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Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.

In this issue we outline activities that should be part of the routine functions of the district health management team, led by the district manager. Given that there are four outcomes in the National Health Service Delivery Agreement (NSDA) that the Minister signed with the President and with all the MECs for Health, these priorities must be implemented at every level of the health system. These priorities are:

• Improve life expectancy

• Decrease the burden of disease from HIV and TB

• Decrease infant, child and maternal mortality rates

• Improve the effectiveness of the health system

The District Health Barometer (DHB) is a collection of health indicators which presents a snapshot of how well the health districts in South Africa provide primary health care to the population. These indicators do not provide any form of complex analysis or in-depth research, yet they point to districts that need improvement and support and likewise to those districts that are doing well. They show how districts are performing relative to one another and relative to their province and the national average.Using the District Health Barometer (DHB), comparisons can now be made between the six metropolitan districts, between the 13 rural node districts or between any districts that are of a similar socio-economic status and size. The purpose of this first District Health Barometer is to function as a tool to monitor progress and support improvement of equitable provision of primary health care, as well as to highlight data irregularities and errors that may occur in the collection and collation of data available in the national District Health Information System. The District Health Barometer Year 1, uses the population figures from the DHIS which are closely based on the Census 1996 and Census 2001 data. In both sets of census data there has been an under-estimation of the number of children under 5 years old. The Department of Health are working together with StatsSA to provide accurate and official population estimates of children under 5 years in each district, and hope to have this work completed by March 2006. These estimates affect especially the immunisation indicators. The next District Health Barometer, which should be available by the end of 2006, will show the corrected immunisation and population figures for 2004 and 2005.