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Health Systems Trust launches the latest editions of the annual South African Health Review and District Health Barometer

Launch details:

Date: Tuesday 20 October 2015 

Venue: Southern Sun Hotel

Cnr. Steve Biko and Pretorius Streets

Arcadia, Pretoria

Time: 17h30 to 20h30​

(Registration at 17h00) 


Contact: Wendy Jasson da Costa

HST Communications Officer



​Leading health systems research agency and thought-leader Health Systems Trust proudly announces the combined launch of the South African Health Review (SAHR) 2014/15 and the District Health Barometer (DHB) 2014/15.


Both publications are funded by the National Department of Health. The Director-General of Health, Ms Malebona Precious Matsoso, will deliver the keynote address at the launch to be held in Pretoria on Tuesday 20 October 2015 at 18h00.


The South African Health Review is an accredited, peer-reviewed journal published annually that documents the development of South Africa’s post-apartheid health system, thereby offering:


  • current, evidence-based insights on how translation of policy into practice is impeded or facilitated in a range of healthcare structures, protocols and processes;
  • promising models that address intractable challenges and gaps in health service implementation; and 
  • concepts for and commentary on health system policy innovation and reform. 


The content of this 18th edition of the SAHR is grouped under seven thematic pathways: Health Policy (Chapter 1); Policy Implementation (Chapters 2 to 4); Attaining Equitable Health Systems (Chapter 5 to 8); Strengthening Human Resources (Chapters 9 to 12); Private Sector (Chapter 13); the winning entry for the SAHR’s Emerging Public Health Practitioner Award (Chapter 14); and Tracking Progress (Chapter 15).


As the Review’s standard introductory component, Chapter 1 presents a review of developments in South African health policy and legislation over the past year. Chapter 2 describes the notable progress achieved in the Ideal Clinic Realisation and Maintenance initiative, and Chapter 3 presents valuable lessons learnt in the reference implementation of the eHealth Strategy in selected primary health care (PHC) facilities. To understand the organisational and behavioural characteristics influencing PHC strengthening, the perceptions and experiences of District Clinical Specialist Teams during early implementation stages in three districts are explored in Chapter 4.  


Chapters 5 to 8 respectively address the options for advancing decentralisation of South Africa’s health system; task-shifting psycho-social interventions in public mental health; equitable and accessible health care in relation to disability and rehabilitation; and accounting for the rural context of need in resource allocation of the country’s public health system. 


In the area of human resources for health, Chapter 9 discusses the challenges of and threats to South Africa’s nursing profession, and Chapter 10 focuses on a programme shown to strengthen the leadership capabilities of nurse managers in running clinic operations. Chapter 11 analyses data from a series of case studies that investigated how nurse managers make decisions, and Chapter 12 considers how community participation in the public health system at sub-district level can be enhanced using a range of approaches founded on collective capacity-building.


Following Chapter 13’s attention to private health sector financing, which takes the form of a review of open-market medical scheme benefit options, Chapter 14 is the winning entry for the Review’s Emerging Public Health Practitioner Award, which presents a model of care developed to address the demand for rehabilitation arising from the dramatic extension of the life-span of people living with HIV, along with HIV-related disabilities, co-morbidities and side effects of medication.


Chapter 15 on Health and Related Indicators provides the latest data on demographic and socio-economic aspects of health status indicators, i.e. general mortality and disability, infectious diseases (malaria, tuberculosis, HIV and AIDS), reproductive and child health, nutrition, non-communicable diseases, risk behaviour and determinants of health, and injuries. Health service indicators (facilities and personnel), as well as health financing indicators (provincial health expenditure) are also covered. The chapter lists key new information sources along with central issues and trends emerging from these health statistics, along with provincial maps and definitions for the data tables presented.




Also published annually, the District Health Barometer is designed to assist the National Department of Health in making health and related information available for monitoring progress in health service delivery at district level. The DHB provides current information on functioning and associated fluctuations in all 52 health districts, describing performance over time in relation to previous years as well as other districts. Each edition highlights problem areas, data quality issues, sustained and notable progress, and aspects requiring deeper research into underlying factors contributing to the indicator values and trends. 


This 10th edition of the DHB presents data on 44 indicators, with trend illustrations and health profiles for South Africa, the nine provinces and the 52 districts, and includes chapter on the country’s burden of disease. Once again, the Barometer paints a varied picture in the national profile. 


Significant gains were noted in some areas:


  • The cure rate for new pulmonary smear-positive TB patients has increased over the last eight years to 76.8%. 
  • The stillbirth rate continued to show a downward trend and was 20.7 per 1 000 births, the lowest rate since 2001/02. 
  • Early mother-to-child transmission of HIV was at its lowest level at 1.5% and below the national target of 2%. 
  • The case fatality rates for diarrhoea with dehydration and pneumonia and severe acute malnutrition in children under five years of age continued to show a downward trend.
  • The couple year protection rate increased by almost 10 percentage points from the previous year and was 46.8% in 2014/15.
  • At 90%, the immunisation coverage under 1 year reached its highest level since 2005/06.
  • The percentage of pregnant women who were under 18 years of age at delivery continued to show a downward trend, reaching its lowest level since 2006/07 at 7.4%.
  • The rate for antenatal clients initiated on ART increased by 15 percentage points from the previous year and at 91.2% reached its highest level since 2011/12.


However, persistent challenges prevail in other areas:


  • At 11.6%, the case fatality rate for severe acute malnutrition in children under five years of age remained much higher than the national target of 8%.
  • The Caesarean section rate in district hospitals shows an upward trend since 2004/05, reaching its highest level at 22.7% in 2014/15, this being a percentage point higher than that recorded for 2013/14.
  • The school Grade 1 screening coverage was only 23.2% in 2014/15.
  • The measles 2nd dose coverage of 82.8% remained below the national target of 85%.





​Electronic copies of the South African Health Review and the District Health Barometer will be accessible via the HST website ( after 18h00 on Tuesday, 20 October 2015.  



About Health Systems Trust

Health Systems Trust (HST) is an innovative non-profit organisation working to strengthen ongoing development of comprehensive health systems in southern Africa. Using a primary health care approach, we specialise in conducting health research, providing technical support, and information dissemination. Our strategies are designed to promote equity and efficiency in health and healthcare delivery.


HST produces two flagship publications annually: the District Health Barometer (DHB) and the South African Health Review (SAHR).

  • The DHB provides a detailed overview of the South Africa’s public health services in and across all 52 health districts, and has become an important planning and management resource for health service providers, managers, researchers and policy-makers in the country.
  • Published since 1995 a​nd officially accredited as a peer-reviewed journal, the SAHR provides a South African perspective on prevailing local and international public health issues, and is widely read, used and quoted as an authoritative reference work in the country and abroad.​