Health System TrustSouth African Health Review and

District Health Barometer

Monitoring Health & Advising Policy

Fiorenza Monticelli

ANC Health and Education PEC sub-committee meeting

29 April 2010

Presentation outline

Primary Health Care Indicators 2008/09 The good and the not so good

(District Health Barometer)

Health policy recommendations (South African Health Review & related research)

All available at www.hst.org.za

South Africa

Gauteng is ranked second best of all the provinces after Western Cape

The good: TB Cure Rate MDG Goal 6: Combat HIV and AIDS, malaria & other diseases

PercentPercent

TB cure rate by district, 2007

Ekurhuleni 79.5%

Johannesburg 76.1%

West Rand 72.4%Sedibeng 71.7%Metsweding 71.5%

Tshwane 72.6%

TB cure rate - District trends

City of Johannesburg Ekurhuleni City of Tshwane

Sedibeng Metsweding West Rand

Percentage

The good: Immunisation coverage <1

MDG Goal 4: Reduce child mortality

South Africa

Gauteng is ranked second best of all the provinces after Western Cape

Percent Percent

Immunisation coverage <1 year District trends

City of Johannesburg Ekurhuleni City of Tshwane

Sedibeng Metsweding West Rand

Percentage

Needing attention: Primary Health Care Utilisation Rate

South Africa

Gauteng has the lowest PHC utilisation rate of all the provinces

PHC utilisation rate by district 2008/09

West Rand 2.2City of Johannesburg 2.1City of Tshwane 2.1Sedibeng 1.9Ekurhuleni 1.7Metsweding 1.6

SA average = 2.4Metro average = 2.3Gauteng average = 2.0

Not so good: HIV testing rate of pregnant women

MDG Goal 4: Reduce child mortality & MDG Goal 5: Improve maternal health

South Africa Trend by Province

Proportion ANC clients tested for HIV

Percentage

Proportion of ANC clients tested for HIV 2008/09

SA average = 86.7%Metro average = 78.5%Gauteng average = 78.4%

Sedibeng 92.3%City of Johannesburg 81.2%City of Tshwane 78.1%West Rand 77.7%Ekurhuleni 72.3%Metsweding 72.2%

Health Policy Recommendations “ Tackle inequitable distribution of resources” “ Efficiency and outcomes need attention...” “ Improve management and governance of clinics

and hospitals….” “ Measure the problem and its solutions through

improving the health information system....as it is essential to be able to monitor progress and inequities”

Bradshaw D. Determinants of Health and Health Trends. In: Barron P, Roma-Reardon J, editors. South African Health Review 2008. Durban: Health Systems Trust; 2008.

Blecher MS, Day C, Dove S, Cairns R. Primary Health Care Financing in the Public Sector. In: Barron P, Roma-Reardon J, editors. South African Health Review 2008. Durban: Health Systems Trust; 2008.

Padarath A, Freedman I. The state of clinic committees in primary level public health sector facilities in South Africa. Durban: Health systems Trust ; 2007.

Tackle inequitable distribution of resourcesProportion of District Health Services Expenditure on District

Hospitals

Tackle inequitable distribution of resources

Proportion of District Health Services Expenditure on District Management

”

Cost per patient visit to a PHC facility 2008/09

Metsweding R 222.8

City of Johannesburg R 175.0

Sedibeng R 133.8

Ekurhuleni R 130.0

West Rand R 117.6

City of Tshwane R 103.2

“ Efficiency and outcomes need attention...”

Improve management and governance of clinics and hospitals

Research done on the status of clinic committees in primary level public health sector facilities recommends:

1. Develop a comprehensive framework for clinic committees. Guidelines on what governance structures are meant

to do, how they should be constituted & operate

2. Develop & implement capacity development programme for clinic committee members Training programme – roles & responsibilities,

procedural issues related to functioning & community health related issues.

Thank you