District Hospital Performance Assessment

Mpumalanga Province

2008-2010

Kathryn Chu, Sizulu Moyo, Catherine Ogunmefun, Thokozani Mbatha, Peter Bock, Rene English

District Hospital Performance Assessment

Mpumalanga Province 2008-2010

Kathryn Chu, Sizulu Moyo, Catherine Ogunmefun, Thokozani Mbatha, Peter Bock, Rene English

Published by Health Systems Trust

34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] South Africa http://www.hst.org.za

Published: November 2011

Suggested citation:

Chu K, Moyo S, Ogunmefun C, Mbatha T, Bock P, English R. District Hospital Performance Assessment: Mpumalanga State Province 2008-2010. Health Systems Trust; Durban, 2011

The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes.

Acknowledgements

We would like to thank the National Department of Health for providing the data for the report. We are also grateful to Candy Day for assistance with the data. We thank Dr Kathryn Chu for writing the first draft of the report, and Dr Peter Barron for input and guidance in writing the final report.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 i

Contents

INTRODUCTION ...... 1 BACKGROUND ...... 3 A GERT SIBANDE – DC30 ...... 5 1. Carolina Hospital ...... 5 i: Description ...... 5 ii: Input and process indicators ...... 5 iii: Outcome indicators ...... 8 iv: Impact indicators ...... 9 v: Conclusions ...... 11 2. Embhuleni Hospital ...... 12 i: Description ...... 12 ii: Input and process indicators ...... 12 iii: Outcomes indicators ...... 15 iv: Impact indicators ...... 16 v: Conclusions: ...... 18 3. Bethal Hospital ...... 19 i: Description ...... 19 ii: Input and process indicators ...... 19 iii: Outcome indicators ...... 22 iv: Impact indicators ...... 23 v: Conclusions ...... 25 4. Evander Hospital ...... 26 i: Description ...... 26 ii: Input and process indicators ...... 26 iii: Outcomes indicators ...... 29 iv: Impact Indicators ...... 30 v: Conclusion: ...... 32 5. Standerton Hospital ...... 33 i: Description ...... 33 ii: Input and process indicators ...... 33 iii: Outcomes indicators ...... 36 iv: Impact Indicators ...... 37 v: Conclusions: ...... 39 6. Piet Retief Hospital ...... 40 i: Description ...... 40 ii: Input and process indicators ...... 40 iii: Outcomes indicators ...... 43 iv: Impact Indicators ...... 44 v: Conclusions: ...... 46 7. Amajuba Memorial Hospital ...... 47 i: Description ...... 47 ii: Input and process indicators ...... 47 iii: Outcome indicators ...... 50 iv: Impact indicators ...... 51

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 ii

v: Conclusions ...... 53 8. Elsie Ballot Hospital ...... 54 i: Description ...... 54 ii: Input and process indicators ...... 54 iii: Outcomes indicators ...... 57 iv: Impact Indicators ...... 57 v: Conclusions: ...... 59 B NKANGALA – DC31 ...... 60 1. Bernice Samuels Hospital ...... 60 i: Description ...... 60 ii: Input and process indicators ...... 60 iii: Outcomes indicators ...... 63 iv: Impact Indicators ...... 63 v: Conclusions: ...... 65 2. Mmametlhake Hospital ...... 66 i: Description ...... 66 ii: Input and process indicators ...... 66 iii: Outcomes indicators ...... 69 iv: Impact Indicators ...... 70 v: Conclusions: ...... 72 3. HA Grove Hospital ...... 73 i: Description ...... 73 ii: Input and process indicators ...... 73 iii: Outcomes indicators ...... 76 iv: Impact Indicators ...... 76 v: Conclusions: ...... 78 4. Waterval Boven Hospital ...... 79 i: Description ...... 79 ii: Input and process indicators ...... 79 iii: Outcomes indicators ...... 82 iv: Impact Indicators ...... 82 v: Conclusions: ...... 84 5. Impungwe Hospital ...... 85 i: Description ...... 85 ii: Input and process indicators ...... 85 iii: Outcomes indicators ...... 88 iv: Impact Indicators ...... 88 v: Conclusions: ...... 90 6. Middleburg Hospital ...... 91 i: Description ...... 91 ii: Input and process indicators ...... 91 iii: Outcomes indicators ...... 94 iv: Impact Indicators ...... 95 v: Conclusions: ...... 97 7. KwaMhlanga Hospital ...... 98 i: Description ...... 98 ii: Input and process indicators ...... 98

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 iii

iii: Outcomes indicators ...... 101 iv: Impact Indicators ...... 102 v: Conclusions: ...... 104 C EHLANZENI – DC32 ...... 105 1. Matikwana Hospital ...... 105 i: Description ...... 105 ii: Input and process indicators ...... 105 iii: Outcomes indicators ...... 108 iv: Impact Indicators ...... 109 v: Conclusions: ...... 111 2. Tintswalo Hospital ...... 112 i: Description ...... 112 ii: Input and process indicators ...... 112 iii: Outcomes indicators ...... 115 iv: Impact Indicators ...... 116 v: Conclusions: ...... 118 3. Barberton Hospital ...... 119 i: Description ...... 119 ii: Input and process indicators ...... 119 iii: Outcomes indicators ...... 122 iv: Impact Indicators ...... 123 v: Conclusions: ...... 125 4. Lydenburg Hospital ...... 126 i: Description ...... 126 ii: Input and process indicators ...... 126 iii: Outcomes indicators ...... 129 iv: Impact Indicators ...... 130 v: Conclusions: ...... 132 5. Sabie Hospital ...... 133 i: Description ...... 133 ii: Input and process indicators ...... 133 iii: Outcomes indicators ...... 136 iv: Impact Indicators ...... 137 v: Conclusions: ...... 139 6. Matibidi Hospital...... 140 i: Description ...... 140 ii: Input and process indicators ...... 140 iii: Outcomes indicators ...... 143 iv: Impact Indicators ...... 144 v: Conclusions: ...... 146 7. Shongwe Hospital ...... 147 i: Description ...... 147 ii: Input and process indicators ...... 147 iii: Outcomes indicators ...... 150 iv: Impact Indicators ...... 151 v: Conclusions: ...... 153 8. Tonga Hospital ...... 154

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 iv

i: Description ...... 154 ii: Input and process indicators ...... 154 iii: Outcomes indicators ...... 157 iv: Impact Indicators ...... 158 v: Conclusions: ...... 160

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 v

Introduction

Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.

This report aims to provide health managers at all levels within the health services, with a useful screening tool for assessing District Hospital management performance. It provides managers with a snap shot of how a facility is performing in key areas of hospital management. It focuses on individual facilities and assesses seven key hospital performance indicators listed in Table 1. Data on these seven indicators is retrieved primarily from the DHIS. Individual facility data is compared to the national and provincial indicator average values. The hospitals are assessed over a period of three financial years: 2008/2009; 2009/2010 and 2010/2011. These are depicted as 2008, 2009 and 2010 respectively in the graphs and text in the report. The data presented should be viewed with an awareness of problems common to routine data, namely incorrect and missing data, as well as specific contextual factors.

The report should be considered in conjunction with a number of other published documents including; Key District Health Indicators in Primary Health Care- Volume 1,- 2007, The Guidebook for District Hospital Managers- Health Systems Trust-2006, A District Hospital Service Package for South Africa – The South African National Department of Health – 2002, and the Negotiated Service Delivery Agreement.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 1

Table 1: Selected Hospital performance indicators: definitions and description

Indicator Definition Description Numerator Denominator Unit of reporting Average How long on The average Inpatients Separations: - Day length of average each length of time days + 1/2 Discharges + stay patient spends in inpatients spend Day patients Deaths + (ALOS) hospital in hospital Transfers out + Day patients

Cost per The average cost The average cost Total Total patient Rand patient day per patient day per patient per expenditure on day equivalent equivalent seen in a hospital day seen in a health per (CpPDE) hospital hospital

Usable bed The proportion of The number of Total patient Total usable Percent utilisation beds in hospital patient days days - bed days (%) rate (BUR) that were utilised during the (Inpatient days or occupied reporting period, + 1/2 Day expressed as a patients) x 100 percentage of the sum of the daily number of useable beds. Caesarean The proportion The number of Caesarean All deliveries Percent section rate deliveries in which caesarean section section in the facility (%) (CS rate) a caesarean deliveries, deliveries section is expressed as a performed percentage of all deliveries Facility The proportion of The number of all Total inpatient Total inpatient Percent crude death all inpatient inpatient deaths deaths separations- (%) rate separations that expressed as a Includes - (FCDR): are deaths percentage of all inpatient inpatient transfers out, separations day patients, inpatient deaths and inpatient discharges. Perinatal The number of The sum of still Still births and Total births in Perinatal mortality perinatal deaths births + those inpatient early facility deaths/ rate (PNMR) per 1000 births. babies dying neonatal 1000 The perinatal within 7 days of deaths in births period starts at life per 1000 births facility the beginning of foetal viability (28 weeks gestation or 1000g) and ends at the end of the 7th day after delivery Still birth The number of still The number of The number of The total Still rate (SBR): births per 1000 babies who are still births number of births/ births “born dead” per births 1000 1000 births births

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 2

Background

The Mpumalanga Province is divided into three District Municipalities demarcated as shown in Figure 1. In 2010, the province had 23 District Hospitals serving an estimated population of 3, 365,188 people. Table 2 gives a list of District Hospitals in the province by District and sub-district location. The number of useable beds per facility is also listed in Table 2.

Figure 1: Map of the Mpumalanga province depicting District boundaries

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 3

Table 2: District hospitals in Mpumalanga Province: Location by District and local municipality

District Name Sub-district Hospital Usable hospital Beds Gert Sibande – Albert Luthuli Carolina Hospital 79 DC30 Embhuleni Hospital 189

Govan Mbeki Bethal Hospital 187

Evander Hospital 112

Lekwa Standerton Hospital 171

Mkhondo Piet Retief Hospital 171

Pixley Ka Seme Amajuba Memorial Hospital 95

Elsie Ballot Hospital 22

Nkangala- DC 31 Delmas Bernice Samuels Hospital 29

Dr. JS Moroka Mmametlhake Hospital 60

Emakhazeni HA Grove Hospital 12

Waterval Boven Hospital 12

Emalahleni Impungwe Hospital 66 (Wolwekrans) Steven Middelburg Hospital 218 Tshwete Thembisile KwaMhlanga Hospital 148

Ehlanzeni –DC 32 Bushbuckridge Matikwana Hospital 178

Tintswalo Hospital 329

Barberton Barberton Hospital 155

Thaba Chweu Lydenburg Hospital 90

Sabie Hospital 83

Matibidi Hospital 50

Nkomazi Shongwe Hospital 183

Tonga Hospital 143

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 4

A Gert Sibande – DC30

Gert Sibande District had a population of approximately 943,137 people in 2010. It has 8 district hospitals, 56 clinics, 16 CHCs (Community Health Centres), 24 mobile services, 1 regional hospital and 1 specialised hospital. 1. Carolina Hospital

i: Description Carolina District Hospital has 79 beds and lies in the Albert Luthuli sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased sharply between 2008 and 2009(a 43% decrease), before increasing again in 2010. It was higher than the national and provincial averages throughout the reporting period.

Average Length of Stay 7.0 6.0 5.0

4.0

3.0 Days 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Carolina Average 6.9 4.4 5.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 5

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE declined marginally between 2008 and 2010. The 2010 value (R1559) was in line with the national average and both were lower than the provincial average.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Carolina Average 1 593.4 1 547.7 1 559.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 6

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR increased to 63% in 2009 before decreasing to its previous (2008) level in 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Carolina Average 57.9 62.7 57.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 7

iii: Outcome indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate decreased sharply between 2008 and 2009 and remained unchanged in 2010. It was in line with the provincial averages in 2009 and 2010, but was lower than the national averages throughout the reporting period.

Caesarean Section Rate 30.0

25.0

20.0 15.0

Percentage 10.0 5.0 0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Carolina Average 26.0 16.2 16.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 8

iv: Impact indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated, declining to a low rate in 2009 before increasing again in 2010. It was significantly higher than the national and provincial averages except in 2009 and 2010. These data should be reviewed and the reasons for the fluctuation observed and the high FCDR ascertained.

Facility Crude Death Rate 14.0 12.0 10.0

8.0 6.0 4.0 Percentage 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Carolina Average 10.9 5.6 11.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 9

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased significantly over the reporting period. The 2010 rate was closer to the national and province should be reviewed and the reasons for the extremely high rate in 2008 ascertained.

Perinatal Mortality Rate 200.0

160.0

120.0

80.0

40.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Carolina Average 180.1 56.0 36.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 10

3. Still birth rate (SBR): number of babies born dead/1000 births Similar to the PNMR, the SBR decreased significantly over the reporting period and was closer to the national and provincial averages in 2010.

Still Birth Rate

160.0

120.0

80.0

Still births/1000Still births 40.0

0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Carolina Average 171.2 51.2 30.3

v: Conclusions The reasons for the high ALOS and the low BUR should be ascertained. The FCDR data should be reviewed and the reasons for the fluctuation and the high rates observed ascertained. The PNMR and SBR data should also be reviewed to ascertain the reasons for the extremely high rates observed in 2008 and to exclude data error.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 11

2. Embhuleni Hospital

i: Description Embhuleni District Hospital has 189 beds and lies in the Albert Luthuli sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased to 3.7 days in 2009 before increasing again in 2010, when it was then in line with the national and provincial averages.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Embhuleni Average 5.0 3.7 4.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 12

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased significantly (2.6 times) over the reporting period. It was significantly higher than both the national and provincial averages in 2010. The reasons for this rapid large increase should be ascertained.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Embhuleni Average 852.3 1587.4 2255.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 13

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased steadily over the reporting period (a decline of 52%), and was lower than the national and provincial averages in 2010. These data should be reviewed to ascertain the reasons for the very high rate in 2008.

Usable Bed Utilisation Rate 140.0

120.0

100.0 80.0

60.0 Percentage 40.0 20.0 0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Embhuleni Average 123.0 76.3 58.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 14

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased steadily over the reporting period. It was lower than the national and provincial averages throughout this period.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Embhuleni Average 11.3 12.9 14.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 15

iv: Impact indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased significantly over the reporting period and was lower than the national and provincial averages in 2010.

Facility Crude Death Rate 14.0 12.0 10.0

8.0 6.0

4.0 Percentage 2.0 0.0 2008 2009 2010 SA Average 6.0 6.0 6.0 MP Average 7.0 7.0 6.0 Embhuleni Average 8.3 5.7 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 16

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR increased significantly between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the increase in the rate should be ascertained.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Embhuleni Average 20.1 46.9 46.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 17

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR increased significantly between 2008 and 2009, and then decreased slightly in 2010. It was higher than the national and provincial averages in 2009 and 2010. The reasons for this should be ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Embhuleni Average 18.1 31.4 29.3

v: Conclusions: The input and process indicators (the high CpPDE and low BUR) point to inefficiency at this hospital; the reasons for the rates observed should be ascertained. The high PNMR and SBR in 2009 and 2010 are concerning and the reasons for this should also be ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 18

3. Bethal Hospital

i: Description Bethal District Hospital has 187 beds and lies in the Govan Mbeki sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS declined between 2008 and 2009 before increasing in 2010. It was lower than the national and provincial averages throughout the reporting period.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Bethal Average 3.5 2.3 3.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 19

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased significantly between 2008 and 2009 and then declined slightly in 2010. It was higher than the national and provincial averages throughout the reporting period.

Cost per Patient Day Equivalent 3 000.0 2 500.0

2 000.0

1 500.0

Rands 1 000.0 500.0 0.0 2008 2009 2010 SA Average 1 256.0 1 384.4 1 543.1 MP Average 1 339.8 1 594.9 1 703.8 Bethal Average 1 409.9 2 278.6 1 916.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 20

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR fluctuated significantly, decreasing to a very low rate in 2009 and then increasing in 2010. It was higher than the national and provincial averages in 2010.These data should be reviewed to ascertain the reasons for the fluctuation observed and the true rates for the hospital.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Bethal Average 57.2 37.3 77.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 21

iii: Outcome indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate was relatively constant over the reporting period and was lower than the national and provincial averages.

Caesarean Section Rate 25.0

20.0

15.0

10.0

Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Bethal Average 13.0 14.0 13.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 22

iv: Impact indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR declined over the reporting period reaching a level of 2.6% in 2010. It was well below the national and provincial averages throughout the reporting period

Facility Crude Death Rate 14.0 12.0

10.0

8.0 6.0

4.0 Percentage 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Bethal Average 3.7 3.5 2.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 23

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR was unchanged between 2008 and 2009 and increased to 38/1000 births in 2010, when it was then higher than the national and provincial averages.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Bethal Average 26.1 26.5 38.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 24

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR fluctuated over the reporting period, decreasing between 2008 and 2009 and then increasing in 2010. The 2010 rate was higher than the national and provincial averages in the same year.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Bethal Average 22.9 15.4 27.4

v: Conclusions The reasons for the low ALOS and the high CpPDE should be ascertained. The BUR data should be reviewed to ascertain the reasons for the fluctuation observed and the true rates for the hospital. The high PNMR and SBR also require investigation.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 25

4. Evander Hospital

i: Description Evander District Hospital has 112 beds and lies in the Govan Mbeki sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased between 2008 and 2009 and was unchanged in 2010. It was lower than the national and provincial averages in 2009 and 2010.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Evander Average 4.5 3.8 3.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 26

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE fluctuated, increasing between 2008 and 2009 and then decreasing sharply in 2010, when it was then much lower than the national and provincial averages. The data should be reviewed to ascertain the reasons for the fluctuation and the true rates for the hospital.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Evander Average 1382.9 1808.7 1191.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 27

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased between 2008 and 2009 and was unchanged in 2010. It was higher than the national and provincial averages throughout the reporting period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Evander Average 79.9 71.3 71.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 28

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased slightly over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high rates should be ascertained.

Caesarean Section Rate 30.0

25.0

20.0 15.0

Percentage 10.0 5.0 0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Evander Average 24.2 26.3 27.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 29

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated, decreasing between 2008 and 2009 and then increasing sharply to 14% in 2010. The 2010 rate was much higher than the national and provincial averages. The reasons for this should be ascertained.

Facility Crude Death Rate 14.0 12.0

10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Evander Average 9.2 7.4 13.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 30

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased significantly between 2008 and 2010. It was well below the national and provincial averages in 2010.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Evander Average 56.1 36.2 25.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 31

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR decreased significantly over the reporting period. It was in line with national and provincial averages in 2010.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Evander Average 45.4 31.6 25.1

v: Conclusion: The CpPDE data should be reviewed to ascertain the reasons for the fluctuation observed and the true rates for the hospital. The reasons for the high CS rate and the high FCDR should also be ascertained as should the changes in the SBR and PNMR.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 32

5. Standerton Hospital

i: Description Standerton District Hospital has 171 beds and lies in the Lekwa sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS increased to 4.2 days in 2008 and was unchanged in 2010. It was in line with the national and provincial averages in 2009 and 2010.

Average Length of Stay 5.0

4.0

3.0 Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Standerton Average 3.8 4.2 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 33

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE was constant in 2008 and 2009 and increased to R1404 in 2010. It was lower than the national and provincial averages throughout the reporting period.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Standerton Average 1237.5 1236.8 1404.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 34

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased steadily over the reporting period, and was lower than the national and provincial averages in 2010.

Usable Bed Utilisation Rate 100.0

80.0

60.0

Percentage 40.0

20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Standerton Average 79.1 73.9 60.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 35

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate was high and increased steadily over the reporting period. It was significantly higher than the national and provincial averages throughout this period.

Caesarean Section Rate 40.0 35.0 30.0

25.0 20.0 15.0

10.0 Percentage 5.0 0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Standerton Average 27.1 31.8 38.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 36

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased significantly between 2008 and 2010, and was much lower than the national and provincial averages in 2010.

Facility Crude Death Rate 14.0 12.0 10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Standerton Average 8.4 7.7 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 37

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages in 2009 and 2010.

Perinatal Mortality Rate

60.0 50.0 40.0 30.0

20.0 Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Standerton Average 29.0 47.0 35.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 38

3. Still birth rate (SBR): number of babies born dead/1000 births As with the PNMR, the SBR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010.It was higher than the national and provincial averages throughout the reporting period.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Standerton Average 26.0 32.6 25.9

v: Conclusions: The reasons for the high CS rate should be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed and the high rates (higher than the national and provincial averages) in 2010.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 39

6. Piet Retief Hospital

i: Description Piet Retief District Hospital has 171 beds and lies in the Mkondo sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased significantly between 2008 and 2009, and with a further marginal decrease in 2010. It closer to the national and provincial averages in 2010

Average Length of Stay 8.0 7.0 6.0

5.0

4.0 Days 3.0 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 P. Retief Average 7.9 5.0 4.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 40

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased over the reporting period. It was lower than the national and provincial averages throughout this period.

Cost per Patient Day Equivalent 3000 2500

2000

1500

Rands 1000 500 0 2008 2009 2010 SA Average 1256 1384 1543 MP Average 1340 1595 1704 P. Retief Average 1 178 1 353 1 469

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 41

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR declined from a high level (90% in 2008) to 64% in 2010, a level in line with the national and provincial averages.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 P. Retief Average 89.9 69.9 64.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 42

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased steadily over the reporting period. It was higher than the provincial average in 2010, and was lower than the national average throughout the reporting period.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 P. Retief Average 13.9 15.6 17.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 43

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR was relatively constant in 2008 and 2009, and declined in 2010. It was higher than the national and provincial averages throughout the reporting period.

Facility Crude Death Rate 14.0

12.0 10.0 8.0

Percentage 6.0 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 P. Retief Average 8.7 8.9 7.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 44

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, increasing to a high level in 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 P. Retief Average 34.6 47.5 38.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 45

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was largely unchanged between 2008 and 2009 and decreased in 2010. The 2010 rate was in line with the national and provincial averages.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 P. Retief Average 28.0 28.9 23.6

v: Conclusions: The reason for the high FCDR should be ascertained. The PNMR data should be reviewed to ascertain the reasons for the fluctuation and the high rates observed.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 46

7. Amajuba Memorial Hospital

i: Description Amajuba Memorial District Hospital has 95 beds and lies in the Pixley Ka Seme sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was constant in 2008 and 2009 and increased to 4.1 days in 2010. The 2010 value was in line with the national and provincial averages in the same year.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Amajuba M Average 3.4 3.4 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 47

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased steadily over the reporting period. It was lower than the provincial average in 2010.

Cost per Patient Day Equivalent 3 000.0 2 500.0 2 000.0

1 500.0

Rands 1 000.0 500.0 0.0 2008 2009 2010 SA Average 1 256.0 1 384.4 1 543.1 MP Average 1 339.8 1 594.9 1 703.8 Amajuba M Average 1 531.7 1 635.5 1 670.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 48

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR was very low. It fluctuated slightly, decreasing between 2008 and 2009 before increasing in 2010. It was significantly lower than the national and provincial averages throughout the reporting period .The reasons for these very low rates should be ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage

20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Amajuba M Average 44.9 40.6 43.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 49

iii: Outcome indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased during the reporting period. It was much higher than the national and provincial averages throughout this period. The reasons for these high rates should be ascertained.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Amajuba M Average 19.4 23.4 24.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 50

iv: Impact indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased steadily between 2008 and 2010. The 2010 rate of 4.9% was lower than both the national and provincial averages.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Amajuba M Average 7.4 6.9 4.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 51

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, decreasing significantly between 2008 and 2009 before increasing in 2010. It was higher than the national and provincial averages in 2008 and 2010. These data should be reviewed and the reasons for the fluctuation observed and the high rates (in 2008 and 2010) ascertained.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Amajuba M Average 48.9 29.7 40.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 52

3. Still birth rate (SBR): number of still births/1000 births The SBR shows a trend similar to that of the PNMR. It fluctuated, reaching a low rate in 2009 before increasing in 2010. It was much higher than the national and provincial averages in 2010. These data should be reviewed and the reasons for the fluctuation observed and the high rates ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0 Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Amajuba M Average 35.8 25.3 33.7

v: Conclusions The reasons for the very low BUR should be ascertained. The CpPDE data should also be reviewed since it has remained rather low despite the very low BUR. The reasons for the high CS rates should also be ascertained. The PNMR and SBR data should be reviewed and the reasons for the fluctuation and the high rates observed ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 53

8. Elsie Ballot Hospital

i: Description Elsie Ballot District Hospital has 22 beds and lies in the Pixley Ka Seme sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively stable and was lower than the national and provincial averages throughout the reporting period.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Elsie Ballot Average 3.1 3.0 3.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 54

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE was stable between 2008 and 2009 and increased sharply in 2010. It was significantly higher than the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.

Cost per Patient Day Equivalent 3000.0 2500.0 2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Elsie Ballot Average 1532.1 1507.6 2250.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 55

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR increased steadily over the reporting period, and was higher than the national and provincial averages in 2010.

Usable Bed Utilisation Rate 100.0

80.0

60.0

Percentage 40.0

20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Elsie Ballot Average 60.9 64.8 68.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 56

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased significantly over the reporting period, and was in line with the provincial average in 2010.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Elsie Ballot Average 12.2 9.6 6.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 57

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was lower than the national and provincial averages throughout this period. The data should be reviewed and the reasons for the fluctuation observed ascertained.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Elsie Ballot Average 22.4 18.7 27.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 58

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR also fluctuated, decreasing to a low rate in 2009, and then increasing in 2010. The 2010 rate was higher than the national and provincial averages. The data should be reviewed and the reasons for the fluctuation observed ascertained.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Elsie Ballot Average 22.4 15.7 26.5

v: Conclusions: The CpPDE data should be reviewed and the reasons for the sharp increase in 2010 ascertained. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The PNMR and SBR data should be reviewed and the reasons for the fluctuations observed ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 59

B Nkangala – DC31

Nkangala District had a population of approximately 1,128,194 people in 2010. It has 7 district hospitals, 68 clinics, 18 CHCs, 22 mobile services and 1 provincial tertiary hospital. 1. Bernice Samuels Hospital

i: Description Bernice Samuels District Hospital has 29 beds and lies in the Delmas sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS fluctuated, decreasing to 1.9 days in 2009 before increasing in 2010. It was lower than the national and provincial averages throughout this period.

Average Length of Stay 5.0

4.0

3.0

2.0 Days

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 B. Samuels Average 3.9 1.9 3.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 60

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE fluctuated increasing significantly (by 84%) between 2008 and 2009 before declining to a level below the 2008 average in 2010. These data should be reviewed and reasons for the fluctuation observed ascertained.

Cost per Patient Day Equivalent 3500.0 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 B. Samuels Average 1636.6 3011.6 1392.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 61

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR fluctuated, decreasing significantly (by almost 50%) between 2008 and 2009, before increasing again in 2010. In 2010 it was higher than the national and provincial averages. These data should be reviewed and reasons for the fluctuation observed ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 B. Samuels Average 72.2 38.4 68.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 62

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated, decreasing significantly to a very low rate on 1.7% in 2009 before increasing in 2010. It was in line with the provincial average in 2010. These data should be reviewed to ascertain the reasons for the fluctuation observed.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 B. Samuels Average 7.9 1.7 6.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 63

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR increased significantly (more than two-fold), between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

Perinatal Mortality Rate

60.0 50.0 40.0 30.0

20.0 Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 B. Samuels Average 20.4 40.0 44.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 64

3. Still birth rate (SBR): number of babies born dead/1000 births As with the PNMR, the SBR increased significantly during the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the high SBR should be ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 B. Samuels Average 15.1 32.2 30.4

v: Conclusions: The ALOS, CpPDE, BUR, FCDR data should be reviewed to ascertain the reasons for the fluctuations observed. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the SBR and PNMR values that are above the national and provincial averages should be ascertained

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 65

2. Mmametlhake Hospital

i: Description Mmametlhake District Hospital has 60 beds and lies in the Dr JS Moroka sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased during the reporting period, and was in line with the national and provincial averages in 2010.

Average Length of Stay 6.0 5.0

4.0

3.0 Days 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Mmametlhake Av 5.2 4.9 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 66

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased steadily over the reporting period. It was higher than the national and provincial averages throughout this period.

Cost per Patient Day Equivalent 3000.0 2500.0 2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Mmametlhake Av 1487.9 1621.1 2046.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 67

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR was very high in 2008 and 2009, and was much higher than the national and provincial averages during this period. It decreased substantially in 2010, but remained higher than the national and provincial averages.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Mmametlhake Av 94.6 95.9 72.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 68

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate decreased between 2008 and 2009 and then increased in 2010. It was higher than the national and provincial averages in 2010.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Mmametlhake Av 17.4 16.9 21.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 69

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated marginally between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Mmametlhake Av 6.2 6.9 6.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 70

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased steadily over the reporting period. It was significantly higher than the national and provincial averages throughput this period. The reasons for the very high PNMR should be ascertained.

Perinatal Mortality Rate

70.0

60.0 50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Mmametlhake Av 60.4 54.6 44.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 71

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was constant in 2008 and 2009 and decreased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high SBR should be ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Mmametlhake Av 42.0 42.0 30.4

v: Conclusions: The reasons for the high CpPDE and the high CS rate should be ascertained. The declining trend of the PNMR and SBR should be maintained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 72

3. HA Grove Hospital

i: Description HA Grove District Hospital has 12 beds and lies in the Emakhazeni sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS increased steadily between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 HA Grove Average 2.3 2.9 3.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 73

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased between 2008 and 2010. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 HA Grove Average 2022.3 2339.5 2656.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 74

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR increased over the reporting period, and was higher than the national and provincial averages in 2009 and 2010. The reasons for the high BUR should be ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 HA Grove Average 67.4 75.8 83.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 75

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated; it decreased to a low rate of 2.9% in 2009 before increasing in 2010. The 2010 rate was in line with the provincial average. The data should be reviewed and the reasons for the fluctuation observed ascertained.

Facility Crude Death Rate 14.0

12.0

10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 HA Grove Average 5.6 2.9 6.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 76

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased between 2008 and 2009 before increasing in 2010. It was lower than the national and provincial averages throughout the reporting period. The data should be reviewed and the reasons for the fluctuation observed ascertained.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 HA Grove Average 28.3 19.8 21.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 77

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR decreased over the reporting period. It was lower than the national and provincial averages throughout this period.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 HA Grove Average 19.3 17.1 13.8

v: Conclusions: The reasons for the high CpPDE and the BUR should be ascertained. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The FCDR and PNMR data should be reviewed and the reasons for the fluctuations observed ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 78

4. Waterval Boven Hospital

i: Description Waterval Boven District Hospital has 12 beds and lies in the Emakhazeni sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively constant over the reporting period, and was lower than the national and provincial averages.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 W. Boven Average 3.1 3.0 3.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 79

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was much higher than the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain reasons for the high CpPDE and the fluctuation observed.

Cost per Patient Day Equivalent 4000.0 3500.0 3000.0

2500.0 2000.0 Rands 1500.0 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 W. Boven Average 2164.2 3832.5 2760.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 80

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR increased between 2008 and 2010. It was in line with the national and provincial averages in 2010.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 W. Boven Average 53.6 64.5 65.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 81

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed Data on the CS rates were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR increased steadily between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

Facility Crude Death Rate 14.0 12.0

10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 W. Boven Average 4.0 6.9 7.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 82

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased between 2008 and 2010. It was lower than the national and provincial averages in 2010.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 W. Boven Average 35.6 38.2 29.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 83

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR decreased significantly between 2008 and 2009, and increased marginally in 2010. It was in line with the national and provincial averages in 2010.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 W. Boven Average 35.6 22.4 23.9

v: Conclusions: The CpPDE data should be reviewed to ascertain the reasons for the high values and the fluctuation observed. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The increasing FCDR also requires attention.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 84

5. Impungwe Hospital

i: Description Impungwe District Hospital has 66 beds and lies in the Emalahleni sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was very high and was significantly higher than the national and provincial averages in 2008 and 2009. It decreased steadily over the reporting period and was closer to the national and provincial averages in 2010.

Average Length of Stay 9.0 8.0 7.0 6.0 5.0

4.0 Days Days 3.0 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Impungwe Average 8.8 7.5 4.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 85

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased over the reporting period and was significantly higher than the national and provincial averages in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Impungwe Average 1235.2 1350.9 2233.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 86

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased substantially between 2008 and 2009, with a further smaller decrease in 2010. It was lower than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Impungwe Average 61.3 57.9 56.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 87

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed Data on the CS rates were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR increased between and 2008 and 2009 and then decreased significantly in 2010. These data should be reviewed to ascertain the reasons for the fluctuation observed.

Facility Crude Death Rate 14.0

12.0

10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Impungwe Average 8.6 10.4 4.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 88

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births There were no PNMR data in 2009. The rates in 2008 and 2010 were significantly lower than the national and provincial averages. These data should be reviewed to confirm the 2008 and 2010 rates and to ascertain the reasons for the absence of data in 2009.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Impungwe Average 6.9 13.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 89

3. Still birth rate (SBR): number of babies born dead/1000 births As with the PNMR there were no data for 2009. The rate in 2010 was unchanged from that in 2008. These data should be reviewed to confirm the 2008 and 2010 rates and to ascertain the reasons for the absence of data in 2009.

Still Birth Rate 60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000 Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Impungwe Average 6.9 7.1

v: Conclusions: The reasons for the high CpPDE and the low BUR should be ascertained. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The FCDR data should be reviewed to ascertain the reasons for the fluctuation observed. The PNMR and SBR data should also be reviewed to confirm the rates observed in 2008 and 2010 and to ascertain the reasons for the absence of data in 2009.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 90

6. Middleburg Hospital

i: Description Middleburg District Hospital has 218 beds and lies in the Steven Tshwete sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was largely unchanged at about 4 days throughout the reporting period, and was in line with the national and provincial averages in 2010.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Middelburg Average 4.2 4.4 4.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 91

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased substantially between 2008 and 2010. It was much higher than the national and provincial averages in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0 2000.0

1500.0

1000.0 Rands 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Middelburg Average 1385.1 1675.2 2238.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 92

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased steadily between 2008 and 2010. It was lower than the national and provincial averages in 2009 and 2010.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Middelburg Average 69.2 63.5 57.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 93

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate fluctuated slightly between 2008 and 2010. It increased between 2008 and 2009 and decreased in 2010. It was higher than the provincial average in 2010.

Caesarean Section Rate 25.0

20.0

15.0

10.0

Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Middelburg Average 17.3 21.6 18.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 94

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR increased marginally between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Middelburg Average 6.2 6.9 6.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 95

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR increased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high PNMR should be ascertained.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Middelburg Average 39.2 43.0 50.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 96

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR increased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high SBR should be ascertained.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

Still births/1000 Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Middelburg Average 27.7 30.5 36.7

v: Conclusions: The reasons for the high CpPDE should be ascertained. The declining BUR requires investigation. The reasons for the high PNMR and SBR should also be ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 97

7. KwaMhlanga Hospital

i: Description KwaMhlanga District Hospital has 148 beds and lies in the Thembisile sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively constant between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

Average Length of Stay 6.0 5.0

4.0

Days 3.0 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 KwaMhlanga Average 5.2 5.5 5.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 98

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE fluctuated, decreasing between 2008 and 2009 and increasing to R1915 in 2010, when it was higher than the national and provincial averages.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 KwaMhlanga Average 1556.0 1471.1 1915.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 99

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR fluctuated slightly, increasing between 2008 and 2009 and then decreasing in 2010. It was in line with the national and provincial averages in 2010.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 KwaMhlanga Average 70.5 74.1 66.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 100

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate was largely constant over the reporting period. It was lower than the national and provincial averages throughout this period.

Caesarean Section Rate 25.0

20.0

15.0

Percentage 10.0

5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 KwaMhlanga Average 10.5 10.5 11.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 101

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR increased marginally between 2008 and 2009, before decreasing in 2010. It was higher than the national and provincial averages throughout this period.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 KwaMhlanga Average 8.2 9.0 7.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 102

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR increased slightly between 2008 and 2009 and then decreased substantially in 2010. It was significantly higher than the national and provincial averages throughout the reporting period. The reasons for the high PNMR should be ascertained.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0

20.0 Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 KwaMhlanga Average 54.1 56.0 41.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 103

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR fluctuated, increasing to a high rate of 41/1000 births in 2009 before decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period. The data should be reviewed and the reasons for the fluctuation and the high rates observed ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000 Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 KwaMhlanga Average 32.9 40.8 28.4

v: Conclusions: The reasons for the high CpPDE should be ascertained. Although the PNMR and SBR declined, they were higher than the national and provincial averages; the reasons for this should be ascertained. The SBR data should also be reviewed to ascertain the reasons for the fluctuation observed.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 104

C Ehlanzeni – DC32

Ehlanzeni District had a population of approximately 1,563,857 people in 2010. It has 8 district hospitals, 105 clinics, 14 CHCs, 32 mobile services 1 specialised hospital and 1 provincial tertiary hospital.

1. Matikwana Hospital

i: Description Matikwana District Hospital has 178 beds and lies in the Bushbuckridge sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively constant throughout the reporting period and was in line with the national and provincial averages.

Average Length of Stay 5.0

4.0

3.0

2.0 Days

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Matikwana Average 4.5 4.3 4.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 105

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE was very low in 2008, and increased steadily over the reporting period. It was closer to national and provincial averages in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Matikwana Average 790.8 1028.3 1598.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 106

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR increased slightly between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Matikwana Average 82.4 85.4 84.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 107

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate decreased sharply between 2008 and 2009, with a further smaller decline in 2010. It was lower than the national and provincial averages in 2009 and 2010.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Matikwana Average 24.4 13.0 11.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 108

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR was constant between 2008 and 2009 and decreased in 2010. It was higher than the national and provincial averages throughout the reporting period.

Facility Crude Death Rate 14.0 12.0 10.0 8.0

6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Matikwana Average 7.4 7.3 6.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 109

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, increasing between 2008 and 2009, and then decreasing in 2010 to a rate in line with that observed in 2008. It was lower than the national and provincial averages in 2010.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Matikwana Average 31.9 36.0 30.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 110

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was relatively constant throughout the reporting period and was lower than the national and provincial averages.

Still Birth Rate

60.0 50.0 40.0 30.0

20.0 Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Matikwana Average 21.2 22.6 20.2

v: Conclusions: The indicators for this hospital are generally below or in line with the national or provincial averages, and should be maintained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 111

2. Tintswalo Hospital

i: Description Tintswalo District Hospital has 329 beds and lies in the Bushbuckridge sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was high. It was constant at 8 days in 2008 and 2009 and decreased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high ALOS should be ascertained.

Average Length of Stay 9.0 8.0 7.0

6.0

5.0

Days 4.0 3.0 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Tintswalo Average 8.0 8.0 6.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 112

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE fluctuated, increasing between 2008 and 2009 and then decreasing in 2010, when it was then lower than the national and provincial averages.

Cost per Patient Day Equivalent 3000.0 2500.0 2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Tintswalo Average 1262.6 1549.2 1394.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 113

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR was constant in 2008 and 2009 and decreased in 2010. It was higher than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Tintswalo Average 77.5 77.6 69.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 114

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased slightly between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

Caesarean Section Rate 25.0

20.0

15.0

10.0

Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Tintswalo Average 14.6 16.5 13.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 115

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased over the reporting period. It was in line with the national and provincial averages in 2010.

Facility Crude Death Rate 14.0 12.0

10.0

8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Tintswalo Average 9.8 8.4 5.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 116

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, increasing between 2008 and 2009, and then decreasing in 2010, when it was lower than the national and provincial averages. The data should be reviewed and the reasons for the fluctuation observed ascertained.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Tintswalo Average 26.9 37.7 25.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 117

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR fluctuated slightly. It was lower than the national and provincial averages throughout the reporting period.

Still Birth Rate

60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Tintswalo Average 19.6 15.8 18.5

v: Conclusions: The reasons for the high ALOS should be ascertained. The PNMR data should be reviewed and the reasons for the fluctuation observed ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 118

3. Barberton Hospital

i: Description Barberton District Hospital has 155 beds and lies in the Umjindi sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively constant, and was lower than the national and provincial averages.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Barberton Average 3.9 4.0 3.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 119

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased steadily between 2008 and 2010. It was significantly higher than the national and provincial averages throughout the reporting period. The reasons for this high CpPDE should be ascertained.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Barberton Average 2250.7 2618.4 2559.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 120

3. Usable bed utilisation rate (BUR): measures occupancy of beds that are available for use The BUR increased steadily between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

Percentage 40.0

20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Barberton Average 53.9 60.6 62.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 121

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate increased marginally between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for this high rate should be ascertained.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Barberton Average 20.6 21.3 22.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 122

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR was constant in 2008 and 2010, and decreased significantly in 2010. It was much lower than the national and provincial averages in 2010. These data should be reviewed to confirm the very low rate observed in 2010.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Barberton Average 5.8 5.7 2.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 123

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR was relatively constant between 2008 and 2010 and was lower than the national and provincial averages.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Barberton Average 25.1 26.5 26.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 124

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was constant in 2008 and 2009, and increased to 22/1000 births in 2010, when it was then generally in line with the national and provincial averages.

Still Birth Rate

60.0 50.0 40.0 30.0

20.0 Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Barberton Average 17.6 17.9 22.1

v: Conclusions: The reasons for the high CpPDE, and the high CS rates should be ascertained. The FCDR data should be reviewed to confirm the very low rate observed in 2010.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 125

4. Lydenburg Hospital

i: Description Lydenburg District Hospital has 90 beds and lies in the Thaba Chweu sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively constant, and was in line with the national and provincial averages in 2009 and 2010.

Average Length of Stay 5.0

4.0

3.0

2.0 Days

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Lydenburg Average 4.0 4.3 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 126

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased over the reporting period. It was in line with the national average and was lower than the provincial average in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0 2000.0

1500.0

1000.0 Rands 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Lydenburg Average 1377.5 1567.7 1572.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 127

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR fluctuated, increasing to 68% in 2009 and then decreasing in 2010. It was lower than the national and provincial averages throughout the reporting period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

Percentage 40.0

20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Lydenburg Average 58.5 68.4 62.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 128

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate deceased over the reporting period reaching a rate of 17% in 2010. It was higher than the provincial averages throughout this period, and was lower than the national average in 2010.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Lydenburg Average 21.1 20.3 17.3

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 129

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased over the reporting period. It was lower than the national and provincial averages in 2010.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Lydenburg Average 6.4 6.3 4.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 130

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR increased steadily between 2008 and 2010, and was higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0

20.0 Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Lydenburg Average 28.7 34.7 41.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 131

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR increased significantly over the reporting period and was higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Lydenburg Average 19.3 27.9 31.8

v: Conclusions: The reasons for the high PNMR and SBR should be ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 132

5. Sabie Hospital

i: Description Sabie District Hospital has 83 beds and lies in the Thaba Chweu sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased between 2008 and 2010, and was lower than the provincial average in 2010.

Average Length of Stay 6.0 5.0

4.0

3.0 Days 2.0 1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Sabie Average 5.5 4.4 3.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 133

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased steadily over the reporting period. It was in line with the provincial average but higher than the national average in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Sabie Average 1402.9 1608.2 1703.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 134

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR declined significantly over the reporting period to a level well below the national and provincial averages in 2010. The reasons for this significant decline should be ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Sabie Average 76.3 69.6 53.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 135

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate fluctuated marginally. It was significantly higher than the national and provincial averages throughout the reporting period. The reasons for the high rates should be ascertained.

Caesarean Section Rate 30.0 25.0

20.0 15.0

10.0 Percentage 5.0 0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Sabie Average 25.8 27.8 24.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 136

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR declined over the reporting period. It was lower than the national and provincial averages throughout this period.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0 Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Sabie Average 4.7 4.6 3.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 137

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuation observed.

Perinatal Mortality Rate 60.0

50.0 40.0 30.0 20.0

10.0 Deaths/1000 births 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Sabie Average 36.0 45.3 38.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 138

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR also fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was in line with the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuation observed.

Still Birth Rate

60.0 50.0 40.0 30.0 20.0

Still births/1000Still births 10.0 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Sabie Average 19.7 31.3 24.3

v: Conclusions: The reasons for the low BUR in 2010 should be ascertained. The reasons for the high CS rates and the high PNMR should also be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 139

6. Matibidi Hospital

i: Description Matibidi District Hospital has 50 beds and lies in the Thaba Chweu sub- district

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS decreased from 4 days in 2008 to 3 days and 2010. It was lower than the national and provincial averages in 2009 and 2010.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Matibidi Average 4.3 3.4 3.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 140

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased significantly over the reporting period. It was higher than the national and provincial averages throughout this period.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Matibidi Average 1621.9 1747.3 2258.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 141

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR was very low throughout the reporting period, and reached an exceptionally low level of 23% in 2010. It was much lower than the national and provincial averages. The reasons for the low BUR should be ascertained.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Matibidi Average 38.7 32.3 23.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 142

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate was very low (3.9%) in 2008, decreased further in 2009, and data were not available in 2010. This requires urgent investigation.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Matibidi Average 3.9 0.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 143

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased steadily over the reporting period. It was higher than the national and provincial averages.

Facility Crude Death Rate 14.0 12.0

10.0 8.0 6.0

Percentage 4.0 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Matibidi Average 7.6 7.3 6.8

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 144

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR decreased steadily over the reporting period and was in line with and the national and provincial averages in 2010.

Perinatal Mortality Rate

60.0

50.0 40.0 30.0 20.0

Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Matibidi Average 41.9 34.9 32.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 145

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR decreased over the reporting period and was in line with the national and provincial averages in 2009 and 2010.

Still Birth Rate 60.0

50.0 40.0 30.0 20.0

10.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Matibidi Average 30.0 25.0 24.8

v: Conclusions: The high CpPDE and very low BUR require urgent attention as they suggest inefficiency at this hospital. The reasons for the low CS rate and absence of CS rate data in 2010 should also be ascertained. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 146

7. Shongwe Hospital

i: Description Shongwe District Hospital has 183 beds and lies in the Nkomazi sub- district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS was relatively stable over the reporting period. It was in line with the national and provincial averages in 2010.

Average Length of Stay 5.0

4.0

3.0

Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Shongwe Average 4.2 3.9 4.1

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 147

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE decreased over the reporting period. It was lower than the provincial average in 2010.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0 Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Shongwe Average 1890.8 1695.3 1602.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 148

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR decreased over the reporting period. It was higher than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0

Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Shongwe Average 80.0 72.5 71.4

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 149

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate fluctuated, increasing to 15.3% in 2009 before decreasing in 2010. It was lower than the national and provincial averages throughout the reporting period.

Caesarean Section Rate 25.0

20.0

15.0

10.0 Percentage

5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Shongwe Average 14.2 15.3 13.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 150

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR fluctuated; increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

Facility Crude Death Rate 14.0 12.0

10.0

8.0 6.0

4.0 Percentage 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Shongwe Average 6.3 7.1 5.0

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 151

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR was extremely high in 2008, and decreased significantly in 2009, with a further smaller decrease in 2010. It was higher than the national and provincial averages throughout the reporting period. The data should be reviewed and reasons for the very high rate in 2008 ascertained.

Perinatal Mortality Rate

140.0

120.0 100.0 80.0 60.0

40.0 Deaths/1000 births 20.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Shongwe Average 135.8 42.4 39.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 152

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was also extremely high in 2008, and decreased significantly in 2009, with further smaller decrease in 2010. It was higher than the national and provincial averages throughout the reporting period. The data should be reviewed and reasons for the high rate in 2008 ascertained.

Still Birth Rate

120.0

100.0 80.0 60.0 40.0

20.0 Still births/1000Still births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Shongwe Average 101.7 30.5 25.5

v: Conclusions: The PMNR and SBR data should be reviewed and the reasons for the extremely high rates observed in 2008 ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 153

8. Tonga Hospital

i: Description Tonga District Hospital has 143 beds and lies in the Nkomazi sub-district.

ii: Input and process indicators 1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital The ALOS increased marginally. It was lower than the national and provincial averages throughout the reporting period.

Average Length of Stay 5.0

4.0

3.0 Days 2.0

1.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 MP Average 4.7 4.3 4.3 Tonga Average 3.2 3.4 3.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 154

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital The CpPDE increased over the reporting period, and was lower than the national and provincial averages throughout this period.

Cost per Patient Day Equivalent 3000.0 2500.0

2000.0

1500.0

Rands 1000.0 500.0 0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 MP Average 1339.8 1594.9 1703.8 Tonga Average 1157.7 1351.3 1481.5

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 155

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use The BUR was largely constant in 2008 and 2009 and decreased slightly in 2010. It was higher than the national and provincial averages throughout this period.

Usable Bed Utilisation Rate 100.0

80.0

60.0

40.0 Percentage 20.0

0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 MP Average 74.6 67.7 65.9 Tonga Average 76.0 76.6 74.9

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 156

iii: Outcomes indicators Caesarean section (CS) rate: proportion of deliveries for which a CS is performed The CS rate fluctuated between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

Caesarean Section Rate 25.0

20.0

15.0

Percentage 10.0

5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 MP Average 14.6 16.2 15.8 Tonga Average 11.6 14.9 12.7

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 157

iv: Impact Indicators 1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths The FCDR decreased steadily over the reporting period. It was lower than the national and provincial averages throughout this period.

Facility Crude Death Rate 14.0 12.0

10.0

8.0 6.0

4.0 Percentage 2.0 0.0 2008 2009 2010 SA Average 6.4 6.0 5.7 MP Average 7.2 6.7 6.2 Tonga Average 5.0 4.8 3.2

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 158

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births The PNMR fluctuated marginally between 2008 and 2010. It was higher than the national and provincial averages.

Perinatal Mortality Rate

60.0 50.0 40.0 30.0

20.0 Deaths/1000 births 10.0 0.0 2008 2009 2010 SA Average 31.0 32.1 32.8 MP Average 34.3 35.8 33.2 Tonga Average 39.1 37.3 40.6

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 159

3. Still birth rate (SBR): number of babies born dead/1000 births The SBR was constant in 2008 and 2009 and increased in 2010. It was higher than the national and provincial averages in 2010.

Still Birth Rate 60.0

50.0 40.0 30.0 20.0

10.0 Still Still births/1000 births 0.0 2008 2009 2010 SA Average 22.2 22.8 23.0 MP Average 24.5 24.8 24.3 Tonga Average 23.1 23.0 26.7

v: Conclusions: The BUR was higher than the national and provincial averages and the reasons for this should be ascertained. The reasons for the increasing PNMR and SBR should also be ascertained.

District Hospital Performance Assessment: Mpumalanga Province 2008-2010 160