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Health Systems Trust (HST) is proud to publish the 2017/18 edition of the District Health Barometer (DHB) as well as a new resource: the District Health Profiles.
The DHB 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. Over the years, the DHB has become an important planning and management resource for health service providers, managers, researchers and policy-makers.
After consultation with key stakeholders HST decided to divide the DHB into two separate but complementary publications: the DHB: District Health Profiles 2017/18 and the District Health Barometer 2017/18.
This edition of the District Health Profiles includes 60 indicators on social determinants of health, women and maternal health, child and school health, HIV, TB, non-communicable diseases and Ideal Clinics.
It also includes the population distribution, local municipality boundaries and health facility locations, the leading causes of death as well as budget and expenditure information for each district.
The DHB: District Health Profiles provide a wide variety of information designed to facilitate the district health planning process while the District Health Barometer will continue to provide its traditional analysis and commentary across selected indicators. CEO of Health Systems Trust, Dr Themba Moeti said that the value of the publication lies in both the depth and breadth of information that the Barometer brings together.
"The very valuable role it plays in the provision of data, and its analysis to inform planning and improvement of health services access, delivery and outcomes has made it a critical tool for health workers and managers at levels. The quality and richness of the data contained in this publication is testament to the many hours, days and months that have gone into its preparation through the excellent support and collaboration that we receive from all our partners."
The DHB and District Profiles are available on our website: http://www.hst.org.za/publications/Pages/DHB20172018.aspx
There are two clear trends in the composition of health expenditure.
Firstly, expenditure on the HIV/AIDS sub-programme increased dramatically as a percentage of total District Health Services expenditure, from 7.3% in 2004/05 to 20.7% in 2017/18. This is largely attributed to the growth of the antiretroviral treatment (ART) programme for which eligibility has been progressively expanded. South Africa now has the largest ART programme in the world with just over 4.2 million patients receiving treatment.
The second trend is the declining proportion spent on district hospitals with the move towards a more PHC-centric approach, but still funding district hospitals responsibly.
The national antenatal 1st visit before 20 weeks rate increased from 61.2% in 2015/16 to 66.6% in 2017/18. The introduction of MomConnect in August 2014 can be linked to this increase. Improved antenatal visits also contributed to the intervention of initiating antenatal clients onto ART The national antenatal client initiated on ART rate increased from 76.3% in 2013/14 to 93.9% in 2017/18.
Infants born to HIV positive mothers are tested for HIV by means of the PCR test at birth and the test is repeated at 10 weeks. The infants that tested positive at 10 weeks decreased from 1.3% in 2016/17 to 0.9% in 2017/18, indicating an improvement in prevention of mother-to-child transmission of HIV.
In some cases, data quality remains problematic and resulted in poor performance. Examples are the huge decline in the number of male condoms distributed around 220 million which resulted in the drop in the male condom distribution rate from 48.6 condoms per male 15 years and older in 2016/17 to 36.1 condoms in 2017/18. The huge decline in the number of male condoms distributed in 2017/18 also contributed to the relatively low couple year protection rate in some districts.
The immunisation coverage under 1 year remained below the national target in 2017/18, mostly due to the global shortage of some of the vaccines and a major revision of the denominator (population under 1 year) by Statistics South Africa.
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