gert sibande district municipality · according to census 2011, 11.7% of household heads are...

GERT SIBANDE

DISTRICT MUNICIPALITY

2

Table of Contents

1. Demographic Information ......................................................................................................................................... 3

2. Social Determinants of Health .................................................................................................................................. 5

3. Service Delivery Platform .......................................................................................................................................... 9

3.1. Public Health Facility Types Sub-Districts ......................................................................................................... 9

3.2. Private Medical Practices and Hospitals ......................................................................................................... 10

3.3. Maps ................................................................................................................................................................ 11

3.4. District Hospital Performance ......................................................................................................................... 14

3.5. Trend of Public Health Expenditure ................................................................................................................ 16

3.6. Trend of Health Services Delivery ................................................................................................................... 17

3.1. Burden of Disease ........................................................................................................................................... 18

3.1.1. Poverty and Hunger ................................................................................................................................ 18

3.1.2. Child Health ............................................................................................................................................. 19

3.1.3. Maternal and Woman’s Health ............................................................................................................... 20

3.1.4. HIV/TB ..................................................................................................................................................... 21

4. Performance on Priority Indicators 2012/13 .......................................................................................................... 23

5. Glossary ................................................................................................................................................................... 28

6. Indicator Definitions................................................................................................................................................ 29

3

1. Demographic Information

Gert Sibande is one of the 3 districts of Mpumalanga province of South Africa. The seat of Gert Sibande is Ermelo.

The district code is DC30. The district is named after the ANC activist Gert Sibande.

Gert Sibande District has the following neighbours:

Nkangala to the north (DC31)

Ehlanzeni to the north-east (DC32)

The kingdom of Swaziland to the east

Zululand to the south-east (DC26)

Amajuba to the south (DC25)

Thabo Mofutsanyane to the south-west (DC19)

Fezile Dabi to the south-westDC20)

Sedibeng to the west (DC42)

The district contains the local municipalities of Govan Mbeki , Albert Luthuli , Mkhondo, Msukaligwa, Lekwa ,Pixley

Ka Seme and Dipaleseng .

The District has a total population of 1,043,193, with a population density of 32.7/Km2.

Demographic Data

Geographical area 31,841 Km2

Total population (Census 2011) 1,043,193

Population density (Census 2011) 32.7/Km2

Percentage of population with medical insurance (General Household Survey 2007) 14. %

4

Age Group

Female

Male

Number

% Of total population

Number

% Of total population

0-4 Years

59,063.00

6%

59,731.00

6%

5-9 Years

53,751.00

5%

53,899.00

5%

10-14 Years

50,997.00

5%

51,984.00

5%

15-19 Years

54,201.00

5%

54,324.00

5%

20-24 Years

52,533.00

5%

55,195.00

5%

25-29 Years

48,103.00

5%

51,613.00

5%

30-34 Years

35,718.00

3%

38,747.00

4%

35-39 Years

32,140.00

3%

31,878.00

3%

40-44 Years

29,144.00

3%

26,867.00

3%

45-49 Years

28,031.00

3%

23,462.00

2%

50-54 Years

23,532.00

2%

20,863.00

2%

55-59 Years

18,729.00

2%

16,586.00

2%

60-64 Years

13,696.00

1%

11,331.00

1%

65-69 Years

9,613.00

1%

7,183.00

1%

70-74 Years

8,152.00

1%

4,870.00

0.5%

75-79 Years

5,002.00

0.5%

2,738.00

0.3%

80+ Years

6,383.00

1%

3,134.00

0.3%

Total

528,788.00

51%

514,405.00

49%

The majority of household heads are males and black Africans and 1.6% of households have teenage household

heads (less than 19 years).

Age Household Head

19 Years and

younger 20-35 Years 36-65 Years 66-84 Years 85 Years and older

1.6% 31.7% 56.2% 9.6% 1%

Race Household Head

Gender Household Head

Black Coloured Indian or Asian White

Female Male

89.5% 0.7% 0.9% 8.5% 38.8% 61.2%

5

The main language spoken in Gert Sibande is

IsiZulu (60%), followed by Siswati (13%), and

Afrikaans (9%).

2. Social Determinants of Health

According to the 2007 DHB, the deprivation index for

the district is 2.5.

In terms of services to communities, 9% of households do not have access to piped water, 19.8% have no access to

improved sanitation (bucket system, pit latrines without ventilation or no toilet) and 35.4% have no access to refuse

removal by local authority or private company. In terms of housing, 10.8% of households live in informal dwellings or

squatter settlements.

Household Access to Basic Services Census 2011

Percentage traditional and informal dwelling, shacks and squatter settlement 10.8%

Percentage households without access to improved sanitation 19.8%

Percentage households without Access to Piped Water 9.0%

Percentage households without access to electricity for lighting 16.6%

Percentage households without refuse removal by local authority/private company 35.4%

6

According to Census 2011, 11.7% of household heads are unemployed and 19.2% of households live with an annual

income below R4, 800 or less than R400 per month. In terms of the education level, 9.1% of the population have no

schooling. The majority of the households have 5 or less people per household and only 2.8% of households have 10

or more people per household.

7

The proportion of enumeration area types gives an indication of infrastructure development, rural/urban settings

and population distribution in the district. 69.9% of enumeration areas are formal residential areas, 11.1% traditional

residential areas, 11.8% farming areas or smallholdings and 5.1% informal residential areas.

The map below displays the geographical space that the different enumeration area types occupy in the district. Gert

Sibande district has vast farming areas. Traditional residential areas occupy a large area of the district. There are big

industrial areas around Secunda and relatively big vacant areas in Albert Luthuli sub-district.

9

3. Service Delivery Platform

Sub District ClinicCommunity

Health CentreDistrict

Hospital Mobile

Regional Hospital

Satellite Clinic

Specialised TB Hospital

Grand Total

Albert Luthuli 17 4 2 4 27

Dipaleseng 4 2

1

7

Govan Mbeki 9 3 2 5

19

Lekwa 6 1 1 3

1 12

Mkhondo 7 4 1 8

4

24

Msukaligwa 9 2 (Functioning as Clinics)

4 1

1 17

Pixley Ka Seme 5 2 2 3

12

Total 57 18 8 28 1 4 2 118

Public Health Facility Types Sub-Districts

Health services are delivered by 8 district hospitals, 1 regional hospital, 18 community health centers, 57 clinics, 4 satellite clinics and 28 mobile clinics.

10

3.1. Private Medical Practices

Sub-District Number

Albert Luthuli Local Municipality 12

Dipaleseng Local Municipality 4

Govan Mbeki Local Municipality 67

Lekwa Local Municipality 15

Mkhondo Local Municipality 8

Msukaligwa Local Municipality 30

Pixley Ka Seme Local Municipality 12

Grand Total 148

11

3.2. Maps

12

Lekwa LM

Msukaligwa LM

Mkhondo LM

Albert Luthuli LM

Pixley Ka Seme LM

Govan Mbeki LM

Dipaleseng LM

Leslie

Iswepe

Ermelo

Bethal

Secunda

Panbult

Lothair

Lochiel

Leandra

Kinross

Breyton

Berbice

Balfour

Carolina

Badplaas

Volksrust

Trichardt

Eersthoek

Amsterdam

Wittenberg

StandertonMeyerville

Holmerdene

Commondale

Bettiesdam

Amersfoort Piet Retief

Wakkerstroom

Greylingstad

Braunschweig

Chrissiesmeer

Quintile 1 and Quintile 2 Schools in Relation to Public Health Facilities.

District

Sub-Districts

Towns

Clinics_Satellites

CHC

District Hospitals

Q2Schools

Q1Schools

14

3.3. Hospital Performance

3.3.1. District Hospitals

District hospital performance on 4 key indicators is displayed in the table below. Usable bed utilisation measures the

occupancy of district hospital beds, namely the proportion of usable beds occupied over the year, and therefore

measures how efficiently a hospital is using its available capacity. BUR should be read in conjunction with the average

length of stay (ALOS). If a low ALOS occurs in conjunction with a high bed utilisation rate (>90%), this suggests that the

hospital has a high demand for beds. A very high bed utilisation rate (BUR) suggests that the quality of care provided to

the patients may be compromised due to insufficient staff to provide optimal care to patients or patients might get

discharged before optimal recovery due to the high demand for beds. A very low BUR may suggest that the hospital is

under-utilised either because there is no need for the service in the area, or because patients choose not to use the

hospital. The BUR rate in Gert Sibande district was low for Amajuba hospital throughout the reporting period.

The average length of stay (ALOS) indicator measures how long on average each patient spends in hospital. It measures

aspects of the quality and efficiency of the hospital. If the ALOS is persistently high it suggests that patients spend too

much time in hospital either because they are not timeously discharged or appropriately treated resulting in longer

recovery times, or they are not discharged when they should be often due to shortage of doctors in a hospital.

Admission, treatment and discharge procedures should therefore be reviewed. If the ALOS is persistently low (less than

1.5 days), it could mean that patients are discharged earlier than they should be, or referral rates to other hospitals are

high. The ALOS in Gert Sibande district was within acceptable range from national and provincial averages in the 4

financial years under review.

The Caesarean section (C-section) rate is an important indicator of access to essential (and emergency) obstetric care

and is one of the key maternal health indicators. It is also an important indicator that contributes to the quality of

maternal and neonatal care. Elsie Ballot hospital does not seem to do any Caesarean sections. The caesarean section

rate in the other hospitals was within acceptable range of the national and provincial average.

The perinatal mortality rate (PNMR) is the number of perinatal deaths per 1 000 births. Perinatal deaths are the sum of

stillbirths plus early neonatal deaths (<7 days). The PNMR is the most sensitive indicator of obstetric care. The perinatal

mortality rate was within acceptable range from provincial and national averages in 2012/13 for all hospitals.

15

Indicators values in black font are within an acceptable range from national and provincial average. Indicator values highlighted in yellow are considerably

below or above the national or provincial average and should raise concern.

Hospital Average length of stay -

total Usable bed utilisation

rate - total Caesarean section rate Perinatal mortality rate in facility

2010/11 2011/12 2012/13 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13

Amajuba Memorial 4.1 4.7 4.5 43.6 54.7 57.4 24.0 17.9 18.8 39.4 23.7 31.8

Bethal 3.4 4.7 4.6 54.7 64.7 68.6 13.6 14.1 17.1 37.5 37.0 33.4

Carolina 5.3 3.5 3.7 61.0 56.7 69.0 18.1 15.2 23.2 36.6 33.6 39.2

Elsie Ballot 3.6 2.9 4.1 68.8 59.1 86.9 0.0 0.0 0.0 30.4 9.9 33.7

Embhuleni 4.6 4.2 3.7 70.8 75.6 79.6 14.0 18.7 16.8 45.3 28.5 39.2

Evander 4.0 4.3 4.6 72.4 67.8 74.0 27.6 27.6 22.8 24.6 40.6 41.1

Piet Retief 4.8 5.0 4.8 70.9 74.7 69.2 18.9 19.2 17.4 42.5 44.1 37.8

Standerton 4.0 3.8 3.5 60.5 59.3 61.3 38.2 28.7 30.1 35.1 42.4 35.9

G Sibande 4.2 4.3 4.1 62.8 65.8 69.3 21.1 20.3 19.7 36.9 35.7 37.5

Mpumalanga 4.3 4.2 4.1 65.4 68.8 69.9 15.8 17.2 17.6 36.5 34.9 34.5

National Average 4.3 4.3 4.2 65.0 67.1 67.3 18.2 19.1 20.8 30.7 29.5 29.3

3.3.2. Regional Hospitals

All the indicator values for the Ermelo regional hospital were within acceptable range from the provincial and district averages.

Hospital

Average length of stay - total

Usable bed utilisation rate - total

Caesarean section rate Perinatal mortality rate

in facility 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13 2010/11 2011/12 2012/13

Ermelo 3.3 4.4 7.3 64.8 73.7 74.8 20.3 21.3 21.2 28.1 36.0 35.8

Mpumalanga 4.4 4.6 5.1 70.8 72.6 79.4 20.7 18.9 19.7 34.5 34.2 34.4

National Average 4.6 4.6 4.6 72.0 75.8 76.4 32.3 33.9 35.3 40.0 39.4 39.8

16

3.4. Trend of Public Health Expenditure

PHC (non-hospital) expenditure per capita, uses a

subset of total PHC expenditure; most importantly

it excludes DHS expenditure on HIV, nutrition,

coroner services and district hospitals.

Per capita expenditure in Gert Sibande increased in

line with the provincial average, but is still

significantly below the national average.

The PHC expenditure per patient visit indicator

measures the average cost of a patient visit to a

primary care facility. In practice it is the average

cost to the health service of a patient visit to a

community health centre (CHC), clinic, satellite

clinic or mobile clinic, excluding district hospitals.

This indicator’s numerator is thus the total cost in a

particular district of running all these facilities for a

year. The denominator is the total PHC headcount

for these facilities for the same year. It does not

take into account the patient case mix found in

practice.

The cost per patient visit in Gert Sibande increased

in line with the provincial and national average.

The District Health Services (DHS) expenditure per

capita refers to the total expenditure on DHS,

including the expenditure of local government

(LG).

The district’s DHS expenditure increased

significantly above the national and provincial

average in the reporting period.

17

3.5. Trend of Health Services Delivery

The primary health care (PHC) utilisation

rate indicators measures the average

number of PHC visits per person per year

to a public PHC facility. It is calculated by

dividing the PHC total annual headcount

by the total catchment population. The

target for the South African public health

sector is 3.5 PHC visits per person per

year.

The utilisation rate in Gert Sibande

decreased slightly, but remained above

the provincial and national average for

the past 4 financial years.

The PHC under 5 utilisation rate has

increased slightly over the past 4 financial

years, but is still significantly below the

provincial and national average.

Supervisory visits provide a system for

identifying and addressing problems at

facility level. The supervision rate is the

number of fixed PHC facilities visited by a

clinical supervisor at least once a month,

as a proportion of the total number of

fixed PHC facilities in the district. The

target for monthly visits is 100%.

The supervision visit rate in Gert Sibande

increased slightly above the national

provincial average.

18

1.8

1.8

2.9

3.4

3.5

4.0

11.5

14.5

14.7

16.0

0 5 10 15 20

10. Diabetes mellitus

9. Preterm birth complications

8. Meningitis/Encephalitis

7. Cerebrovascular disease

6. Hypertensive heart disease

5. Road injuries

4. Diarrhoeal disease

3. Lower respiratory tract…

2. HIV/AIDS

1. Tuberculosis

Percentage of total YYL

LEADING CAUSES OF YEARS OF LIFE LOST (YLL): MORTALITY AND CAUSES OF DEATH REPORT 2010

82.8 80.4 79.9 84.4 85.2 82.8 91.6 90.5 93.2 91.1

0.0

20.0

40.0

60.0

80.0

100.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Weighing Rate under 5 years 2003-2012

G Sibande DM Mpumalanga

ZA Linear (G Sibande DM)

3.1. Burden of Disease

Years of Life Lost (YLLs) are an estimate

of premature mortality based on the

age at death and thus highlight the

causes of death that should be targeted

for prevention. The four leading single

causes of YLLs in South Africa were TB,

pneumonia, diarrhoea and HIV related.

As these are all linked to HIV it suggests

that HIV-related mortality is by far the

leading cause of YLLs in the majority of

districts in South Africa.

The three leading causes of death in

Gert Sibande district were TB, HIV/AIDS

and Lower respiratory infection.

.

3.1.1. Poverty and Hunger

A child that does not gain weight (failure to

thrive) is one of the first signs that there

might be serious underling disease such as

anaemia, malnutrition, TB or HIV. All

children should therefore be weighed at

every visit to a facility and the weight should

be recorded on the Road to Health card.

The weighing rate in Gert Sibande has

increased above the national and provincial

average.

19

9.8 8.7

7.7

5.4 5.6 4.7 5.3

3.6 2.7 3.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

r 1

00

0 p

op

Severe malnutrition incidence under 5 years

2003-2012



25.1

75.3 75.8 72.4 76.7 73.0 61.2 56.8

41.0 24.0

0.0

50.0

100.0

150.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

r 1

00

0 p

op

Diarrhoea incidence under 5 years 2003-2012



56.3 49.5 44.0 38.4 33.7 37.2 31.4 27.1 21.9 19.3

0.0

20.0

40.0

60.0

80.0

100.0

120.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

r 1

00

0 p

op

Pneumonia incidence under 5 years 2003-2012



Malnutrition is mostly linked to poverty. Severe

malnutrition serves as a vital domestic

indicator in tracking efforts directed towards

eradicating extreme poverty and hunger in

South Africa as part of Millennium

Development Goal (MDG) 1.1. Malnutrition

and disease form a horrendous cycle – one

feeds off the other. Malnourished children

have more frequent and severe infections,

particularly diarrhoeal and respiratory

diseases. More frequent and severe infections

lead to increasing malnutrition.

The severe malnutrition rate in Gert Sibande

district decreased below the national and

provincial average.

3.1.2. Child Health

Diarrhoea and Pneumonia are leading causes

of death among children in SA.

The impact of Rota Virus vaccination is

evident in the significant decrease in

diarrhoea incidence rate in Gert Sibande

district in line with the provincial average and


The impact of Pneumococcal vacination is

evident in the significant decrease in the

pneumonia incidence rate in Gert Sibande, in

line with the provincial average and


20

84.7 92.9 98.4 95.5 96.3 91.6

100.5 93.1 97.0 102.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Antenatal coverage rate 2003-2012



27.9 28.5 29.2 27.6 26.8 29.1

32.5 32.5 36.6 36.9

0.0

10.0

20.0

30.0

40.0

50.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Antenatal visits before 20 weeks rate 2003-2012



.

Immunisation coverage can serve as an

indicator of a health system’s capacity to

deliver essential services to the most

vulnerable members of a population. The

Measles coverage figures are also used to

report on Target 4A of MDG4 which is to

reduce the under-five mortality rate.

The measles 1st dose coverage in Gert

Sibande has increased over the years in line

with the provincial average, but is still below

the national average.

3.1.3. Maternal and Woman’s Health

Antenatal Coverage monitors to what

extent antenatal services are reaching

pregnant women. It measures the

percentage of pregnant women that

attend an antenatal clinic in a health care

facility at least once during her pregnancy

and is proxy indicator for MDG 5b for

measuring access to reproductive health

services. The Antenatal coverage in Gert

Sibande district has increased in line with

the national and provincial average in

2012.

Early booking rate is very important

especially for PMTCT. The antenatal visits

before 20 weeks rate increased steadily

but remained below the national and

provincial average since 2010.

61.4 66.9 71.4 74.2 68.9 78.2 78.5 78.7 82.7 87.8

0.0

20.0

40.0

60.0

80.0

100.0

120.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Measles under 1 year coverage rate 2003-2012



21

36.9

15.9 14.9 12.8 13.2

20.7

25.1 25.6 27.9

33.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Couple year protection rate 2003-2012



32.9

51.3 58.1

67.6 70.7 75.4 78.2 80.1 80.1 81.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

Delivery in facility rate 2003-2012



The delivery rate in facility indicator

measures the proportion of all deliveries

that take place in public health facilities

under the supervision of trained personnel.

The indicator serves as a proxy measure of

access to public sector facilities and the

measure of utilisation of these facilities by

pregnant women and is used to track

improvements in maternal health as part

of Millennium Development Goal 5.

The delivery in facility rate increased

significantly but remained below the

national and provincial average.

The couple year protection rate is a

composite indicator of the different

contraceptive methods. It reflects the

availability, accessibility and acceptability

of reproductive health services and serves

as proxy indicator for MDG 5b.

The couple year protection rate increased

but remained below the provincial and

national average.

3.1.4. HIV/TB

The TB programme aims to reduce the pool of infected people in South Africa. The strategy employed to do this,

attempts to prevent transmission of TB and to cure those who have already contracted the disease.

22

42.5

29.1

45.2 53.0 56.1 57.6 61.4 64.0

0.0

20.0

40.0

60.0

80.0

2003 2004 2005 2006 2007 2008 2009 2010

Pe

rce

nta

ge

TB Cure Rate 2003-2010 (DHB 2011/12)

G Sibande: DC30 MP

ZA Linear (G Sibande: DC30)

0

10

20

30

40

50

2006 2007 2008 2009 2010 2011

Pe

rce

nta

ge

HIV Prevalence Antenatal Survey 2006-2011 (Antenatal Survey 2011)

Gert Sibande Mpumalanga

ZA Linear (Gert Sibande)

The TB Cure rate in Gert Sibande increased

steadily over the years but remains below

the national and provincial average.

The HIV prevalence in the Gert Sibande

increased significantly above the national

and provincial average in 2011.

23

4. Performance on Priority Indicators 2012/13

The charts below are constructed using statistical process control (SPC) principles and use control limits to indicate variation from the national average (as well as national target where available). The purpose of this type of display is to give feedback on the performance of the district compared to the performance range of all 52 districts for the period under review (2011/12) for selected priority indicators. The display shows one standard deviation (68%), two standard deviation (95%) and three standard deviation (99.8%) control limits. Values within the 1SD below or above national average are said to display 'normal cause variation' in that variation from the mean can be considered to be random. Values outside these limits (in the darker green or orange sections) are said to display 'special cause variation' at a two standard deviation level, and a cause other than random chance should be considered. Values outside these sections (in the dark green or red sections) also display 'special cause variation' but at against a more stringent test. Variation at the two standard deviation level can be considered to raise an alert, and variation at the three standard deviation level to raise an alarm.

* Values that fall in the positive standard deviations are good for certain indicators e.g. Immunisation coverage where higher is better, but the opposite is true for indicators that measures disease burdens or e.g. PCR test positive at 6 weeks rate where lower (negative standard deviations) is better. For other indicators like ALOS both too high and too low is bad and the "good range" will fall in both 1SD and -1SD. Performance should therefore be interpreted in conjunction with the colours codes above.

24

Cervical cancer screening

coverage45.8 23.5 55.4 140.2

INDICATOR PERFORMANCE COMMENT

DISTRICT HEALTH SERVICES

1 SD below the national average and significantly below the ANHP target of 2.8.

1 SD below the national average and significantly below the national target of 5.

1 SD above the national average but below national target of 90%

MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION

1 SD below the national average and significantly below national target of 60%

1 SD above the national average and above national target of 2.5%

1 SD below the national average and significantly below national target of 62%

Utilisation rate PHC 2.2 1.7 2.5 3.5

Utilisation rate under 5

years - PHC 4.0 3.4 4.6 6.7

0.5 75.9 100Fixed PHC facilities with a

monthly supervisory visits rate81.4

73.6Antenatal visits before 20

weeks38.3 31.5 44

7.8Baby PCR test positive

around 6 weeks rate 2.80 2.5

25


1 SD below the national average and below the national target.

1 SD above the national average and above the national target of 9%.

1 SD above the national average and above the national target of 148.

1SD below the national average.

1 SD below the national average and below the national target of 90%.

1 SD below the national average and below the national target of 93%.

1 SD below the national average but in line the national target of 91%.

73.3Couple year protection rate 33.1 23.7 37.8

13.4Delivery in facility under 18

yers10.2 4 7.7

Maternal mortality ratio in

facility187.6 0 132 292

4.4Facility mortality under 5

years rate0.8 4.5 9.9

Immunisation coverage

under 1 year81.7 69.6 94 118

75 99.7 125.1Measles 1st dose under

1 year coverage88.4

72.1 98.4 124PCV 3rd dose coverage 91.6

26


1 SD below the national average but above the national target of 91%.

2 SD below the national average and significantly below the national target of 50%

1 SD below the national average.

2 SD below the national average (lowest incidence in country) and significantly below national target of 68.

1 SD below the national average (good), and significantly below the national benchmark target of 10.

HIV AND TB

1 SD below the national average and below the national benchmark target of 100%.


65.3 100.3 128.9RV 2nd dose coverage 99.0

21.9 42.8 60.9Vitamin A coverage 12-59

months28.7

Diarrhoea with dehydration

incidence under 5 years9.5 4.7 12 32.9

21.0Pneumonia incidence

under 5 years66.8 177.921

0.9Severe malnutrition

under 5 years incidence3.1 4.4 18.1

79.4 94 100HIV testing rate

(excluding antenatal)90.1

Male condom distribution

rate19.0 5.4 22.1 69.3

27


HOSPITAL

1SD below the national average (good) but slightly above the national target of 3.8.


1 SD above the national average (good) but below the national target of 73%.

1 SD above the national average but below the national target of 1500.

1 SD below the national average and significantly below the national target

6.8Average length of stay -

total4.1 1.1 4.2

40.1Caesarean section rate 19.7 0 20.8

69.3

Usable bed utilisation rate 43.6 67.3 94.3

Cateract surgery rate 832.2 0 553 2832

100Complains resolution rate 56.2 0 68.6

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5. Glossary

Deprivation indices and socio-economic data

The deprivation index is a measure of relative deprivation across districts within South Africa. Just as any index, the deprivation index is a

composite measure derived from a set of variables. Variables included in the analysis are considered to be indicators of material and social

deprivation. The deprivation indices for this report were generated using StatsSA’s GHS and 2007 Community Survey (CS) data and have been

calculated in such a way that the indices are directly comparable to the deprivation indices generated from the 2005 GHS data. This therefore

provides three years of deprivation trend data. To simplify interpretation, the deprivation index was normalised such that the district that is least

deprived has a deprivation index of 1. Districts with higher values are relatively more deprived than districts with lower values. The score itself does

not have any intrinsic meaning, but the relative scores show which districts are more deprived than others and can be used to rank districts. Each

district was thus ranked according to levels of deprivation and categorised into socioeconomic quintiles (SEQ). Districts that fall into quintile 1

(worst off) are the most deprived districts. Those that fall into quintile 5 are the least deprived (best off).

Since there is no official consensus on a single measure of poverty or deprivation, an additional indicator is included with the deprivation index.

This is the percentage of households with access to piped water. This indicator is provided from both the GHS and the CS data up to 2007.

Unfortunately no new district level data for the deprivation index or access to piped water has been collected since 2007, thus the socio-economic

quintiles from 2007 have been used for each of the years thereafter to enable on-going analysis of equity according to socio-economic status.

Variables included in the calculating the deprivation index were:

The proportion of the district’s population that are children below the age of five

The proportion of the district’s population that are black Africans

The proportion of household heads in the district that are females

The proportion of household heads in the district that has no formal education

The proportion of working-age population within the district that is unemployed (

The proportion of the district’s population that lives in a traditional dwelling, informal shack or tent

The proportion of the district’s population that has no piped water in their house or on site

The proportion of the district’s population that has a pit or bucket toilet or no form of toilet

The proportion of the district’s population that does not have access to electricity, gas or solar power for lighting, heating or cooking.

District boundaries and maps

Geographic information from the Municipal Demarcation Board is used to define district and provincial boundaries and is the same as is followed

by the DHIS.

For some DHB indicators such as the deprivation index, old demarcation boundary data was used.

Averages

It is important to note that all averages (provincial, national, metro and ISRDP) are weighted averages, based on the total numerator and

denominator for all the sub-areas included, and are thus not averages of the district indicator values.

Financial year and calendar year

Some indicators are displayed for (April – March), which is the financial year of the Department of Health. Indicators for financial years are

annotated as 2012/13. Other sources such as the TB data from ETR.net, antenatal HIV survey, water quality and cause of death data cover a

calendar year (January – December). Data from StatsSA surveys are for the period of the census or survey.

Finance indicators

All expenditure trends over time used from the DHB have been adjusted for inflation, and figures are quoted in real 2011/12 prices, unless

indicated otherwise.

29

6. Indicator Definitions

Indicator name Indicator definition Numerator description Denominator description Source

Dep

riva

tio

n Deprivation Index The deprivation index is a

composite index of deprivation using StatsSA Census and household survey, recalculated to a district level.

Health Economics Unit, UCT - based on data from StatsSA Census 2001, GHS and Community Survey

Bas

ic s

ervi

ces

Percentage traditional and informal dwelling, shacks and squatter settlement

Number of households that are informal dwellings, shacks or squatter settlements as percentage of total households

Total number of informal dwellings, shacks or squatter settlements

Total number of households

Census 2011

Percentage households without access to improved sanitation

Number of households that do not have access to improved sanitation (bucket, pit latrine or no toilet facilities) as percentage of total households

Total number of households without access to improved sanitation.


Census 2011

Percentage households without Access to Piped Water

Number of households that do not have access to piped water within 200m from dwelling as percentage of total households

Number of households without access to piped water


Census 2011

Percentage households without access to electricity for lighting

Number of households that do not have access to electricity for lighting (as proxy of availability of electricity in community) as percentage of total households

Number of households without access to electricity for lighting


Census 2011

Percentage households without refuse removal by local authority/private company

Number of households that do not have access to refuse removal by local authority/private company

Number of households without refuse removal by local authority/private company


Census 2011

Fin

ance

Cost per Patient Day in district hospitals

Average cost per patient per day seen in a hospital (Expressed as Rand per patient day equivalent).

Total expenditure on health district hospitals Percentage of District

Patient day equivalent - Total

DHB 2011/12

30


Percentage of District Health Expenditure on District Management

Percentage of total district health services spent on district management

Provincial expenditure on District Management

Total provincial expenditure on District Health Services

DHB 2011/12

Non-hospital PHC expenditure per capita

Total amount spent on non-hospital PHC health services per person without medical scheme coverage. PHC (non-hospital) expenditure per capita, uses a subset of total PHC expenditure; most importantly it excludes DHS expenditure on HIV, nutrition, coroner services and district hospitals

Provincial expenditure on the following sub-programmes of DHS (district management, clinics, CHCs, community based services and other community services) plus nett local government expenditure on PHC

Uninsured population (total population less medical scheme coverage x population)

DHB 2011/12

Non-hospital PHC expenditure per patient visit

Total amount spent on non-hospital PHC health services per primary health care visit. The PHC expenditure per patient visit indicator measures the average cost of a patient visit to a primary care facility. In practice it is the average cost to the health service of a patient visit to a community health centre (CHC), clinic, satellite clinic or mobile clinic, excluding district hospitals but including the cost of managing the district. This indicator’s numerator is thus the total cost in a particular district of running all these facilities for a year. The denominator is the total PHC headcount for these facilities for the same year. It does not take into account the patient case mix found in practice.

Provincial expenditure on the following sub-programmes of DHS (district management, clinics, CHCs, community based services and other community services) plus nett local government expenditure on PHC

Total PHC headcount DHB 2011/12

31

Indicator name Indicator definition Numerator description Denominator description Source In

sura

nce

Medical scheme coverage Percentage of population who have medical scheme insurance

Modelled from StatsSA GHS

Uti

lisat

ion

ALOS: Average length of stay (district hospitals)

The average number of patient days that an admitted patient spends in hospital before separation. If the ALOS is persistently high it suggests that patients spend too much time in hospital either because they are not timeously discharged or appropriately treated resulting in longer recovery times, or they are not discharged when they should be. Admission, treatment and discharge procedures should therefore be reviewed. If the ALOS is persistently low (less than 1.5 days), it could mean that patients are discharged earlier than they should be, or referral rates to other hospitals are high.

Inpatient days + 1/2 Day patients

Separations - Discharges + Deaths + Transfers out + Day patients

DHIS NDoH5 (data for District Hospitals only)

BUR: Usable bed utilisation rate (district hospitals)

The number of patient days during the reporting period, expressed as a percentage of the sum of the daily number of useable beds. (Comment: The calculation here is an approximation - it assumes (1) a day patient occupies a bed for half a day, (2) there are always 30 days in a month. A very high bed utilisation rate (BUR) suggests that the hospital is very busy and that the quality of care provided

Total patient days - (Inpatient days + 1/2 Day patients) x 100

Total usable bed days DHIS NDoH5 (data for District Hospitals only)

32


to the patients may be compromised due to insufficient staff to provide optimal care to patients. A very low BUR may suggest that the hospital is under-utilised either because there is no need for the service in the area, or because patients choose not to use the hospital.

PHC utilisation rate The rate at which PHC services are utilised by the catchment population, represented as the average number of visits per person per year in the catchment population. The denominator is usually Census-derived population estimates. It is calculated by dividing the PHC total annual headcount by the total catchment population. The target for the South African public health sector is 3.5 PHC visits per person per year.

PHC total headcount Total population DHIS NDoH5

PHC under 5 year utilisation rate

The rate at which PHC services are utilised by children under 5 years in the catchment population, represented as the average number of PHC visits per child under 5 per year in the target population. The denominator is usually Census-derived population estimates.

PHC headcount under 5 years

Total population below 5 years

DHIS NDoH5

33

Indicator name Indicator definition Numerator description Denominator description Source M

anag

emen

t

Fixed PHC facilities with a monthly supervisory visit rate

Proportion of fixed PHC facilities visited by a dedicated clinic supervisor, who performs a visit according to the clinic Supervision manual. The target for monthly visits is 100%.

Number of fixed PHC facilities visited at least once

Number of fixed PHC facilities

Ch

ild H

ealt

h

Measles 1st dose coverage The percentage of children who received their 1st measles dose (normally at 9 months) - annualised.

Measles 1st dose under 1 year

Target population under 1 year

DHIS NDoH5

Diarrhoea incidence under 5 years

The number of children with diarrhoea per 1 000 children in the catchment population.

Diarrhoea cases under 5 years -new

Population under 5 years DHIS NDoH5

Severe malnutrition under 5 years incidence

The number of children who weigh below 60% Expected Weight for Age (new cases that month) per 1 000 children in the target

Severe malnutrition under 5 years - new

Target population under 5 years

DHIS NDoH5

Pneumonia under 5 years incidence

Children under 5 years diagnosed with pneumonia, per 1,000 children in the catchment population

Pneumonia under 5 years - new ambulatory

Target population under 5 years

DHIS NDoH5

Mat

ern

al H

ealt

h

Perinatal mortality rate in facility

The perinatal mortality rate (PNMR) is the number of perinatal deaths per 1 000 births. Perinatal deaths are the sum of stillbirths plus early neonatal deaths (<7 days). The perinatal period starts as the beginning of foetal viability (28 weeks gestation or 1 000g) and ends at the end of the 7th day after delivery

Stillbirths and Inpatient early neonatal deaths in facility

Total births in facility DHIS NDoH5

Delivery rate in facility The percentage of deliveries taking place in health facilities under supervision of trained

Deliveries in facility All expected deliveries in target population

DHIS NDoH5

34


personnel. The number of children under one year, factorised by 1.07 due to infant mortality, is used as an estimated proxy denominator for expected deliveries per month.

Antenatal coverage The proportion of pregnant women coming for at least one antenatal visit. The census number of children under one year factorised by 1.15 is used as a proxy denominator - the extra 0.15 (15%) is a rough estimate to cater for late miscarriages (~10 to 28 weeks), still births (after 28 weeks gestation), and infant mortality.

Antenatal 1st visit Children under one year factorised by 1.15

DHIS NDoH5

Couple year protection rate The couple year protection rate is a composite indicator of the different contraceptive methods. The numerator is contraceptive years equivalent and the denominator is the female target population (between 15 and 44 years). It is measured as a percentage and reflects the availability, accessibility and acceptability of reproductive health services and serves as proxy indicator for MDG 5b.

Contraceptive years equivalent

Female target population (between 15 and 44 years).

DHIS NDoH5

TB cure rate (new smear positive PTB clients)

The proportion of new smear positive PTB patients who completed treatment and were proven to be cured (which means that they had two negative smears on separate occasions at least 30 days apart).

The number of initially smear positive patients who converted to negative smears at two or three months after starting treatment

Total number of new PTB smear positive cases started on treatment during the specified time.

NDoH TB Directorate

35

Indicator name Indicator definition Numerator description Denominator description Source B

OD

Percentage of deaths due to communicable diseases, maternal, HIV/TB, non-communicable diseases and injuries

The proportion of deaths due to communicable diseases /maternal, HIV/TB, non-communicable diseases and injuries.

Number of deaths due to communicable diseases /maternal, HIV/TB, non-communicable diseases and injuries.

Total number of deaths StatsSA Causes of Death

36

For more information on the content contact

Milani Wolmarans : Director Planning – 012 395 9149

Bennett Asia : Director District Health Services - 012 395 8760

Supported and funded by:

gert sibande district municipality · according to census 2011, 11.7% of household heads are...

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