start on

treatment

MDR

Register

No - - - 118 153 174 190

Reduce the TB

incidence to

450 (or less) per

100 000 by

March 2021

11. TB incidence TB register;

ETR.Net

Annual

No per

100,000 pop

527/100000 468/100000 408/100000 460/100000 470/100000 481/100000 450/100000 450 (or less)

per 100 000

New confirmed TB

cases

TB Register No 2 714 2 450 2 165 2 612 2 717 2 826 2 691

Total population in

KZN

DHIS; Stats

SA

Population 514 976 522 639 530 477 566 862 576 906 587 035 595 573

Improve Drug

Resistant TB

outcomes by

ensuring that

90% (or more)

diagnosed

MDR/XDR-TB

patients are

initiated on

treatment by

March 2020

12. TB XDR confirmed

client start on

treatment

XDR TB

register; EDR

Web;

TIER.Net

Quarterly

No

Not reported Not reported Not reported Not reported Not reported Not reported Not reported -

Strategic Objective: Reduce HIV Incidence

Decrease male

urethritis

syndrome to at

13. Male urethritis

syndrome

incidence

DHIS; Stats

SA

Quarterly

No per 1000

37.1 26.5 19.5 22.7 26.0 20.5 18.1 -


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

least 38 / 1000

by March 2021 Male urethritis

syndrome

treated – new

episodes

PHC Register No 4 875 3 564 2 688 3 200 3 762 3 325 2 752

Male population 15-

49 years

DHIS; Stats

SA

Population 131 392 134 442 137 527 140 956 144 687 148 616 152 643

Strategic Objective: Manage HIV prevalence

Increase the

number of

patients on ART

to at least 76

000 by March

2021

(cumulative)

14. ART adult remain

on ART end of

period

ART Register;

TIER.Net

Quarterly

No

Not reported Not reported 46 388 50 469 55 161 66 171 73 620 -

15. ART child under

15 years remain

on ART end of

period

ART Register;

TIER.Net

Quarterly

No

Not reported Not reported 2 134 2 350 2 253 2 300 2 380 -

TB Indicators: Reporting for TB has changed from reporting only New Smear Positive PTB cases in the denominator to reporting all TB cases as part of the denominator


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Table 7: Strategic Objectives, Indicators and Targets – MCWH & N

Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21


Increase the

antenatal 1st

visit before 20

weeks rate to

73% (or more)

by March 2021

1. Antenatal 1st visit

before 20 weeks

rate

PHC

register;

DHIS

Quarterly

%

52.8 58.8% 67% 66.3% 65% 70% 73% -

Antenatal 1st visit

before 20 weeks

PHC register No 5 615 5 408 5 970 5 970 6103 8 078 8 176

Antenatal 1st visit total PHC register No 10 636 9 200 8 914 8 914 9 200 12 429 11 200

Increase the

postnatal visit

within 6 days

rate to 65% (or

more) by

March 2021

2. Mother postnatal

visit within 6 days

rate

PHC &

Delivery

register;

DHIS

Quarterly

%

79.1 50.1 71.9% 71.9% 66% 65%

66%

-

Mother postnatal visit

within 6 days after

delivery

PHC register No 7 184 7 057 6 289 6 289 5 810 5 684 6 395

Delivery in facility total Delivery

Register

No 9 083 9 300 8 745 8 745 8 756 8 745 9 690


Initiate 98 %

eligible

antenatal

clients on ART

by March 2021

3. Antenatal client

start on ART rate

ART & PHC

register;

DHIS

Annual

%

93.1 94.2 92.6% 92% 98.2% 98% 98%

Antenatal client start

on ART

ART & PHC

register

No 2 319 2 370 1 875 1 696 1 987 2 688 2 968

Antenatal client

known HIV positive

but not on ART at 1st

visit

ART & PHC

register

No 2 511 2 516 2 024 1842 2 024 2 830 3029

Strategic Objective: Reduce infant mortality


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Reduce the

mother to child

transmission of

HIV to less than

0.8% by March

2021

4. Infant 1st PCR test

positive around 10

weeks rate

PHC

register;

TIER.Net;

DHIS

Quarterly

%

1.0% 1.9% 1.8% 1.15% <1% 0.6% 0.8%

Infant PCR test

positive around 10

weeks

PHC register No 32 40 30 24 18 15 17

Infant PCR test around

10 weeks

PHC register No 3 079 2 082 1 880 2 082 2 639 2 500 2 312

Strategic Objective: Reduce under 5 mortality

Increase

immunisation

coverage to

85% or more by

March 2021

5. Immunization under

1 year coverage

(annualized)

PHC

register;

DHIS

Quarterly

%

79.2% 81.6% 75% 79.3% 79% 79.1% 85% -

Immunised fully under

1 year new

PHC register No 11 422 9 957 9 484 11 604 11 835 12 072 13 107

Population under 1

year

DHIS; Stats

SA

No 11 699 12 200 12 641 14 624 14 973 15 257 15 421

Maintain the

measles 2nd

dose coverage

of 88% (or

more) by

March 2021

6. Measles 2nd dose

coverage

(annualised)

PHC

register;

DHIS

Quarterly

%

98.8 85.8% 95.8% 88.2% 83% 84% 88% -

Measles 2nd dose PHC register No 13 507 10 463 12 116 12 924 12 493 12 742 13 313

Population 1 year DHIS; Stats

SA

No 11 699 12 200 12 641 14 657 14 823 14 988 15 129

Reduce the

under-5

diarrhoea case

fatality rate to

2% (or less) by

March 2020

7. Diarrhoea case

fatality under 5

years rate

PHC &

Death

register;

DHIS

Quarterly

%

3.0 1.3% 0.9% 2.3% 2.0% 1.5% 2% -

Diarrhoea death

under 5 years

Death

Register

No 16 6 6 11 14 10 13


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Diarrhoea separation

under 5 years

Admission &

Discharge

register

No 730 469 624 469 705 690 698

Reduce the

under-5

pneumonia

case fatality

rate to less than

1% by March

2021

8. Pneumonia case

fatality under 5

years rate

DHIS Quarterly

%

0.9 1.5% 1.4% 1.5% 0.9 0.7 1% -

Pneumonia death

under 5 years

Tick

Register/

Death

Register

No 6 8 12 8 8 6 9

Pneumonia

separation under

5 years

Admission

records

No 691 539 878 539 870 895 900

Reduce the

under-5 severe

acute

malnutrition

case fatality

rate to 6% by

March 2020

9. Severe acute

malnutrition case

fatality under 5

years rate

DHIS Quarterly

%

11.0% 6.5% 4.6% 9.8% 7.5% 7.0% 6%

-

Severe acute

malnutrition

death in facility

under 5 years

Tick

Register/

Death

Register

No 23 12 6 18 19 19 16

Severe acute

malnutrition

separation under

5 years

Admission &

Discharge

records

No 228 184 130 184 263 276 268


Increase the

number of

learners

screened with

10. School Grade 1

learners

screened

School

Health

register;

DHIS

Quarterly

No

- - 2 861 12 612 13 242 13 746 14 021 -


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

at least 5% per

annum 11. School Grade 8

learners

screened

School

Health

register;

DHIS

Quarterly

No

- - 1 274 3 761 3 949 4 146 4 353 -


Reduce

deliveries under

19 years to 9.0%

or less by March

2021

12. Delivery in 10 to

19 years in

facility rate

DHIS Quarterly

%

Not reported Not reported 8.3% 8.6% 8.8% 9.2% 9%

Delivery 10 to 19 years

in facility

Tick Register No - - 726 760 770 810 800

Delivery in facility -

total

DHIS/Stats

SA

No - - 8 745 8 756 8 745 8 779 8 890

Strategic Objective: Improve women’s health

Increase the

couple year

protection rate

to 55% by

March 2021

13. Couple year

protection rate

(international)

DHIS Quarterly

%

51.9 52.7% 54% 50% 52% 53% 55% 36%

Couple year

protection

Tick Register

PHC/

Hospital

Register

No 73 957 76 070 78 654 98 135 99 243 101 229 88 256

Population 15-49 years

females

DHIS/Stats

SA

No 141 827 144 261 146 806 150 977 154 157 157 560 160 466

Maintain the

cervical cancer

screening

coverage of

14. Cervical cancer

screening

coverage 30

years and older2

DHIS Quarterly

%

62.8 57.8% 85% 67% 74.4% 79% 85% 75%

2 Replaced the approved customised indicator “Cervical cancer screening coverage 20 years and older” as per communicate from the Director General Health dates 09 February 2017


of 63

Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

75% (or more) Cervical cancer

screening in woman

30 years and older

Tick Register

PHC/

Hospital

Register

No 6 599 6 201 9 420 7 086 8 093 8 845 9 725

Population 30 years

and older female/10

DHIS/Stats

SA

No 10 444 10 722 10 975 10 576 10 883 11 191 11 441

Strategic Objective: Improve women’s health

Maintain

programme to

target 9 year

old girls with

HPV vaccine 1st

and 2nd dose as

part of cervical

cancer

prevention

programme

17. Human

papilloma virus

(HPV) 1st dose

HPV register;

DHIS

Annual

No

3 806 4 830 4 865 4 757 4 564 4 660 4 612

18. HPV 2nd dose HPV register;

DHIS

Annual

No

3 087 4 323 4 163 4 068 3 910 3 989 3 949 -


Increase the

Vitamin A dose

12-59 months

coverage to

62% or more by

March 2021

19. Vitamin A dose

12-59 months

coverage

(annualised)

PHC

register;

DHIS; Stats

SA

Quarterly

%

50.2% 53% 55.4% 57% 60% 62% 62%

-

Vitamin A dose 12 - 59

months

PHC register No 54 727 49 349 52 402 66 929 70 752 73 454 73 854

Population 12-59

months (multiplied by

2)

DHIS; Stats

SA

No 115 664 93 270 94 604 117 420 117 920 118 474 119 120



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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Reduce the

maternal

mortality in

facility ratio to

110 (or less) per

100 000 live

births by March

2021

20. Maternal

mortality in

facility ratio

(annualised)

Midnight

census;

Maternity &

Death

register DHIS

Annual

No per

100,000

143.2 161.7 91.9 119 112 112 110 100 (or less)

per 100 000

live births

Maternal death in

facility

Midnight

census/

Death

Register

No 20 14 8 11 10 10 10

Live birth in facility plus

Born alive before

arrival at facility

Maternity

Register

No 13 965 8 660 8 706 9 219 9 058 9 239 9 297

Strategic Objective: Reduce infant mortality

Reduce the

neonatal death

in facility rate to

at least

10.5/1000 by

March 2021

21. Neonatal death

in facility rate

Midnight

census;

Maternity &

Death

register;

DHIS

Annual

No per 1000

6.8 10.4 13.8 12.4 7.5 7.5 7.5 -

Neonatal 0-28 days

death in facility

Midnight

census/

Death

Register

No 96 90 120 107 68 65 69

Live birth in facility Maternity

register

No 13 965 8 660 8 706 8 660 9 058 9 239 9 278


Reduce the

under 5

mortality rate to

4.5 per 1000 live

births by March

2021

22. Under 5 mortality

rate

Bethesda

Model

Annual

No per 1000

pop

5.9 2.3 2.6 4.2 4.0 4.5 4.5 4.5/1000 live

births


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Reduce under-

5 diarrhoea

with

dehydration

incidence to 8

(or less) per

1000 by March

2021

23. Diarrhoea with

dehydration in

child under 5

years incidence

(annualised)

PHC

register;

DHIS; Stats

SA

Annual

No per 1000

31.8 31.3 12.1 9.1 8.5 8.7 8.0

Diarrhoea with

dehydration new in

child under 5 years

PHC register No 1 843 1 843 724 670 610 498 723

Population under 5

years

DHIS; Stats

SA

No 57 831 58 834 59 944 73 334 73 933 74 494 90 402

Reduce the

under-5

pneumonia

incidence to

65(or less) per

1000 by March

2021

24. Pneumonia in

child under 5

years incidence

(annualised)

PHC

register;

DHIS; Stats

SA

Annual

No per 1000

77.9 76.6 47.7 66.4 66.0 65 65 -

Pneumonia new in

child under 5 years

PHC register No 4 507 4 507 2 860 4 872 4 881 4 853 5 876

Population under 5

years

DHIS; Stats

SA

No 57 831 58 834 59 944 73 334 73 933 74 494 90 402

Reduce severe

acute

malnutrition

incidence

under 5 years to

3.4 (or less) per

1000 by March

2021

25. Child under 5

years severe

acute

malnutrition

incidence

(annualised)

DHIS Annual

No per 1000

4.4 4.9 5.5 3.7 3.7 3.4 3.3 4.6/1 000

Child under 5 years

with severe acute

malnutrition new

DHIS/ Tick

Register

PHC

No 255 293 330 269 274 244 271

Population under 5

years

DHIS/Stats

SA

No 57 831 58 834 59 944 73 334 73 933 74 494 90 402


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Reduce the

death in facility

under 1 year

rate to 6% or

less by March

2021

27. Death in facility

under 1 year

rate (annualised)

Midnight

census;

Admission

Discharge &

Death

register;

DHIS

Annual

%

9.0% 6.7% 5.9% 6.4% 5.9% 5.6% 6%

-


1 year total

Death

Register

No 180 147 142 149 143 138 149


under 1 year

Midnight

census/

Admissions,

Discharge &

Death

registers

No 1 990 2 190 2 422 2 335 2 393 2 453 2 488

Reduce the

death in facility

under 5 years

rate to 4% (or

less) by March

2021

28. Death in facility

under 5 years

rate

Midnight

census;

Admission

Discharge &

Death

register;

DHIS

Annual

%

6.2% 4.2% 3.6% 4.1% 3.9% 3.6% 4% -


5 years total

Death

Register

No 196 155 156 159 156 152 171


under 5 years

Midnight

census/

Admissions,

Discharge &

Death

registers

No 3 118 3 619 4 298 3 841 4 033 4 235 4 277

Reduce early

neonatal death

Early neonatal death

in facility rate

Midnight

census/

Quarterly % 0.8 1.0% 1.3% 0.9% 1.0% 1.0% 1%

109 90 114 79 91 92 96


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

in facility rate to

1 % by March

2021

Admissions,

Discharge &

Death

registers

13 965 8 660 8 706 8 660 9 058 9 239 9 690


of 63

Table 9: Strategic Objectives, Indicators and Targets - NCD

Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Strategic Objective: Reduce incidence of non-commutable diseases

Increase the

cataract surgery

rate to at least

599.1 per 1 mil

uninsured

population by

March 2021

1. Cataract surgery

rate (annualised)

DHIS Quarterly

No per 1mil

uninsured

population

547.5 344.2 7.9 568.2 571.3 571.3 599.1 -

Total number of

cataract surgeries

completed

DHIS/Theatre

Register

No 283 163 4 294 300 306 324

Population uninsured DHIS/Stats SA No 494 377 473 509 509 257 517 422 525 109 535 611 524 104

Strategic Objective: Eliminate malaria

Maintain the

malaria case

fatality rate to

less than 0% by

March 2021

2. Malaria case

fatality rate

Malaria

Information

System

Quarterly

%

0 0 0 0 0 0 0 0%

Deaths from malaria Malaria

register/Tick

sheets PHC

No 0 0 0 0 0 0 0

Total number of

Malaria cases

reported

Malaria

register/Tick

sheets PHC

No 0 0 0 0 0 0 0

Zero new local

malaria cases by

March 2020

3. Malaria

incidence per

1000 population

at risk

Malaria

Register; Stats

SA

Annual

No per 1000

pop at risk

0 0 0 0 0 0 0 Zero new

local

infections

Number of malaria

cases (new)

Malaria

Register/Tick

Register PHC

No 0 0 0 0 0 0 0

Population Amajuba

DHIS; Stats

SA

Population 0 0 0 0 576 906 585 389 595 573


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Strategic Objective: Reduce mortality and morbidity of non-communicable diseases

Screen at least

118 657 people

(40 years and

older) per

annum for

hypertension by

March 2021

4. Clients 40 years

and older

screened for

hypertension

DHIS/ Tick

Register

Quarterly

No

Not reported Not reported Not reported 117 479 140 000 119 839 120 800 -

Hypertension

incidence of 11

per 1000

population by

March 2021

5. Hypertension

incidence

(annualised)

PHC register;

DHIS

Annual

No per 1000

14.9 13.8 30.2 9.9 11 11.5 11 23/ 1000

Hypertension client 40

years and older

new

PHC register No 1 692 1 603 3 544 1 096 1 243 1 330 1 306

Population 40 years

and older

DHIS; Stats

SA

Population 113 286 116 149 117 310 110 720 113 072 115 664 118 781

Screen at least

2.5 million

people (40 years

and older) per

annum for

diabetes by

March 2020

6. Clients 40 years

and older

screened for

diabetes

DHIS/ Tick

Register

Quarterly

No

Not reported Not reported Not reported 117 479 140 000 119 839 120 800 -

Diabetes

incidence of 1.2

per 1000

population by

March 2021

7. Diabetes

incidence

(annualised)

PHC register;

DHIS

Annual

No per 1000

0.7 0.9 1.3 0.9 1.0 1.2 1.2 3.1/ 1000

Diabetes client

treatment new

PHC register No 370 467 676 517 574 637 714

Population total DHIS; Stats

SA

Population 514 977 522 642 530 477 566 862 576 906 585 389 595 573

Screen at least

35% of PHC

8. Mental disorders

screening rate

PHC register;

DHIS

Quarterly

%

Not reported - 37% 45% 39.6% 35% 35% -


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Strategic

Objective

Statement

Performance


Frequency

Type


Performance

2017/18


Plan Target

2019/20 2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

clients annually

for mental

disorders by

March 2021

PHC client screened

for mental disorders

PHC register No - - 451 435 516 600 499 058 442 750 443 826

PHC headcount - total PHC register No - 1 219 715 1 118 515 1 134 629 1 260 000 1 265 000 1 268 075

Increase the

number of

wheelchairs

issued to 255 by

March 2019

9. Wheelchairs

issued

PHC & OPD

register; DHIS

Quarterly

No

123 102 295

172 255 260 270 -

Strategic Objective: Improve quality of care

Improve the

restoration to

extraction ratio

to 12:1 or less by

March 2021

10. Dental extraction

to restoration

ratio

PHC register;

OPD &

Theatre

register; DHIS

Quarterly

No

21.3 19.3 11.7 17.4 11.6 10.3 11:0 -

Tooth extraction PHC register;

OPD &

Theatre

register

No 36 398 35 642 39 448 38 252 40 165 40 173 40 300

Tooth restoration PHC register;

OPD &

Theatre

register

No 1 711 1 849 3 362 2 202 3 470 3 864 3 650

Strategic Objective: Reduce mortality and morbidity of non-communicable diseases

Improve access

to palliative care

services

11. Number of

patients offered

Palliative Care

services

Palliative

care register

No Not reported Not reported Not reported Not reported 700 800 900

12. Number of

Health Workers

trained in

Palliative Care

Skills

Development

register

No Not reported Not reported Not reported Not reported 60 70 80


of 63

ANNEXURE B – CUSTOMISED INDICATOR TABLES ALIGNED TO APP (2018/19 – 2020/21)

Social determinants of health

Sub-Districts Data Source

Tota

l n

um

be

r o

f h

ou

seh

old

s

Un

em

plo

ym

en

t ra

te

Pe

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nta

ge

of

po

pu

latio

n

liv

ing

be

low

po

ve

rty

lin

e o

f

R28

3 p

er

mo

nth

Nu

mb

er

of

ho

use

ho

lds

in

Info

rma

l d

we

llin

g

Nu

mb

er

of

ho

use

ho

lds

in

form

al d

we

llin

g

Pe

rce

nta

ge

of H

ou

seh

old

s

with

ac

ce

ss t

o s

an

ita

tio

n

Ho

use

ho

lds

with

ac

ce

ss t

o

po

tab

le w

ate

r

Pe

rce

nta

ge

of H

ou

seh

old

s

with

ac

ce

ss t

o e

lec

tric

ity

Ad

ult lite

rac

y r

ate

Dannhauser

Census 2001 19 320 70% - 598 12 895 17% 2 798 43.5% 77%

Community Survey 2016 20 167 21% - 261 13 992 - 18 392 92.4% 90%

Census 2011 20 439 47.6% - 493 16 905 23% 10 175 80.7% -

Emadlangeni

Census 2001 6 187 56% - 184 2 836 29% 1 947 30.6% 75%

Community Survey 2016 6 667 27% - 89 4 494 - 4 273 57% 86%

Census 2011 6 252 37.6% - 148 3 644 45% 2 410 48.5% -

Newcastle

Census 2001 71 164 40% - 6 851 59 423 62% 43 886 84% 87%

Community Survey 2016 90 347 21% - 5 803 80 473 - 89 057 94.8% 93%

Census 2011 84 272 37.4% - 4 459 76 792 63% 71 635 87% -

District Total

Census 2001 96 671 55% - 7 633 75 154 51% 48 631 - 84%

Community Survey 2016 110 963 41.9% - 6 153 98 958 - 111 623 97.4% 92%

Census 2011 110 963 40.8% - 5 100 97 341 54% 84 220 - -

Source: Stats SA (Local Government Handbook)


of 63

Population per selected category


under 1 year 14 207 14 556 14 917 15 231 15 421

under 5 years 72 717 73 293 73 900 74 479 74 981

05-09 years 71 778 72 416 72 806 73 087 73 474

10-14 years 64 637 66 904 68 968 70 732 72 117

15-19 years 54 691 55 255 56 965 59 358 62 072

20-24 years 56 751 55 828 54 635 53 420 52 739

25-29 years 53 152 54 020 54 606 55 044 55 041

30-34 years 42 295 44 501 46 635 48 764 50 956

35-39 years 32 699 34 428 36 029 37 436 38 535

40-44 years 23 813 24 908 26 121 27 441 28 855

45-49 years 18 604 19 014 19 521 20 141 20 886

50-54 years 16 091 16 076 16 136 16 257 16 443

55-59 years 15 012 14 857 14 636 14 411 14 238

60-64 years 12 350 12 521 12 668 12 769 12 794

65-69 years 9 072 9 252 9 429 9 595 9 745

70-74 years 6 101 6 218 6 325 6 435 6 553

75-79 years 3 449 3 564 3 673 3 766 3 844

80 years and older 2 131 2 170 2 211 2 257 2 306

Total 555 347 565 227 575 265 585 389 595 573

Estimated pregnant women* 15 201 15 575 15 961 16 297 16 500

Source: Mid-Year Population Estimates 2016, StatsSA (as per 2016 demarcations)


of 63

Management and efficiency indicators for the service delivery platform - PHC

Sub-districts

Efficiency Management

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xp

en

ditu

re p

er

ca

pita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xp

en

ditu

re

pe

r c

ap

ita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t e

xp

en

ditu

re

pe

r p

rim

ary

he

alth

ca

re

he

ad

co

un

t (R

an

d)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C f

ac

ilitie

s w

ith

90%

of

the

tra

ce

r m

ed

icin

es

av

aila

ble

(%

)

Pe

rce

nta

ge

Id

ea

l C

linic

s

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(No

)

8 7 6 5 4 3 2 1

Dannhauser SD Indicator - - - 100% 100% 100% 2.4

Numerator - - - 10 11 10 261 239

Denominator - - - 10 11 10 1 297 671

Emadlangeni SD Indicator - - - 100% 50% 100% 2.6

Numerator - - - 2 1 2 97 094

Denominator - - - 2 2 2 440 499

Newcastle SD Indicator - - - 100% 100% 100% 2.0

Numerator - - - 13 13 13 775 442

Denominator - - - 13 13 13 4 652 817

Amajuba District

Indicator 1 216 1 006 431 100.0 96.2 100% 2.1

Numerator 590 984 146 488 952 668 488 952 668 26 25 26 1 133 775

Denominator 486 142 486 142 1 133 775 26 26 26 6 390 987

Source: DHIS, BAS, Ideal Clinic Information System


of 63

Management and efficiency indicators for the service delivery platform - Hospitals

Hospital

District Hospital Regional Hospital

Av

era

ge

len

gth

of

sta

y -

to

tal (

Da

ys)

Exp

en

ditu

re p

er

pa

tie

nt

da

y

eq

uiv

ale

nt

(Ra

nd

)

Inp

atie

nt

be

d

utilis

atio

n r

ate

- t

ota

l

(%)

Inp

atie

nt

cru

de

de

ath

ra

te (

%)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Av

era

ge

len

gth

of

sta

y -

to

tal (

Da

ys)

Exp

en

ditu

re p

er

pa

tie

nt

da

y

eq

uiv

ale

nt

(Ra

nd

)

Inp

atie

nt

be

d

utilis

atio

n r

ate

- t

ota

l

(%)

Inp

atie

nt

cru

de

de

ath

ra

te (

%)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17

Emadlangeni SD Indicator 4.5 3 788 71.5 7.2 48.2 - - - - -

Numerator 12 442 84 302 443 12 442 200 3 224 - - - - -

Denominator 2 760 22 258 17 400 2 670 6 690 - - - - -

Newcastle SD Indicator - - - - - 7.6 2 880 66.7 5.7 40.1

Numerator - - - - - 262 051 994 064 337 262 051 1 976 31 490

Denominator - - - - - 34 612 345 118 393 057 34 612 78 550

Amajuba Indicator 4.5 3 788 71.5 7.2 48.2 7.6 2 880 66.7 5.7 40.1

Numerator 12 442 84 302 443 12 442 200 3 224 262 051 994 064 337 262 051 1 976 31 490

Denominator 2 760 22 258 17 400 2 760 6 690 34 612 345 118 393 057 34 612 78 550


of 63

Annual trends Deaths and Patient day equivalent, 2014/15 - 2016/17

2014/15 2015/16 2016/17

Data Element

(Number)

PH

C

/ C

HC

/

MO

U*

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

ho

spita

l

Dis

tric

t To

tal

Maternal deaths - - 20 - 20 - - 14 - 14 2 9 - 11

Live births 685 630 12650 - 13965

601 582 7477 - 8660 718 537 7185 - 8440

Still births 21 10 284 - 315 8 5 216 - 229 6 6 198 - 210

Ch

ild (

un

de

r 5 y

ea

rs)

Infa

nt

(un

de

r 1

ye

ar)

Ne

on

ata

l

Death in

facility 0-7days

- 2 107 - 109 1 2 87 - 90 1 5 96 - 102

Death in

facility 8-28

days

- 4 28 - 32 - 2 26 - 28 - 1 14 - 15

Death in

facility 29 days

- 11 months

- 7 32 - 39 - 1 25 - 26 - 1 22 - 23

Death in

facility 12 – 59

months

- 2 14 - 16 - 2 6 - 8 - 1 19 - 20

Diarrhoea death under 5 years - 3 13 - 16 - - 6 - 6 - - 3 - 3

Pneumonia death under 5 years - 1 4 - 5 - - 8 - 8 - - 8 - 8


of 63

2014/15 2015/16 2016/17

Data Element

(Number)

PH

C

/ C

HC

/

MO

U*

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

ho

spita

l

Dis

tric

t To

tal

Severe acute malnutrition death under 5

years

- - 20 - 20 - 3 9 - 12 - - 7 - 7

TB Deaths 324 159 519 - 1 002 261 147 459 - 867 - - - - -

Inpatient death total 183 1 962 2 145 - - 186 1 989 2 175 - - 200 1 976 2 176 - 183

Patient day equivalent - 33 693 35548

4

- 38917

7

7 27748 32962

2

- 357

377

3 592 22258 34511

8

- 37096

8


of 63

Burden of disease profile


of 63


of 63

Women and Maternal Health

Impact Outcome Output

Inst

itu

tio

na

l

ma

tern

al

mo

rta

lity

ratio

(P

er

10

0K

)

An

ten

ata

l c

lie

nt

initia

ted

o

n

AR

T

rate

(%

)

De

live

ry

in

fac

ility

un

de

r 1

8

ye

ars

rate

(%

)

An

ten

ata

l 1

st

vis

it

be

fore

2

0

we

ek

s

rate

(%

)

Ce

rvic

al

scre

en

ing

co

ve

rag

e (

%)

Co

up

le

ye

ar

pro

tec

tio

n r

ate

(%

)

Mo

the

r p

ost

na

tal

vis

it

with

in

6

da

ys

rate

(%

)

7 6 5 4 3 2 1

Dannhauser SD

Indicator - 97.3 8.1 72.6 114.8 62.6 538.6

Numerator - 285 17 1 211 2 351 17 281 1 131

Denominator 218 293 210 1 669 2 033 27 615 210

Emadlangeni SD

Indicator 372.4 67.4 10.0 64.5 83.5 117.1 57.6

Numerator 2 122 54 427 578 10 699 312

Denominator 537 181 542 662 688 9 134 542

Newcastle SD

Indicator 117.1 96.9 8.0 70.1 83.1 44.9 54.8

Numerator 9 1 278 620 4 723 6 901 49 501 4 241

Denominator 7 685 1 319 7 743 6 735 8 254 110 055 7 743

Amajuba District

Indicator 130.3 94.0 8.1 70.2 89.0 52.8 66.9

Numerator 11 1 685 691 6 361 9 830 77 481 5 684

Denominator 8 440 1 793 8 495 9 066 10 974 146 804 8 495


of 63

Annual trends Child Health

Impact Outco

me

Output

Ch

ild u

nd

er

5 y

ea

rs

dia

rrh

oe

a c

ase

fa

tality

rate

(%

)

Ch

ild u

nd

er

5 y

ea

rs

pn

eu

mo

nia

ca

se f

ata

lity

rate

%

Ch

ild u

nd

er

5 y

ea

rs

sev

ere

ac

ute

ma

lnu

tritio

n c

ase

fa

tality

rate

%

Inp

atie

nt

de

ath

< 1

ye

ar

rate

Inp

atie

nt

de

ath

< 5

ye

ars

rate

Inp

atie

nt

ea

rly

ne

on

ata

l

de

ath

ra

te P

er

1K

Inp

atie

nt

ne

on

ata

l d

ea

th

rate

Pe

r 1K

Infa

nt

1st

PC

R t

est

po

sitiv

e a

rou

nd

10

we

ek

s

rate

(%

)

Sc

ho

ol G

rad

e 1

scre

en

ing

co

ve

rag

e (

%)

Sc

ho

ol G

rad

e 8

scre

en

ing

co

ve

rag

e (

%)

HPV

1st

do

se c

ov

era

ge

(%)

HPV

2n

d d

ose

co

ve

rag

e

(%)

Vita

min

A c

ove

rag

e 1

2-

59 (

%)

Imm

un

isa

tio

n c

ov

era

ge

un

de

r 1

ye

ar

(%)

Me

asl

es

2n

d d

ose

co

ve

rag

e (

%)

Infa

nt

ex

clu

siv

ely

bre

ast

fed

at

DTa

P-I

PV

-

Hib

-HB

V 3

rd d

ose

ra

te

(%)

Dannhauser SD

Indicator - - - - - - - 1.1 46.3 15.5 - - 84.1 66.2 85.4 64.9

Numerator - - - - - - - 4 1 323 484

- -

18

571

2 025 2 478 1 058

Denominator - - - - - 218 218 371 2 856 3 128

- -

21

988

3 044 2 889 1 629

Emadlangeni SD

Indicator - - - 4.0 2.3 9.3 11.2 - 51.8 28.4 - - 52.6 60.6 104.6 59.5

Numerator - - - 7 8 5 6 - 427 341 - - 3556 532 896 336

Denominator 86 104 12 173 343 537 537 138 825 1 199 - - 6 734 873 855 565

Newcastle SD

Indicator 0.7 1.1 6.8 6.1 4.0 12.6 14.4 1.1 62.7 12.4 - - 58.6 81.9 93.2 55.7

Numerator 3 8 7 133 152 97 111 17 5 273 838

- -

38

771

7 166 7 930 3 800

Denominator 455 707 103 2 172 3 766 7 685 7 685 1 595 8 411 6 744

- -

65

876

8 720 8 472 6 818

Amajuba District Indicator 0.6 1.0 6.1 6.0 3.9 12.1 13.9 1.0 58.1 15.0 - - 64.1 76.6 92.1 57.6


of 63

Impact Outco

me

Output

Ch

ild u

nd

er

5 y

ea

rs

dia

rrh

oe

a c

ase

fa

tality

rate

(%

)

Ch

ild u

nd

er

5 y

ea

rs

pn

eu

mo

nia

ca

se f

ata

lity

rate

%

Ch

ild u

nd

er

5 y

ea

rs

sev

ere

ac

ute

ma

lnu

tritio

n c

ase

fa

tality

rate

%

Inp

atie

nt

de

ath

< 1

ye

ar

rate

Inp

atie

nt

de

ath

< 5

ye

ars

rate

Inp

atie

nt

ea

rly

ne

on

ata

l

de

ath

ra

te P

er

1K

Inp

atie

nt

ne

on

ata

l d

ea

th

rate

Pe

r 1K

Infa

nt

1st

PC

R t

est

po

sitiv

e a

rou

nd

10

we

ek

s

rate

(%

)

Sc

ho

ol G

rad

e 1

scre

en

ing

co

ve

rag

e (

%)

Sc

ho

ol G

rad

e 8

scre

en

ing

co

ve

rag

e (

%)

HPV

1st

do

se c

ov

era

ge

(%)

HPV

2n

d d

ose

co

ve

rag

e

(%)

Vita

min

A c

ove

rag

e 1

2-

59 (

%)

Imm

un

isa

tio

n c

ov

era

ge

un

de

r 1

ye

ar

(%)

Me

asl

es

2n

d d

ose

co

ve

rag

e (

%)

Infa

nt

ex

clu

siv

ely

bre

ast

fed

at

DTa

P-I

PV

-

Hib

-HB

V 3

rd d

ose

ra

te

(%)

Numerator 3 8 7 140 160 102 117 21 7 023 1 663

- -

60

898

9 723 11

304

5 194

Denominator 541 811 115 2 345 4 109 8 440 8 440 2 104 8 954 11

071 - -

94

598

12

637

12

216

9 012

Annual trends HIV

3rd 90

Outcome

2nd 90

Output

1st 90

Process and Input

Sub-District

Pro

po

rtio

n V

ira

l lo

ad

do

ne

- A

du

lt (

%)

Pro

po

rtio

n v

ira

l lo

ad

do

ne

- C

hild

(%

)

Pro

po

rtio

n V

ira

l lo

ad

sup

pre

sse

d

- A

du

lt

(%)

Pro

po

rtio

n V

ira

l Lo

ad

Su

pp

ress

ed

-

ch

ild

(%)

Pro

po

rtio

n r

em

ain

ing

in c

are

- A

du

lts

(%)

Pro

po

rtio

n r

em

ain

ing

in c

are

- c

hild

(%

)

Clie

nts

re

ma

inin

g o

n

AR

T ra

te -

all (

%)

H

IV

test

p

osi

tiv

e

clie

nt

15

y

ea

rs

an

d

old

er

rate

(in

clu

din

g

AN

C)

(%

HIV

te

stin

g

co

ve

rag

e (i

nc

lud

ing

an

ten

ata

l c

are

) (%

)

Me

dic

al

ma

le

circ

um

cis

ion

ra

te

(%)

Ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Fe

ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

12 11 10 9 8 7 6 5 4 3 2 1

Dannhauser SD Indicator 34.4 51.6 94.1 75.0 80.5 81.6 - - 36.7 10.3 79.8 1.8


of 63

3rd 90

Outcome

2nd 90

Output

1st 90

Process and Input

Sub-District

Pro

po

rtio

n V

ira

l lo

ad

do

ne

- A

du

lt (

%)

Pro

po

rtio

n v

ira

l lo

ad

do

ne

- C

hild

(%

)

Pro

po

rtio

n V

ira

l lo

ad

sup

pre

sse

d

- A

du

lt

(%)

Pro

po

rtio

n V

ira

l Lo

ad

Su

pp

ress

ed

-

ch

ild

(%)

Pro

po

rtio

n r

em

ain

ing

in c

are

- A

du

lts

(%)

Pro

po

rtio

n r

em

ain

ing

in c

are

- c

hild

(%

)

Clie

nts

re

ma

inin

g o

n

AR

T ra

te -

all (

%)

H

IV

test

p

osi

tiv

e

clie

nt

15

y

ea

rs

an

d

old

er

rate

(in

clu

din

g

AN

C)

(%

HIV

te

stin

g

co

ve

rag

e (i

nc

lud

ing

an

ten

ata

l c

are

) (%

)

Me

dic

al

ma

le

circ

um

cis

ion

ra

te

(%)

Ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Fe

ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Numerator - 16 - 12 - 40 - - 19 337 385 2 436

629

65 602

Denominator 1 039 31 357 16 1 367 49 - - 52 408 24 793 30 369 38 703

Emadlangeni SD

Indicator 48.6 54.3 93.1 73.7 79.2 87.8 - - 33.8 31.8 135.9 1.1

Numerator - 19 - 14 - 36 - - 6 387 452 1 625

919

12 497

Denominator 479 35 233 19 611 41 - - 18 779 9 645 11 901 12 475

Newcastle SD

Indicator 34.6 70.5 93.9 79.9 70.2 77.7 - - 38.6 25.4 35.5 1.0

Numerator - 134 - 107 - 205 - - 82 265 3 634 4 356

722

144 617

Denominator 3 829 190 1 323 134 6 030 264 - - 212 136 102 081 121 949 152 018

Amajuba District

Indicator 35.8 66.0 93.8 78.7 72.7 79.4 62.1 9.2 37.9 23.0 51.0 1.2

Numerator - 169 - 133 - 281 53 646 10 761 107 989 4 471 8 419

270

222 716

Denominator 5 347 256 1 913 169 8 008 354 86354 116 765 283 323 136 519 164 219 203 196


of 63

Annual trends TB

Impact Outcome Output Process

Sub-district

TB d

ea

th r

ate

(ETR

.ne

t)

(%)

Dru

g-r

esi

sta

nt

TB c

lie

nt

de

ath

ra

te (

%)

TB/H

IV c

o-i

nfe

cte

d

clie

nt

on

AR

T ra

te

(ETR

.Ne

t) (

%)

TB c

lie

nt

tre

atm

en

t

suc

ce

ss r

ate

(ETR

.ne

t)

(%)

TB c

lie

nt

loss

to

fo

llo

w

up

ra

te (

ETR

.Ne

t) (

%)

TB r

ifa

mp

icin

resi

sta

nc

e c

on

firm

ed

clie

nt

rate

(%

)

TB r

ifa

mp

icin

re

sist

an

t

co

nfirm

ed

tre

atm

en

t

sta

rt r

ate

(%

)

Dru

g-r

esi

sta

nt

TB

tre

atm

en

t su

cc

ess

rate

(%

)

Dru

g-r

esi

sta

nt

TB c

lie

nt

loss

to

fo

llow

-up

ra

te

(%)

TB c

lie

nt

initia

ted

on

tre

atm

en

t ra

te (

%)

TB s

ym

pto

m 5

ye

ars

an

d o

lde

r sc

ree

ne

d in

fac

ility

ra

te (

%)

11 10 9 8 7 6 5 4 3 2 1

Dannhauser SD

Indicator 6.9 - 81.4 87.2 4.4 - - - - - 59.3

Numerator 22 - 92 279 14 - - - - - 129 604

Denominator 320 - 113 320 320 - - - - - 218 491

Emadlangeni SD

Indicator 18.1 - 69.9 68.8 6.2 - - - - - 76.9

Numerator 50 - 102 190 17 - - - - - 59 359

Denominator 276 - 146 276 276 - - - - - 77 151

Newcastle SD

Indicator 12.2 - 86.4 77.2 6.2 - - - - - 92.3

Numerator 218 - 758 1 380 110 - - - - - 586 288

Denominator 1 787 - 877 1 787 1,787 - - - - - 634 966

Amajuba District

Indicator 12.2 21.6 83.8 77.6 5.9 55.6 8.0 58.3 18.7 52.0 83.3

Numerator 290 30 952 1 849 141 95 171 81 26 1 113 775 251

Denominator 2 383 139 1 136 2 383 2 383 171 2 141 139 139 2 141 930 608


of 63

Annual trend Non-communicable diseases 2016/17

Sub-districts Outcome

Diabetes incidence (Per 1K) Hypertension incidence (Per 1K)

2 1

Dannhauser SD

Indicator 0.7 7.0

Numerator 74 160

Denominator 59 062 59 062

Emadlangeni SD

Indicator 3.5 31.0

Numerator 127 253


Newcastle SD

Indicator 1.3 27.7

Numerator 522 2 462


Amajuba District

Indicator 6.7 26.9

Numerator 723 2 875


amajuba district district health plan 2018/19 - 2020/21€¦ · amajuba district health plan...

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