Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
During 2006/07, the non-hospital primary health care expenditure in the public sector in South Africa ranged from a low of R151 per capita in Siyanda (Northern Cape) to a high of R497 per capita in Namakwa (also in the Northern Cape). This wide range, reflecting a 3.3 fold difference between highest and lowest spending district, is significantly down from 2001, where there was a nine fold difference between the highest and the lowest spend per district. Improvements have also been seen amongst provinces where the difference between the highest and the lowest spending province was 1.9 fold in 2006/07 compared to 4.4 in 2001.
The average primary health care utilisation rate in South Africa during 2006/07 was 2.25 visits per person per year to a public facility, up from 2.08 in 2003/04 and ranged from 1.4 visits per person per year in Metsweding (Gauteng province) to 4.6 in the Central Karoo (Western Cape).
The average TB cure rate for South Africa increased to 57.6% in 2005 from 50.8% the year before. While encouraging, this increase remains below the national target increase of 10%, and is still far below acceptable limits. Although the gap in the cure rate between the least and the most deprived districts in the country is decreasing, it still remains large, with a median cure rate of 71% for the least deprived versus a median cure rate of 61% for the most deprived districts.
These are among some of the 27 health, finance and socioeconomic indicators which are presented in the District Health Barometer 2006/07, and discussed in the report in order to monitor progress and support the improvement of equitable provision of primary health care by:
- Analysing key health system indicators at district level
- Ranking, classifying and analysing health districts (in various groupings e.g. Metropolitan districts, rural development districts, provinces), on the basis of these indicators, and
- Comparing these indicators over time.
The data is obtained from the government's District Health Information System, the financial management information system, the General Household Survey and other sources such as the National TB register and Census 2001.
Colourful representation of the indicators in league tables and maps facilitates identification of problem areas and also highlights data irregularities. The gaps that exist between the most and least deprived districts are dealt with under a separate section on inequity whilst differences in performance in rural and urban areas are addressed throughout the report.
The 2006/07 report also comes with a CD that provides a full database of the indicators, resources, references, software, maps, graphs, additional information on financial indicators, the original DHIS files as well as the GHS 2005 data files.
New developments include a web GIS page at http://webgis.hst.org.za:8081/ which enables users to remotely access district indicator information over a three year period by way of maps, tables and charts.
The DHB is freely available and can be downloaded from here >>.
To order a report or a CD, please email the HST resource centre at rc@hst.org.za, or contact Sithandiwe at tel +27+31 307 2954 or fax +27+31 304 0775