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District Health Barometer 2019/2020 release

​​​"The 2019-2020 District Health Barometer once again sheds light on SA health's progress with Sustainable Development Goals and the Universal Health Coverage index"​

The Health Systems Trust is proud to present the 2019/20 edition of the District Health Barometer (DHB). The District Health Barometer is the premier resource for information on health system performance, inequities in health outcomes, and health resource allocation and delivery. It also tracks healthcare delivery processes across all provinces and districts in South Africa.

As with the 2018/19 edition of the DHB, the areas of focus of the 2019/20 edition are the Sustainable Development Goals and the Universal Health Coverage index. It includes 8 chapters covering 30 indicators. In addition, the publication focuses on the burden of disease to assess and compare the cause-of-death profiles for each of the 52 health districts in South Africa. It also includes a chapter on the evolution of the COVID-19 pandemic and health system responses in South Africa with an analysis of provincial data and lessons learnt from the Western Cape Province − how decision-making was supported by data.

The country is on track with some of the 2030 Sustainable Development Goals and the Universal Health Coverage index goals and targets. Some of the key issues we can take away from the DHB are:

  • Based on the downward trend in the national maternal mortality in facility ratio the country may achieve this 2030 Sustainable Development Goals target. The maternal mortality in facility ratio recorded in 2019/20 was the lowest since 2009/10. The country has already reached the 2030 Sustainable Development Goals target for the neonatal death in facility rate. The pneumonia incidence, number of deaths, and case fatality rate continued to decline since 2009/10. However, the death in facility under-5 years' rate has increased annually since 2016/17 and the rate of 5.0% in 2019/20 was the highest since 2015/16. Of concern is that 70.7% of the under-5 years' deaths occurring in facilities were in the neonatal period, and 19.0% in the age group 29 days to 11 months. The country again did not meet the global target for immunisation under-1 year coverage of 90% in 2019/20.  Variation in the vaccine expenditure patterns is noted between provinces and among districts in the same province. Of note is that high vaccine expenditure is not necessarily an indicator for high immunisation coverage, as much as low expenditure does not necessarily lead to suboptimal immunisation coverage.
  • On maternal health, there was an annual increase in the delivery in facility rate among 10–19 year olds between 2017/18 and 2019/20. Three percent of the deliveries in the age group 10–19 years were deliveries of girls younger than 15 years. Each of the 3 870 pregnancies among 10−14-year-old girls in the country is an undesirable event with severe consequences for the life of the mother and her family, and efforts to prevent such events should be intensified.
  • The 15.4 percentage points decline in the couple year protection rate since 2016/17 is of concern. The impact of contraceptive stock-outs at facilities that occurred during 2019/20 may be a contributing factor to the decrease in the national rate and to the decrease in uptake of certain methods and increases of others.
  • In 2018, the national tuberculosis drug susceptible client treatment success rate was 79.2%, well below the national target of 90%. To reach the Universal Health Coverage target for TB effective treatment, more effort is needed to increase the tuberculosis drug susceptible treatment success rate in all provinces. ​
  • Only 70% of people living with HIV were on antiretroviral therapy in 2019/20. South Africa is not on track towards meeting the second UNAIDS 90-90-90 target by December 2020. The country is also below the East and Southern Africa regional average of 83 per cent. The antiretroviral therapy viral load suppressed rate among adults has been stable around 88% during the last four-year period. However, of concern is the lower viral load suppressed rate in children, which is far from the envisaged target of 90% and shows no improvement over time.

Mortality rates in South Africa increased between 1997 and 2006 and declined thereafter until 2017, mainly due to the HIV epidemic and the roll-out of antiretroviral therapy respectively. Despite this, HIV and AIDS and associated conditions still stand out as a leading cause of years of life lost together with cerebrovascular diseases, ischaemic heart disease, diabetes mellitus, interpersonal violence and hypertensive heart disease. The quality of the cause-of-death data is still a matter of concern since there is still a high proportion of ill-defined and garbage codes. A garbage code refers to anything that is marked as a cause of death on a death certificate that cannot officially kill you. These official causes of death are listed in the International Classification of Diseases (ICD).

  • The ratio values for medical practitioners, professional nurses, and pharmacists in the public sector in South Africa still fall short in relation to the ratio values in the Universal Health Coverage framework needed to ensure that countries are on track to meet Sustainable Development Goals targets. Professional Nurses have the highest share of 50- to 65-year-olds at 40%. This poses a risk for South Africa in the implementation of NHI, which relies heavily on nursing staff as part of PHC re-engineering.

These are just some of the many gleanings that emanated from the detailed analysis of the data and the 2019-2020 edition will most assuredly be used as extensively as other editions have been over the years.

As said by the CEO of the Health Systems Trust, Dr Themba Moeti, "the value of the publication lies in both the depth and breadth of information that the publication brings together," This has certainly rung true in terms of the value the publication has added over time to not only district managers and public health practitioners to whom it is targeted, but increasingly to private individuals and companies who request information based on the DHB from HST.​​

The DHB can be access on​

About the District Health Barometer  

The District Health Barometer plays an important role in providing information for district managers to benchmark their districts against others in the country and in strengthening the use of data for priority-setting and decision-making. This annual publication continues to provide policy-makers, healthcare workers, planners, researchers, academics and other consumers of national health system information a unique overview of the performance of public health services in South Africa. The publication seeks to highlight inequities in health outcomes and health-resource allocation and delivery, and to track the efficiency of health processes across all provinces and districts.

The District Health Barometer is published by the Health Systems Trust.

About the Health Systems Trust​

The Health Systems Trust (HST) is a leading role-player in the South African public health arena, focusing on health systems strengthening, research, and strategic support in the implementation of priority health programmes. Established in April 1992, on the brink of democracy in South Africa, HST has played a significant role in the evolution of the national health system. Today our strength lies in the knowledge, insight and experience we harness through synergising our research and implementation outputs towards a healthy life for all.

Media Queries​

Antoinette Stafford Cloete, E:

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