[afro-nets] A report on monitoring primary health care and district performance

["Fiorenza Monticelli" <fiorenza@hst.org.za>]

Monitoring primary health care and district performance 

On the eve of the 30th anniversary of the Alma Ata Declaration, HST?s third edition of the District Health Barometer, the 2006/07 report, provides a snapshot of the status of primary health care in South Africa by monitoring the trend of key health, socio-economic and financial indicators by district and province. 

The report also aims to enable health managers to :

1)     Look more closely at equity issues between districts and between provinces and between districts within provinces and if these have worsened or improved over the last few years.

2)     Critically look at the health indicators with the view of finding data irregularities and correcting these at source of error.

3)     Look at trends over time in all areas and monitor progress towards goals.

The Barometer provides 27 health, socioeconomic and financial indicators by district and province, presented in maps, graphs and district and province profiles.

Data feeding the report is drawn from a wide range of sources, which include:
*     the National Department of Health?s District Health Information System (DHIS), from which about 60% of indicator data is drawn,
*	the National Department of Health?s HIV and Syphilis prevalence survey 2006 among Antenatal clinic attendees. 
*	the National TB register,  
*	Census 2001 and the General Household Survey 2005 , Statistics South Africa, 
*	financial health expenditure data from the National Treasury.

The report includes a CD that provides a database, resources, references, software, maps, graphs, additional information on financial indicators, the original DHIS files used, as well as the General Household Survey 2005 data files. 

The database houses up to four years of indicator data including new indicators that are not covered in detail in the report, such as access to medical aid coverage and poverty rate by district and is also available as an Excel file on the HST website under the section:  Raw Data, Sources and Working Documents at  
http://www.hst.org.za/publications/717

Other new developments include a web GIS page at
http://webgis.hst.org.za:8081/ which is unique in South Africa (there being nothing similar available at the moment) and which provides three years of indicator data for each of the 52 districts by way of maps, tables and graphs.

Should you wish to download the report, it is freely available and can be downloaded (section by section or in one go) from the HST website at
http://www.hst.org.za/publications/717

If you wish to order the hard copy report or the CD, please email the HST resource centre at mailto:sithandiwe@hst.org.za, or contact Sithandiwe at  tel 031 307 2954 or fax 031 304 0775

Indicators in the DHB 2006/07 (hard copy) report include
- Socioeconomic indicators
- Deprivation indices
- Access to water
- Inequity: The gap between the most and least deprived districts

Input indicators (related to resources put into the health system)
- Per capita expenditure on Primary Health Care - PHC (excluding district hospitals)
- Proportion of district health services expenditure on district management 
- Proportion of district health services expenditure on district hospitals 
- Cost per patient day equivalent in district hospitals 

Process indicators (related to the activities of the health system) 
* Nurse clinic workload (PHC)
* Average length of stay (ALOS)
* Bed utilisation rate (BUR)
* Clinic supervision rate

 
Output indicators (related to how much the health system has done)
* Male condom distribution rate 
* Immunisation 
      o       Immunisation coverage 
      o       Immunisation drop out rate (DTP1-3)
* Caesarean Section rate
* Prevention of Mother to Child Transmission (PMTCT) indicators: 
      o       Proportion of antenatal clients tested for HIV
      o       HIV prevalence rate amongst antenatal clients tested
      o       Nevirapine uptake rate among HIV+ve pregnant women
      o       Nevirapine uptake rate among babies born to women with HIV
* Primary health care utilisation rate 

Outcome Indicators (show what has happened as a result of the outputs)
* Incidence of Sexually Transmitted Infections (STIs) treated-new
* Tuberculosis
      o       Smear conversion rate
      o       TB Cure rate 
* Diarrhoeal incidence in children under 5 years (per 1000) 
* Rate of children under 5 years not gaining weight
* Delivery rate in facility

Impact Indicators (show what has happened to the health status of particular groups of people)
* Stillbirth rate
* Perinatal mortality rate (PNMR)


Barron P, Day C, Monticelli F, editors. The District Health Barometer
2006/07
Durban: Health Systems Trust; December 2007
ISBN 1-919839-60-7, Funded by Atlantic Philanthropies.  

http://www.hst.org.za/publications/717

--
Fiorenza Monticelli
Health Systems Trust
Project Manager: District Health Barometer
HealthLink
Tel: +27 31 307 2954
Fax: + 27 31 304 0775
http://www.hst.org.za 
mailto:fiorenza@hst.org.za