The District Health Barometer 2005/06

Fiorenza Monticelli, HST, 21 February 2007, District management meeting, Kwazulu-Natal

The District Health BarometerWhat is it?

• A report that provides a snapshot of performance in key health areas at a specific time across the 53 health districts in SA

• A tool for all managers at district, province and national level for : – Monitoring and evaluation– Strategic planning and annual performance

planning– Identifying quality issues in DHIS data that

need to be addressed.

What is the purpose of the District Health Barometer?

It functions as a TOOL to monitor progress and support improvement of equitable provision of primary health care by: – Illustrating important aspects of the health

system at district level through analysis of indicators.

– Ranking , classifying and analysing health districts (in various groupings eg. metros, provinces, ISRDP sites), by indicators

– Comparing these indicators over time.

What is measured? (DHB year 1) Nurse clinical work load (PHC) Per capita health expenditure (Public sector) Caesarean section rate Male condom distribution rate Immunisation coverage <1y Immunisation drop out rate (DTP-Hib 1 – DTP-Hib 3) Proportion antenatal clients tested for HIV HIV prevalence among antenatal clients tested

Nevirapine uptake rate among HIV+ pregnant women Nevirapine uptake rate among babies born to HIV+

women PHC Utilisation rate TB cure rate Smear conversion rate Incidence of diarrhoea under 5 years (per 1000).

Stillbirth Rate

What is new in the DHB year 2 (2005/06)?Socioeconomic background data

– Household access to piped water– Deprivation indices and quintiles

Financial data– % of DH services expenditure on management – % of DH services expenditure on district hospitals

Health indicators - 3 financial years and additional indicators– Incidence of STIs treated – Underweight rate for age < 5 years – Delivery rate in facility – Perinatal mortality rate in facility – Average length of stay– Bed utilisation rate

Facility data– Number of public and private facilities – Number of public and private beds.

Publication ContentsBackground, Introduction & Overview , Methodology

Section A : Indicator Comparisons by district – For 53 districts, 6 metro and 13 rural nodes– Change in performance 2003/04 to 2005/06

Section B : District and province profiles– Map, data table & summary analysis

Appendices : – Definitions, Deprivation indices detail,

indicator correlations, maps, data table, resources and references.

Districts by deprivation indexDeprivation index, 2001

0 1 2 3 4 5

West Coast DMOverberg DM

Cape Winelands DMEden DM

Central Karoo DMNamakw a DM

Cape Tow n MMSiyanda DM

Johannesburg MMN Mandela MMSedibeng DM

Pixley ka Seme DMFrances Baard DM

Tshw ane MMEkurhuleni MMWest Rand DM

Cacadu DMMetsw eding DM

Xhariep DMeThekw ini MMSouthern DM

Fezile Dabi DMMotheo DM

Lejw eleputsw a DMNkangala DM

uMgungundlovu DMBojanala Platinum DM

Amajuba DMWaterberg DMG Sibande DM

T Mofutsanyane DMEhlanzeni DM

Central DMBophirima DMAmathole DMCapricorn DMKgalagadi DM

Mopani DMC Hani DM

Bohlabela DMiLembe DM

Ukhahlamba DMUthungulu DM

Uthukela DMVhembe DM

Ugu DMSisonke DM

Gr Sekhukhune DMZululand DM

Umkhanyakude DMUmzinyathi DM

A Nzo DMO Tambo DM

better Index worse

EC

FS

GP

KZN

LP

MP

NC

NW

WC

Metros

Umkanyakude UmzinyathiA Nzo & O R Tambo all are ISRDS nodes

uMgundundlovu

SOCIOECONOMIC INDICATOR

Per Capita Health Expenditure (PHC public sector) 2005/06

0 100 200 300 400 500

Gr Sekhukhune DMMetsw eding DM

Siyanda DMG Sibande DMBohlabela DM

West Rand DMAmajuba DMNkangala DM

Waterberg DMCapricorn DM

Lejw eleputsw a DMA Nzo DM

Uthukela DMCacadu DM

Tshw ane MMN Mandela MMOverberg DM

Frances Baard DMUkhahlamba DMCape Winelands

Fezile Dabi DMO Tambo DM

iLembe DMEhlanzeni DM

Umzinyathi DMuMgungundlovu

Zululand DMBojanala Platinum

Sedibeng DMUgu DM

Mopani DMT Mofutsanyane

Motheo DMVhembe DM

Pixley ka Seme DMUthungulu DMAmathole DM

Eden DMJohannesburg MM

C Hani DMKgalagadi DMSouthern DM

eThekw ini MMEkurhuleni MM

Sisonke DMCentral DM

West Coast DMUmkhanyakude DM

Central Karoo DMCape Tow n MM

Xhariep DMNamakw a DMBophirima DMSouth Africa

Rand

EC

FS

GP

KZN

LP

MP

NC

NW

WC

SA

SA ave 2005 = R232

SA ave in 2001= R168

INPUT INDICATOR

R115

R166

R309

Change in per capita expenditure 2001/02 to 2005/06

-150 -100 -50 0 50 100 150 200 250

Ekurhuleni MMJohannesburg MM

Metsw eding DMOverberg DM

Eden DMCape Tow n MM

Central Karoo DMWest Rand DM

Cape Winelands DMTshw ane MMAmajuba DMSiyanda DM

uMgungundlovu DMGr Sekhukhune DM

West Coast DMBophirima DMUthukela DMSouthern DM

Waterberg DMUgu DM

Frances Baard DMZululand DM

N Mandela MMSedibeng DM

Pixley ka Seme DMBojanala Platinum

Ehlanzeni DMeThekw ini MMUmzinyathi DM

Mopani DMLejw eleputsw a DM

Uthungulu DMBohlabela DM

iLembe DMG Sibande DM

Sisonke DMCapricorn DM

Motheo DMAmathole DMVhembe DM

A Nzo DMKgalagadi DM

Fezile Dabi DMO Tambo DMCacadu DM

Nkangala DMCentral DM

Umkhanyakude DMNamakw a DM

C Hani DMT Mofutsanyane DM

Ukhahlamba DMXhariep DM

South Africa

Rand (change)

EC

FS

GP

KZN

LP

MP

NC

NW

WC

SA

Change in per capita health expenditure 2001-2005

UmkhanyakudeR143 more

Amajuba R18 more

Metros and less deprived

districts spending less

Perinatal mortality rate 2005/06Perinatal mortality rate, 2005/06

0 20 40 60 80 100

N Mandela MMZululand DM

A Nzo DMO Tambo DMAmajuba DM

Ukhahlamba DMCacadu DMiLembe DM

Lejw eleputsw a DMNkangala DMBohlabela DMAmathole DM

Sisonke DMG Sibande DM

T Mofutsanyane DMMotheo DM

Gr Sekhukhune DMeThekw ini MM

Xhariep DMSiyanda DM

Capricorn DMUmzinyathi DMEkurhuleni MM

Ugu DMWest Rand DM

Ehlanzeni DMuMgungundlovu DM

Central Karoo DMFezile Dabi DM

Mopani DMUthungulu DM

Uthukela DMWaterberg DMTshw ane MM

Umkhanyakude DMSedibeng DMNamakw a DM

Frances Baard DMJohannesburg MM

Eden DMC Hani DM

Cape Winelands DMWest Coast DMCape Tow n MM

Vhembe DMOverberg DM

Pixley ka Seme DMKgalagadi DM

Central DMBophirima DM

Bojanala Platinum DMSouthern DM

Metsw eding DMSouth Africa

Per 1000 births

EC

FS

GP

KZN

LP

MP

NC

NW

WC

SA

Below SA ave of

34/1000

More deaths than SA ave and over 40

Unrealistic/ data

problems

Unrealistic/ data

problemsIMPACT INDICATOR

Immunisation coverage 2005/06Immunisation coverage 2005/06

0 20 40 60 80 100 120 140

Metsweding DMWaterberg DM

West Rand DMNamakwa DMEhlanzeni DM

Central DMG Sibande DM

Southern DMWest Coast DM

Zululand DMOverberg DMUthukela DM

Xhariep DMCape Winelands DM

Bojanala Platinum DMAmajuba DM

eThekwini MMEkurhuleni MMNkangala DM

Lejweleputswa DMSiyanda DM

Bophirima DMEden DM

Ukhahlamba DMJohannesburg MM

Gr Sekhukhune DMUmzinyathi DMBohlabela DM

T Mofutsanyane DMMotheo DM

Cape Town MMMopani DM

Sedibeng DMCacadu DM

Central Karoo DMCapricorn DMKgalagadi DM

Umkhanyakude DMFezile Dabi DM

Tshwane MMiLembe DM

Uthungulu DMAmathole DM

Pixley ka Seme DMVhembe DM

O Tambo DMSisonke DM

A Nzo DMN Mandela MM

Frances Baard DMuMgungundlovu DM

Ugu DMC Hani DM

South Africa

Percentage

EC

FS

GP

KZN

LP

MP

NC

NW

WC

SA

SA ave 90.3% up from 80.7% 2003

Ugu 117.9 %Zululand 79.5 %

OUTPUT INDICATOR

TB Cure rate, 2004

0 10 20 30 40 50 60 70 80 90 100

Nkangala DMUthungulu DM

Frances Baard DMuMgungundlovu DM

G Sibande DMAmathole DM

Ugu DMeThekw ini MM

Umkhanyakude DMO Tambo DM

A Nzo DMEhlanzeni DMUthukela DMSiyanda DMiLembe DM

Pixley ka Seme DMN Mandela MM

C Hani DMSouthern DMSisonke DMZululand DM

Ukhahlamba DMMopani DMCacadu DM

Gr Sekhukhune DMUmzinyathi DMEkurhuleni MM

Central DMBojanala Platinum DM

Namakw a DMKgalagadi DM

Fezile Dabi DMSedibeng DMAmajuba DM

Johannesburg MMTshw ane MM

Cape Winelands DMMotheo DM

Cape Tow n MMT Mofutsanyane DM

Bophirima DMXhariep DM

Capricorn DMLejw eleputsw a DM

Metsw eding DMCentral Karoo DM

West Rand DMWest Coast DM

Vhembe DMBohlabela DM

Waterberg DMEden DM

Overberg DMSouth Africa

Percentage

EC

FS

GP

KZN

LP

MP

NC

NW

WC

SA

TB cure rate 2004 SA target 2005/6 = 65%

SA ave 2004 = 50.8%, SA ave 2003 = 56.7%

Overberg 84.5%

34 districts achieved over 50% cure rate

uMgungundlovu 23%Uthungulu 18.1%

Nkangala 12%

Sisonke 50.6% from 23.7%

OUTCOME INDICATOR

61.1%

District Profiles

Vhembe

• 1.3 mil in lowest socio-economic quintile • 86.4% households access to piped water. • Per capita PHC expenditure R237 - highest in

province. • Nurse clinical workload 26.6 patients p/d• PHC utilisation rate 4.1 visits p/y - highest in

Limpopo, 2nd highest in SA • TB cure rate 63.5% to 75.1% • Smear conversion 65% to 73.1% • proportion of pregnant mothers tested for HIV

(47.1%). • Condom distribution rate. • incidence of STI’s has been consistently high

at 10.4% , which is the highest in SA. • Highest Caesarean section rate in Limpopo

(15.4%). • Decline in the stillbirth and perinatal mortality

rates, lowest in the province. • Immunisation has improved • increase in immunisation drop out rate.

DC27 Umkhanyakude• 586 000 with v. poor socio-economic status • PHC expenditure per person=R309, incr of R143 from 2001, rank = 6• PHC utilisation 2.2 visits pp/y. • Nurse clinical workload 22.7 in 2005 from 38.8

in 2004.• TB cure rate improved from 30.0% in 2003 to

34.9% in 2004 , rank 45• Smear conversion rate 47.1% in 2004 to 44% in

2005 !!!!!• Pregnant mothers tested for HIV decr to 58.6%

from 73.1 in 2004! • HIV+ve mothers receiving NVP from 57.5 % in

2003 to 68.5% in 2005. • NVP - newborn babies decr to 77%! Rank 45• Male condom distribution ave 10.9 per man. • Perinatal mortality declining 47.7 – 30.8 – 30.1

rank 18 • Immunisation coverage 96.8, Drop out rate 5.1.

Data Quality!• DHB is considered a valuable tool (National DOH,

Treasury, WHO, health managers at all levels)• Data extracted is the official dataset for 2005/06,

(extracted June 2006) as submitted by the provinces to Treasury and the NDOH

• Bad quality data is brought to light in DHB• Report could be more useful with better quality & reliable

DHIS data – decision making improved• Improving quality of DHIS data is ongoing - BUT leads to

multiple data extractions / sources.

Use the DHB to identify areas which require improvement in data quality and improvement in

performance.

How to use the DHB

• Gives an idea which areas to focus your attention on– Explain the data, look at the trends, look for

underlying reasons why, how can it be improved in the future, set a new target and steps to achieve it.

• Can compare your district to other districts – what can one learn from one another.

• Monitor and evaluate progress.

• Identify and improve data quality issues

We acknowledge the National Department of Health for access to and use of their data for this publication and Atlantic Philanthropies

for funding the project

Your comments / suggestions are valued!

e-mail fiorenza@hst.org.zaThank you