Human Interest

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:

• Step-by-Step Guide to using the DHB Data File
• DHB Data 2006-2007
• Expenditure_29Aug200
• Cost per PDE 25Oct2007
• Deprivation in South Africa and its potential relevance to resource allocation issues: An analysis of 2001 Census data
• Supervision Rate 10/2007
• TB District Data for CF & SCR 2006-2005
• SA Population Estimates 2006

The District Health Barometer (DHB) supports district managers with monitoring and evaluation of district performance and with their annual District Health Plans. It translates routinely collected service level data into information that supports effortless interpretation which leads to engagement.

The report compares key health indicators between the six metropolitan districts, between the 13 rural node districts and between all the districts throughout the country. Analysis of this carefully selected range of health indicators, facilitates identification of problem areas and the corresponding corrective measures. Inequities between rural and urban areas are addressed throughout the report.

Managers at all levels in the health sector and those in other sectors such as the national treasury, academia and policy, can use the DHB to

• investigate reasons why and solutions to inequitable access to health within and between districts,
• plan and facilitate equitable distribution of funds
• identify gaps in data quality
• identify research into equity,
• identify operational research for clarification of reasons of poor performance and identification of corrective measures.

The DHB is a unique tool which aims to improve the quality, capacity and use of health information and the equitable allocation of health resources at all levels.

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

Full pdf of the DHB

Foreword
Introduction, Background and Overview

Section A: Indicator comparisons by district

1. Socioeconomic Indicators
   1. Deprivation Index
   2. Access to Water
2. Input Indicators
   2.1 Per Capita Expenditure on Primary Health Care (excluding district hospitals)
   2.2 Proportion of District Health Services Expenditure on District Management
   2.3 Proportion of District Health Services Expenditure on District Hospitals
3. Process Indicators
   3.1 Nurse Clinical Workload
   3.2 Average Length of Stay
   3.3 Bed Utilisation Rate
4. Output Indicators
   4.1 Male Condom Distribution Rate
   4.2 Immunisation
   4.2.1 Immunisation Coverage
   4.2.2 Immunisation Drop Out Rate (DTP1-3)
   4.3 Caesarean Section Rate
   4.4 PMTCT Indicators
   4.4.1 Proportion of antenatal clients tested for HIV
   4.4.2 HIV Prevalence amongst antenatal clients tested
   4.4.3 Nevirapine uptake rate among pregnant HIV+ve women
   4.4.4 Nevirapine uptake rate among babies born to women with HIV
   4.5 Primary health care utilisation rate
5. Outcome Indicators
   5.1 Incidence of STI treated-new
   5.2 Tuberculosis
   5.2.1 Smear Conversion Rates
   5.2.2 TB Cure Rate
   5.3 Diarrhoea incidence in children under 5 years
   5.4 Not gaining weight rate under 5 years
   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 
- 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
Map of 53 Health Districts in South Africa
Data Tables
Correlation Graphs
Deprivation Indices
The District Health Information System
Tuberculosis Surveillance and data collection in South Africa
Indicator Definitions
References and further reading