"The Health Systems Trust launches the 16th edition of the District Health Barometer, a valuable resource, that presents key findings on the performance of South Africa's 52 health districts using key public health indicators."
Johannesburg, South Africa
Leading non-governmental health organisation, the Health Systems Trust (HST), is proud to present the District Health Barometer (DHB) online interactive dashboard and its most recent District Health Barometer. The dashboard offers a user-led navigation system that allows users to drill down geographically from the province level to the district level.
The 2022/23 edition continues a long-standing tradition of reporting and reflecting on health system performance, inequities in health and health resource allocation and delivery. It includes 15 chapters which range from maternal and neonatal health to service capacity and access. This edition also includes a chapter on air pollution and health; a first for the DHB.
Some examples of key issues from the DHB in relation to the 2022/23 edition of the DHB:
Maternal and child health
The Barometer shows a mixed picture; despite a declining antenatal 1st visit coverage, 70% of women received antenatal care within the first 20 weeks. However, there are wide variations between the provinces ranging from 69.6% (North West) to 91.2% (Northern Cape).
Eight provinces recorded a decline in their maternal mortality in-facility ratio, with four of them achieving rates below the national average. Over the past 5 years, three provinces recorded an increase in the MMR. There was a 12.2% increase in the Northern Cape and 23.9% in Mpumalanga. All other provinces experienced a decline in the maternal mortality in-facility ratio between 2018/19 and 2022/23 ranging from 2.3% in Limpopo (LP) to 43.5% in the Free State (FS).
Cervical cancer
While none of the districts across South Africa reached the WHO cervical screening target of 70% by 2030, it's important to acknowledge the progress we have made in advancing women's health. KwaZulu-Natal was the best performing province in 2022/23, with all the districts obtaining a cervical cancer screening coverage above the national average of 21,4%.
Infectious diseases
By March 2023, none of the 52 districts had reached the second 95-95-95 UNAIDS target.
KwaZulu-Natal was the best performing province with the clients remaining on ART at 76.0% while the Western Cape was the poorest performing province with a rate of 54.4%.
The national ART viral load suppression rate for Quarter 1 of 2023 was 90.0%. Overall the country is on target to reach the third 95 within the cohort of those on ART by 2026 as per the National Strategic Plan (NSP). However, there are variations in the cascade, with the paediatric and adolescent cascades showing worrying trends as they lag behind adult Viral Load Suppression (VLS). In addition, unless the ART rate can be improved and the second 95 achieved, the total VLS when measured against the denominator of PLHIV remains concerning.
There have been decreases in TB symptom screening during and in the years following the acute phases of the COVID-19 pandemic, with DHIS data from 2022/23 recording less screening events in children under the age of five years, and less PHC visits during the year than in 2019/20. Despite this, the national TB symptom under-5 screened in facility rate improved markedly to 94.5% in 2022/23, an increase of 6.9 percentage points from 2019/20.
Health finance
The low growth rates in the provincial budgets reflect a very constrained fiscus. Also masked in expenditure outcomes is that the total PHC expenditure per capita in the country increased by 0.3% over the past five years (2018/19– 2022/23) and district health services expenditure per capita declined by 0.2% in the same period. This may be an indication of prioritisation of PHC services which is encouraging.
Human resources for health
Data show an estimated 17% emigration rate for skilled health professionals, which is a key risk for the current health system and the health system envisioned under National Health Insurance. A further challenge is the concerning ageing profile of the professional nursing workforce, with 38% of the of the workforce over 50 years, implying that nearly two in five nurses will retire in the next 15 years.
Commenting on the release of this new edition, CEO, Dr Themba Moeti said that, "Through this 16th edition of the Barometer, it is a pleasure for HST to share this valuable resource with colleagues within and beyond the sector. An innovation in this edition is the interactive online dashboard that promises more user engagement. We trust that the addition of a chapter on air pollution and health will be welcomed as the DHB evolves to provide information on emerging health challenges ensuring its relevance to health workers, researchers and officials at all levels of the health service, as well development partners who have all expressed a keen interest in its return. The DHB continues to fill a particular niche in making accessible health data and analyses related to key health indicators over time. enabling monitoring and assessment of health sector performance, while providing the data to inform targeted action for improved performance of our health system."
Speakers at the webinar launch will include Professor Salome Maswime, who is the Chairperson of the Health Systems Trust's Board of Trustees and the Head of the Global Surgery Division at the University of Cape Town and Dr Sandile Buthelezi, Director General of the National Department of Health, a seasoned health practitioner with extensive experience in health governance, policy, and programme management. HST is also pleased to have Dr Ayanda Ntsaluba, Group Executive Director of Discovery Limited and Chair of the Project Committee of Public Health Enhancement Fund as a speaker. For all the biographies kindly go to the HST website dedicated page for the DHB webinar.
The link to the online interactive dashboard is: https://dhb.hst.org.za/
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 publication provides 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
communications@hst.org.za OR hst@hst.org.za