1. Fiorenza Monticelli Gauteng District Health Systems Summit 22 August 2008

2. Presentation Overview Background Indicators: –Per capita Expenditure and Cost per PDE –Nurse clinical workload –Immunisation coverage –HIV prevalence among antenatal clients tested –Proportion antenatal clients tested for HIV –Nevirapine uptake rate among pregnant HIV+ women –PHC utilisation rate –TB cure rate and Smear conversion rate –Rate of children under 5 years not gaining weight –Delivery rate in facility –Perinatal Mortality rate Overall rankings Conclusion Gauteng

3. Background 27 health, socioeconomic and financial indicators Up to four years of data for monitoring trends Profile for SA, 9 provinces and 52 districts CD with full database, resources, references and original data files used for the report A ‘live’ web-enabled GIS maps and indicators http://webgis.hst.org.za:8081/

5. R497 SA ave: R256 R167 R319

6. Expenditure by District

7. SA ave: R303 R233 R418 Preliminary

8. SA ave: R954 R1 390 R952

9. SA ave: 27 38.2 19.8

11. * *Proxy for MDGs SA ave: 85% 83% 101%

12. 34.6% 26.5% SA ave: 29.1%

13. SA ave: 67.9% 48.6% 95.2 93.9

14. * *Proxy for MDGs SA ave: 61.1% 91.3% 66.8%

16. SA ave: 57.6% * *Proxy for MDGs 70.6% 57.8%

17. 200320042005

18. Province200320042005 EC50.740.853.7 FS64.867.267.5 GP61.362.666.7 KZN44.034.845.2 LP53.669.560.8 MP43.732.051.8 NC64.638.350.1 NW59.856.657.6 WC71.970.171.9 SA56.750.857.6 TB cure rate per province * *Proxy for MDGs

19. Smear conversion rate per province Province200420052006 EC37.341.8 49.9 FS58.561.1 67.2 GP57.862.269.2 KZN38.740.448.4 LP43.262.054.3 MP34.235.644.4 NC31.840.548.4 NW48.447.748.1 WC58.060.766.9 SA46.650.5 55.8 * *Proxy for MDGs

20. * SA ave: 1.3% (Under 5 years) 1.3% 0.3%

22. 88.6% 66.5% SA ave: 77.7%

23. * *Proxy for MDGs

24. Spider graph illustrating rankings in 2006/07 Sedibeng

25. City of Johannesburg Spider graph illustrating rankings in 2006/07

26. DistrictTB Cure rate Smear conver- sion rate Non-Hosp PHC exp per capita Immuni- sation coverage < 1 year Clinic super- vision rate Nevirapine uptake rate among pregnant HIV+ women Not gaining weight under 5 years rate Perinatal mortality rate in facility (per 1000 births) 2003 200 42005 20 03 20042004 20 05200220062007200620072006/07 2005/ 06 2006/07 200 4/05 200 5/06 200 6/07 200 4/0 5 200 5/0 6 200 6/0 7 Sedibeng 252134321133942425289161916554 Metsweding 339281522236501163817723 -- - West Rand 57966619 3223446515117432 Ekurhuleni 212723513117166433711101817345 Johannesburg 2219134354712552344411111 Tshwane 27182224415187361421521268663 Performance/Overall rankings

27. Performance/rankings District Proportion ANC clients tested for HIV HIV prevalence among ANC clients tested (National survey)Utilisation rateDelivery rate in facility 2004/052005/062006/07Rank 2006/07 2004/ 052005/062006/07 2004/052005/062006/07 Sedibeng 1210842474849141820 Metsweding 27307 - 53 52 - - West Rand 3340424051 488821 Ekurhuleni 3848 3752 50111012 Johannesburg 13123631484641293443 Tshwane 2832462150 31192836

28.  More must be done to improve the following: Proportion of antenatal clients tested for HIV, Nevirapine uptake rate among pregnant HIV+ve women HIV prevalence among ANC clients tested, Delivery rate in facility, PHC utilisation rate TB cure rate  About 60% of the information in the DHB relies on data extracted from the DHIS. The quality of this data affects what you see in the District Health Barometer publication and also the managerial decisions informed by this data.  Where DHIS data differs with what districts have, is often an indication of a need for sub-district and facility level support.  Improving the quality of data may cause the district raking to deteriorate initially, however, the districts will then have accurate and reliable data to base decisions on and can begin to see a true improvement. Conclusion

29. THANK YOU! We acknowledge the National Department of Health, Treasury and all other providers for access to and use of their data for this publication and Atlantic Philanthropies for funding the project. For more information, contact Fiorenza Monticelli at fiorenza@hst.org.za Or Elliot Sello at elliot@hst.org.za Telephone: (031) 307 2954