District Health Barometer (DHB)
The District Health Barometer (DHB) contributes to improved quality and access to primary health care through monitoring, over time, important aspects of the health system at district level. Analysis of a carefully selected range of health indicators, from which comparisons between and among districts (across provinces) can be made, facilitates identification of areas of poor quality requiring appropriate corrective measures.
What is the District Health Barometer?
The DHB is a tool designed to assist with making functional information available for monitoring progress in health services delivery at the district level as a means to help improve health systems organisation and delivery. It is linked to district, provincial and national strategic plans in that it measures similar indicators, but the DHB still functions as an independent ‘watchdog' to provide input and pinpoint where there are serious gaps or performance issues.
The DHB aims to improve the quality, capacity and use of health information at all levels in the governmental health sector. It is also intended to provide the public, other sectors such as Treasury, the international health community, and donors with greater access and insight into the public health sector in South Africa through pooling the best available data and providing it in an easy to understand and use format.
Why a District Health Barometer?
The vision of the District Health Barometer project is to assist in the transformation of the culture and use of health information in the public health sector in South Africa. It provides a product in which key health statistics are easily understood and used for decision making.
The goals of the DHB are to improve the quality and transparency of health systems information in South Africa, to house an authoritative and accurate database of key health and health-related indicators and to produce an annual publication of health sector performance data covering several years, therefore enabling ongoing monitoring and evaluation.
Managers at all levels of the health system need appropriate information to analyse the health situation, set relevant objectives and develop plans susceptible to monitoring. Currently the consensus is that there is an abundance of information available, but that it is not that useful and often difficult to consolidate. Tools such as the District Health Barometer therefore provide a carefully seclected set of health and socio-economic indicators to aid decision making in the health sector.
The District Health Barometer publications have been well received by all levels of the public health sector.
The DHB does not provide ‘new' information on public health management. The information is however presented in such a way that catches management's eye, which is something that the same information presented in other reports and tables has not been able to do. The Barometer is also a useful tool to highlight areas that need further investigation.
The DHB has helped in the pursuit of more reliable information. There is a slowly growing awareness by districts that if data collected at base level is not accurate, the information presented in the DHB will also be skewed, thus showing the incorrect ranking of a district or districts.
The DHB has increased focus and attention on the importance of the District Health Information System and the quality of its data, which needs ongoing maintenance, quality control and validation in order for it to be useful. There is need for leadership and commitment from national level for this.
The DHB has accentuated awareness of the need for capacity building in information systems on all levels, but especially at management level.
Definitions and Targets
The spectre of reliable data-driven, inter-district comparison has led to a realisation that there is a definite need to standardise indicator definitions and agree on and publish a formal set of achievable targets.
The Next Phase
The success of the DHB reports, and in particular the perception of health sector managers that it is a valuable tool, emphasises the need to continue refining and developing it.
In order to contribute to strengthening capacity at a provincial and district level, ongoing workshops, presentations and meetings will provide an opportunity to discuss the findings and implications of the DHB. At the same time this will build capacity to understand indicators and how they can assist management to improve equity and quality of care at PHC level.
A number of benefits to health information systems, and thereby to health systems broadly, are expected from the DHB, including:
- integration of information from a number of sources into a single, accessible repository in the public domain
- strengthening integration in the health information system
- assisting managers at all levels to improve the quality and use of health indicators
- providing trend data to monitor change
- identifying gaps in data collection
- identifying problems with information systems or data quality
- strengthening existing information systems and the culture of information use and feedback
- improving and developing skills in analysis and interpretation of health indicators.
The District Health Barometers are freely downloadable via the following links and include full colour graphs, league tables and GIS maps:
- The District Health Barometer Year 1. January-December 2004,
- District Health Barometer 2005/06
- District Health Barometer 2006/07
- District Health Barometer 2007/08
- District Health Barometer 2008/09
- District Health Barometer 2010/11
For further information contact Candy Day (firstname.lastname@example.org)
Most of the compressed files are in 7zip format. This free software can be downloaded from http://www.7-zip.org/
Raw Data, Sources and Working Documents:
- Step-by-Step Guide to using the DHB Data File (1.43 MB)
- DHB Data 2007/08 (508.22 KB)
- Deprivation Index - Sub districts (508.22 KB)
- Cost per PDE (114.1 KB)
- Deprivation Index Tables (27.98 KB)
- Supervision Rate (346.85 KB)
- TB District Data for CF & SCR 2005/06 (180.5 KB)
- National Antenatal Survey Report 2007 (42.5 KB)
- National Antenatal Survey Report 2007 - Addendums (42.5 KB)
- Utilisation Survey on the District Health Barometer (174.83 KB)
- DHB 2008/09 Launch at the NDHSC Meeting . Fiorenza Monticelli, 19 May 2010
- ANC Health and Education PEC sub-committee meeting (1011 KB). Fiorenza Monticelli, 29 April 2010
- South Africa: monitoring health system performance at subnational level, Candy Day, Global Health Information Forum, Thailand, January 2010 You can get copies of the PowerPoint (1.49 MB) and PDF(paper) (856.52 KB) here
- The District Health Barometer 2007/8: Assessment & adjustment for data quality used in the South African DISTRICT HEALTH BAROMETER.(1.96 MB) Candy Day, 21 September 2009
- PHC Financing at District level Data, Equity & Analysis. (167.79 KB) Candy Day, Presentation at the PHASA Conference 2008
- The District Health Barometer 2006/7: Gauteng District Health Systems Summit. (1.76 MB) Fiorenza Monticelli, 22 August 2008
- PHASA 2008: PHC Financing at District level Data, Equity & Analysis. (697 KB) Candy Day, June 2008
- The District Health Barometer: Monitoring Health Systems Strengthening (459.5 KB), Dar es Salaam. Fiorenza Monticelli, 16/17 April 2008
- The South Africa National Conference on Primary Health Care: Alma Ata and Primary Health Care - Where are we now? Monitoring progress (244 KB). Fiorenza Monticelli, 10/11 April 2008
- The District Health Barometer 2006/07: World TB Day (798 KB). Peter Barron, 14 March 2008
- The District Health Barometer: A tool to monitor progress and support improvement of equitable provision of primary health care (1.08 MB). Fiorenza Monticelli, 10/11 October 2007
- The District Health Barometer: Gauteng Health Summit (1.76 MB). Fiorenza Monticelli, 17 September 2007
- The District Health Barometer 2005/06: District management meeting, Kwazulu-Natal (1.5 MB). Fiorenza Monticelli, 21 February 2007
- Variation and Variability of Inequities (3 MB), Candy Day, PHASA 2009.
- Making Key health Indicator Data more Accessible - The District Health Barometer Web GIS. (505.65 KB) Elliot Sello & Candy Day, HISA Conference 2008
- The District Health Barometer 2006/07 - A tool which measures and monitors equity in the provision of primary health care and highlights the quality of health data used for decision-making at district level. (741.28 KB) Elliot Sello & Fiorenza Monticelli, PHASA Conference 2008
It is anticipated that the Barometer will be of value to several groups.
Current HST activities related to the DHB concept
HST is currently involved in a number of activities which relate to the DHB, which will provide some baseline infrastructure, expertise and linkages.
Further Health Statistics
The objective of this section is to present the best available data on a wide range of health and related indicators. This should provide health planners and managers with easy access to data from a variety of sources.