By: Naomi Massyn (Project Manager: District Health
The first District Health Barometer (DHB) was published in 2005 and the 2019/20 DHB is the Health Systems Trust's (HST's) 15th edition! Naomi Massyn has been the main editor since the third publication. She is a health professional with post-graduate training in nursing administration, nursing education, public administration and health management and has been with the HST for more than 18 years. With more than 44 years of experience in different fields and at all levels of the South African health care system as professional nurse, administrator, educator, facilitator, consultant and manager she also has extensive experience in health service management at various levels and is skilled in training and capacity building methodologies. In addition to the DHB she also manages several other projects, including having provided providing quality assurance at each step of the Health Facility Audit in Namibia and Eswatini and verifying the quality of the sampling, data collection, analysis and reporting of the Health Facility Audit. She has also managed several other projects.
Naomi works closely closely with Candy Day who has been responsible for the creation of the datafile, league and maps since the 2009/10 publication. Candy originally trained as a pharmacist but has spent the past twenty years as a data analyst in support of the HST's publications. Candy was involved in the conceptualisation of the Barometer from the beginning, together with Fiorenza Monticelli. She has been involved in the production of each edition, including co-editing most editions and being co-author of a variety of chapters as well as data management, analysis and visualisation. Selected methods and findings from the DHB have been presented nationally and globally and collaborations with the World Health Organization and the Countdown to 2030 initiatives to improve the use of routine health facility data in low- and middle-income countries around the world have taken place. Candy's current position is technical specialist and has been working with HST for the past 24 years!
The team was joined in 2018 by Noluthando Ndlovu who took over the creation of the maps. Noluthando is also an integral part of data management and has also co-authored and edited in some editions. Each year another person from HST joins the team to assist with the first round of editing before the chapters are edited by public health specialists and for the 2019-20 edition it was Thesandree Padayachee, Senior Programme Manager in Health Systems Research.
The publication is also enhanced by the contribution of Dr Peter Barron who has done specialist editing since the first publication in 2005. Dr Barron is a leading public health specialist and was with the National Department of Health for many years including setting up the mHealth-based MomConnect used by over 1.5 million women in South Africa during pregnancy. The DHB was his brain child and he worked for the HST since the establishment of the organisation. When he left HST he became a specialist advisor for Dr Yogan Pillay – a past Deputy Director-General at the National Department of Health. He retired at the end of last year at age 70, but is still involved with the DHB even after retirement. He was co-author of several papers in several journals and was Naomi's mentor over the years.
The DHB 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.
Compilation of the 2019/20 DHB was guided by a technical working group made up of key people from HST as well as eight Public Health specialists. Data are drawn from the District Health Information Software (WebDHIS), the Ideal Clinic Realisation and Maintenance system, Statistics South Africa (Stats SA) surveys, the National Treasury Basic Accounting System (BAS), the Personnel Administration System (PERSAL), the Three Integrated Electronic Registers (TIER.Net) for tuberculosis (TB) and antiretroviral therapy (ART) data, the Electronic Drug-resistant Tuberculosis Register (EDRWeb), the National Income Dynamics Study (NiDS) and other National Department of Health information systems.
The main focus of the 2019/20 edition is on the Sustainable Development Goals (SDG's) and Universal Health Coverage (UHC) index. The district chapters in the DHB contain trend graphs of the indicators included in Section A: Indicator Comparisons per programme, as well as additional indicators [Health indicators are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a population.] aligned with the District Health Plan template of the National Department of Health. The district chapters also include the burden of disease (BOD) profiles for 2012−2017. The BOD profiles cover the percentage of deaths by broad cause; deaths are classified into four groups, namely: (i) injuries; (ii) non-communicable diseases; (iii) HIV and TB; and (iv) communicable diseases together with maternal, perinatal and nutritional conditions. Data are presented by gender and age group as well as the 10 leading single causes of death within each age group and by gender.
The DHB is a compilation of health data that takes many months to pull together. It takes a team of dedicated specialists who know that the work that they do plays a critical role in terms of creating insights into the public health system that can assist with enhancing and improving how services are delivered as well as received.
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