Health Summit: Kwazulu Natal Department of HealthPoster with PHC utilisation rate background map,...
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Health Summit: Kwazulu‐Natal Department of Health Presentation by: Milani Wolmarans Presentation by: Milani Wolmarans Director Planning 1
Transcript of Health Summit: Kwazulu Natal Department of HealthPoster with PHC utilisation rate background map,...
Health Summit: Kwazulu‐Natal Department of Health
Presentation by: Milani WolmaransPresentation by: Milani Wolmarans
Director Planning
1
Content of Presentation
• Data mapping and presentation of provincial profileprofile
• District scoring and ranking
• Public Health facilities Audit
• Health Service Deliveryy
2
Data Mapping for Provincial and ProfilesProfiles
• Data has been collected to develop profiles of health p pdistricts, for selection and prioritization for piloting
• Following dimension have been applied:– Demographic– Socio‐economic– Epidemiology/ Health StatusEpidemiology/ Health Status– Service delivery– Performance
• Data from all 52 health districts has been analyzed and preliminary ranking of districts based on these dimensions have been completedhave been completed
3
KWAZULU NATAL PROVINCIAL PROFILE
4
KWAZULU‐NATAL PROVINCE Demographic Information
Age Household Head
19 Years and younger
20‐24 Years 25‐39 Years40‐64 Years
65 Years and older
1.4% 4.5% 27.9% 49.9% 16.2%
Race Household HeadGender
Household Head
Black ColouredIndian or Asian
White Female MaleDemographic Data
82% 2% 9% 7% 45.4% 54.6%Geographical area 87,153.2 Km2
Total Population (Midyear 2011 DHIS) 10,622,204
Population density (Midyear 2011) 121.9/Km2Percentage of population with medical insurance (General Household Survey 2007)
11.8%Mid-Year Population 2011
insurance (General Household Survey 2007)
40-44 yrs45-49 yrs50-54 yrs55-59 yrs60-64 yrs65-69 yrs70-74 yrs75-79 yrs
80+ yrs
Age
IsiZulu , 80.9%
Main Languages Census 2001
-800000 -600000 -400000 -200000 0 200000 400000 600000 800000
0-4 yrs5-9 yrs
10-14 yrs15-19 yrs20-24 yrs25-29 yrs30-34 yrs35-39 yrs
yA
IsiXhosa , 2 3% Sepedi , 800000 600000 400000 200000 0 200000 400000 600000 800000
Number
Female MaleAfrikaans ,
1.5%English , 13.6%
IsiNdebele , 0.2%
2.3% p ,0.1%
Sesotho , 0.7%
5
A l H h ld I C i S 2007
Social Determinants of Health
1 2 3 4 5
Deprivation Index DHB 2007 Provincial Average
0 0%
50%
100%
12%39%
23% 10% 2% 15%
Annual Household Income Community Survey 2007
Least Deprived Most Deprived No income or
less than R4 800
R4,801‐R38,400
R38,400‐R153,600
R153,600‐R614,400
R614,400 and more
Respose not given
Indicator Census 2001Community Survey 2007
Percentage unemployed 26.5% 20.6%
Percentage traditional and informal dwelling, shacks and squatter settlement
36.7% 42.3%
Percentage households without access to improved sanitation
17.1% 10.9%
Percentage households without Access to Piped Water 26.0% 20.7%
Percentage households without access to electricity for lighting
37.8% 28.6%
Percentage households without refuse removal by local authority/private company
49.6% 48.1%authority/private company
6
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8
PHC (Non Hospital) Expenditure per Capita
PHC Utilization Rate 2007/08‐2009/10
Service DeliveryTrend of Public Health Expenditure Trend of Health Services Delivery
200
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1200
(real 20
08/09 p
rices)
PHC (Non Hospital) Expenditure per Capita 2005/06 ‐2008/09
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real 20
08/09 p
rices)
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Cost per Patient Day EquivalentDistrict 80.0
PHC Supervision Rate 2007/08‐2009/10
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P
KwaZulu‐Natal ZA Linear (KwaZulu‐Natal)
9
Poster with PHC utilisation rate background map, pie graphs illustrating what proportion of ambulatory patients are seen at OPD (should ideally be 7‐10% if patients are not “bypassing” clinics to go straight to hospitals with minor ailments) and bar graphs illustrating percentage of population with medical insurance. Where medical insurance is low and proportion of ambulatory headcounts seen at OPD is not too high (e.g. UMkhanyakude) the PHC utilisation should be higher. Distribution of facilities and district cross boundary utilisation of facilities might also influence PHC utilisation rate.
10
Diarrhoea Incidence Rate under 5 years 2001‐2010
Millennium Development Goals MDG 4: Reduce child mortalityMDG 1: Eradicate extreme poverty and hunger
60.0
80.0
100.0
age
Weighing Rate under 5 Years 2001‐2010
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er 5 years
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60.0
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Percen
t
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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Per 1
KZN ZA Linear (KZN)
KZN ZA Linear (KZN)
Severe Malnutrition Incidence Rate under 5 years 2001‐2010 100.0
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p un
der 5
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Pneumonia Incidence Rate under 5 Years 2003‐2010
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20.0
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nder 5 years
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Per 1
000
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100.0
120.0
ercentage
Measles 1 st Dose Coverage Rate 2001‐2010
0.0
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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Pe
KZN ZA Linear (KZN)11
Antenatal Coverage 2001‐2010
MDG 5: Improve maternal health MDG 6: Combat HIV/AIDS, malaria, and other diseas
36.233.5
36.5 37.540.7 39.1 39.1 38.7 38.6 39.5
2530354045
tage
HIV Prevalence Antenatal Clients 2000‐2009 (Antenatal Survey 2009)
60.0
80.0
100.0
120.0
140.0
Percen
tage
Antenatal Coverage 2001‐2010
0510152025
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Percen
t
0.0
20.0
40.0
P
KZN ZA Linear (KZN)
KZN South Africa Linear (KZN)
80.0
TB Cure Rate 2003‐2008 40.0
60.0
80.0
100.0
Percen
tage
Delivery in Facility Rate 2001‐2010
30.0
40.0
50.0
60.0
70.0
80.0
Percen
tage
0.0
20.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
P
KZN ZA Linear (KZN)
0.0
10.0
20.0
2003 2004 2005 2006 2007 2008
KZN ZA Linear (KZN)15.0
20.0
25.0
30.0
35.0
ercentage
Couple Year Protection Rate 2001‐2010
0.0
5.0
10.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
P
KZN ZA Linear (KZN)12
Usable bed utilisation rate Average length of stay Caesarean section rate Perinatal mortality rate
Hospital PerformanceDistrict Hospitals
District Hospitalg g y y
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
AmajubaNiemeyer Mem Hosp
47.0 52.7 51.1 52.8 3.6 3.5 3.1 2.8 0.0 0.0 0.0 11.1 17.3 18.6 29.6 17.3
Amajuba Total 47.0 52.7 51.1 52.8 3.6 3.5 3.1 2.8 0.0 0.0 0.0 11.1 17.3 18.6 29.6 17.3
eThekwini
McCords Hosp 54.9 48.0 68.6 36.8 3.5 3.4 2.7 2.1 36.2 40.1 44.9 57.9 15.2 15.0 13.4 14.2
Osindisweni Hosp
71.8 69.4 60.3 76.3 8.7 7.0 4.9 5.7 29.7 28.4 30.9 30.2 52.5 34.7 35.3 33.6
St Mary's Hosp (Mar)
101.3 104.9 92.5 112.5 3.8 3.7 3.4 3.2 29.2 28.9 34.2 35.3 28.0 29.7 21.2 26.1(Mar)Wentworth Hosp
63.2 69.4 44.3 36.5 5.4 4.9 3.8 3.7 0.0 0.0 0.0 0.0 7.8 5.9 4.7 10.9
eThekwini Total 72.6 73.0 63.0 57.9 5.0 4.5 3.7 3.6 28.4 28.2 32.6 35.0 30.1 27.0 22.5 25.1
Montebello Hosp
65.5 57.3 44.4 93.5 8.1 6.6 4.8 6.7 19.2 20.1 39.9 34.3 36.6 10.6 78.7 43.1
iLembe
HospUmphumulo Hosp
61.0 66.1 75.0 78.0 6.9 6.9 5.2 5.8 8.9 10.6 10.4 23.4 39.0 25.9 33.4 23.1
Untunjambili Hosp
59.7 62.6 66.0 61.6 7.3 5.5 4.5 4.5 17.1 26.1 16.4 22.3 32.6 38.1 37.9 28.1
iLembe Total 61.7 62.5 63.0 74.5 7.3 6.3 4.9 5.5 14.9 18.1 21.9 28.3 36.3 24.3 49.0 31.5
Sisonke
Christ the King Hosp
62.0 58.4 69.4 72.6 5.2 4.7 4.1 4.5 22.0 20.5 30.9 32.6 33.3 30.9 30.1 19.2
EG Usher Mem Hosp
58.7 62.3 63.9 56.2 4.9 5.2 4.4 4.1 21.1 22.0 23.8 26.6 22.4 25.6 32.4 37.6
Rietvlei Hosp 52.2 49.3 71.3 64.2 7.6 6.5 5.4 5.1 15.3 16.6 16.3 18.0 75.5 34.2 35.6 32.1
St Apollinaris Hosp
61.1 63.4 73.3 72.5 5.1 4.9 4.5 4.7 25.7 24.7 26.8 27.6 28.4 27.7 23.0 24.8
Sisonke Total 58.2 58.0 69.1 65.9 5.5 5.2 4.6 4.6 21.2 20.9 24.8 26.2 36.0 29.7 30.3 28.013
District HospitalUsable bed utilisation rate Average length of stay Caesarean section rate Perinatal mortality rate
District Hospitals continue
District Hospital
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
Ugu
GJ Crooke's Hosp
75.2 74.3 74.0 71.3 4.8 4.8 4.4 4.6 27.4 34.8 50.3 52.8 19.9 16.6 28.5 18.2
Murchison Hosp 69.8 71.2 70.3 77.5 6.8 6.6 5.2 5.9 19.7 25.4 23.4 38.7 29.1 27.1 24.3 28.8
St Andrew's Hosp
59.6 68.6 81.2 73.4 5.6 5.7 5.3 5.0 24.2 31.6 28.1 65.8 32.0 27.9 26.2 31.2
Ugu Total 68.7 71.6 74.3 74.2 5.6 5.6 4.9 5.2 24.3 31.3 37.6 51.3 25.7 22.4 26.6 25.1
uMgungundlovu AppelsboschHosp
46.3 51.6 55.9 61.2 6.8 6.1 5.2 5.2 23.9 24.1 29.0 28.0 22.7 30.6 33.3 20.1Hosp
Northdale Hosp 73.8 75.2 79.7 83.3 4.4 4.5 4.3 4.5 25.2 26.0 36.5 30.9 18.6 14.5 18.6 23.5
uMgungundlovu Total 66.3 69.5 73.6 77.6 4.8 4.7 4.4 4.6 25.0 25.8 35.6 30.4 19.3 16.8 20.7 23.0
Bethesda Hosp 64.3 66.7 69.5 59.1 5.7 5.7 5.2 5.0 20.4 26.4 23.7 16.3 28.8 29.7 34.2 24.1
Umkhanyakude
Hlabisa Hosp 71.3 59.1 64.5 60.6 7.2 6.3 4.0 4.5 19.7 19.4 22.3 23.4 30.1 26.2 27.3 28.1
Manguzi Hosp 65.8 72.4 73.7 67.9 7.3 7.4 5.7 5.6 18.1 17.7 28.5 28.2 19.2 22.9 25.9 23.5
Mosvold Hosp 76.1 108.5 57.1 52.8 9.0 9.9 6.2 4.8 14.2 16.7 17.0 29.1 9.5 21.6 18.8 16.0
Mseleni Hosp 71.5 69.8 74.4 64.2 5.4 5.4 4.8 4.4 14.7 16.1 18.8 19.3 31.3 37.6 30.0 29.3p
Umkhanyakude Total 69.7 72.9 67.7 61.1 6.8 6.8 5.0 4.9 17.8 19.0 22.3 23.1 24.5 27.1 26.9 24.5
C Johnson Mem Hosp
60.3 57.9 58.3 48.0 6.3 6.1 4.8 4.4 12.7 16.8 24.0 26.0 36.4 28.6 36.9 20.5
Church of S l d H
70.0 66.9 65.0 62.6 7.7 6.9 5.5 5.5 17.0 20.7 16.6 25.9 14.9 18.1 25.1 18.1Umzinyathi Scotland Hosp
Dundee Hosp 58.3 60.5 60.4 57.8 4.4 4.1 3.5 3.4 16.6 15.9 18.1 20.4 27.4 26.1 18.2 16.2
Greytown Hosp 65.3 72.3 70.2 53.9 5.2 5.7 4.7 4.5 16.6 21.8 23.3 20.8 27.3 12.9 31.5 28.1
Umzinyathi Total 63.8 63.8 62.8 55.4 6.0 5.7 4.6 4.5 15.4 18.7 20.7 23.8 26.6 22.2 28.9 20.0
14
District HospitalUsable bed utilisation rate Average length of stay Caesarean section rate Perinatal mortality rate
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
District Hospitals continue
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
Uthukela Emmaus Hosp 51.0 58.9 73.0 65.1 4.1 4.3 4.2 4.1 16.3 16.7 19.4 20.7 36.8 50.8 51.5 58.6
Estcourt Hosp 59.0 53.3 64.8 62.7 4.8 4.0 4.2 4.3 24.5 25.1 31.9 31.3 31.0 31.8 39.3 45.9
Uthukela Total 56.2 55.8 67.6 63.5 4.5 4.2 4.2 4.2 21.3 21.9 26.5 27.4 33.2 39.0 44.4 51.0
Uthungulu
C Booth Hosp 61.6 47.4 45.9 46.6 7.0 3.5 3.9 4.1 24.8 19.7 21.3 24.2 34.7 32.5 24.7 46.4
Ekhombe Hosp 32.4 37.4 51.3 43.8 6.2 6.1 5.2 5.3 9.3 21.3 16.3 19.9 28.5 27.4 41.9 41.5
Eshowe Hosp 53.6 59.8 59.6 74.9 6.1 5.7 4.8 4.7 27.7 25.6 33.2 42.1 15.8 22.6 15.3 14.4
KwaMagwaza 59 2 58 8 88 9 69 7 6 3 6 0 5 4 5 8 20 5 20 4 32 6 35 2 26 3 15 8 25 4 18 0
gHosp
59.2 58.8 88.9 69.7 6.3 6.0 5.4 5.8 20.5 20.4 32.6 35.2 26.3 15.8 25.4 18.0
Mbongolwane Hosp
57.4 43.5 45.7 53.9 10.2 7.6 6.5 6.7 10.0 11.4 18.6 15.7 27.7 57.4 34.2 51.3
Nkandla Hosp 47.2 46.1 47.3 49.1 7.2 6.4 4.6 4.7 26.5 19.4 22.1 27.4 41.3 28.8 37.0 31.6
Uthungulu Total 52 1 51 3 55 3 58 7 6 8 5 6 4 9 5 0 22 7 21 7 28 0 33 5 25 4 26 0 25 8 26 1Uthungulu Total 52.1 51.3 55.3 58.7 6.8 5.6 4.9 5.0 22.7 21.7 28.0 33.5 25.4 26.0 25.8 26.1
Zululand
Benedictine Hosp
47.6 45.3 53.9 67.1 6.2 5.7 4.1 5.8 13.7 14.6 13.9 13.8 25.4 18.2 28.6 28.7
Ceza Hosp 42.8 47.6 54.8 50.3 7.8 7.2 5.7 5.2 18.5 19.2 26.0 27.5 21.3 27.1 30.5 19.3
Itshelejuba Hosp
60.0 56.1 73.4 75.1 4.8 4.4 4.6 4.7 14.4 13.8 21.0 26.1 21.4 14.9 43.9 22.8Hosp
Nkonjeni Hosp 51.3 47.9 53.4 243.4 7.8 5.2 4.4 5.7 22.0 22.5 32.9 24.9 19.9 14.5 43.4 33.0
Vryheid Hosp 65.3 72.7 70.7 69.0 4.2 4.1 4.1 4.2 22.3 25.2 31.5 38.8 32.9 42.8 40.3 37.9
Zululand Total 53.6 54.4 60.6 75.5 5.5 5.0 4.4 5.0 18.3 19.1 25.1 26.8 26.1 24.9 37.4 30.0
KZN Province Totals 61.7 62.7 64.5 64.7 5.7 5.4 4.5 4.6 20.9 22.4 27.2 29.4 27.4 25.5 29.8 27.0
ZA average 65.0 67.5 67.5 65.4 4.5 4.1 4.1 4.1 15.5 18.6 18.6 19.3 30.9 31.1 31.1 31.0
ZA target 70.0 70.0 70.0 75.0 4.2 4.2 4.2 3.5 12.5 12.5 12.5 15.0 30.0 30.0 30.0 30.015
Regional Hospital
Usable Bed Utilisation Rate Average Length of Stay Caesarean Section Rate Perinatal Mortality Rate 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
Addington H
84.6 85.7 80.4 47.1 4.6 4.5 4.0 3.5 27.6 29.0 29.4 27.4 16.7 17.1 18.8 19.3
Regional Hospitals
HospEdendale Hosp
71.9 76.3 95.1 66.9 4.9 4.4 4.6 4.8 40.3 32.7 49.2 40.1 22.8 14.0 28.1 32.4
King Edward VIII Hosp
63.5 65.7 61.1 49.2 5.5 5.1 4.1 4.0 47.8 49.4 52.0 56.0 66.8 44.1 40.4 45.8
L UmfoloziL Umfolozi War Mem Hosp
82.9 80.6 72.2 74.8 3.7 3.7 3.3 3.3 33.3 37.1 44.2 50.3 40.8 39.5 49.2 42.7
Ladysmith Hosp
68.2 69.6 66.7 55.9 4.2 4.3 3.7 3.2 20.0 19.9 19.0 21.0 38.5 25.1 31.8 33.8
M Gandhi H
72.6 88.6 88.3 77.9 4.8 4.7 4.3 4.5 34.6 32.9 38.7 38.5 33.5 39.2 43.1 42.5HospMadadeni Hosp
42.4 45.3 53.1 48.8 8.1 7.5 5.5 5.1 14.1 15.4 17.7 21.6 36.9 53.1 37.8 8.6
Newcastle Hosp
54.7 61.0 62.1 66.4 2.9 2.8 3.1 3.7 33.0 32.3 33.6 35.1 26.1 20.4 37.5 30.0
Ngwelezana 71.8 61.0 73.1 87.0 8.0 6.7 6.2 6.8
Hosp71.8 61.0 73.1 87.0 8.0 6.7 6.2 6.8
P Shepstone Hosp
85.2 79.6 79.4 78.7 6.3 5.9 4.9 4.4 35.9 39.8 51.4 46.2 42.3 42.2 55.1 43.5
Prince Mshiyeni H
65.9 72.8 72.5 69.7 4.1 4.5 4.9 4.4 32.4 32.4 33.7 37.0 32.2 31.9 33.3 35.1HospRK Khan Hosp
75.9 84.8 82.9 92.2 4.3 5.2 4.1 3.3 32.6 32.6 44.3 55.9 41.7 42.8 47.5 59.0
St Aidans Hosp
38.0 39.4 22.2 17.2 5.8 5.1 3.1 2.6
Stanger Hosp 74.3 77.8 79.1 74.9 5.3 5.2 4.8 4.9 29.6 27.9 26.1 20.1 36.3 39.8 49.0 50.5Sta ge osp 3 8 9 9 5 3 5 8 9 9 6 9 6 0 36 3 39 8 9 0 50 5
KZN 66.8 70.0 71.9 62.9 4.9 4.8 4.4 4.2 32.0 32.4 38.0 38.9 36.1 33.8 38.1 37.1
ZA average 72.2 74.3 75.3 70.6 4.6 4.6 4.4 4.4 27.6 29.3 31.9 33.6 39.8 39.2 41.5 42.3
ZA target 75.0 75.0 75.0 75.0 4.8 4.8 4.8 4.8 22.0 22.0 22.0 25.0 30.0 30.0 30.0 30.016
Tertiary Hospital
Usable Bed Utilisation Rate Average Length of Stay Caesarean Section Rate Perinatal Mortality Rate
Tertiary Hospital
Hospital2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
Grey's Hosp 74.4 71.1 69.3 75.1 10.3 9.0 7.1 7.1 61.2 62.3 69.4 64.9 58.8 71.2 62.7 94.0
ZA 71.1 74.6 73.6 74.3 5.5 5.4 5.4 5.7 29.6 33.1 38.8 42.6 57.5 58.5 50.6 57.7ZA 71.1 74.6 73.6 74.3 5.5 5.4 5.4 5.7 29.6 33.1 38.8 42.6 57.5 58.5 50.6 57.7
ZA target 75.0 75.0 75.0 75.0 6.8 6.8 6.8 5.5 32.0 32.0 32.0 30.0 30.0 30.0 30.0 30.0
National Central Hospital
Central Hospital
Usable Bed Utilisation Rate Average Length of Stay Caesarean Section Rate Perinatal Mortality Rate
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
National Central Hospital
2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11 2007/08 2008/09 2009/10 2010/11
A Luthuli Hosp
49.3 63.9 67.8 68.0 11.3 8.0 6.4 6.3 77.6 79.5 73.8 70.5 174.4 135.3
ZA average 71.3 74.8 76.6 72.1 5.8 5.8 5.7 5.6 35.1 37.9 39.6 41.1 49.3 54.2 57.7 54.4g
ZA target 75.0 75.0 75.0 75.0 6.8 6.8 6.8 5.5 32.0 32.0 32.0 50.0 30.0 30.0 30.0 30.0
17
DISTRICT PROFILE SUMMARIES
District profiles (similar to provincial profile above) have been developed f h di t i tfor each districtDistricts were ranked from best to worst performing for the 26 selected indicators in three categories:
Socio‐economicSocio economicService delivery, expenditure and utilisationHealth outcomes (MDG proxy)
A score from 1‐52 were given where 1 is best performing district and 52 the worst for each indicator. Totals for each district were added for each category and districts were ranked from best to worst performing in province and in SA.This allows districts and provinces to evaluate their performance across allThis allows districts and provinces to evaluate their performance across all 52 districts in each category as well as the performance in their province
18
Socio‐Economic Indicators:Ranking per province and number ranking across all 52 districts
50
60
4446
4950
4345
4748
30
40
4144
2425
37
2021
26
31
3638
404243
22
3234
3639
272831
1819
30
23
2933
35
umbe
r
0
10
20
10
15
9
16
81213
17
11
5
141819
1 2 3 46 7
Nu
ec N M
ande
la
ec Cacadu
ec Amatho
le
ec Ukhahlamba
ec C Hani
ec A Nzo
ec O Tam
bo
fs F Dabi
fs M
othe
o fs Lejwelep
utsw
a fs Xhariep
fs T M
ofutsanyane
gp City
of Joh
anne
sburg
gp Sed
iben
g gp
City
of T
shwane
gp Ekurhulen
i gp
Metsw
eding
gp W
est R
and
kz eThekwini
kz uMgungun
dlovu
kz Amajub
a kz iLem
be
kz Uthun
gulu
kz Uthukela
kz Ugu
kz Umkhanyakude
kz Zululand
kz Sison
ke
kz Umzinyathi
lp W
aterbe
rg
lp Capricorn
lp Vhe
mbe
lp M
opani
lp Gr Sekhukhu
ne
mp Gert S
ibande
mp Nkangala
mp Eh
lanzen
i
nc Nam
akwa
nc Frances Baard
nc Siyanda
nc Pixley ka Sem
e nc JT
Gaetsew
e
nw Dr K
Kaund
a nw
B Platin
um
nw Dr R
S Mom
pati
nw NM M
olem
a
wc West C
oast
wc Overberg
wc City of C
ape Town
wc Ca
pe W
inelands
wc Ce
ntral Karoo
wc Eden
g
19
Health Outcome Indicators: Ranking per province and number ranking across all 52 districts
50
60
48
40
50
3033
3538
3235
374041
42434445
464748
3637
31
3639
34
20
30
171821
30
19
24
29 28
131514
2225
27 26
2023
21
31
12
16
Num
ber
0
10
o o g i g u d a e
24 5
7 811
3
13
6
1
9 1012
ec Chris Hani
ec Oliver Tam
b oec Cacadu
ec Ukhahlamba
ec Amatho
le
ec Nelson Mande
la
ec A Nzo
fs Fezile Dabi
fs Lejwelep
utsw
a fs T M
ofutsanyane
fs M
othe
ofs Xhariep
gp Tshwane
gp Sed
iben
ggp
West R
and
gp Ekurhulen
igp
Johann
esbu
rg
gp M
etsw
eding
kz Umzinyathi
kz Uthun
gul u
kz iLembe
kz Zululand
kz Amajub
akz Ugu
kz eThekwini
kz Uthukela
kz Umkhanyakude
kz Sison
ke
kz uMgungun
dlovu
lp Gr Sekhukhu
ne
lp M
opani
lp Capricorn
lp Vhe
mbe
lp W
aterbe
rg
mp Eh
lanzen
i mp Gert S
ibande
mp Nkangala
nc Frances Baard
nc Jo
hn Taolo Gaetsew
e nc Nam
akwa
nc Pixley ka Sem
enc Siyanda
nw Bojanala Platinum
nw
Dr K
enne
th Kaund
a w Ngaka M
odiri M
olem
a uth Segomotsi M
ompati
wc West C
oast
wc Ce
ntral Karoo
wc Ca
pe W
inelands
wc Eden
wc City of C
ape Town
wc Overberg
n
nwnw
Dr R
u
Eastern Cape KwaZulu‐Natal North WestFree State Limpopo Northern CapeGauteng Mpumalanga Western Cape
20
Health Service, Utilisation and Expenditure Indicators: Ranking per province and number ranking across all 52 districts
50
60
40
30
36
323435
37
313334
3030er
20
30
1617
22
28
2426
30
1515
24
14
17
20212324
26
1415
1921
2527
29
18
23
3030
Num
be
10 7 7
10 10
5
12
8
14
6
11
14
9
1 2 3 46
13
0
ec Ukhahlamba
ec Nelson Mande
la
ec Cacadu
ec Amatho
le
ec A Nzo
ec Chris Hani
ec Oliver Tam
bo
fs Xhariep
fs T M
ofutsanyane
fs M
othe
ofs Fezile Dabi
fs Lejwelep
utsw
a
gp Ekurhulen
igp
Metsw
eding
gp Jo
hann
esbu
rg
gp Sed
iben
ggp
Tshwane
gp W
est R
and
kz Umkhanyakude
kz Uthun
gulu
kz Umzinyathi
kz eThekwini
kz Sison
ke
kz Amajub
akz iLem
be
kz Ugu
kz uMgungun
dlovu
kz Zululand
kz Uthukela
lp Capricorn
lp Vhe
mbe
lp M
opani
lp Gr Sekhukhu
ne
lp W
aterbe
rg
mp Eh
lanzen
i mp Gert S
ibande
mp Nkangala
hn Taolo Gaetsew
e nc Pixley ka Sem
enc Frances Baard
nc Nam
akwa
nc Siyanda
egom
otsi M
ompati
aka Mod
iri M
olem
a Bojanala Platinum
Dr K
enne
th Kaund
a
City
of C
ape Town
wc Overberg
wc Eden
wc West C
oast
wc Ce
ntral Karoo
wc Ca
pe W
inelands
e k
nc Jo
h
nw Dr R
uth Se
nw Nga nw nw D
wc w
Eastern Cape KwaZulu‐Natal North WestFree State Limpopo Northern CapeGauteng Mpumalanga Western Cape 21
Preliminary District management functionality self assessment results
90100 95
9188 86
83
405060708090 83 81 81 80 80 80 80 79 79 77 77 77 77 76 75 75 75 74 73 72 72 71 71 70 70 69 69 69 69 68 68 67 64 64 63 62 62
5854 51 50
46 45
ge
0102030
esbu
rg
thern)
hirima)
rhulen
i
t Rand
hwane
erbe
rg
angala
entral)
nyathi
dibe
ng
Mop
ani
ison
ke
atinum
wed
ing
majub
a
lamba
ed Nzo
band
e
hembe
luland
ndlovu
Cacadu
Mothe
o
anzeni
khun
e
kz Ugu
t Coast
Tambo
anyane
e Dabi
putswa
hariep
elands
c Eden
Metro
a Seme
iyanda
hukela
ungulu
pricorn
erbe
rg
e Town
lagadi)
yakude
makwa
Baard
atho
le
is Hani
ekwini
Lembe
Karoo
0 0 0 0 0Percen
tag
gp City
of Joh
anne
Dr K
enne
th Kaund
a (Sou
gomotsi M
ompati (Bop
h
gp Ekur
gp W
est
gp City
of T
sh
lp W
ate
mp Nka
gaka M
odiri M
olem
a (Ce
kz Umzi
gp Sed
lp M
kz S
lp Bojanala Pla
gp M
etsw
kz Am
ec Ukhah
ec Alfre
mp Gert S
i
lp Vh
kz Zu
kz uMgungun
ec C
fs M
mp Eh
la
lp Greater Sekhu
k
wc West
ec O.R. T
fs Thabo
Mofutsa
fs Fezil
fs Lejwelep fs X
wc Ca
pe W
ine
wc
ec Nelson Mande
la Bay
nc Pixley ka
nc Si
kz Uth
kz Uthu
lp Cap
wc Ove
wc City of C
ape
hn Taolo Gaetsew
e (Kgal
kz Umkhany
nc Nam
nc Frances
ec Am
ec Chri
kz eThe
kz iL
wc Ce
ntral
nw D
nw Dr R
uth Seg
nw N
nc Jo
h
22
District Health Expenditure ReviewsDistrict Health Expenditure Reviews
• The process for completing structure District Health Expenditures started in June 2011and will be completed by the end of October 2011– The information will present a clearer picture of funding, distribution p p g,
and use of health resources in the District and the Province– The DHER is used as a diagnosis tool to assess to what extent
allocation (budget) and use of resources (expenditure) advance the di t i t/ i bj ti fdistrict/ province objectives of:
• Access • Qualityy• Efficiency• Equity S i bili• Sustainability
23
Public Health Facility AuditPublic Health Facility Audit
24
Audit ScopeAudit Scope
• To conduct an INDEPENDANT audit of all public health pfacilities;– Infrastructure
Equipment– Equipment
– HR
– Finance management
– Services provided
– Quality of care (sub‐set of Core Standards)
• A baseline for improvement planA baseline for improvement plan
25
MethodologyMethodology
• Direct observations
Ph i l• Physical assessments
• Records reviews• Records reviews
• Patient interviewsPatient interviews
• Staff interviews
26
Six Priority Areas of Qualityy Q y
• Availability of medicine and supplies• Availability of medicine and supplies– Stock control and –management
– Availability of tracer medicines
b– Prescribing practices
– Storage
– Patient and staff interviews
• Cleanliness– Patient Satisfaction results
Inspect records of daily inspections of cleanliness– Inspect records of daily inspections of cleanliness
– Cleaning procedures
– Toilets, Bathrooms, kitchens, laundry, grounds
27
Six Priority Areas of Quality (cont)Six Priority Areas of Quality (cont)
• Improved patient safetyImproved patient safety– Physical safety measures
– Emergency services response times
P k f i– Packages of services
– Management of adverse events, clinical audits
• Infection prevention and controlInfection prevention and control– Surveillance and reporting systems
– Health care associated infections
– Waste management– Waste management
– Management of infectious diseases
28
Six Priority Areas of Quality (cont)Six Priority Areas of Quality (cont)
• Positive and caring attitudesPositive and caring attitudes– Patient perceptions of service
– Patient knowledge of their rights and responsibilities
C l i t t t– Complaints management system
– Observation of staff interactions with patients
– Privacy
St ff ti f ti– Staff satisfaction
• Waiting times– Management monitoring action– Management, monitoring, action
– Patients with special needs
– Physical layout of facility
29
Public Health FacilitiesPublic Health Facilities
Province PHC District Regional Specialised Tertiary Central Total Hospital Hospital Hospital Hospital Hospital
EC 808 45 2 18 6 1 880
FS 280 25 5 4 1 1 316FS 280 25 5 4 1 1 316
GP 421 10 12 6 0 4 453
KZN 591 37 12 18 2 1 661
LP 463 31 5 3 2 0 504
MP 305 23 3 5 2 0 338
NC 212 18 2 3 0 0 235
NW 363 18 4 2 0 0 387
WC 282 34 5 11 1 3 436WC 282 34 5 11 1 3 436
TOTAL 3825 241 50 70 14 10 421030
Summary of Completion rate end of August 2011
% Completedat the end
Hosp CHC Clinic Prov Total Tot Fac of August
EC 29 10 242 281 880 32%
FS 16 6 136 158 312 51%FS 16 6 136 158 312 51%
GP 16 17 132 165 453 36%
KZN 23 2 247 272 662 41%
LP 14 7 166 187 504 37%
MP 16 20 104 140 338 41%
NW 11 28 140 179 387 46%
NC 23 35 157 215 235 91%
WC 13 6 59 78 439 18%
31
WC 13 6 59 78 439 18%
Total 161 131 1383 1675 4210 40%
Facility Audit ProgressFacility Audit Progress
At the end of August the facilities Audit in the gfollowing districts were complete.
• KwaZulu‐Natal: Umkhanyakude, Uthukela, Uguand Zululandand Zululand
• Gauteng: Sedibeng• Limpopo: Greater Sekhukhune• Limpopo: Greater Sekhukhune• North West: Ngaka Modiri Molema• Northern Cape: Frances Baard Pixley Ka SemeNorthern Cape: Frances Baard, Pixley Ka Seme, Siyanda and Namakwa
• Western Cape: Eden
32
Preliminary findings: National Summary as at 10 A 2011August 2011
33
Preliminary findings: KZN as at 10 August 2011
34
Health Service Delivery Indicators
35
CHILD HEALTH
Diarrhoea and Pneumonia are the leading causes of death among children under 5 years The NDOH have introduced two new vaccineschildren under 5 years. The NDOH have introduced two new vaccines namely Rota Virus and Pneumococcal immunisation to decrease the incidence of Pneumonia (and blood and ear infections as well as
meningitis caused by the Streptococcus pneumonia bacteria) and seriousmeningitis caused by the Streptococcus pneumonia bacteria) and serious diarrhoea causing dehydration.
36
KZN: Diarrhoea with Dehydration Incidence Rate Compared to RV Coverage 2009/10 210/11Compared to RV Coverage 2009/10‐210/11
60 0
70.0
80.0
5 ye
ars
100.0
120.0
30.0
40.0
50.0
60.0
opul
atio
n un
der 5
40 0
60.0
80.0
Per
cent
age
0.0
10.0
20.0
9 9 09 09 9 9 9 09 9 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1
Per 1
000
po
0.0
20.0
40.0
Apr
-0
May
-0
Jun-
0
Jul-0
Aug
-0
Sep
-0
Oct
-0
Nov
-0
Dec
-0
Jan-
1
Feb-
1
Mar
-1
Apr
-1
May
-1
Jun-
1
Jul-1
Aug
-1
Sep
-1
Oct
-1
Nov
-1
Dec
-1
Jan-
1
Feb-
1
Mar
-1
Diarrhoea with dehydration incidence under 5 years (annualised)RV 2nd dose coverage (annualised)Linear (Diarrhoea with dehydration incidence under 5 years (annualised))Linear (Diarrhoea with dehydration incidence under 5 years (annualised))
Illustrates the decrease of diarrhoea with dehydration incidence as RV coverage increased 37
KZN: Pneumonia Incidence Rate Compared to PCV3 Coverage 2009/10‐210/11
200.0
250.0
5 ye
ars
100.0
120.0
100.0
150.0
popu
latio
n un
der
40.0
60.0
80.0
Per
cent
age
0.0
50.0
pr-0
9
y-09
n-09
ul-0
9
g-09
p-09
ct-0
9
ov-0
9
c-09
n-10
b-10
ar-1
0
pr-1
0
y-10
n-10
ul-1
0
g-10
p-10
ct-1
0
ov-1
0
c-10
n-11
b-11
ar-1
1
Per
100
0
0.0
20.0
Ap
May Ju Ju Aug
Se Oc
No
Dec Ja Fe Ma
Ap
May Ju J u Aug
Se Oc
No
Dec Ja Fe Ma
Pneumonia incidence under 5 years (annualised) PCV7 3rd dose coverage (annualised)
Linear (Pneumonia incidence under 5 years (annualised))
Illustrates the decrease of pneumonia incidence as Pneumococcal immunisation coverage increased 38
KZN Districts: Diarrhoea with Dehydration Incidence Rate 2008/09‐2010/11
60.0
70.0
ears
30.0
40.0
50.0
00 p
op u
nder
5 y
e
0.0
10.0
20.0
M M M M M u e M M M M
Per 1
00
Am
ajub
a D
M
eThe
kwin
i MM
iLem
be D
M
Sis
onke
DM
Ugu
DM
uMgu
ngun
dlov
uD
M
Um
khan
yaku
deD
M
Um
ziny
athi
DM
Uth
ukel
a D
M
Uth
ungu
lu D
M
Zulu
land
DM
2008/09 2009/10 2010/11
All districts had significant decrease in incidence rate of Diarrhoea with dehydration 39
KZN Districts: Pneumonia Incidence Rate 2008/09‐2010/11/ /
250.0
300.0
350.0
er 5
yea
rs
100.0
150.0
200.0
er 1
000
pop
unde
0.0
50.0
a D
M
ni M
M
e D
M
e D
M
u D
M
ndlo
vu
akud
e
hi D
M
a D
M
u D
M
nd D
M
P
Am
ajub
eThe
kwi n
iLem
b
Sis
onk
Ug
uMgu
ngu n
DM
Um
khan
y aD
M
Um
ziny
ath
Uth
ukel
Uth
ungu
l
Zulu
lan
2008/09 2009/10 2010/11
All districts had significant decrease in incidence rate of Pneumonia40
SERVICE VOLUMESSERVICE VOLUMES
Services volumes will increasingly be used by National Treasury for budget allocations The strike in Aug last year had negative impact on serviceallocations. The strike in Aug last year had negative impact on service volumes for public health for 2010.
41
KZN: Patient Encounters and Data Records in DHIS 1999‐2010in DHIS 1999 2010
PHC total OPD total CAS/Emerg Encounters Encounter Data Records Year PHC total
headcountOPD total headcount ency
headcountSeparations Encounters
TotalEncounter
Growth (PHC/Hosp) in DHIS
Comments
1999 1,643,853 77,529 1,325 6,506 1,729,213 30,944
2000 10,177,677 3,155,962 425,932 634,891 14,394,462 217,500
2001 14,360,802 4,214,366 646,635 810,821 20,032,624 309,487
2002 15,285,854 4,168,062 593,730 699,687 20,747,333 3.6% 373,076
2003 16,091,359 4,283,171 652,935 658,761 21,686,226 4.5% 460,813 KZN has significant gaps/errors for the years 2006-2008, due to the use of 2004 16,903,453 4,283,980 754,880 712,391 22,654,704 4.5% 558,385the PTSS application for capturing hospital data (replaced by the DHIS in early 2009)
2005 17,076,164 4,380,988 718,356 718,054 22,893,562 1.1% 678,352
2006 21,047,379 5,459,735 959,421 863,573 28,330,108 23.7% 839,706
2007 22,112,325 6,843,602 961,845 816,332 30,734,104 8.5% 1,012,591 Strike
2008 24 193 041 7 113 191 920 868 816 811 33 043 911 7 5% 1 063 7212008 24,193,041 7,113,191 920,868 816,811 33,043,911 7.5% 1,063,721
2009 25,637,076 8,364,125 906,270 777,065 35,684,536 8.0% 1,712,688
2010 25,850,205 6,885,289 797,283 702,924 34,235,701 -4.1% 2,844,326 Strike
Total 224,522,933 62,616,772 8,758,281 8,573,846 304,471,832 11,505,552
The table shows how patient encounters (red column) and data records (blue column) have escalated past 12 years for KZN. The huge increase in data records from 2008‐2010 is partially due to hospital ward level data capturing as well as increased number of data sets (for e.g. EMS, EHS) and data elements being captured in DHIS .
42
KZN:PHC Headcount 48 Months (last 4 fin years)(last 4 fin years)
2,500,000
3,000,000
1,500,000
2,000,000
Num
ber
Strike
0
500,000
1,000,000Strike
0
Apr-
07
May
-07
Jun-
07
Jul-0
7
Aug-
07
Sep-
07
Oct
-07
Nov
-07
Dec
-07
Jan-
08
Feb-
08
Mar
-08
Apr-
08
May
-08
Jun-
08
Jul-0
8
Aug-
08
Sep-
08
Oct
-08
Nov
-08
Dec
-08
Jan-
09
Feb-
09
Mar
-09
Apr-
09
May
-09
Jun-
09
Jul-0
9
Aug-
09
Sep-
09
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-
10
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Oct
-10
Nov
-10
Dec
-10
Jan-
11
Feb-
11
Mar
-11
Normal “seasonal” drop of headcounts December. 45% Drop in Jun 2007 and 30% drop in Aug 2010 due to strikes.
43
KZN:PHC Headcount 2007/08‐2010/11
22 224 26624,206,103
26,020,339 26,151,072
25,000,000
30,000,000
22,224,26621,155,91320,848,816
19,453,25317,604,862
15,000,000
20,000,000
mbe
r
4,995,1595,171,5234,752,8504,619,4045,000,000
10,000,000
Nu
02007/08 2008/09 2009/10 2010/11
PHC headcount under 5 years PHC headcount 5 years and older PHC Headcount totaly y
44
KZN: Hospital Separations 2007/08‐2010/11
882,953939,334
1,071,012 1,042,899
1,000,000
1,200,000
400,000
600,000
800,000
Num
ber
0
200,000
400,000
2007/08 2008/09 2009/10 2010/112007/08 2008/09 2009/10 2010/11
45
KZN: Hospital Patient Day Equivalent 2007/08‐2010/11
8,874,8408,086,9918,370,432 8,277,526
8,000,000
9,000,000
10,000,000
4,000,000
5,000,000
6,000,000
7,000,000
Num
ber
0
1,000,000
2,000,000
3,000,000
0
2007/08 2008/09 2009/10 2010/11
46
KZN Districts: PHC Headcount 2007/08‐2010/11
2 53
7,14
7,41
07,
938,
634
8,69
4,38
8,89
1,95
6 000 000
7,000,000
8,000,000
9,000,000
10,000,000
r
72,9
54
1,51
1,81
4
39,6
45 1,62
1,96
4
2,46
5,34
5
1,49
2,40
5
,057
,152
1,34
2,79
1
1,95
7,62
1
1,81
5,16
5
98,7
60
1,71
4,94
2
45,9
42
1,72
9,18
3
2,65
3,82
8
1,62
2,44
5
1,22
1,44
1
1,34
4,25
1
2,11
9,89
5
1,91
6,78
2
,073
,574
1,74
3,71
3
,047
,547
1,87
1,90
7
2,81
7,13
5
1,84
2,16
2
1,26
0,76
5
1,48
8,46
3
2,33
1,53
0
1,84
9,16
1
,065
,320
1,74
2,80
7
,079
,469
2,00
3,84
6
2,68
2,83
8
1,94
6,54
8
1,28
8,73
3
1,34
7,49
3
2,34
4,30
2
1,75
7,76
3
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Num
ber
97 83 19 9 941 11 1
0
1,000,000
Am
ajub
a
eThe
kwin
i
iLem
be
Sis
onke
Ugu
gung
undl
ovu
khan
yaku
de
Um
ziny
athi
Uth
ukel
a
Uth
ungu
lu
Zulu
land
uMg
Um
k
PHC Headcount Total
'2007/08 '2008/09 '2009/10 '2010/11
47
KZN Districts: Hospital Separations Total 2007/08‐2010/11
356,
644
376,
419
381,
530
386,
548
300 000
350,000
400,000
450,000
500,000
14 90 6 922
92,5
19
68 568
152
75,6
48
,102
277
983
46 318 10
6,42
5
86 485
04 80,7
83
2,80
8
3,78
1
608
097
6,17
3 129,
142
628
,827 836
91,1
18
4,27
2
,728
16 33 6,22
0 119,
903
958
216
281 93,4
57
0,13
9
100,000
150,000
200,000
250,000
300,000
Num
ber
40,1
1
43,3
30,2
2 6
53,9
41,6
6
43,5
47,1 7
58,
47,2
46,9
31,9
4
54,3
44,0
46,4
41,8
0 8
6263 49,6
45,0 66 56,
57,
55, 7
58,
42,2
44,2 6 6 54,
53,2
53,2 70
0
50,000
,
Am
ajub
a
Thek
win
i
iLem
be
Sis
onke
Ugu
ngun
dlov
u
anya
kude
mzi
nyat
hi
Uth
ukel
a
Uth
ungu
lu
Zulu
land
A eT
uMgu
n
Um
kha
Um U U
Separations
'2007/08 '2008/09 '2009/10 '2010/11
48
KZN Districts: Hospital Patient Day Equivalent Total 2007/08‐2010/11/ /
3,59
8,65
43,
417,
654
3,49
1,79
93,
021,
660
3 000 000
3,500,000
4,000,000
4,500,000
5,000,000
252
2,82
6
961
8,56
6 1,12
2,56
5
089
174
842
43,5
48
51,9
56
414
3,40
6
554
6,02
3 1,09
2,21
7
234
304
221
51,3
77
1,12
2
173
,481
,789
7,83
8
1,49
5,76
9
,415
,040
085
13,3
73
4,07
7
107
798
269
96,9
12 1,24
1,66
7
,219
,702
025
32,5
45
7,08
6
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Num
ber
279,
2
432
313,
9
508
291,
0
333,
294,
8 64 55
303,
4
473
321,
5
52
317,
2
362,
291,
2 6 52
363,
376 ,
402, 53 389,
374,
346,
0 61 484
365,
313,
7
348, 59
381,
370,
338,
0 63
477
0
500,000
Am
ajub
a
eThe
kwin
i
iLem
be
Sis
onke
Ugu
ungu
ndlo
vu
hany
akud
e
mzi
nyat
hi
Uth
ukel
a
Uth
ungu
lu
Zulu
land
e
uMgu
Um
kh Um
Patient day equivalent - total
'2007/08 '2008/09 '2009/10 '2010/11
49
