harry gwala district health plan 2018/19 - 2020/21€¦ · harry gwala district health plan 2018/19...

HARRY GWALA

DISTRICT HEALTH PLAN

2018/19 - 2020/21

(KWAZULU-NATAL)

Harry Gwala District Health Plan 2018/19

of 78

ACKNOWLEDGEMENTS

The Planning Monitoring and Evaluation Unit wishes to extend its acknowledgements to the

members of District Office Management, Hospital and CHC Management for their

dedication and commitment and involvement in the whole process of data collection,

collation and finalization of the plan. A high level of teamwork and active participation of

different people in the district, BroadReach Healthcare (supporting partner) has resulted in

the successful completion of the health plan.

A special thank you goes to the following people:

1. Mrs G.L.L. Zuma District Manager

2. Mrs B.A. Mkhize Deputy District Manager Planning, M&E Unit

3 Mr. S.A. Cekwana Cooperate Service Manager

4 Mr. B.H.S Makhaye Deputy Manager Clinical & Programme Services

5 Ms K.A. Mtinjana Deputy Manager District Planner

6 Mrs. N. Binase CEO-EGUM

7 Mrs S. Maseko CEO- Christ the King Hospital

8 Ms N. Hadebe CEO –St. Apollinaris Hospital

9 Dr. N. Gumede CEO- Pholela CHC

10 Mrs. N.A. Keswa CEO-Rietvlei Hospital

11 Dr. E. Mthembu CEO/ Medical Manager –St Margaret’s TB/MDR Hospital

12 Mr. R. Hadebe CEO Umzimkhulu Hospital

13 Mrs R Dladla District Human Resource Manager

14 Ms T.Manzi District Principal accountant

15 Mrs N. Nxele District Finance Manager

16 Mr. S. Zwane District Pharmacist

17 Mrs. T.G.O. Sikhakhane Nursing Manager - Pholela CHC

18 Miss L. Mthembu Nursing Manager – Christ the King

19 Mrs. J. Mlotshwa Nursing Manager - St Margaret’s TB/MDR Hospital

20 Mrs. J. Nqophiso Nursing Manager - Rietvlei Hospital

21 Mr. B. Msibi Nursing Manager - Umzimkhulu Hospital

22 Miss T. Khumalo Nursing Manager - St. Apollinaris Hospital

23 Mr. S. Maphumulo Nursing Manager - EGUM

24 Mr. T. Zondi District Information Officer

25 Ms F.F. Shabalala District Facilities Information Officer

26 Mrs N.Ngubane Civil Society Sector Chairperson

27 Mrs M, Hlongwa Harry Gwala District Municipality

28 Mrs F. Dlamini EGUM M&E Manager

29 Miss S Mpongomo Rietvlei M&E Manager

30 Mrs E. Zondi St Margaret’s M&E Manager

31 BroadReach Healthcare NGO Partner


of 78

OFFICIAL SIGN-OFF

It is hereby certified that this District Health Plan:

Was developed by the district management team of Harry Gwala District with the

technical support from the district health services and the strategic planning Units at the

Provincial head office.

Was prepared in line with the current Strategic Plan and Annual Performance Plan of the

KwaZulu Natal Department of Health.


of 78

EXECUTIVE SUMMARY BY THE DISTRICT MANAGER

The District Health Plan will give a brief overview of the 2016/2017 previous performance and

outline the Districts aspirations based on the diseases burden and the outcomes of the

indicators as per District Health Barometer 2016 2017.

1 DISTRICT SERVICE DELIVERY PERFORMANCE

Harry Gwala health district has performed fairly well in previous years in terms of strategic

priority programmes though there are challenges to meet some of the set targets. These

challenges have been identified and will be addresses in this plan.

PHC SERVICES

PHC Re engineering

Family health teams are in place though not enough to cover entire district due to financial

constraints which made it impossible to enrol teams to entire district. This has contributed to

below target performance of PHC utilisation rate 2.7 in 2016/17

School health teams have performed exceptionally well in terms of schools that were

accredited as health promoting school which totalled to 20 schools for previous year

2017/18.

The challenge remained with meeting the targets of screening of grades R and 8 thus the

district aspiration being increase PHC utilisation and increase screening of Grade R and 8

IDEAL CLINIC REALISATION AND MAINTAINANCE (ICRM)

National and Provincial assessment of clinics is still ongoing, marked achievements noted at

UMzimkhulu supported clinics all have achieved the status. Focus will be at Dr. NDZ clinics

and Ubuhlebezwe clinics for the next 3yr cycle.

The challenge in some of the clinics is related to infrastructure especially at NDZ sub-district.

The district aspiration is to increase the number of facilities scoring from 53%to above 80%

and the vital measures scoring on NCS from 0% to 100% BY 2021.

HIV and AIDS

HIV and AIDS nerve centre meetings and reviews are in place, implementation of Universal

testing and treatment (UTT) and capacitation of health care workers on key population

service provision is ongoing. Challenges identified: low paediatric initiation, low viral load

done and increasing numbers of loss to follow up. These challenges will be addressed in this

three year plan. The district interventions will focus on NIMART training acceleration plan and

mentorship especially in support of paediatric initiation , retaining clients on treatment and

active defaulter tracing at all levels assisted by supporting partner BroadReach.


of 78

TB CONTROL PROGRAM

TB control program has performed well this financial year as it is on track with the 90/90/90

strategic goals targets; with achievements of 92% TB on Success rate ; 85 % Cure rate; death

rate at 4 % below; and the loss to follow up (Defaulter)rate at 3%. The district is still struggling

with meeting roll out targets for TIER.Net TB module.

Strategies on clinical, systems and community interventions are in place to upscale the roll

out with inclusion of Sub districts teams and supporting partner (BroadReach).

District aspiration will focus on to reduce HIV incidence using 90/90/90 strategy.

MCWHN

The MNCWH program has remarkable improved Maternal, Child and Women’s Health and

has managed to achieve low baby PCR positivity rate around 10 weeks to 1%, under 5 year

severe acute malnutrition fatality rate at 2.1%.

Maternal death is within 95/100 000 and cervical cancer screening at 80%.

Despite the hard work and engagements the District is still struggling to achieve targets on

immunization coverage under 1 year, couple year protection rate, child under 1year

mortality and in patient early neonatal death rate.

Immunisation coverage has improved at UMzimkhulu and Ubuhlebezwe sub districts. Focus

for the district will be in the remaining sub districts DR.NDZ and Ubuhlebezwe.

The district aspiration will channel strategies and resources towards reducing neonatal

deaths and under 5 year’s mortality rate.

Women’s health will focus on improving couple year protection rate and decreasing

teenage pregnancy.

NON COMMUNICABLE DISEASES

Non Communicable Diseases have become the 3rd leading cause of death for ages

between 25-64 years and 65 and above both in males and females in Harry Gwala district as

per 2010-2016 barometers. Though screening services has improved in terms of targets, it is

not convincing that all deserving clients have been initiated on treatment and well

managed. Cataract surgeries have improved; as the projection shows that the district will

meet the target of 700 clients since for the past 3 quarters of 2017/18 698 cataracts were

conducted.

Shortage of ophthalmic nurses and optometrists in the district has negatively affected eye

care services.

Lack of community awareness in screening and dangers of chronic conditions has drastically

increased the risk mortality and morbidity.


of 78

The district will be focusing on community awareness, community screening campaigns and

roll out of Palliative care services. Integration of 90-90-90 strategies in management of NCD

will be rolled out in the next 3 year cycle.

SUPPORT SERVICES

Pharmaceuticals

The District Pharmaceutical services are currently managing CCMDD in the entire district. The

district has achieved to reduce stock out of tracer items through implementation of stock

visibility system, which tracks and monitor stock outs, thus enabling shifting of stock within

facilities.

Transport

Transport remains the cost driver in the district in terms of maintenance and repairs resulting

from poor topography, terrains and distance in-between service points. EMS and Forensic

services vehicles are managed through district fleet management.

The focus on EMS is to reduce the response times as of the pillars to improve quality of care

according to the key steps to prevent avoidable maternal, neonatal and child mortality is

rapid inter-facility emergency transport system

Infrastructure

District infrastructure unit has supported institutions towards ensuring all planned projects are

implemented and maintenance budget utilised appropriately.

Finance

The district has managed to channel more budgets to PHC with the previous DHER; this will

be maintained as the district is prioritizing PHC health services over district hospital services.

District budget for 2017/18 has been managed as per prescript with 92% spent by end

February 2018.

Human resource

WISN training has been completed, implementation pending because of budgetary

constraints. District Equity Plan is in place and is being implemented in all sub districts.


of 78

EPIDEMIOLOGICAL PROFILE

The District planning process required District Information Officer compile comprehensive

epidemiological health information of the District (as per Annexure C) before the district planning

workshop and make it available to the District Management Team to define aspirations, and

identify key interventions.

Provide the following sections of the comprehensive epidemiological health information for the

District, as a minimum:

District Map with Population distribution, sub district boundaries,

6.Population distribution


of 78

Greater Kokstad Local Municipality has 17% of the population. The municipality is mainly

composed of low cost houses which are located at Shayamoya, Horse shoe , Mphela

,Franklin (Lindelani).Quarters informal settlement ward 2,Marikana ward 8,Bambayi ward8

and Chocolate City ward 1 and farm areas. There are formal house for the middle income

group.

NDZ Local Municipality contributes 23% of the total district population with 94% of the

population living below poverty line, with Ward 4 at Kilmun and Ward 7 at Gqumeni and

Qulashe being the most deprived wards in the sub-district; It is the 2nd largest sub- district

within Harry Gwala District.

Underberg areas are most dominated with migrant laborers from Lesotho and Eastern Cape

and from the nearby Swartberg Farms which contribute to treatment defaulter rates. (see

graph above).

UBuhlebezwe Local Municipality’s population is predominantly formed by formal (traditional)

dwellings with few sugar cane and forestry farm areas. This Local Municipality is marked with low

cost houses at Mahehle, Springvale, Ndwebu area which was previously at UGu district and

Fairview with informal dwellings as well.

UMzimkhulu Local Municipality has the largest population. It is mainly constituted of traditional

dwellings with few low cost at Ibisi, Riverside and informal settlement like Sisulu Settlement areas

close to town enroute R56 which is a main road which has high accidents occurrences.

37%

17%

23%

23%

Umzimkhulu

Kokstad

NDZ

Ubuhlebezwe


of 78

Harry Gwala District is sub-divided into four local municipalities following merge r of Ingwe and

KwaSani local municipalities, to form Dr. Nkosazane Dlamini- Zuma Local Municipality known as

NDZ Local municipality.

NDZ Local municipality comprises of both tribal and pockets of farm areas with hard to reach

areas. There are variations of head count from clinic to clinic some with high headcount others

with low headcount, like Underberg clinic with high headcount. This is mainly due to the transport

flow from two clinics i.e. Kilmun and Qulashe to Underberg, Ncwadi clinic’s performance is


of 78

affected by UMgungundlovu District due to its proximity resulting in low PHC utilization rate from

the low headcount.

The sub- district has the second largest population; this population is affected by the migrant

labourers from Lesotho and Eastern Cape Province as well as from nearby Swartberg farms. The

mobility of this population, especially found in farms where farmers import seasonal workers from

Eastern Cape and Lesotho also contributes to high treatment defaulter rates, which is addressed

in terms of cross-border meetings. The sub-district has one district one district hospital and CHC

with 12 clinics, 3 WBOT Underberg Clinic has an MOU (Maternal and Obstetric units).

Greater Kokstad Local Municipality has got two fixed clinics, 3 Health Posts , 3 mobile clinics and 1

district hospital that refers to Edendale Regional Hospital at UMgungundlovu District, transfers to

the nearest Port Shepstone Regional Hospital which is in UGu district is dependent on the

availability of beds. There are no WBOTs due to staff shortages.

Kokstad Local Municipality‘s services are affected directly by Eastern Cape Province because of

its soft boundary, this is evident in the high number of non-referred cases and high TB defaulter

rate of clients mostly from Eastern Cape. People from nearby villages access services from

Kokstad PHC facilities as they are centrally situated in town where people do their day to day

shopping.

Ubuhlebezwe Local Municipality has the third largest population. It has 10 clinics, 2 mobile services

and 2 WBOTs. Health post at ward 5 is operating with challenges of staff retention as it is in a

grossly rural hard to reach area, but its need to exist is obvious from the 100% increase of the

headcount from the previous year. There is one district hospital which refers to uMgungundlovu.

UMzimkhulu Local Municipality has the largest population and is the most rural poverty stricken

hence it was identified as the Presidential Node. It has 16 fixed PHC clinics with 3 mobile clinics, 4

WBOTs . This local municipality has 1 district hospital and 2 specialized hospitals i.e. MDR TB Hospital

St. Margaret Hospital and UMzimkhulu Psychiatric Hospital. Roads are mostly gravel with poor

terrains; making it difficult for the people to access health services. The situation is worse during the

rainy season

The district has a functional District AIDS Council (DAC) and OSS (DTT) which is working closely with

the Department of Health providing intersectoral strategic direction in response to community

health related interventions.

6. Population per selected category

Population category 2016 2017 2018 2019 2020

under 1 year 14407 14457 14470 14409 14219

under 5 years 72589 73011 73061 72782 72257

05-09 years 66387 67833 69021 70025 70987


of 78


10-14 years 55463 57255 59395 61642 63715

15-19 years 51329 50282 50113 50658 51905

20-24 years 55669 54036 52097 49973 48111

25-29 years 53387 54241 54434 54211 53414

30-34 years 37890 40956 44006 47005 49859

35-39 years 23714 25787 28043 30313 32373

40-44 years 16330 16904 17578 18434 19585

45-49 years 13383 13375 13442 13596 13847

50-54 years 12228 12090 11929 11759 11603

55-59 years 10910 10785 10674 10574 10465

60-64 years 9327 9257 9168 9065 8954

65-69 years 7394 7339 7278 7211 7137

70-74 years 5574 5522 5448 5358 5262

75-79 years 3948 3906 3863 3803 3723

80 years and older 3899 3850 3812 3780 3761

Total 499428 506435 513362 520188 526956

Estimated pregnant women 15415 15469 15483 15418 15214

Source: Mid-Year Population Estimates 2016, StatsSA (as per 2016 demarcations)

Note ; the highlighted population categories are some of the life course groups that will be

focussed on.

The projections on population growth for the under five years from 2019 onwards seems to be

declining. This could be attributed to high death rate in this age category (as evident in the

DHB 2015/16). The major causes of death for this age category are diarrhoeal diseases

(22.5%) as well as lower respiratory infections (22.5%). There is also a noticeable decline in the

reproduction rate as indicated on the estimated pregnant of women (as indicated from the

table above). This will be monitored against the performance of indicators like the child

mortality rate and couple year protection rate.

The high death rate due to injuries as well as HIV/AIDS amongst the 15 to 24 years according

to Health Barometer 2015 within the district is seen as contributing to the decline of the

population projection of growth rate from 2020. The effectiveness of interventions that are

planned for the three years should be targeting the injuries of this age group and research if

need be to focus on this life group.


of 78

There is a gradual decline in life span of the 50 years and above due to increase in deaths on

clients with NCDs (as evident in the DHB 2015/16). Key interventions addressing the NCD

program will be implemented as part of this plan.

While there is decline in estimated pregnant women, the increase in delivery in the facility

under 18 years rate is a cause for concern. Harry Gwala District is ranked amongst the top 10

worst performing districts for this indicator. This has implications for child under 1 year mortality

and maternal deaths.

7. Social determinants of health

Sub-Districts Data Source Greater

Kokstad NDZ Ubuhlebezwe Umzimkhulu District

Un

em

plo

ym

en

t

rate

Census 2001 41.2% 46.1% 61.6% 68.0% 52.6%

Census 2011 28.9% 27.7% 34.0% 46.6% 33.0%

C/ S 2007 11% 18.% 12% 25% 17%

C / S 2016

Tota

l nu

mb

er

of

ho

use

ho

lds

Census 2001 20566 26032 23107 36677 106382

Census 2011 19140 26746 23487 42909 112282

C/ S 2007 14321 26710 21804 43545 127659

C / S 2016 19140 26201 25516 42909 116766

Pe

rce

nta

ge

of

po

pu

latio

n li

vin

g

be

low

po

ve

rty li

ne

of

R2

83

pe

r m

on

th Census 2001

Census 2011 57.0% 58% 68% 73.0% 62.9%

C/ S 2007 97% 86% 97% 98% 93%

C / S 2016 11220 28637 56937 30245 127039

Nu

mb

er

of

ho

use

ho

lds

in

Info

rma

l dw

elli

ng

Census 2001 6725 19458 17724 29305 73404

Census 2011 3139 17322 16371 28878 65685

C/ S 2007 6336 1131 3334 3080 13881

C / S 2016

Nu

mb

er

of

ho

use

ho

lds

in

form

al d

we

llin

g

Census 2001 13841 6574 5383 7372 32978

Census 2011 16001 9424 7116 14031 46597

C/ S 2007

C / S 2016

P e r c e n t a g e

o f H o u s e h o l d s w it h

a c c e s s t o

s a n it a ti o n

Census 2001 59.9% 16% 9.9% 2.3% 20.8%


of 78

Sub-Districts Data Source Greater

Kokstad NDZ Ubuhlebezwe Umzimkhulu District

Census 2011 60.1% 17% 12.0% 6.4% 22.4%

C/ S 2007 88% 92% 88% 92% 90%

C / S 2016 12437 3364 3007 4363 23171

Ho

use

ho

lds

with

ac

ce

ss t

o p

ota

ble

wa

ter

Census 2001 19365

Census 2011 9676 8958 4955 6277 5973

C/ S 2007 12891 10255 3920 19365 9486

C / S 2016 14311 9995 5081 7231 36618

Pe

rce

nta

ge

of

Ho

use

ho

lds

with

ac

ce

ss t

o

ele

ctr

icity

Census 2001 49.9% 36.9% 28.6% 54% 36.7%

Census 2011 80.7% 62.7% 53.9% 64.5% 64.9%

C/ S 2007 58.5% 50% 46% 54% 52%

C / S 2016 15446 14013 27656 14273 71388

Ad

ult li

tera

cy r

ate

Census 2001 25.7% 15.4% 13.9% 11.8% 16.4%

Census 2011 31.1% 26.1% 33% 202% 28%

C/ S 2007 32% 37% 35% 42% 36%

C / S 2016

Source: Stats SA (Local Government Handbook)

The Unemployment rate is at 33 % for the district according to the Census 2011 with the adult

literacy of 28%. The high adult illiteracy results in the high levels of people earning below R283 per

month (62.9 %) and high levels of unemployment. The low socio- economic status of communities

renders them vulnerable to diseases. This too could contribute to treatment defaulter rate of

chronic diseases as a patient who does not have enough money will opt to buy food than to go

and collect medication. The implementation of CCMDD program may address some of these

challenges.

The source of employment for most of people is forestry farms, sugar plantations and

supermarkets. Those qualifying for social grants are using them as their main source of income.

Informal dwellings linked to poor access to sanitation are associated with sporadic diarrheal cases

that are reported from time to time. This has been noted during information meetings.

Ubuhlebezwe Local Municipality has the lowest electricity supply of at 53 % followed by NDZ Local

municipality with 62.7% of electricity supply. All health facilities in the district have electricity supply

but there are challenges with back up supply of generators to maintain in instances when there

are electricity interruptions. According to South African Multidimensional Poverty Index (SAMPI)

Harry Gwala District has got two wards that fall within the most deprived top 34 wards i.e. Ward 5


of 78

at Ubuhlebezwe (which ranks number 19) and ward 4 at NDZ (which ranks number 23). Seven

wards are within the top 100 most deprived wards, 4 are from UMzimkhulu one from NDZ .These

wards are prioritized when allocating outreach services.

Water and Sanitation

Greater Kokstad local Municipality is ahead in the provision of sanitation and water services

compared to other local municipalities. This is largely caused by the mushrooming of informal

settlement this Municipality which has resulted in the provision of sanitation through mobile toilets.

Informal settlements such as Bhambayi, Chocolate city and Marikana have no basic water and

sanitation services; this becomes a threat of waterborne diseases.

NDZ Local Municipality has wards that comprise of formal traditional dwellings which never had

piped water (these are most from the previous Ingwe Municipality). These areas are entirely

dependent on boreholes and pit privy systems however the construction of Bulwer Dam will be a

source of water supply once it has been completed. Areas which are from previously Kwa Sani

Local Municipality have piped water except informal dwellings where they are dependent on

springs and boreholes. Municipality provides technical support in cases of drought. Sporadic

cases of diarrhoea are reported if there is extra influx of people.

UMzimkhulu Local Municipality comprise of formal traditional dwellings which never had piped

water, 28 000 informal dwellings do not have water and sanitation services. Communities from

these formal traditional dwellings are dependent on boreholes and spring water and sometimes

supplies from Municipality. Sanitation is mainly pit privy .The picture contributes to sporadic cases

of diarrhoea which is reported throughout the year.

These challenges and water and sanitation in the district are addressed by IDPs.

8. Causes of Mortality

The five leading causes of death in the under 5 years are mainly diarrhoeal diseases, lower

respiratory infections, Preterm birth complications , birth asphyxia and HIV and AIDS

according to the DHB 2015/16. Diarrhoeal diseases deaths related contributory factors have

been identified to be mostly related to herbal intoxication. This has been identified in all sub-

districts .Preterm birth complications deaths are mostly related to extreme prematurity mostly

due to low socio economic background. Specialised equipment like CPAP and presence of


of 78

Medical Air are essential in management of premature babies of which not all District

Hospitals have got them like EGUM and St Apollinaris. Deaths from asphyxia are due to

compromised intra partum care.

HIV and AIDS related conditions have taken the lead in the 10 major causes of deaths as per

2014/2015 Health Barometer from 15.7% in 2013/ 2014 to 19.4% in 2014/2015. The key

population group mostly affected being within the ages of 15 and 24 years which is mostly

the child bearing age as well as the life course group tertiary education level.

Ages between 25 and 64 are equally affected but according to the population ratio both

males and females share almost the same percentage.

There have been no significant changes in HIV ANC Prevalence. It has been constantly be

above 35%. In 2011 it has been 35.9% in 2012, 36.6 in 2013 and 35.7 in 2014.

TB death rate is fluctuating between 26.2 .8%, 23.1 and 16.4% in 2014/ 2015 according to

Health Barometer 2015/2016. Previously Ingwe as a sub- district recorded the highest rate in

the district at 15.4%, and Ubuhlebezwe sub- district the lowest at 3.9%. The rest of the sub-

districts range from 7% to 7.6%.

Kokstad is having the highest defaulter rate, 13.3% in 2015. This seems to be the common

trend. The contributory factors being the soft boundary between KZN and Eastern Cape.

Kokstad is an economic hub thus attracting job seekers and has low cost houses as well as

informal settlements with poor ventilation facilities

Non Communicable diseases appear to be remaining at the same level but in terms of the

death figures rate they are increasing , Cerebro vascular diseases 5.6 % in 2013/ 2014 and 5.

7 in 2014/ 2015. Hypertensive heart diseases 2.0% in 2013/2014 and 2.4 in 2014/ 2015 diabetes

mellitus 2.9 % in 2013/ 2014 and 3.8 in 2014/ 2015.

Years of life lost due to interpersonal violence are a new trend that is gradually increasing

from 1.4% in 2013/2014 to 2.05 in 2014/ 2015. This is more related to alcohol and drug abuse

that are on the increase even in the rural communities. This will be addressed in the Part B of

the document

9. SERVICE DELIVERY PLATFORM AND MANAGEMENT

The District planning process required District Information Officer compile comprehensive

epidemiological health information of the District before the district planning workshop and make

it available to the District Management Team to define aspirations, and identify key interventions.

Provide the following sections of the comprehensive epidemiological health information for the

District (as outlined in Annexure C) is required as a minimum:


of 78

Number of facilities per sub- district by level, 2016/17

Sub-districts

Wa

rd b

ase

d o

utr

ea

ch

tea

ms

Clin

ic

CH

C

Mo

bile

s

He

alth

Po

sts

Hig

h T

ran

smis

sio

n A

rea

s

Dis

tric

t H

osp

ita

l

Re

gio

na

l Ho

spita

l

Ce

ntr

al/

Tert

iary

Ho

spita

ls

Oth

er

Ho

spita

ls

Greater Kokstad 0 2 0 3 3 1 1 0 0 0

Dr. NDZ 3 12 1 5 1 1 1 0 0 0

Ubuhlebezwe 2 9 0 2 1 1 1 0 0 0

Umzimkhulu 4 16 0 3 0 1 1 0 0 2

DISTRICT 9 39 1 13 5 4 4 0 0 2

Primary Health Care delivery platform is affected by the number of clinics resulting in long

distances that the clients have to travel to what they refer as the nearest health facility. Due the

high poverty rate, makes the community to weigh between goings to the clinic against buying

food with the little money he has got, resulting in defaulter rate. Use of WBOT and any outreach

programs to be considered in supporting the continuum of care.

The funding challenges have put on hold on construction of some clinics even though they have

been approved like the construction of CHC at Umzimkhulu Local Municipality.

The WBOT functionality is mostly affected by the staff retention which is a general challenge in the

district.

The two specialised hospitals at Umzimkhulu is the Psychiatric hospital, which serves beyond the

Harry district population, part of Ugu population and part of Alfred Nzo , Eastern Cape

Municipality because of its proximity.

St. Margaret hospital has been utilized as MDR TB hospital but discussion is under way to be

converted to a CHC by 2022

10. Human Resources for Health (filled posts)

Co

mm

un

ity

h

ea

lth

wo

rke

r

Nu

rsin

g A

ssis

tan

t

En

rolle

d n

urs

e

Pro

fess

ion

al n

urs

e

Do

cto

r

Ph

arm

ac

ist

De

ntist

Oc

cu

pa

tio

na

l

the

rap

ist

Ph

ysi

oth

era

pis

t

Sp

ee

ch

th

era

pis

t

Au

dio

log

ist

Clin

ica

l A

sso

cia

tes

Oth

er


of 78

Co

mm

un

ity

h

ea

lth

wo

rke

r

Nu

rsin

g A

ssis

tan

t

En

rolle

d n

urs

e

Pro

fess

ion

al n

urs

e

Do

cto

r

Ph

arm

ac

ist

De

ntist

Oc

cu

pa

tio

na

l

the

rap

ist

Ph

ysi

oth

era

pis

t

Sp

ee

ch

th

era

pis

t

Au

dio

log

ist

Clin

ica

l A

sso

cia

tes

Oth

er

Greater Kokstad 108 34 34 94 6 2 1 0 1 0 0 0 9

Dr. NDZ 233 68 74 166 11 1 0 1 2 0 0 2 12

Ubuhlebezwe 237 68 71 131 8 5 0 2 1 0 0 2 13

Umzimkhulu 319 45 130 257 17 4 1 3 3 0 0 3 17

HARRY GWALA

DISTRICT

878 215 309 648 42 12 2 7 7 0 0 7 51

District has been successful in deployment of human resources equitably within all sub

districts such as, Professional Nurses, Pharmacist and Allied Health workers.

All institutions within the district including district office as an institution are operational with

the approved organization structure although some of the posts that have been approved in

the organogram are not yet implemented due to the shortage of funds for the filling of the

post.

The district is unable to recruit scarce skills employees, the challenge is that there is no

retention strategy in place to prevent high turnover rate, the multiracial / private schools that

are preferred by the child bearing age of the middle class are only at Greater Kokstad and

Ubuhlebezwe Local Municipalities. This put pressure to other sub- districts that do not have

them.

The unavailability of the Audiologist in the whole district compromises the management of

the clients that are in need of the service as they have to be referred to the nearest districts.

Community Health Workers may be seen as one of the category with high numbers but due

to the rural nature of the district their availability in all municipality wards provide the

seamless continuum of care in the wards however due to the vast nature of the wards they

are not availability in all villages.

The shortage of doctors is amongst the top 5 commonest patient’s complaints. This is linked

to long waiting periods which compromised quality care. Close monitoring of sessional

doctors has to be done by Medical Managers.

Low numbers of dentists are to be seen against low restoration and creative interventions are

to be put in place to address the challenge.


of 78

11. Management and efficiency indicators for the service delivery platform

Sub-districts

Hospital PHC

District Hospital Efficiency Management

Av

era

ge

len

gth

of

sta

y (

da

ys)

Inp

atie

nt

be

d u

tilis

atio

n r

ate

(%

)

OP

D n

ew

clie

nt

no

t re

ferr

ed

rate

(%

)

Exp

en

ditu

re p

er

pa

tie

nt

da

y

eq

uiv

ale

nt

(R

an

d)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Pro

vin

cia

l an

d lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xpe

nd

itu

re p

er

ca

pita

(un

insu

red

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l an

d lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xpe

nd

itu

re p

er

ca

pita

(un

insu

red

po

pu

latio

n)

(Ra

nd

) P

rov

inc

ial a

nd

loc

al

go

ve

rnm

en

t e

xp

en

ditu

re p

er

prim

ary

he

alth

ca

re h

ea

dc

ou

nt

(Ra

nd

)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C

fac

ilitie

s w

ith

90

% o

f th

e t

rac

er

me

dic

ine

s a

va

ilab

le (

%)

Pe

rce

nta

ge

Id

ea

l Clin

ics

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(N

o)

23

22

21

20

19

8

7

6

5

4

3

2

1

DR. NDZ

Indicator 5.3 63.3 38.2 3264 6.1

Numerator 33742 33742 2856 133046261 390 2.6

Denominator 6349 53296 7479 40756 6349 279167

Greater Kokstad

Indicator 4.9 43.5 56.1 2524 5.4 1284168

Numerator 36758 36758 6079 140659609 405 2.4

Denominator 7566 84416 10858 55728 7566 179127

Ubuhlebezwe

Indicator 4.8 53.4 50.1 2791 5.7 878049

Numerator 39338 39338 4692 149195165 468 2.7


of 78

Sub-districts

Hospital PHC

District Hospital Efficiency Management

Av

era

ge

len

gth

of

sta

y (

da

ys)

Inp

atie

nt

be

d u

tilis

atio

n r

ate

(%

)

OP

D n

ew

clie

nt

no

t re

ferr

ed

rate

(%

)

Exp

en

ditu

re p

er

pa

tie

nt

da

y

eq

uiv

ale

nt

(R

an

d)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Pro

vin

cia

l an

d lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xpe

nd

itu

re p

er

ca

pita

(un

insu

red

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l an

d lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xpe

nd

itu

re p

er

ca

pita

(un

insu

red

po

pu

latio

n)

(Ra

nd

) P

rov

inc

ial a

nd

loc

al

go

ve

rnm

en

t e

xp

en

ditu

re p

er

prim

ary

he

alth

ca

re h

ea

dc

ou

nt

(Ra

nd

)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C

fac

ilitie

s w

ith

90

% o

f th

e t

rac

er

me

dic

ine

s a

va

ilab

le (

%)

Pe

rce

nta

ge

Id

ea

l Clin

ics

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(N

o)

23

22

21

20

19

8

7

6

5

4

3

2

1

Denominator 8278 73647 9371 53449 8278 292889

Umzimkhulu

Indicator 4.7 55.2 89.7 2359 4.5 2.2

Numerator 39688 39688 42891 147015581 376 426157

Denominator 8380 71913 47808 62321 8380 2295315

Harry Gwala

Indicator 4.9 52.8 74.9 2685 5.4 2.5

Numerator 149505 149505 56518 569916617 1639 1254868

Denominator 30573 283271 75486 212254 30573 5928633

KZN Indicator 5.4 56.2 49.4 2566 5.4 2.7

RSA Indicator 4.4 67.4 59.3 2568 5.1 2.3

Source: DHIS, BAS, Ideal Clinic Information System


of 78

ALOS is within Provincial target of 5 days. BUR is constantly below the norm (except for NDZ), the contributory factor has been the under-

utilisation of acute paediatric beds and non-adherence to general admission criteria. OPD Headcount not referred is still high as clients still

bypass PHC facilities. Expenditure per patient day equivalent is high because of the low BUR with full staff complement. High crude death rate

at NDZ is high, the preliminary investigation shows that clients present late. These poor performing indicators will be addressed in this plan.

PHC utilisation rate is low due to WBOT data not included in the numerator. Clients who were enrolled on CCMDD also contributed to the low

PHC utilisation rate.


of 78

12. QUALITY OF CARE

12.1 TOP 20 WORST PERFORMING IDEAL CLINIC ELEMENTS PHC FACILITIES

Poor Signage

Basic Life Support training

Incomplete client Records

Non-functional Clinic Committees

Non availability of National Guidelines (clinical audit, Ordering of general supplies, referral

guidelines, inventory books)

No backup system for electricity black outs

Staffing not in line with WISN

Poor representation in LTT and WTT OSS

No Web access

Doctors and therapists visits

Essential medical equipment unavailability

Policies not signed by National

No storage space

Incomplete Clinical audits

12.2 TOP 20 WORST PERFORMANCE NATIONAL CORE STANDARDS IN DISTRICT HOSPITALS

Emergency trollies not appropriately stocked.

Functional system to supply piped medical gas to all clinical areas is inadequate

Functional system to supply piped suction/vacuum to all clinical areas is not adequate.

Safety checks during and after surgery is not conducted according to WHO guidelines

Informed consent forms are not completed correctly

Some tracer medicines are not available

Clinical audits are not conducted.

Clinical risk forum not existing

Adverse events committee non-functional

Adverse blood reactions are not documented and reported

Disaster management plan is not known by staff

Clinical management group policies are not in place

SOP for needle stick injury not available.

Non functionality Occupational Health and Safety committee.

Staff who have received Post exposure Prophylaxis are not retested

Turn-around-time for critical stock not set and monitored regularly

Annual management inspection reports on safety hazards and maintenance is not done

There is visible loose electric wiring and collapsing ceiling


of 78

Staff –patient ratio in key areas not in accordance with the approved staffing plan for

emergency unit/out-patient/ medical/surgical and Paediatrics

Ramps with hand-rails to cater for disabled clients are not available

12.3 TOP 5 CHALLENGES REPORTED BY PATIENTS IN PATIENT SURVEYS AND PATIENTS COMPLAINTS

Long waiting times

Negative staff attitude

Poor food services

Unavailability of Doctors

Shortage of supplies e.g. hand washing material, toilet papers.


of 78

13 ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT

TEAM

The full establishment of the District Management Team gives support to the sub-districts

which are key services delivery platforms. The challenge is provision of close support and

monitoring of sub-districts is the vast nature of the district which results in travelling long

distances to reach the facilities. The proposed sub- districts plan will probably ideal to

address the challenge.

DISTRICT MANAGER

DEPUTY MANAGER INTEGRATED DHS DEVELOPMENT

PROGRAMME MANAGERS X8

DEPUTY MANAGER DHS PLANNING MONITORING EVALUATION

DISTRICT INFORMATION

TEAM

DISTRICT PLANNER DISTRICT ENGINEER

DEPUTY MANAGER CORPORATE SERVICE

SCM &FINANCE MANAGERS

INSTITUTIONS

4 District Hospitals

2 Specialized Hospitals

1CHC

1vacant,spcialised and chc

CLINIC MANAGERS

MOBILE TEAMS

HEALTH POSTS


of 78

14 DISTRICT HEALTH EXPENDITURE

BUDGET AND EXPENDITURE

Budget: Adjusted Appropriation Expenditure TOTAL

Province *Transfer to LG LG Own Province Transfer to LG LG Own Budget Expenditure

2.1: District Management 25 545 000.00 0.00 0.00 26 668 572.00 0.00 0.00 25 545 000.00 26 668 572.00

2.2: Clinics 234 194 000.00 0.00 0.00 216 767 272.00 0.00 0.00 234 194 000.00 216 767 272.00

2.3: Community Health Centres 42 562 000.00 0.00 0.00 42 483 591.00 0.00 0.00 42 562 000.00 42 483 591.00

2.4: Community Services 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2.5: Other Community Services 80 976 000.00 0.00 0.00 79 896 542.00 0.00 0.00 80 976 000.00 79 896 542.00

2.6: HIV/AIDS 163 718 000.00 0.00 0.00 176 240 700.00 0.00 0.00 163 718 000.00 176 240 700.00

2.7: Nutrition 2 700 000.00 0.00 0.00 3 151 882.00 0.00 0.00 2 700 000.00 3 151 882.00

2.9: District Hospitals 480 437 000.00 0.00 0.00 469 747 986.00 0.00 0.00 480 437 000.00 469 747 986.00

TOTAL DISTRICT 1 030 132 000.00 0.00 0.00 1 014 956 545.00 0.00 0.00 1 030 132 000.00 1 014 956 545.00

Source: District Health Expenditure Review (2016/17) or BAS*LG - Local Government

The increase in budget and expenditure in the past years has been gradual e.g Clinics budget has increased from R206 854.00 in 20115/16 to

R234 194 000 in 2016/17.The expenditure has been maintained within the limits. The reflection of Clinics to be under spending should not be seen

as true reflection, as this is mainly due to delays in journals as well as BAS that closed early before all the payments being processed.

HIV and AIDS budget has increased from R161921000 IN 2015/16 to R163 718 000 in 2016/17 but over expenditure remains.


of 78

Overspending in HIV/ AIDS budget was incurred from VCT test kits which are in line with the increase in the number of people tested and the

coverage. The increase in the number of test kits used was in response the Universal test and treat program ( UTT) that was introduced in

September 2016. The support of Partner Broad Reach and other Community Based Organizations through additional Human Resource assisted

the district to be able to do Community testing. The implementation of UTT meant increase in the ARV Therapy expenditure as well.

The District Management over expenditure resulted from the out of adjustment of two officials one at level 12 and the other at level 10 at the

district that whom HR issues are not resolved.


of 78

15 DISTRICT ASPIRATIONS AND INDICATOR TARGETS

List the District aspirations, and map to the Provincial DoH Strategic Plan 2015-2020 goals.

# District Aspiration Provincial Strategic Plan

2015-2020 Goal(s)

1. 1.1 Reduce neonatal mortality rate from 12.5 to 7.0 by 2021 Reduce neonatal and

under 5 years child mortality

1.2 Maintain under 5 child mortality below 5% by 2021

2. Reduce maternal mortality rate from 97/k to 95/k Reduce maternal mortality

2.1 Increase ANC visit before 20 weeks from 73.3% to 80% by 2021

2.2 Reduce teenage pregnancy rate from 10.4% to 7%by 2021

3 Improve Women’s Health

3.1 Increase couple year protection rate from 69% to 80% by 2021

Improve Women’s Health

3.2 Increase cervical cancer coverage from 79% to 86% by 2021

4. Reduce HIV incidence using 90/90/90 strategy Manage HIV prevalence

4.1 Increases number of HIV test from 137449 to 197650 by 2021

4.2 Increase the number MMC from 5231 to 6432 by 2021.

4.3Mantain PCR positivity rate around 10 weeks at <1% by 2021

4.4 Increase the number of clients started (adult) on ART from 10271 to 13000

by 2021

4.5 Increase the number of clients started (children) on ART from 395 to 438 by

2021

4.6 Increase the number of ANC clients on ART from 1513 to 1708 by 2021

4.7 Reduce LTFU rate from 25% to <10% by 2021

4.8 Increase total remaining on ART from 49519 to 82120 by 2021

4.9. Increase viral load completion rate from 67% to 90% by 2021

4.10.Increase viral load suppression rate 92% to 95 %by 2021

5. Reduce premature mortality from NCD through prevention and treatment

5.1 Reduce the incidence of hypertension of clients from 40 years and above

from 49.5 to 23.8 to by 2021

Reduce mortality and

morbidity of non-

communicable diseases

Re-engineering primary and

community-based mental

health services

Screen at least 35% of PHC

clients for mental disorders

by March 2020

5.2 Increase the number( screenings ) of clients screened for diabetes from 40

years and above from 120 000 to 138 915 by 2021

5.2.2 Maintain reduction of the incidence of clients with diabetes of clients

from 40years and above at 1.9

5.3. Increase the number of clients screened for mental disorders from 378939


of 78


2015-2020 Goal(s)

to 391885 by 2021

5.4 Increase the cataract surgery rate from 1222.2 /1ml to 830 (per 1 million) to

2230/million by 2021

5.5. Increase the number of eligible clients accessing rehabilitation services

from 18687 to 19621 by March 2021

6.

Improve patient experience survey rate from 82 % to 95% by 2021 Sustain a complaint

resolution rate of 95% (or

more) in all public health

facilities from March 2020

onwards

7. Improve compliance to the Ideal Clinic and National Core Standards

7.1. Increase percentage of clinics scoring above 80% on ideal clinic

realisation from 53% to 80 %y 2021

Improve compliance to the

Ideal Clinic and National

Core Standards

7.2 Increase percentage of health facilities (district hospitals) scoring above

80% on extreme and vital measures of National Core Standards from 0% to

100% by 2021

8. Accelerate implementation of PHC re-engineering

8.1 Increase PHC utilisation rate (adult) from 3 to 3. 1 by 2021.

Accelerate implementation

of PHC re-engineering

8.2 Increase PHC utilisation rate children <5yrs) from 4.0 to 4.2 by 2021

8.3 Increase the number of accredited health promoting schools from 11 to 30

by 2021

8.4 Increase grade R,1,8 screening coverage from 23.1 by 15% per annum by

2021

9. Improve TB outcomes

9.1 Increase TB screening (5years and older) from 80.8% to 95% by 2021

Improve TB outcomes

9.2 Reduce TB death rate from 11.8 to below <5% by 2021

9.3 Improve TB success rate from 82.5% to 90-% by 2021

9.4 Reduce LTFU rate from 4.4% o <3 5% by 2021

9.5 Improve TB MDR not evaluated rate 10% to 0% by 2021

9.6 Maintain LTFU rate (MDR) at <5 by 2021

9.7 Reduce TB death rate (MDR) from 15% to 10% by 2021

10. Improve hospital efficiencies

10.1 Reduce ALOS from 4.9 to 3.5 by 2021

10.2 Increase BUR from 62.5 % to 70% by 2021

10.3 Reduce OPD Head count unrefferred cases from 56 518 to 42 279 by 2021

Improve hospital efficiencies


of 78


2015-2020 Goal(s)

10, 4 Maintain cost per PDE within R2250

11. Reduce deaths due to injuries within 14 to 24 age group of males ( High

according District Health Barometer)


of 78

16. Indicator Targets for Theory of Change (impact, outcome and output) of aspirations

District Aspiration 1:

District Aspiration Indicato Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Dis

tric

t A

spira

tio

n 1

. 1

.1 R

ed

uc

e

un

de

r 5 c

hild

mo

rta

lity ra

te

fro

m

12. R

ed

uc

e n

eo

na

tal

de

ath

ra

re fr

om

12.5

to

7

.0

Type

Imp

ac

t

Inpatient neonatal

death rate

18.7 13.6 12.5 12 14.6 7.0 7.0

Numerator 163 109 95 66 111 558 586

Denominator 8705 8009 7593 5627 7593 7973 8371

Ou

tco

me

PCR Positive around

10weeks

1.5 0.9 0.8 <1% 1% 1 1

Numerator 55 29 22 10 27 12 18

Denominator 3655 2616 2698 1447 2668 1205 1708

Under 1 year

Immunization

coverage

77 68.5 70.5 60% 90% 90% 90%

Numerator 9743 8798 9128 8701 13023 12968 12797

Denominator 12596 12799 155430 14457 14470 14409 14219

Ou

tco

me

Under 5yrs mortality

rate

42.0 50.0 39 46.1 46 46.7 46.4

Numerator 70 56 79 117 112 107 101

Denominator 2946 2808 3119 2540 2413 2293 2178


of 78

District Aspiration Indicato Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Ou

tpu

t

Diarrhoeal 3.1 2.5 2.5 5 2.6 2% 2%

Numerator 24 13 14 12 11 7 4

Denominator 777 529 571 325 529 364 191


District Aspiration Indicator(refer to Annex C for

the proposed indicator names

for health

outcomes/programmes)

Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

1.

Re

du

ce

ma

tern

al d

ea

th r

ate

Imp

ac

t

Maternal deaths 136/k 97/k 92/k 97/k 95/K 95/K 95K

Numerator 12 8 7 6 6 8 8

Denominator 8797 8227 7593 6212 7593 8608 9005

Ou

tco

me

Delivery in facility

under 18

year’s

9.7 9.9 10.4 24.1 7.2 7% 7%

Numerator 850 800 796 460 551 562 586

Denominator 8750 8050 7650 1904 7650 8033 8371

Ou

t

pu

t ANC 1ST visit be

before 20 weeks

57.1% 64.6% 73.3% 73% 84% 80% 80%


of 78



for health


Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Numerator 6593 6460 6790 6683 8707 8678 9111

Denominator 11507 10007 9393 9155 10332 10847 11389

I

Antenatal clients

initiated on ART

97.6 93.4 93.0 94% 100% 100% 100%

Numerator 2359 1695 1513 944 1612 1434 1708

Denominator 732 1823 1627 1089 1612 1434 1708

Ou

tco

me

N/A N/A N/A N/A N/A N/A N/A N/A

Numerator N/A N/A N/A N/A N/A N/A N/A

Denominator N/A N/A N/A N/A N/A N/A N/A

Ou

tpu

t

Mother Post-natal

visit within 6 days %

72% 72% 64.2 70.3 85% 90% 90%

Numerator 6296 5858 4915 5335 6503 7230 7534

Denominator 8750 8050 7650 7614 7650 7650 8371


District Aspiration Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

A s p ir a ti o n : 3 :

I m p r o v e

w o m e n ’s

h e a lt h

Type


of 78


performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Ou

tco

me

Couple year

Protection

22% 63% 75% 33% 80% 80% 80%

Numerator 70511 82457 121037 45148 108722 110842 112561

Denominator 324019 131739 1609620 135141 135903 138552 140701

Ou

tpu

t

Cervical Cancer

screening

81.8 73.4 110% 79.1 85% 85% 85.9%

Numerator 6822 6641 10133 7152 13615 81021 83197

Denominator 137102 90012 111216 35951 16018 95319 98232


District

Aspiration

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

1 st 9 0

P r o c e s s & i n p u t

MMC 6035 4854 5213 7396 5601 6432 5895

Ou

t

pu

t HIV test done -

total

144 221 135 444 319 015 137449 189616 231694 197650

Type Male condom

distribution

8061653 10804875 11469300 3048000 8718602 14009823 15410805

Female condom

distribution

84392 192427 228074 181542 241925 253268 265931

O u t c o m e

2 n d

9 0 - 9 0 - 9 0 Number of clients 1998 7795 10249 7059 10710 12011 12612


of 78

District

Aspiration

Indicator Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

started (adult) on

ART

Ou

t

co

me

2n

d

90-

90-

90 number of clients

started (children

98 297 349 10 337 365 388

Outcome

2nd 90-

90-90

TROA 38894 46656 49519 55776 61984 77064 82120

Ou

tco

me

2n

90

-90-

90

Viral load

suppression @ 6

months

83.3% 84.6% 92.2% 92.3% 90% 90% 90%

Numerator 2171 4002 4741 1155 10271 10024 10530

Denominator 2606 4728 8193 1252 11412 11138 11700

Viral load

completion at

6months

42.4% 46% 62.7% 90% 90% 90% 90%

Numerator 2606 4728 5141 1252 10271 11138 1300

Denominator 6144 10332 18193 1863 11412 12376 13300


District

Aspiration

Indicator(refer to Annex C for


for health


Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21


of 78

District

Aspiration

Indicator(refer to Annex C for


for health


Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Asp

ira

tio

n:

5

Re

du

ce

p

rem

atu

re

mo

rta

lity

fro

m

NC

D

thro

ug

h

pre

ve

ntio

n

a

nd

tre

atm

en

t

Ou

tco

me

Hypertension

incidence

New Indicator 2.3 11.3 26.0 25/1000 24/1000 23/1000

Numerator New Indicator 207 1021 2161 2080 2006 1940

Denominator New Indicator 88657 89951 83192 83192 83580 84337

Ou

tco

me

Diabetes

incidence

New Indicator 31.1/1000 10.36/1000 11.1/1000 8/1000 5/1000 3.1/1000

Numerator New Indicator 2758 932 915 666 418 257

Denominator New indicator 88657 89951 83192 83192 83580 84337

Ou

tco

me

Cataract Rate 177.6/1ml 562.5/1ml 683/1ml 577/1ml 1948/1ml 2019/million 2230/million

Numerator 85 273 721 877 1000 1050 1175

Denominator 478535 485308 492203 506435 513362 520188 526956

Ou

tpu

t Clients screened

for mental

disorders

8% 10% 36% 36.1% 37% 40% 45%

Numerator 112339 150394 378939 541661 568744 624197 716266

Denominator 1 404 242 1 457 778 1 053 280 1501782 1539951 1560492 1591702


of 78




for health


Audited

performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Asp

ira

tio

n 6

: Im

pro

ve

TB

ou

tco

me

s

Imp

ac

t TB death rate 6.1 6 7.5 5.2 <5% <5% <5%

Numerator 79 50 248 25

Denominator 1279 831 3326 480

Ou

tco

me

TB success Rate 73% 62% 81.6 78.3 85% 90% 90%

Numerator 102 111 2713 376

Denominator 139 178 3326 480

Numerator



performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Asp

ira

tio

n:

Imp

rove

TB

co

me

s

Ou

tco

me

TB clients LTFU 5% 5% 4.4% <3 % <3.5% 3.5% 3.5%


Denominator 1279 831 3326 481

Ou

tco

me

TB/HIV co infected i

client initiated on ART

rate

83% 24% 87.8% 97% 97% 97% 97%


of 78


performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Numerator 914 17 1210 1591 1670 1753 1840

Denominator 1099 708 1378 1643 1725 1811 1901



performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Imp

rove

Ho

spita

l Eff

icie

nc

ies

ALOS 5.1 5.1 4.9 5.0 5.0 5.1 5.1

Inpatient days 274698 164602 149505 156980 164829 173070 181723

Separations 33695 33330 30573 30781 32320 33936 35632

BUR 65.0% 63.0% 52.8 57.6 60.9 67.1 70.5

Inpatient days 274698 164602 149505 156980 164829 173070 181723

Inpatients beds 726 706 706 706 706 706 706

New not referred

cases

39.8 62.7 74.9 61.2 50.1 41.0 33.5

Numerator 69819 72320 56518 50866 45779 41201 37080

Denominator 178179 116128 75486 83034 91337 100470 110517

Cost per PDE 2162.8 2250 2685 2250 2250 2250 2250

Expenditure total 443822163 455367004 569916617 1 379 634 750


of 78


performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

PDE 231552 231903 212254 233479



performance

2014/15

Audited

performance

2015/16

Audited

performance

2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

A

cc

ele

rate

PH

C R

e-

en

gin

ee

rin

g

PHC utilisation rate 2.9 3.0 3.0 2.6 2.7 3.0 3.1

Numerator 1404242 1457778 1254868 1317611 1317611 1560564 1633564

Denominator 478535 485308 499428 506435 513362 520188 526956

PHC Utilisation rate

under 5yrs

4.1 4.5 4.2 4.6 5.1 5.6 6.2

Numerator 252714 280736 308809 339689 373657 411022 452124

Denominator 61967 62566 72589 73011 73061 72782 72257

Number of Health

Promoting schools

11 12 11 19 22 26 30


of 78

17 BOTTLENECKS AND ROOT CAUSES

Summarise Bottlenecks and Root-causes in the template below along with the corresponding aspiration:

Bottlenecks / Challenges Root Causes District

Aspiration #

District

Aspiration

1.1. Poor communication & intersectoral co-

ordination

1.2. Poor quality of care

1.3.. Inadequate use of service delivery

platforms and referral/linkages with

communities.

2. Shortage of neonatal equipment.

3. Poor Perinatal Care.

Failure to understand dangers of herbal intoxication.

Delay/ ordering of equipment financial.

Inefficient monitoring of partogram

1

1

Reduce under 5 child mortality rate

Reduce neonatal mortality rate from death rate

from to by 2021

2. a. Poor quality of care

b. Inadequate use of service delivery


communities

c. Poor infrastructure, medicine and

procurement and supply chain management

Non adherence to guidelines and protocols 2 Reduce number of maternal deaths from 5 to 2 by

2021

3a. Failure to understand indicators and targets

b. Poor quality of care

Negative Staff attitude 3 Improve Women’s Health

4. Failure to understand indicators and targets

b. Poor quality of care

Negative Staff attitude 4 Reduce HIV incidence using 90/90/90 strategy from

35.7to…by 2021

Poor quality of care Negative Staff attitude 4

4a. Poor quality of care

b. Poor communication & intersect oral co-

ordination

c. Inadequate use of service delivery

Poor healthy lifestyle 5 Reduce premature mortality from NCD’s through

prevention and treatment to <10% by 2021


of 78


Aspiration #

District

Aspiration


communities

6. Poor quality of care

b. Poor communication & intersectoral co-

ordination

Negative Staff attitude 6 Improve patient satisfaction rate from 82 % to 95%

by 2021

7. Poor communication & intersectoral co-

ordination

7.1 Quality of service

7.2 Communication and inter-sectoral

coordination

Negative Staff attitude

Gaps in filling of client records

Poor performing indicators without monitoring

progress in quality

improvement plans

Clinic committees are not empowered enough to

understand their roles and support

7 Improve compliance to the Ideal Clinic and

National Core Standards

Increase the number of clinics with Ideal Clinic

Realisation Status from to Clinics by 2021

8.1 Service delivery platform

8.2 Human Resource

Poor access due to geographical/topography

Transport route is redirecting the clients to outside the

Sub-district

Shortage of staff has

Shortage of vehicles interferes with the outreach

schedule

8

Accelerate implementation of PHC re-engineering

9.1 Service delivery platform Noncompliance and defaulting of treatment

especially the males

Beliefs and use of other methods resulting in late

reporting

Associated comorbidities in one client(more than

one condition)

Stakeholders like Traditional healers and faith healers

9 Improve TB outcomes

9.2 Communication and inter-sectoral

coordination

9


of 78


Aspiration #

District

Aspiration

are not empowered to identify early signs and

symptoms of TB

10.1 Service delivery platform Implementation of UTT has improved quality of life

Clients not meeting admission criteria

Doctors not admitting patients consistently for

observations

10 Increase bed utilisation rate from % to % by 2021

Poor communication & intersectoral co-

ordination

c. Inadequate use of service delivery


communities

Lack of recreational facilities

Increase in substance abuse

11 Reduce deaths due to injuries within 14 to 24 age

group of males


of 78

18. KEY INTERVENTIONS

District

Aspiration #

Population Geography Public Health Intervention Costing

Life Course

Group

Key Population

**

(Sub-

district)** Ward ** Key Intervention Root Cause**

Service

Delivery

Platform*

Amount Funding

Source

1.1

1.2.

0-28 days

0-4 years

Neonates all

sexes

Children under

5 years

All sub-

districts

All sub-

districts

All Wards Skilling Health Care providers

on identification of danger

signs on new born babies

(ESMOE.

Resourcing Health facilities with

essential equipment.

Empower OMs on quality of

information to be discussed

with Clinic Committees.

Skilling of Health Workers on

IMCI

Community dialogues on

dangers of herbal intoxication

Lack of skills (BLS),

reading of CTG and

intervention

Failure to understand

dangers of herbal

intoxication by the

communities

DH , PHC

PHC

Voted funds

2

10-40 years Women of

bearing

ALL

2.1Skilling Health Care

Providers ( ESMOE . EOST)

2.2. Monitor the availability of

resources in health care

Lack of skills (BLS),

reading of CTG and

intervention

DH &PHC


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

facilities including equipment

and HR.

2.3. Liaise with EMS in provision

of rapid interfaculty and

community transport system.

2.4 Provide support on sub-

district Child/ PPIP review

meetings to improve quality of

labour and delivery

management

Insufficient infrastructure

to provide medical air

DH, PHC

Delayed EMS response

time

DH, PHC

3. 10-40 years Young Women

& men.

Child bearing

stage women

All Sub-

districts.

3.1 Extend of SRH services to

the Youth at FET/TVETS.

3.2 Promote dual protection.

3.3. Enforce Health workers

cervical cancer screening

norm

3.4 Conduct value clarification


DH, WBOT ,

PHC

Voted funds

4. 1.5 and older Males and

Females

All All Develop partnerships with

community based partners to

service key populations to

increase HTC coverage.

Poor intersectoral

coordination

DH,PHC Voted Funds,

CG

4 All age groups Males and

females

All All Monitor the implementation of

UTT in facilities

Provide NIMART mentorship

Conduct value clarification


Lack of skills in HIV

management

DH, WBOT.

PHC

Voted funds

&CG


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

4 15-49 years Males All Market quarterly MMC camp

schedule and walk in.

Increase demand creation by

collaborating with community

structures,

Targeting TVETs, Prisons and

tribal courts.

Collaborate with (GPs )

general practitioners, other

departments and izindlondlo

to increase MMC uptake

Poor intersectoral

coordination

DH, PHC

CG

5. +40years Males and

females

All sub-

districts

Facilitate screening services for

all clients 40 years and above

for hypertension in all facilities


Negative staff attitude DH,WBOT,PHC Voted funds

5 +40years Males and

females

All sub-

districts

Facilitate screening services for

all clients 40 years and above

for diabetes in all facilities


Negative staff attitude DH,WBOT,PHC Voted funds


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

5 +40years Males and

females

All sub-

districts

Monitor the availability of

screening equipment for all

health facilities

Delay/ ordering of

equipment financial.

DH, PHC,

WBOT

Voted funds

6. n/a n/a All sub-

districts

Conduct biannual NCS and

IPC audits in all health facilities.

Monitor the implementation of

QIP’s


DH, PHC,

DH,PHC

Voted funds

7 n/a n/a All sub-

districts

7.1 Training of Health Care

Providers on BLS and infection

control practises.

7.2.Marketing of importance of

patient experience of care to

Clinic Committees and OSS

Lack of skills

Poor communication,

poor intersectoral

coordination

DH, PHC.

OSS DTT,

DAC,PHC., DH

Voted funds


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

8 All age groups

All age groups

Males and

Females

Males and

females

All

All

8.1.Community Stakeholder

awareness on Preventive and

Promotive health.

8.2 Advocate for an increase

in the number of clinics

operating on extended hours

poor intersectoral

coordination

Poor access due to

geographical/topograph

y

WBOT, PHC

PHC

Voted Funds

9. 5 years and

above

Males and

females

All 9.1 TB Screening of 5 years

and above

9.2 Review tracing of lost to

follow up system within the

District.

9.3 Communicate with

referring facility on tracing and

screening of MDR-TB contacts.

9.4 Use patient centered care

(Patient empowerment,

engagement and increase

family involvement) in the

management of TB&MDR TB.

Revive Quarterly Cross border

meetings with Ugu and Alfred


Poor communication

Poor communication

Beliefs and use of other

methods resulting in late

presentation

DHY, WBOT,

PHC, DH

CG and voted

funds


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

Nzo districts

10. All age groups Males &

females

All 10.1 Monitor performance

district hospitals on patient’s

average length of stay on

quarterly basis.

10.2 Monitor performance

district hospitals on bed

utilisation rate on quarterly

basis.

10.3 Monitor functionality of

Gateways in terms extended

operating hours on quarterly

basis.

10.4. Conduct Resource

Planning meetings to monitor

district Hospital expenditure

per PDE

Noncompliance to

Admission and discharge

criteria.

District Office, DH

DH

DH

PHC

Voted

11. 14- 24 years Males and

females

All Facilitate community Youth

dialogues and camps on

substance abuse.

Present to community

structures the status of self-

Increased Substance

abuse.

Peer Pressure

PHC, OSS Voted Funds


of 78

District

Aspiration #


Life Course

Group

Key Population

**

(Sub-


Service

Delivery

Platform*

Amount Funding

Source

inflicted

Youth Festival, Sports

recreational activities

WBOT, ISHP, PHC, DH, SsH (refer to PART B: STEP 3 and 4 for further guidance)


of 78

19. Public Health Interventions in three dimensions

Provincial District Sub-district Facility

Strategy: Prevent avoidable neonatal and child deaths

Clinical Conduct onsite mentorship and

ESMOE drills

ESMOE drills, BANK, KINC, HBB, IYCF &

IMAM


IMAM

Community Presentations on Perinatal and Child

care at DAC and DTT OSS

Presentations at Local OSS AND

LAC’s

Community Dialogues

Systems Monitor resource Health Care

facilities including equipment and

human resources

Pregnancy testing and PCR kits made

available

Pregnancy testing and PCR kits

made available

Monitor linkage of Babies

District Aspiration 1: 1.2 Maintain under 5 child mortality rate below 5%

Strategy: Improve immunization under 1 year From 70.5% to 90%

Clinical Monitoring and Supervision of sub-

district’s performance

-Intensify and monitor

implementation of fast queues for

immunizations (EPI) especially in Dr.

NDZ

Conduct evidence based profiling of

under 1’s

Community Presentation of district campaigns at

District OSS structures

Community involvement and

accountability

Use of CCG’s in household combing

Systems Monitor the functionality of backup

generators in cases of electricity

failures

Conduct outreach immunisation

catch-up campaigns once a quarter

per facility

-Intensify and monitor

implementation of fast queues for

immunizations (EPI)

Strategy: Reduce severe acute malnutrition incidence under 5 years to below 2.1

Clinical Monitor SAM admitted and identify Audit the functioning of Phila Screen all under five children on


of 78


the affected areas Mntwana Centres weight for height and give

supplements as per need

Community Advocating the use of Phila Mntwana

Centres

Presentation at War rooms the status

of local Phila Mntwana figures

Linkage of MAM to CCG’s and War

rooms

Systems Monitor the availability and shortages

of equipment at Centres

Equipping the Phila Mntwana

Centres with Material resources

Ordering of resources as needed.

Strategy: Reduce under-5 diarrhoea with dehydration incidence to less than 10 per 1000 by March 2020

Clinical Skilling of Health Workers on IMCI Monitor the implementation of

guidelines as per IMCI

Implementation of guidelines

Community Presentation of statistics of diarrhoeal

related deaths related to herbal

intoxication at OSS structures

Community dialogues on dangers of

herbal intoxication

Health Education on dangers of

Herbal intoxication

Systems Monitor the implementation of IMCI

guidelines

Review of admission criteria for

children

Proper assessment and prompt

referral of clients

Strategy Reduce the under-5 pneumonia incidence to less than 85 per 1000 by March 2020

Clinical Skill auditing of Health Care workers

trained on IMCI

Skilling of Health Workers on IMCI Health education on early signs of

Pneumonia

Community Presentation of statistics of

pneumonia related deaths related at

OSS structures

Skilling of CCG’S on Community IMCI Awareness of clinic committees on

childhood illnesses

System Monitor the implementation of IMCI

guidelines

Review of admission criteria for

children

Proper assessment and prompt

referral of clients

District Aspiration 2: 2.1 Reduce maternal deaths


of 78


Strategy: Increase ANC visit before 20 weeks from 70% to 80% by 202 family Planning uptake

Clinical Monitor screening for life threatening

conditions

Monitor ANC before 20 weeks in

Information meeting

Screen all women of child bearing

age for pregnancy

Community Marketing Early ANC bookings at

district structures like OSS

Capacitate community on

importance of early booking by

conducting imbizos and community

dialogues

Monitor households pregnancy

testing by CCG’s

Systems Monitor the implementation of

maternity guidelines

Availability of pregnancy testing kits,

referral of positive cases

Availability of pregnancy testing kits,

referral of positive cases

Strategy: Reduce Primary cause of Maternal deaths

Clinical Skilling of Health Providers (

ESMOE, EOST)


IMAM


IMAM

Community Rapid inter facility and

community Emergency transport

Monitor EMS response time

Capacitate stakeholders on causes

of maternal deaths by conducting

community dialogues

Systems Appropriate resourced health

facilities including equipment &

HR

Market use of mothers lodge Refer clients far from clinic to

mothers lodge

District Aspiration 2: 2.2 Reduce maternal deaths :

Strategy: Reduce teenage pregnancy

Clinical Facilitate the implementation of

Happy hours/ policies and guidelines.

Have functional friendly youth

services in all facilities

Implement happy hour and

FastTrack teenagers

Use guidelines and policies

Community Market contraception, condom use Conduct teenage pregnancy Educate teenagers on


of 78


& dialogues awareness’s in schools disadvantages of teenage

pregnancy

Systems Market youth programs Provide transport for outreaches Have Champions for youth friendly

services

District Aspiration 3: 3.1 Improve women’s Health:

Strategy: Increase couple year protection rate from to

Clinical Extension of SRH services to the Youth

at FET/TVETS

Marketing service through health

talks


talks

Community Marketing of Dual protection

Procurement of condoms, IUCD’s

and other methods

Implementation of dual methods of

contraceptives

Systems Integration of Family Planning with

other services

Training on IUCD insertion & and

promote tubal ligation and

vasectomy.

Insertion IUCD insertion & promotion

of Tubal ligation.

Strategy: Increase cervical cancer screening coverage to 80% or more

Clinical Conduct clinical audit to monitor the

implementation of guidelines

Train on cervical cancer screening

procedure

Conduct cervical cancer screening

procedure as per guidelines

Community Support Phila Mah outreach

campaign.


talks

Health education on Phila service

through health talks by CCG’s

Systems Enforce cervical cancer

screening norm

Monitor Cervical screening in all

facilities

Conduct cervical screening as per

norm

District Aspiration 4: 4.1 Reduce HIV incidence using 90/90/90 strategy

Strategy: Increase number of HIV tests done


of 78


Clinical Facilitate Rapid Testing quality

improvement initiative

Monitor implementation of RTQII Implement RTQII

Community Skilling of Local CBO NGO on

community testing’

Conduct outreaches to reach the

target populations including key

populations

Trace and offer HTSs to contacts of

HIV positive clients

Systems Training of all Health Care on RTQII.

Comply with internal and external

quality testing initiatives

Provide transport for outreaches

Monitor availability of test kits and

drugs

Conduct awareness campaign’s

Strategy: Maintain condom distribution rate to above 50 per male per annum

Clinical Conduct clinical audit to monitor the

implementation of guidelines

Implement and monitor condom

distribution the guidelines

Implement condom distribution the

guidelines

Community Market the condom distribution Monitor the condom and availability

at non- medical sites distribution

WBOT

Distribute Condoms by CCG’s

Systems Increase secondary distribution sites Increase condom distribution to non-

medical

Distribute condoms to

District Aspiration 4: 4.1 Reduce HIV incidence using 90/90/90 strategy

Strategy: Increase total remaining on ART from 49519 to 82120 by 2021

Clinical Enforce implementation of guidelines

clarification in-service training

Upscale UTT implementation

conduct value

Intensify clients recall to start ART

Community Continuum to care through linkage to

Community to track LTFU clients

Market UTT strategy

Market UTT strategy


of 78


Systems Monitor Viral Completion and

Suppression

Conduct regular in-service (case

studies) in ART initiating especially

children on ART

Utilize Tier.net to ID +ve clients

Strategy: Initiate and manage HIV co-infected clients as per protocol

Clinical Clinical auditing of clinical charts to

monitor implementation of guidelines

Conduct in-service training day on

completion of ART adult, paeds and

TB clinical stationary

Implementation of guidelines

Community Educate stakeholders in in co-

infection e.g DAC

Educate stakeholders in in co-

infection at local community

structures

Health Education through CCG, at

warrooms

Systems Train at least one Tier.Net champion

per sub district

Monitor the data quality fow from

facilities

Capturing and submit data to next

level

District Aspiration 5: 5. Reduce premature mortality from NCD through prevention and treatment

Strategy: 5.1 reduce the hypertension incidence to 23/1000 by 2021prove family Planning uptake

Clinical Monitor availability of diabetes

screening tools in all health facilities

Monitor HPT screening coverage in

information meetings

Screening in all service points

Community Marketing of NCD management to

stakeholders

Capacitate community on

importance of screening for

hypertension

Conduct outreaches for screening

for chronic conditions

Systems Facilitate the availability of guidelines Provide transport, guidelines and

treatment and BP machines

Order treatment per re order levels

Strategy: 5. 2 Reduce the diabetes incidence diabetes to < 3.1 by 2021


of 78


Clinical Availability of diabetes screening

tools in all health facilities

Monitor Massive screening at all

service points

Screening at all service points

Community Marketing of NCD management to

stakeholders

Collaborate on community

Campaigns &, Operation MBO

Conduct outreaches for screening

for chronic conditions

Systems Facilitate the availability of

guidelines

Provide transport, guidelines and

treatment and BP machines

Order treatment per re order levels

Strategy: 5.3. Increase the cataract surgery rate to 2230 /million by 2021

Clinical N/A Sustain adequate consumables/

supplies for cataract operations

Screening of clients for referral

Community Marketing vision 2020 to the

community stakeholders

Marketing vision 2020 to the

community stakeholders

Health education on eye conditions

Systems Mobilise for Increase the number of

clients referred by sub- districts

Facilitate referral pathways to Rietvlei

for surgery

Facilitate referral pathways to

Rietvlei for surgery

Strategy: 6.1Improve patients’ experience of care rate from 82% to 95%

Clinical Availability of medicines and

supplies all times

Availability of medicines and supplies

all times

Monitoring of stock levels ordering

according to scheduled dates

Community Investigation of complaints and

client’s dissatisfaction

Market the importance of patients

experience survey rate at district

community structures

Marketing of importance of patients’

experience survey rate to Clinic

Committees and OSS

Educate clients on importance to

give accurate answers

Systems Facilitate the availability of client

satisfaction survey guidelines and

standard operating procedures

Distribute client satisfaction survey

guidelines and standard operating

procedures

Implement guidelines using SOPS

District Aspiration 7: 7. Improve compliance to the Ideal Clinic and National Core Standards


of 78


Strategy: 7.1 Increase the percentage of health facilities scoring above 80% on ideal clinic realisation and NCS from 40 % to 80 % by 2021

Clinical Facilitate training of Health Care

Providers on BLS and infection control

practises

Monitor availability of fully equipped

emergency trolleys

Availability of fully equipped

emergency trolleys

Training of Health Care Providers on

BLS and infection control practises

Availability of essential medical

equipment in all consulting rooms

Monitoring of stock levels and ordering

according to scheduled dates

Community Monitoring of patients’ satisfaction in all

PHC facilities and hospitals through local

structures including OSS

Monitoring of patients’ satisfaction in

all PHC facilities and hospitals

through Board members, clinic

Committees and OSS

Conduct Client satisfaction survey with

community structures

Systems Facilitate availability of standardized

emergency resuscitation

policies/protocols and SOPs

Ensure availability of standardized

emergency resuscitation

policies/protocols and SOPs

Conduct bi-annual NCS and IPC

audits in all health facilities

Develop and implement QIPs

Strategy: 7.2 Increase the percentage of health facilities scoring above 80% on extreme and vital measures of National Core Standards from 60% to 90 % by 2021

Clinical Facility staff appointed in line with WISN

Improve infrastructure to accommodate

clinical programmes and hand washing

facilities(elbow operated taps)

Skilling of Health care Providers on

implementation of QIP

Appointment of staff with relevant

expertise

Orientation of staff in different

programmes

Skilling of Health care Providers on

implementation of QIP

Allocation of duties of duties

according to qualifications and skills

Community

Marketing of complaints resolution

mechanisms


mechanisms

Implement complaint’s mechanism

accordingly


mechanisms

Implement complaint’s mechanism

accordingly

Systems Ensure availability of updated DHIS and NCS assessment –self assessment Complaints mechanism to be


of 78


required tools

Facilitate NCS assessment/peer review

Monitor implementation of QIPs

Complaints mechanism to be

displayed at strategic points for clients

in local languages

displayed at strategic points for

clients in local languages.

Conduct self- assessment

Develop and implement QIPs

District Aspiration 8: 8.1. Accelerate implementation of PHC re-engineering

Strategy: 8.1 Increase PHC utilisation rate (adult) from 3 to 3.1y 2021

Clinical Monitor the medicines out stocks at sub-

districts

Monitor the ordering of medicine

stock by clinics

Maintain medicine stock levels as per

norm

Community Community Stakeholder awareness on

Preventive and Promotive health

Community Stakeholder awareness

on Preventive and Promotive health

Health education on preventive and

promotive health

Systems Advocate for an increase in the number

of clinics operating on extended hours

Assign targets per PN – Staff–patient

ratio.

Clients consultation even after hours

Strategy: 8.2 Increase the number of accredited health promoting schools from 11 to 30 by 2021

Clinical Facilitate that each sub- district prepare

three schools for being processed to be

Health Promoting School

Prepare 3 schools per year to

comply to be a health promoting

school.

Identify and support local schools in

preparation

Community Re-orientate the School principals on

Health Promoting School concept

Identify the Schools with School

principals on Health Promoting

School concept

Introduce the Health Promoting

concepts to School Governing bodies

System Align SHTs into PHC clinics Monitor implementation of school

health services

Support preparation of the identified

schools


of 78


Strategy Increase grade R, 1 and 8 screening coverage

Clinical Facilitate procurement of Dental

materials for teeth restorations,

Procurement of Dental materials for

teeth restorations

Implement the restoration according

to targets

Community Presentation on importance of oral

hygiene at district structures to

stakeholders

Awareness of School governing bodies

and Clinic Committees on importance

of Screening of educators

Health Education on oral hygiene

System Align SHTs into PHC clinics Monitor implementation of school

health services

Support the local health school

teams with material.

District Aspiration 9: 9. Improve TB outcomes

Strategy: u Increase TB screening (5years and older) from 80% to 95% 2021

Clinical Facilitate clinical audits of clinical

charts

Implementation of QIP audit reports Implementation of QIP audit reports

Community Community mobilisation on

readiness for local campaigns

Community outreach programs to

intensify TB screening

Community outreach programs to

intensify TB screening

Systems Data verification Data verification Data verification

Strategy: Improve TB success rate from 82.5% to90% by 2021

Clinical Unlock bottlenecks that hinder

client’s evaluation and transferring

out.

Evaluation of all clients and recall

transferred out

Evaluation of all clients and recall

transferred out

Community Facilitate the availability of family

support structures

Strengthen family support on DOT Facilitate the establishment of

support groups


of 78


Systems Facilitate the linkage of CCG and

DOT support system

Strengthen family support on DOT Strengthen the functionality of

adherence clubs

Strategy Improve TB MDR not evaluated rate (MDR) from 10% to0%y 2021

Clinical Monitor the availability of guidelines

in all sub- districts

Implementation of guidelines Implementation of guidelines

Community Facilitate the availability of family

support structures

Strengthen family support on DOT Strengthen family support on DOT

System Review tracing of lost to follow up

system

Facilitate the tracing of lost to follow

up

Support community and family

linkages

Strategy Reduce LTFU rate from 4.4 to < 3.5 2021

Clinical Facilitate the resources to enhance

tracking system

Implementation of client tracking

system

Implementation of client tracking

system

Community Facilitate the establishment of

Adherence clubs

Strengthen family support on

adherence to treatment

Strengthen family support on

adherence to treatment

System Review tracing of lost to follow up

system within the District.

Strengthen the community facility

linkages

Strengthen the community facility

linkages

District Aspiration 10: 10. Improve hospital efficiencies

Strategy: 10.1 Reduce ALOS from 4.9 to 3.5 days

Clinical Monitor the utilisation of session

doctors

Monitor doctor’s rounds, admission

and discharge criteria.

Follow-up on discharged patients

Community Use OSS structure on orientation of

admission and discharges processes

Empower community for early

consultation

Educate on early consultation


of 78


Systems Value clarification to promote PHC

re- engineering.

Provide transport for outreaches Use guidelines and protocols

Strategy: 10.2 Improve BUR from 62.5. to 70%

Clinical Monitor the utilisation of session

doctors

Review admission criteria Adhere to triaging processes and

referral criteria

Community Promote the utilisation of

Government facilities for

comprehensive care

Capacitate community for early

consultation

Conduct Imbizo`s and community

dialogue

Health education community for

early consultation

Systems Follow up on referral policy to be

signed

Improve referral system Implement policy and guidelines

Strategy 10.3 Reduce OPD Head count unreferred cases by 7% each year

Clinical Monitor sub- districts with clinics

medicines shortages

Address shortage of medicines at PHC

facilities

Monitoring of medicines stock levels

Community District stakeholder presentations on

referral patterns

Clinic Committees and Hospital

Boards education on PHC re-

engineering

Clinic Committees and Hospital

Boards education on PHC re-

engineering

Systems Value clarification to address

negative staff attitudes

Extension of operating hours at PHC

facilities

Extension of operating hours at PHC

facilities

Strategy Maintain cost per PDE within R2555

Clinical Monitor quarterly expenditure Identify cost drivers N/A

Community Information sharing on implications

of cost drivers with District

Cost drivers to be discussed with

Hospital boards and community

N/A


of 78


Community structures structures

System Onsite support of bid committees Monitor cash flow N/A

District Aspiration11: 11. Reduce deaths due to injuries within 14 to 24 age group of males

Strategy: 11.1 Reduce deaths’ due to self-inflicted injuries

Clinical Data analysis to identify the sub-

districts mostly affected

Monitor the sections areas mostly

affected

Health education re-increase of

deaths of young people

Community Diseases burden to be discussed

with District Health council, OSS

structures

Community dialogues to engage

youth on possible causes and

interventions

Present to local War rooms and

izimbizo’s on the severity on the

condition

Systems Identify sub-districts responses in

relation to social ills and substance

abuse

Diseases burden to be discussed with

District Health council, OSS strictures

SEE INTEVENTION STRATGIES


of 78

ANNEXURE A: Comprehensive Health Information to conduct situational analysis

Population distribution, sub-district boundaries and health facility locations

Population per selected category


under 1 year 14407 14457 14470 14409 14219

under 5 years 72589 73011 73061 72782 72257

05-09 years 66387 67833 69021 70025 70987

10-14 years 55463 57255 59395 61642 63715

15-19 years 51329 50282 50113 50658 51905

20-24 years 55669 54036 52097 49973 48111

25-29 years 53387 54241 54434 54211 53414

30-34 years 37890 40956 44006 47005 49859

35-39 years 23714 25787 28043 30313 32373

40-44 years 16330 16904 17578 18434 19585

45-49 years 13383 13375 13442 13596 13847

50-54 years 12228 12090 11929 11759 11603

55-59 years 10910 10785 10674 10574 10465

60-64 years 9327 9257 9168 9065 8954

65-69 years 7394 7339 7278 7211 7137


of 78


70-74 years 5574 5522 5448 5358 5262

75-79 years 3948 3906 3863 3803 3723

80 years and older 3899 3850 3812 3780 3761

Total 499428 506435 513362 520188 526956

Estimated pregnant women 15415 15469 15483 15418 15214

Source: Mid-Year Population Estimates 2016, StatsSA (as per 2016 demarcations)

Number of facilities by level, 2016/17

Sub-districts Ward based

outreach teams Clinic CHC District Hospital

Regional

Hospital

Central/

Tertiary

Hospitals

Other

Hospitals

Greater Kokstad 5 2 0 1 N/A N/A 0

NDZ 17 12 1 1 N/A N/A 0

Ubuhlebezwe 12 9 0 1 N/A N/A 0

UMzimkhulu 19 16 0 1 N/A N/A 2

District 53 39 1 4 N/A N/A 2


of 78

Human resources – filled posts as at 31st March 2017

SUB- DISTRICTS

Co

mm

un

ity

he

alth

wo

rke

r

Nu

rsin

g

Ass

ista

nt

En

rolle

d n

urs

e

Pro

fess

ion

al

nu

rse

Do

cto

r

Ph

arm

ac

ist

De

ntist

Oc

cu

pa

tio

na

l

the

rap

ist

Ph

ysi

oth

era

pi

st

Sp

ee

ch

the

rap

ist

Au

dio

log

ist

Greater Kokstad 34 49 111 7 7

Dr. NDZ 69 97 181 12 10

Ubuhlebezwe 71 86 138 8 8

UMzimkhulu 128 91 199 22 7

HARRY GWALA DISTRICT 639 302 323 629 49 32 5 8 9 2 0

Source: Persal

Management and efficiency indicators for the service delivery platform - PHC

Sub-districts

Efficiency Management

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xp

en

ditu

re p

er

ca

pita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xp

en

ditu

re

pe

r c

ap

ita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t e

xp

en

ditu

re

pe

r p

rim

ary

he

alth

ca

re

he

ad

co

un

t (R

an

d)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C f

ac

ilitie

s w

ith

90

% o

f

the

tra

ce

r m

ed

icin

es

av

aila

ble

(%

)

Pe

rce

nta

ge

Id

ea

l C

linic

s

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(No

)

8 7 6 5 4 3 2 1


of 78

Sub-districts


Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xp

en

ditu

re p

er

ca

pita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xp

en

ditu

re

pe

r c

ap

ita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t e

xp

en

ditu

re

pe

r p

rim

ary

he

alth

ca

re

he

ad

co

un

t (R

an

d)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C f

ac

ilitie

s w

ith

90

% o

f

the

tra

ce

r m

ed

icin

es

av

aila

ble

(%

)

Pe

rce

nta

ge

Id

ea

l C

linic

s

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(No

)

Greater Kokstad

Indicator 2.4

Numerator 179127

Denominator 878049

NDZ

Indicator

Numerator

Denominator

Ubuhlebezwe

Indicator 2.7

Numerator 292889

Denominator

Umzimkhulu

Indicator

Numerator

Denominator

District Indicator


of 78

Sub-districts


Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t d

istr

ict

he

alth

serv

ice

s e

xp

en

ditu

re p

er

ca

pita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t p

rim

ary

he

alth

ca

re e

xp

en

ditu

re

pe

r c

ap

ita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l

go

ve

rnm

en

t e

xp

en

ditu

re

pe

r p

rim

ary

he

alth

ca

re

he

ad

co

un

t (R

an

d)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C f

ac

ilitie

s w

ith

90

% o

f

the

tra

ce

r m

ed

icin

es

av

aila

ble

(%

)

Pe

rce

nta

ge

Id

ea

l C

linic

s

(%)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(No

)

Numerator

Denominator

Source: DHIS, BAS, Ideal Clinic Information System

Management and efficiency indicators for the service delivery platform - Hospitals

Hospital Name

District Hospital Regional Hospital Tertiary / Central Hospitals

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

23 22 21 20 19 18 17 16 15 14 13 12 11 10 9

Christ the king Indicator 4.8 54783 50.1 2851.1 5.7 N/A N/A N/A N/A N/A N/A N/A N/A N/A


of 78

Hospital Name


Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

hospital Numerator 39656 39656 4679

1523878

64 468 N/A


Denominator 8278 187 32778 53449 8278 N/A N/A N/A N/A N/A N/A N/A N/A N/A

EGUM hospital

Indicator 4.9 51506 56.1 2441.5 5.4 N/A N/A N/A N/A N/A N/A N/A N/A N/A

Numerator 36885 36885 4749 1360597

31 405 N/A



Rietvlei

hospital


Numerator 39692 39692 4971 1406695

78 376 N/A



St Apollinaries

hospital


Numerator 33828 33828 4623 1335019

66 390 N/A




of 78

Hospital Name


Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

Ave

rag

e le

ng

th o

f st

ay

(da

ys)

Inp

atie

nt

be

d u

tilis

atio

n

rate

(%

)

OP

D n

ew

clie

nt

no

t

refe

rre

d r

ate

(%

)

Ex

pe

nd

itu

re p

er

pa

tie

nt

da

y e

qu

iva

len

t (

Ra

nd

)

Inp

atie

nt

Cru

de

De

ath

Ra

te (

%)

District


Numerator 150061 150061 18968 56261913

9 1639 N/A



Annual trends Deaths and Patient day equivalent, 2014/15 - 2016/17

2014/15 2015/16 2016/17

Data Element

(Number)

PH

C /

CH

C /

MO

U*

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

ho

spita

l

Dis

tric

t To

tal

Maternal deaths 12 8 7

Live births 8705 8009 6321

Still births 138 140 104


of 78

2014/15 2015/16 2016/17

Data Element

(Number)

PH

C /

CH

C /

MO

U*

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Dis

tric

t H

osp

ita

l

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

Ho

spita

l

Dis

tric

t To

tal

PH

C /

CH

C /

MO

U

Re

gio

na

l H

osp

ita

l

Ce

ntr

al/

tert

iary

ho

spita

l

Dis

tric

t To

tal

Ch

ild (

un

de

r 5 y

ea

rs)

Infa

nt

(un

de

r 1

ye

ar)

Ne

on

at

al

Death in facility 0-7days

Death in facility 8-28 days

Death in facility 29 days - 11

months

Death in facility 12 – 59

months

Diarrhoea death under 5 years 24 13 14

Pneumonia death under 5 years 12 11 13

Severe acute malnutrition death under 5 years 23 17 15

TB Deaths

DR TB Deaths

Inpatient death total - 1827 - 1694 - 1639

Patient day equivalent - 344500 - 23190

3

- 212253

*MOU – Maternal Obstetric Unit


of 78

Burden of disease profile

For 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 given by gender and age group

for the period 2010–2015. The second part of the graph shows the 10 leading single causes of death within each age group (both genders) for

2009–2014 combined.

Percentage of deaths by broad cause and leading causes, 2010- 2015


of 78

Women and Maternal Health

Impact Outcome Output

Inst

itu

tio

na

l m

ate

rna

l

mo

rta

lity

ra

tio

(P

er

10

0K

)

De

live

ry

in

fac

ility

u

nd

er

18 y

ea

rs r

ate

(%

)

An

ten

ata

l c

lie

nt

initia

ted

on

AR

T ra

te (

%)

Mo

the

r p

ost

na

tal

vis

it

with

in 6

da

ys

rate

(%

)

An

ten

ata

l 1st

v

isit

be

fore

20 w

ee

ks

rate

(%

)

Ce

rvic

al

scre

en

ing

co

ve

rag

e (

%)

Co

up

le

ye

ar

pro

tec

tio

n

rate

(%

)

7 6 5 4 3 2 1

Dr Nkosazana Dlamini

Zuma-NDZ

Indicator 11.9 95.6 488.6 74.1 189.0 67.3

Numerator 160 185 671 960 2627 16852

Denominator 1351 197 1351 1298 3482 31940

Greater Kokstad

Indicator 10.8 96.2 55.4 60.3 102.1 58.4

Numerator 161 294 853 820 1225 11036

Denominator 1512 307 1512 1367 1876 22377

Ubuhlebezwe

Indicator 11.0 95.9 59.5 70.5 66.9 62.6

Numerator 181 377 981 1249 1156 16241

Denominator 1604 396 1604 1801 3235 28573

uMzimkhulu

Indicator

8.3 87.7 90.1 77.9 116.1 61.1

Numerator 161 397 1580 2423 3236 24351


of 78

Impact Outcome Output

Inst

itu

tio

na

l m

ate

rna

l

mo

rta

lity

ra

tio

(P

er

10

0K

)

De

live

ry

in

fac

ility

u

nd

er

18 y

ea

rs r

ate

(%

)

An

ten

ata

l c

lie

nt

initia

ted

on

AR

T ra

te (

%)

Mo

the

r p

ost

na

tal

vis

it

with

in 6

da

ys

rate

(%

)

An

ten

ata

l 1st

v

isit

be

fore

20 w

ee

ks

rate

(%

)

Ce

rvic

al

scre

en

ing

co

ve

rag

e (

%)

Co

up

le

ye

ar

pro

tec

tio

n

rate

(%

)

7 6 5 4 3 2 1

Denominator

1790 451 1790 3129 5375 50656

District

Indicator 10.4 93.0 64.2 72.3 109.3 61.3

Numerator 160 1253 4085 5452 8244 68480

Denominator 6257 1351 6257 7595 13968 133546

Annual trends Child Health

Impact Outco

me

Output

Ch

ild u

nd

er

5 y

ea

rs

dia

rrh

oe

a s

e f

ata

lity

rate

(%

Dia

) C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

sev

ere

ac

ute

ma

lnu

tritio

n c

ase

fata

lity

ra

te %

Inp

atie

nt

de

ath

< 1

ye

ar

rate

Inp

atie

nt

de

ath

< 5

ye

ars

ra

te

Inp

atie

nt

ea

rly

ne

on

ata

l d

ea

th r

ate

Pe

r 1

K

Inp

atie

nt

ne

on

ata

l

de

ath

ra

te P

er

1K

In

fan

t 1

st P

CR

te

st

po

sitiv

e a

rou

nd

10

we

ek

s ra

te (

%)

Sc

ho

ol G

rad

e 1

scre

en

ing

co

ve

rag

e

(%)

Sc

ho

ol G

rad

e 8

scre

en

ing

co

ve

rag

e

(%)

HPV

1st

do

se

co

ve

rag

e (

%)

HPV

2n

d d

ose

co

ve

rag

e (

%)

Vita

min

A c

ove

rag

e

12

-59

(%

)

Imm

un

isa

tio

n

co

ve

rag

e u

nd

er

1 y

ea

r

(%)

Me

asl

es

2n

d d

ose

co

ve

rag

e (

%)

Infa

nt

ex

clu

siv

ely

bre

ast

fed

at

DTa

P-I

PV

-

Hib

-HB

V 3

rd d

ose

ra

te

(%)

17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1


of 78

Impact Outco

me

Output

Ch

ild u

nd

er

5 y

ea

rs

dia

rrh

oe

a s

e f

ata

lity

rate

(%

Dia

) C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

sev

ere

ac

ute

ma

lnu

tritio

n c

ase

fata

lity

ra

te %

Inp

atie

nt

de

ath

< 1

ye

ar

rate

Inp

atie

nt

de

ath

< 5

ye

ars

ra

te

Inp

atie

nt

ea

rly

ne

on

ata

l d

ea

th r

ate

Pe

r 1

K

Inp

atie

nt

ne

on

ata

l

de

ath

ra

te P

er

1K

In

fan

t 1

st P

CR

te

st

po

sitiv

e a

rou

nd

10

we

ek

s ra

te (

%)

Sc

ho

ol G

rad

e 1

scre

en

ing

co

ve

rag

e

(%)

Sc

ho

ol G

rad

e 8

scre

en

ing

co

ve

rag

e

(%)

HPV

1st

do

se

co

ve

rag

e (

%)

HPV

2n

d d

ose

co

ve

rag

e (

%)

Vita

min

A c

ove

rag

e

12

-59

(%

)

Imm

un

isa

tio

n

co

ve

rag

e u

nd

er

1 y

ea

r

(%)

Me

asl

es

2n

d d

ose

co

ve

rag

e (

%)

Infa

nt

ex

clu

siv

ely

bre

ast

fed

at

DTa

P-I

PV

-

Hib

-HB

V 3

rd d

ose

ra

te

(%)

Dr Nkosazana

Dlamini Zuma-

NDZ

Indicator 1.7 2.1 2.1 7.2 4.7 13.2 14.9 2.7 63.8 11.6 91.8 85.5 137.2

Numerator 2 3 1 29 34 23 26 7 15545 1956 3162

Denominator 121 145 48 401 730 1340 1340 446 9370 31382 3170

Greater Kokstad

Indicator 0.8 0.8 2.1 6.4 3.7 9.3 11.5 0.6 43.6 41.6 62.7 83.8 128.9

Numerator 1 1 1 29 30 17 21 2 7324 1343 1977

Denominator 132 122 47 455 818 1513 1513 528 4300 1604 1533

Ubuhlebezwe

Indicator 6.9 2.6 11.9 6.4 4.4 8.1 9.1 0.5 39.1 19.6 69.6 82.2 117.0

Numerator 10 6 8 27 35 15 17 4 15156 4306 3238

Denominator 144 233 67 424 789 1679 1679 645 8092 2808 2767

UMzimkulu

Indicator 0.6 2.6 12.8 13.6 8.0 18.8 22.0 0.7 56.5 41.6 84.0 65.7 97.6

Numerator 1 3 5 54 58 40 47 5 771 326 35351 3523 5195

Denominator 174 117 39 398 727 1789 1789 589 15692 5363 5318

District Indicator 2.5 2.1 7.5 8.3 5.1 12.5 14.6 0.8 50.7 29.1 72.9 70.5 106.1


of 78

Impact Outco

me

Output

Ch

ild u

nd

er

5 y

ea

rs

dia

rrh

oe

a s

e f

ata

lity

rate

(%

Dia

) C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

pn

eu

mo

nia

ca

se

fata

lity

ra

te %

C

hild

un

de

r 5 y

ea

rs

sev

ere

ac

ute

ma

lnu

tritio

n c

ase

fata

lity

ra

te %

Inp

atie

nt

de

ath

< 1

ye

ar

rate

Inp

atie

nt

de

ath

< 5

ye

ars

ra

te

Inp

atie

nt

ea

rly

ne

on

ata

l d

ea

th r

ate

Pe

r 1

K

Inp

atie

nt

ne

on

ata

l

de

ath

ra

te P

er

1K

In

fan

t 1

st P

CR

te

st

po

sitiv

e a

rou

nd

10

we

ek

s ra

te (

%)

Sc

ho

ol G

rad

e 1

scre

en

ing

co

ve

rag

e

(%)

Sc

ho

ol G

rad

e 8

scre

en

ing

co

ve

rag

e

(%)

HPV

1st

do

se

co

ve

rag

e (

%)

HPV

2n

d d

ose

co

ve

rag

e (

%)

Vita

min

A c

ove

rag

e

12

-59

(%

)

Imm

un

isa

tio

n

co

ve

rag

e u

nd

er

1 y

ea

r

(%)

Me

asl

es

2n

d d

ose

co

ve

rag

e (

%)

Infa

nt

ex

clu

siv

ely

bre

ast

fed

at

DTa

P-I

PV

-

Hib

-HB

V 3

rd d

ose

ra

te

(%)

Numerator 14 13 15 139 157 95 111 18 771 326 73376 9128 13572

Denominator 571 617 201 1678 3064 6321 6321 2208 37454 12957 12788

Annual trends HIV

3rd 90

Outcome

2nd 90

Output

1st 90

Process and Input

Sub-District

Pro

po

rtio

n

Vira

l lo

ad

do

ne

- A

du

lt (

%)

Pro

po

rtio

n

vira

l lo

ad

do

ne

- C

hild

(%

)

Pro

po

rtio

n

Vira

l lo

ad

sup

pre

sse

d -

Ad

ult (

%)

Pro

po

rtio

n

Vira

l Lo

ad

Su

pp

ress

ed

- c

hild

(%

)

Pro

po

rtio

n

rem

ain

ing

in

ca

re -

Ad

ults

(%)

Pro

po

rtio

n

rem

ain

ing

in

ca

re -

ch

ild (

%)

Clie

nts

re

ma

inin

g

on

AR

T ra

te -

all (

%)

HIV

te

st

po

sitiv

e

clie

nt

15

ye

ars

an

d o

lde

r ra

te

(in

clu

din

g A

NC

) (%

HIV

te

stin

g

co

ve

rag

e

(in

clu

din

g

an

ten

ata

l

ca

re)

(%)

Me

dic

al

ma

le

circ

um

cis

ion

ra

te (

%)

Ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Fe

ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

12 11 10 9 8 7 6 5 4 3 2 1


Zuma-NDZ

Indicator 69.8 2

Numerator 2675866 56167

Denominator 35662 42349


of 78

3rd 90

Outcome

2nd 90

Output

1st 90

Process and Input

Sub-District

Pro

po

rtio

n

Vira

l lo

ad

do

ne

- A

du

lt (

%)

Pro

po

rtio

n

vira

l lo

ad

do

ne

- C

hild

(%

)

Pro

po

rtio

n

Vira

l lo

ad

sup

pre

sse

d -

Ad

ult (

%)

Pro

po

rtio

n

Vira

l Lo

ad

Su

pp

ress

ed

- c

hild

(%

)

Pro

po

rtio

n

rem

ain

ing

in

ca

re -

Ad

ults

(%)

Pro

po

rtio

n

rem

ain

ing

in

ca

re -

ch

ild (

%)

Clie

nts

re

ma

inin

g

on

AR

T ra

te -

all (

%)

HIV

te

st

po

sitiv

e

clie

nt

15

ye

ars

an

d o

lde

r ra

te

(in

clu

din

g A

NC

) (%

HIV

te

stin

g

co

ve

rag

e

(in

clu

din

g

an

ten

ata

l

ca

re)

(%)

Me

dic

al

ma

le

circ

um

cis

ion

ra

te (

%)

Ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Fe

ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(co

nd

om

s)

Greater Kokstad

Indicator 5.5 2.3

Numerator 1707679 60949


Ubuhlebezwe

Indicator 81.2 1.0

Numerator 2521910 36662


UMzimkulu

Indicator 93.8 1.1

Numerator 4563845 74296


District

Indicator 81.5 1.3

Numerator 11469300 228074



of 78

Annual trends TB

Impact Outcome Output Process

Sub-district

TB d

ea

th r

ate

(ETR

.ne

t) (

%)

Dru

g-r

esi

sta

nt

TB c

lie

nt

de

ath

ra

te (

%)

TB/H

IV c

o-i

nfe

cte

d c

lie

nt

on

AR

T ra

te (

ETR

.Ne

t) (

%)

TB c

lie

nt

tre

atm

en

t su

cc

ess

rate

(ETR

.ne

t) (

%)

TB c

lie

nt

loss

to

fo

llo

w u

p

rate

(ETR

.Ne

t) (

%)

TB r

ifa

mp

icin

re

sist

an

ce

co

nfirm

ed

clie

nt

rate

(%

)

TB r

ifa

mp

icin

re

sist

an

t

co

nfirm

ed

tre

atm

en

t st

art

rate

(%

)

Dru

g-r

esi

sta

nt

TB t

rea

tme

nt

suc

ce

ss r

ate

(%

)

Dru

g-r

esi

sta

nt

TB c

lie

nt

loss

to f

ollo

w-u

p r

ate

(%

)

TB c

lie

nt

initia

ted

on

tre

atm

en

t ra

te (

%)

TB s

ym

pto

m 5

ye

ars

an

d

old

er

scre

en

ed

in

fa

cility

rate

(%

)

11 10 9 8 7 6 5 4 3 2 1

Dr Nkosazana

Dlamini Zuma-NDZ

Indicator 7.2% 98.6% 86.5% 1.8%


Denominator 111 289 111 111

Greater Kokstad

Indicator 3.7% 91.4% 85.6% 8.8%



Ubuhlebezwe

Indicator 4.7% 97% 94% 0%



UMzimkulu

Indicator 5.8% 100% 91.4% 2.2%



of 78

Impact Outcome Output Process

Sub-district

TB d

ea

th r

ate

(ETR

.ne

t) (

%)

Dru

g-r

esi

sta

nt

TB c

lie

nt

de

ath

ra

te (

%)

TB/H

IV c

o-i

nfe

cte

d c

lie

nt

on

AR

T ra

te (

ETR

.Ne

t) (

%)

TB c

lie

nt

tre

atm

en

t su

cc

ess

rate

(ETR

.ne

t) (

%)

TB c

lie

nt

loss

to

fo

llo

w u

p

rate

(ETR

.Ne

t) (

%)

TB r

ifa

mp

icin

re

sist

an

ce

co

nfirm

ed

clie

nt

rate

(%

)

TB r

ifa

mp

icin

re

sist

an

t

co

nfirm

ed

tre

atm

en

t st

art

rate

(%

)

Dru

g-r

esi

sta

nt

TB t

rea

tme

nt

suc

ce

ss r

ate

(%

)

Dru

g-r

esi

sta

nt

TB c

lie

nt

loss

to f

ollo

w-u

p r

ate

(%

)

TB c

lie

nt

initia

ted

on

tre

atm

en

t ra

te (

%)

TB s

ym

pto

m 5

ye

ars

an

d

old

er

scre

en

ed

in

fa

cility

rate

(%

)


District

Indicator 5% 26.9% 96.5% 89.1% 3.9% 63% 100% 57.1% 15.1% DHIS DHIS

Numerator 31 32 1607 547 24 75 75 68 18

Denominator 614 119 1666 614 614 119 75 119 119


of 78

Annual trend Non-communicable diseases 2016/17

Sub-districts Outcome

Hypertension incidence (Per 1K) Diabetes incidence (Per 1K)

2 1


Zuma-NDZ

Indicator 81.6 1.3

Numerator 2627 187

Denominator 41407p 122704

Greater Kokstad

Indicator 67.1 4.1

Numerator 817 297


Ubuhlebezwe

Indicator 17.2 1.6

Numerator 366 169


UMzimkhulu

Indicator 19.5 1.5

Numerator 664 279


District

Indicator 49.5 1.9

Numerator 4474 932


Unemployment rate 36.0%

Youth unemployment rate (15-34 years) 44.4%

No schooling 10.2%

Matric 23.5%

Higher education 6.4%

Households 123705

Female headed households 53.9%

Formal dwellings 41.7%

Flush toilet connected to sewerage 18.4%


of 78

Weekly refuge removal 23.1%

Piped water inside dwellings 11.4%

Electricity for lighting 81.0%

Blue drop water score 63.4%

harry gwala district health plan 2018/19 - 2020/21€¦ · harry gwala district health plan 2018/19...

Documents