Health System Trust South African Health Review and District Health Barometer Monitoring Health & Advising Policy Fiorenza Monticelli ANC Health and Education PEC sub-committee meeting 29 April 2010

Presentation outline  Primary Health Care Indicators 2008/09 The good and the not so good (District Health Barometer)  Health policy recommendations (South African Health Review & related research) All available at

South Africa Gauteng is ranked second best of all the provinces after Western Cape The good: TB Cure Rate MDG Goal 6: Combat HIV and AIDS, malaria & other diseases Percent

TB cure rate by district, 2007 Ekurhuleni 79.5% Johannesburg 76.1% West Rand 72.4% Sedibeng 71.7% Metsweding 71.5% Tshwane 72.6%

TB cure rate - District trends City of JohannesburgEkurhuleniCity of Tshwane SedibengMetsweding West Rand Percentage

The good: Immunisation coverage <1 MDG Goal 4: Reduce child mortality South Africa Gauteng is ranked second best of all the provinces after Western Cape Percent

Immunisation coverage <1 year District trends City of JohannesburgEkurhuleniCity of Tshwane Sedibeng MetswedingWest Rand Percentage

Needing attention: Primary Health Care Utilisation Rate South Africa Gauteng has the lowest PHC utilisation rate of all the provinces

PHC utilisation rate by district 2008/09 West Rand 2.2 City of Johannesburg 2.1 City of Tshwane 2.1 Sedibeng 1.9 Ekurhuleni 1.7 Metsweding 1.6 SA average = 2.4 Metro average = 2.3 Gauteng average = 2.0

Not so good: HIV testing rate of pregnant women MDG Goal 4: Reduce child mortality & MDG Goal 5: Improve maternal health South Africa Trend by Province Proportion ANC clients tested for HIV Percentage

Proportion of ANC clients tested for HIV 2008/09 SA average = 86.7% Metro average = 78.5% Gauteng average = 78.4% Sedibeng92.3% City of Johannesburg81.2% City of Tshwane78.1% West Rand77.7% Ekurhuleni72.3% Metsweding72.2%

Health Policy Recommendations  “ Tackle inequitable distribution of resources”  “ Efficiency and outcomes need attention...”  “ Improve management and governance of clinics and hospitals….”  “ Measure the problem and its solutions through improving the health information system....as it is essential to be able to monitor progress and inequities” Bradshaw D. Determinants of Health and Health Trends. In: Barron P, Roma-Reardon J, editors. South African Health Review Durban: Health Systems Trust; Blecher MS, Day C, Dove S, Cairns R. Primary Health Care Financing in the Public Sector. In: Barron P, Roma-Reardon J, editors. South African Health Review Durban: Health Systems Trust; Padarath A, Freedman I. The state of clinic committees in primary level public health sector facilities in South Africa. Durban: Health systems Trust ; 2007.

Tackle inequitable distribution of resources Proportion of District Health Services Expenditure on District Hospitals

Tackle inequitable distribution of resources Proportion of District Health Services Expenditure on District Management ”

Cost per patient visit to a PHC facility 2008/09 MetswedingR City of JohannesburgR SedibengR EkurhuleniR West RandR City of TshwaneR “ Efficiency and outcomes need attention...”

Improve management and governance of clinics and hospitals  Research done on the status of clinic committees in primary level public health sector facilities recommends: 1. Develop a comprehensive framework for clinic committees. Guidelines on what governance structures are meant to do, how they should be constituted & operate 2. Develop & implement capacity development programme for clinic committee members Training programme – roles & responsibilities, procedural issues related to functioning & community health related issues.

Sources  DHB 2008/09 District Health Information System (DHIS) StatsSA National Treasury National HIV and Syphilis Antenatal Sero- prevalence Survey National TB register  SAHR 2008  Padarath A, Freedman I. The state of clinic committees in primary level public health sector facilities in South Africa. Durban: Health Systems Trust ; 2007.

Thank you