Health care system

On the way down

It is a truth universally acknowledged, that a country in possession of economic growth will find the health of its citizens improving. But almost uniquely, South Africa's growing financial strength has been accompanied by a fall in key indicators of health. The tie between health and wealth has held true for most of the world, and for as long as there appear to have been economists to notice it. Wealthier countries tend to be healthier at least until they start to encounter the diseases of affluence such as obesity. In South Africa, and some other surrounding countries, this link has broken. South Africa's Gross Domestic Product per capita has increased by an average of 3% per year for the last decade. Yet the most obvious indicators of health are falling. The easiest way to get snapshot of a nation's health is to look at key indicators: life expectancy at birth, maternal mortality and infant mortality. These are such fundamental markers that they were written into the Millennium Development Goals (MDGs), which South Africa signed in 2000.

Health Ministers to do list, in six months

With just a few months to do the job before the next general election, the new Minister of Health, Barbara Hogan, has her job cut out for her and she is quick to admit that its a tough job ahead one fraught with problems. The Health Minister position has mostly been controversial, largely because of the countrys less than impressive track record in dealing with the issue of HIV/AIDS. Remember the Sarafina! and Virodene scandals under Nkosazana Dlamini-Zuma, the first Health Minister in post-apartheid South Africa? The less said about the shenanigans of her successor, Manto Tshabalala-Msimang, the better. Barbara Hogan, the third Health Minister since 1994 has inherited a legacy that she does not want to continue and there is very little time to prove herself. During this period, she says, her main focus is on two priorities.

World Health Report calls for return to primary health care approach

The World Health Report 2008, launched on 14 October, critically assesses the way that health care is organized, financed, and delivered in rich and poor countries around the world. The WHO report documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance. The World Health Report sets out a way to tackle inequities and inefficiencies in health care, and its recommendations need to be heeded, said WHO Director-General Dr Margaret Chan at the launch of the report in Almaty, Kazakhstan. A world that is greatly out of balance in matters of health is neither stable nor secure.

A Policy for the development of a District Health System For South Africa: executive summary

Published by: 
Department of Health (South Africa)
The challenge facing the South African health system is to be part of a comprehensive programme to redress social and econoniic injustices, and to ensure that emphasis Is placed on health and not just on medical care.

Lack of medical workers plagues developing countries

When her baby turned blue, Nivetha Biju rushed the child to the emergency room of an Indian hospital and watched helplessly as the baby lost consciousness because the nurses on duty had no idea what to do. Eventually a doctor saved the baby's life, but many patients are not so lucky in India and in other developing countries where a scarcity of doctors and trained nurses means there is often no helping hand in times of need. Health systems [in developing countries] are on the brink of collapse due to the lack of skilled personnel, said Ezekiel Nukuro, an official with the World Health Organization. In some countries, deaths from preventable diseases are rising and life expectancy is dropping, he said.

Measuring the move towards equity from the site of service delivery: results from the nine provinces

Published by: 
Health Systems Trust
It is important that policies and strategies towards equity in service provision are measured in terms of their impact on health service delivery. This would begin to demonstrate the practical impact of health reform. In an attempt to measure in part the progress (or lack of progress) towards equity one step would be to measure in part the quality of service provision at the community (primary care) level. This would give an overview of the disparities between as well as in provinces, and between rural, urban and peri-urban parts of the country.

Community health workers in South Africa

Published by: 
Health Systems Trust

International experience has shown that CHWs can make a valuable contribution to improving basic health status in poor communities. However, the nature of their role in South Africa's Primary Health Care (PHC) system has yet to be defined. The development of CHW programmes will be facilitated by the move towards a district-based health system (DHS). However, the message from other countries is that there must be clarity on the status and role of these front-line health workers for them to achieve their full potential.

Top experts examine ARV access and health systems

South Africas top researchers, policy makers, managers and providers have released the outcome of a roundtable discussion held last year, where they grappled with antiretroviral access and the health systems capacity to cope with the increasing demand.

Manto firm over private health care

Health Minister Manto Tshabalala-Msimang has upped the ante in her battle with the private healthcare sector to control the spiralling costs of health and medicines by rejecting suggestions that she was the minister of public health and should only focus on that sector.

The District Health Barometer - Year 2006/07

Published by: 
Health Systems Trust

The District Health Barometer (DHB), now in its third year, is a tool to monitor and support improvement of equitable and efficient provision of primary health care in South Africa by the monitoring of a selected set of socio-economic and health care indicators. The report, which is available on an annual basis and which draws upon data from the District Health Information System (DHIS), StatsSA, the National Treasury (BAS data) and the national TB register, seeks to highlight inequities in health resource allocation, inputs, outputs and outcomes as well as the efficiency of health processes between provinces and between all districts in the country, with particular emphasis on rural and urban (metropolitan) districts.

The DHB is guided by an advisory committee made up of managers from the Departments of Health at national, provincial and district level, and also includes experts and stakeholders from the academic and research arenas. The committee meets twice a year, once to review the final draft and once to plan the next report.

The principle on which the DHB is based is that there should not be any primary data collection in order to construct the indicators. The indicators chosen are all based on secondary data that are either readily available, or on available data that needed manipulation. Averages have been calculated, i.e. for the metro and ISRDP districts and primary health care expenditure values are calculated from the data received from Treasury. Where the data are not publicly available, such as with the DHIS and Treasury data, HST have asked for and received written permission to use the data.

Table of Contents ('right click' on the link and chose 'file save as')

DHB 2006/07

Foreword
Introduction and Overview

Section A - Indicators

1. Socio-economic Indicators
1.1 Deprivation index
1.2 Access to Water
1.3 Inequity: The gap between the most and least deprived districts

2. Input Indicators
2.1 Per Capita Expenditure on Primary Health Care
2.2 Proportion of District Health Services Expenditure on District Management
2.3 Proportion of District Health Services Expenditure on District Hospitals
2.4 Cost Per Patient Day Equivalent in District Hospitals

3. Process indicators
3.1 Nurse Clinical Workload
3.2 Bed Utilisation Rate
3.3 Average Length of Stay
3.4 Clinic Supervision Rate

4. Output Indicators
4.1 Immunisation
4.1.1 Immunisation coverage
4.1.2 Immunisation drop out rate
4.2 Caesarean Section Rate
4.3 Male Condom Distribution Rate
4.4 PMTCT Indicators
4.4.1 Proportion of antenatal clients tested for HIV
4.4.2 HIV prevalence rate amongst antenatal clients tested
4.4.3 Nevirapine uptake rate among pregnant HIV+ve pregnant women
4.4.4 Nevirapine uptake rate among babies born to HIV+ve pregnant women
4.5 Primary health care utilisation rate

5. Outcome indicators
5.1 Incidence of New Sexually Transmitted Infections
5.2 Tuberculosis
5.2.1 Smear conversion rate
5.2.2 TB cure rate
5.3 Diarrhoeal Incidence in Children Under 5 Years
5.4 Rate of Children Under 5 years not Gaining Weight
5.5 Delivery Rate in Facility

6. Impact indicators
6.1 Stillbirth Rate
6.2 Perinatal Mortality Rate (PNMR)

Section B - District and province profiles
- South Africa
- Eastern Cape Province
- Free State Province
- Gauteng Province
- KwaZulu Natal Province
- Limpopo Province
- Mpumalanga Province
- Northern Cape Province
- North West Province
- Western Cape Province

Appendices:
Appendix 1: Correlation of the national antenatal sero-prevalence survey with the national District Health Information System
Appendix 2: Deprivation Indices
Appendix 3: Further notes on methodology
Appendix 4: Indicator Definitions and Sources

Raw Data, Sources and Working Documents: