Produced annually since 2005, the publication seeks to highlight, health system performance, inequities in health outcomes, and health-resource allocation and delivery, and to track the efficiency of healthcare delivery processes across all provinces and districts in South Africa. Over the years, the DHB has become an important planning and management resource for health service providers, managers, researchers and policy-makers. This year, the DHB contains 44 indicators, with trend illustrations and health profiles across South Africa’s nine provinces and 52 health districts. It also includes a chapter on the burden of disease, as well as seven additional indicators, as follows:
Inpatient under 5 years death rate
Percentage of Ideal Clinics
Percentage of assessed PHC facilities with patients who have access to a medical practitioner
MDR-TB treatment success rate
Percentage of polymerase chain reaction (PCR) tests positive within six days (replacing the ‘Infant first PCR test positive around six weeks rate’)
HIV PCR birth testing coverage (replacing ‘Infant first PCR test around six weeks uptake rate’).
The 2015/16 DHB paints a mixed picture in the national profile; however, significant gains were noted in more areas compared to previous years:
South Africa still faces a quadruple disease burden, namely: communicable diseases with maternal, perinatal and nutritional conditions; HIV and TB; non-communicable diseases (NCDs); and injuries. However, the percentage of the burden due to HIV and TB and communicable diseases with maternal, perinatal and nutritional conditions declined between 2008 and 2014 from 60% to 48%, with a corresponding increase in the burden due to NCDs (from 29% to 38%), and to a lesser extent injuries (from 11% to 13.6%).
South Africa has shown a slightly decreasing trend in the maternal mortality in facility ratio over the past five years, and the ratio of 119.1 deaths per 100 000 live births reached the national target of 120 maternal deaths per 100 000 live births.
Over the past few years there has been a general upward trend in the under 1 year immunisation coverage, increasing from 80.8% in 2010/11 to 89.2% in 2015/16. The measles 2nd dose coverage in South Africa was 84.8% in 2015/16. This was above the national target of 83% and a 2.0 percentage point improvement from 2014/15.
The national cervical screening coverage has increased steadily over the last 10 years, from 32.0% in 2006/07 to 56.6% in 2015/16, although this remains slightly lower than the national target of 60% set for 2015/16.
The national TB treatment success rate has been improving steadily, from 68.8% in 2007 to 77.2% in 2014. The cure rate for new pulmonary smear-positive TB patients has increased over the last nine years to 77.4%.
In 2015/16, the antenatal 1st visit before 20 weeks rate in South Africa was 61.2%. This is 1.2 percentage points above the target of 60% for this year.
The antenatal client initiated on ART rate was 93.0% nationally, a 1.8 percentage point increase from the previous year.
The percentage of women under 18 years of age who delivered in hospitals continued to show a downward trend, and reached its lowest level since 2006/07 at 7.1%.
According to National Health Laboratory Service (NHLS) data for 2015/16, the national intrauterine transmission rate is approximately 1.1%.
Vitamin A coverage has more than doubled over the past 10 years, from 25.1% in 2006/07 to 57.0% in 2015/16.
The diarrhoea case fatality rate among children younger than five decreased from 7.0% in 2010/11 to 2.2% in 2015/16, and the pneumonia case fatality rate in this age group fell from 5.8% to 2.3%. The severe acute malnutrition case fatality rate among children under five years of age declined from 16.4% to 8.9% in the same period.
The number of male condoms distributed increased by 17.9% since 2014/15 and during 2015/16; a total of 839 874 751 male condoms were distributed in South Africa.
The South African average rate of HIV testing coverage (including ANC clients) has been increasing steadily, from 26.1% in 2013/14 to 34.5% in 2015/16.
The national average percentage of TB patients with known HIV status increased slightly to 94.8% in 2015, more than double the 2008 rate of 43.3%.
The TB/HIV co-infected client on ART rate for 2015 was 84.5%, down slightly from 85.8% in 2014.
Areas for improvement are:
The national stillbirth in facility rate was 21.1 deaths per 1 000 total births in 2015/16, an increase from 20.7 per 1 000 in 2014/15.
The Caesarean section rate in district hospitals has shown an upward trend since 2004/05, reaching its highest level at 24.1% in 2015/16. The same applies to the overall Caesarean section rate, reaching its highest level at 26.2% in 2015/16.
South Africa still has one of the highest TB burdens in the world, with a TB incidence rate of 520 per 100 000 population in 2015.
Communications Manager: Health Systems Trust
Telephone: 031 266 9090
Cell: 082 782 1276
NOTES FOR EDITORS
About Health Systems Trust and the District Health Barometer:
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, HST specialises in conducting health research and health systems strengthening, providing technical support, and health information dissemination. The organisation’s strategies are designed to promote equity and efficiency in health and healthcare delivery. Among its flagship publications is the DHB, which is funded by the NDoH. The publication is designed to assist the NDoH in making health and health-related information available so that progress in health-service delivery can be monitored at district level.
HEALTH SYSTEMS TRUST - CONTACT DETAILS
34 Essex Terrace, Westville, Durban, 3630
+27(0)31 266 9090