24 Western Cape Province

SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Cape Town Metropolitan Municipality (CPT)

Cape Town Metro has a population of 4 067 774, with a population density of 1 667.3 persons per km2, and is situated in the southern peninsula of the Western Cape Province. The Metro incorporates eight health sub-districts, namely Eastern, Western, Northern, Southern, Khayelitsha, Klipfontein, Tygerberg and Mitchells Plain, and falls into socio-economic Quintile 5, placing it among the wealthiest districts. Estimated medical scheme coverage is 23.9%.

Social determinants of healtha Population per selected category

Unemployment ratea 23.9% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 31.9% under 1 year 65 341 65 410 65 433 64 937 No schooling 2.0% under 5 years 337 760 336 573 334 469 331 642 Matric 34.0% 05-09 years 333 890 335 588 336 607 337 873 Higher education 14.4% 10-14 years 309 870 316 161 322 933 328 693 Households 1 264 949 15-19 years 311 971 311 028 309 296 308 660 Female-headed households 40.0% 20-24 years 334 449 334 547 335 000 334 901 Formal dwellings 81.6% 25-29 years 364 884 363 271 362 164 361 234 Flush toilet connected to sewerage 91.0% 30-34 years 342 138 352 159 363 574 376 021 Weekly refuse removal 87.8% 35-39 years 330 068 331 333 330 115 327 224 Piped water inside dwellings 76.7% 40-44 years 296 409 302 097 307 905 313 201 Electricity for lighting 97.2% 45-49 years 266 370 270 296 273 963 277 903 Blue Drop water score 95.9% 50-54 years 227 744 234 291 240 626 246 290 55-59 years 189 659 194 475 199 218 204 278 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 147 502 153 727 160 094 166 122 65-69 years 112 158 115 592 119 136 123 130 70-74 years 79 660 83 473 87 177 90 637 75-79 years 47 770 50 826 54 149 57 771 80 years and older 38 615 41 604 44 674 47 826 Total 4 070 914 4 127 040 4 181 107 4 233 412 Estimated pregnant women* 69 915 69 989 70 013 69 483 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

747 Section B: NationalProfile Western and District Cape ProfilesProvince

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Eastern SD - 11 0 2 0 0 2 Khayelitsha SD - 7 1 1 0 0 0 Klipfontein SD - 9 2 1 0 0 1 Mitchells Plain SD - 8 1 1 0 0 2 Northern SD - 10 1 0 0 0 3 Southern SD - 15 1 2 1 1 6 Tygerberg SD - 11 2 1 0 1 7 Western SD - 11 1 1 1 2 11 Cape Town - 82 9 9 2 4 32 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Cape Town 2 010 3 152 1 747 3 572 1 085 541 39 112 111 49 Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 CT Eastern SD Indicator 1.9 - - - - - Numerator 1 067 555 - - - - - Denominator 6 653 601 - - - - - CT Khayelitsha SD Indicator 3.2 - - - - - Numerator 1 473 956 - - - - - Denominator 5 454 294 - - - - - CT Klipfontein SD Indicator 2.7 - - - - - Numerator 1 129 151 - - - - - Denominator 5 013 462 - - - - - CT Mitchells Plain SD Indicator 2.5 - - - - - Numerator 1 149 362 - - - - - Denominator 5 471 040 - - - - - CT Northern SD Indicator 1.7 - - - - - Numerator 680 876 - - - - - Denominator 4 944 387 - - - - - CT Southern SD Indicator 1.7 - - - - - Numerator 1 036 135 - - - - - Denominator 7 476 855 - - - - - CT Tygerberg SD Indicator 2.8 - - - - - Numerator 1 850 571 - - - - - Denominator 7 869 831 - - - - - CT Western SD Indicator 2.4 - - - - - Numerator 1 226 876 - - - - - Denominator 6 135 564 - - - - - Cape Town Indicator 2.4 9.4 50.4 1 819 1 178 379 Numerator 9 614 482 12 64 5 631 632 596 3 645 270 098 3 645 270 098 Denominator 49 019 034 127 127 3 095 586 3 095 586 9 614 482 Western Cape Indicator 2.3 15.2 70.7 1 742 1 089 379 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

748 SectionSection B: B: Profile National Western and DistrictCape Province Profiles ------1.5 6.6 2.2 2.5 2.5 20.3 1 187 1 649 81 711 24 872 90 019 196 602 196 (%) OPD new client not not client referred rate rate referred ------4.1 4.1 4.4 5.0 0.8 5.4 154 2 874 2 505 2 022 5 533 4 858 19 581 65 586 65 49 862 135 029 rate (%) Inpatient Inpatient crude death ------85.4 78.8 86.8 85.4 85.4 84.3 99 291 78 222 78 303 811 505 215 820 616 355 914 438 584 438 960 420 960 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 195 347 438 5 194 6 248 55 05 4 227 5 432 5 432 123 748 435 898 435 day 1 116 423 1 116 2 891 991 2 399 594 6 064 780 (Rand) equivalent equivalent 773 714 194 per patient Expenditure ------6.1 6.1 6.1 6.7 4.0 6.9 19 581 78 222 78 65 58665 777 556 49 862 820 616 135 029 438 584 438 (Days) Average length of of length stay - total ------7.3 0.6 3.7 5.2 119 303 811 37.2 1 131 1 250 15 414 34 218 18 804 (%) OPD new client not not client referred rate rate referred ------63 1.4 0.3 2.3 2.3 556 18 971 23 933 rate (%) Inpatient Inpatient crude death ------90.8 89.4 78.3 5.0 96.0 104.6 1 923 74 833 110 668 110 12 188 961 619 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------2 314 2 871 3 024 2 652 2 894 91 988 142 412 day (Rand) equivalent equivalent per patient 408 735 810 621 703 801 Expenditure ------4.1 4.6 4.4 4.0 5.3 18 971 78 293 893 212 066 78 293 23 933 42 904 234 400 196 757 42 904 110 668 110 188 961 (Days) Average length of of length stay - total 2.1 1.8 3.8 2.9 247 791 305 27.0 18.9 16.2 62.3 18.2 59.3 8 366 1 038 28 412 17 262 16 698 16 19 234 31 034 150 198 (%) OPD new client not not client referred rate rate referred 2.1 5.1 3.1 4.4 2.6 2.9 2.7 3.0 4.2 3.0 120 629 864 650 403 1 047 5 626 27 723 3 550 1 522 1 030 4 488 23 729 27 003 29 770 23 907 37 782 26 984 21 343 145 707 145 rate (%) Inpatient Inpatient crude death 67.4 74.2 91.8 84.3 95.3 83.3 85.9 83.5 84.8 115.4 9 149 148 13 115 17 674 10 951 94 910 94 047 113 527 109 512 108 195 109 729 120 526 104 401 534 743 (%) utilisation rate - total Inpatient bed District Hospital District 302 6 617 1 462 1 875 2 556 2 406 3 030 2 307 2 796 2 568 2 480 2 14 913 115 951 142 183 137 573 137 139 834 131 779 180 393 795 733 582 756 day 1 973 411 1 973 411 (Rand) 98 673 595 94 834 542 equivalent equivalent per patient 324 224 229 423 705 597 351 700351 004 338 663 251 Expenditure 4.6 3.6 4.4 2.3 4.4 3.7 3.3 2.6 3.2 3.2 9 149 5 626 64 887 35 50 13 115 23 729 29 770 23 907 79 982 342 021 672 79 982 94 047 37 782 21 343 108 195 145 707 145 109 729 120 526 534 743 (Days) Average length of of length stay - total Denominator Numerator Indicator Denominator Numerator Numerator Indicator Denominator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Denominator Indicator Numerator Indicator Indicator Numerator Indicator D

CT Western SD CT Tygerberg SD CT Southern SD Southern CT CT Mitchells Plain SD Plain Mitchells CT CT Klipfontein SD CT Khayelitsha SD Khayelitsha CT Western Cape Western South Africa South Cape Town CT Eastern SD Source: HIS and BAS.

749 Section B: NationalProfile Western and District Cape ProfilesProvince

Annual trends Management and efficiency indicators for the service delivery platform, 2016/17

WC, CPT, City of Cape Town Metropolitan Municipality, SEQ 5 (least deprived)

8 Measure Names IndValue Inpatient crude 6 Prov_av death rate ZA_av

1_Impact 4

1_Management 2 8 6 Average length of stay (district 4 hospitals) 2

2_Outcome Expenditure per patient day 3K equivalent (district 2K hospitals) 1K

Inpatient bed 100 utilisation rate (district hospitals) 50

100 3_Output OPD new client not referred rate 50 (district hospitals)

0 100

Percentage 50 Ideal clinics

Provincial and 3K LG District Health Services 2K expenditure per capita (uninsured) 1K

Provinc ial and 1500

4_Process_input LG PHC expenditure per 1000 capita (uninsured) 500

Provincial and 400 LG PHC expenditure per PHC headcount 200

2008 2010 2012 2014 2016 2018 Year

750 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 12 67 29 36 141 100 450 1 132 10 665 10 60 303 Total District District 2 182 7982 182 11 28 25 65 84 130 278 636 5 533 10 030 tertiary 1 116 423 1 116 Central/ hospital 10 68 619 15 555 15 2016/17 Hospital Regional Regional 84 185 189 4 488 15 961 795 733 234 400 District District Hospital - 1 - - 1 1 - 6 1 8 2 5 5 1 25 20 122 18 757 18 36 242 / MOU PHC / CHC 21 43 110 150 433 1 138 10 755 10 Total District District 2 212 9342 212 17 31 80 85 90 138 275 699 5 615 10 245 62 109 tertiary Central/ 1 138 149 1 138 Hospital 16 92 174 648 16 210 2015/16 Hospital Regional Regional 32 170 4 453 16 575 16 District District Hospital - 3 1 - 4 1 -- 4 6 6 4 5 3 39 95 34 19 079 / MOU PHC / CHC 18 85 34 124 320 358 1 207 10 428 63 805 Total District District 2 183 3512 183 34 527 802 826 237 432 13 72 26 113 171 276 659 5 606 10 318 tertiary Central/ Hospital 1 139 8461 139 - 17 12 93 253 644 16 237 225 941 2014/15 Hospital Regional Regional 11 52 40 164 4 129 17 368 783 148 District District Hospital - 5 - ---77---66------4-15-1179-1- - - 1 2 4 2 13 16 49 131 6 656 - - - 6 656 7 040 - - - 7 040 - - - - - 34 416 19 882 / MOU* PHC / CHC

Death in facility – 59 months 12 Death in facility months 29 days - 11 Death in facility 8-28 days Death in facility 0-7days

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata Inpatient death total Patient day equivalent day Patient TB Deaths Pneumonia death under 5 years Severe acute malnutrition death under 5 years Diarrhoea death under 5 years Live births birthsStill Maternal deaths deaths Maternal D (Number) Source: HIS. *MOU – Maternal Obstetric Unit.

751 Section B: NationalProfile Western and District Cape ProfilesProvince

Burden of disease profile For the percentage of deaths by broad cause, deaths are classified into four groups namely: (i) injuries; (ii) non-communicable diseases; (iii) HIV and TB; and (iv) communicable diseases together with maternal perinatal and nutritional conditions. Data are given by gender and age group for the period 2010–2015. The second part of the graph shows the 10 leading single causes of death within each age group (both genders) for 2010–2015 combined.

WC,Percentage Cape Town: of deaths CPT, by 2010broad -cause 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 63% 5% 25% 6% 65% 5% 22% 8% causes and 5-14 23% 11% 34% 33% 18% 8% 27% 46% single leading 15-24 12% 43% 20% 25% 3%10% 10% 78% causes 25-64 6% 30% 58% 6% 4% 25% 48% 23% 65+ 7%2% 89% 3% 5%3% 88% 3% Broadcause 10% 16% 69% 5% 8% 16% 56% 20% Total Injury NCD Rank.. Female Male 1 Preterm birth complications (16.3%) Preterm birth complications (18.6%) HIV and TB 2 Diarrhoeal diseases (11.9%) Diarrhoeal diseases (12.0%) Comm_mat_peri_nut 3 Lower respiratory infections (11.8%) Lower respiratory infections (11.0%) 4 Birth asphyxia (6.1%) Birth asphyxia (6.5%) Prov, District 5 Sepsis/other newborn infectious (5.6%) Sepsis/other newborn infectious (6.0%) WC, Cape Town: CPT 6 Congenital heart anomalies (5.4%) Congenital heart anomalies (4.3%) Show history

<5 years <5 7 HIV/AIDS (4.0%) HIV/AIDS (3.6%) 8 Other respiratory (3.7%) Other respiratory (3.5%) Percentages are shown 9 Other perinatal conditions (3.4%) Other perinatal conditions (3.4%) according to all the deaths 10 Other congenital abnormalities (3.4%) Other congenital abnormalities (3.1%) within the age/gender 1 Road injuries (10.1%) Road injuries (13.4%) category of each box, 2 Fires, hot substances (9.6%) Drowning (9.3%) although only the leading 3 HIV/AIDS (7.7%) Fires, hot substances (7.6%) 10 causes are displayed. 4 Accidental threats to breathing (5.6%) HIV/AIDS (6.3%) 5 Other malignant neoplasms (4.4%) Mechanical forces (5.3%)

5-14 6 Tuberculosis (4.0%) Interpersonal violence (4.5%) 7 Lower respiratory infections (3.8%) Accidental threats to breathing (3.9%) 8 Meningitis/encephalitis (3.4%) Leukaemia (3.2%) 9 Leukaemia (3.1%) Meningitis/encephalitis (2.7%) 10 Mechanical forces (2.9%) Other malignant neoplasms (2.5%) 1 HIV/AIDS (26.7%) Interpersonal violence (33.5%) 2 Tuberculosis (16.5%) Mechanical forces (29.2%) 3 Mechanical forces (5.5%) Tuberculosis (6.1%) 4 Interpersonal violence (4.7%) Accidental threats to breathing (5.5%) 5 Accidental threats to breathing (4.2%) Road injuries (4.3%)

15-24 6 Fires, hot substances (4.0%) HIV/AIDS (3.5%) 7 Road injuries (3.3%) Fires, hot substances (2.5 %) 8 Lower respiratory infections (3.0%) Drowning (1.0%) 9 Other musculo-skeletal (2.0%) Lower respiratory infections (0.9%) 10 Leukaemia (1.5%) Other neurological conditions (0.8%) 1 HIV/AIDS (19.9%) HIV/AIDS (12.9%) 2 Tuberculosis (10.2%) Tuberc ulosis (11.6%) 3 Cerebrovascular disease (6.4%) Ischaemic heart disease (7.7%) 4 Ischaemic heart disease (5.8%) Mechanical forces (7.5%) 5 Breast (5.4%) Interpersonal violence (6.9%)

25-64 6 Diabetes mellitus (4.2%) Trachea/bronchi/lung (5.7%) 7 Trachea/bronchi/lung (3.3%) Cerebrovascular disease (4.6%) 8 Nephritis/nephrosis (3.3%) COPD (3.6%) 9 Cervix (2.6%) Accidental threats to breathing (2.7%) 10 COPD (2.3%) Diabetes mellitus (2.5%) 1 Ischaemic heart disease (16.2%) Ischaemic heart disease (17.4%) 2 Cerebrovascular disease (13.7%) Cerebrovascular disease (9.8%) 3 Diabetes mellitus (6.4%) Trachea/bronchi/lung (7.5%) 4 Nephritis/nephrosis (4.7%) COPD (6.8%) 5 Hypertensive heart disease (4.7%) Prostate (5.8%)

65+ 6 Trachea/bronchi/lung (4.7%) Nephritis/nephrosis (4.4%) 7 COPD (4.5%) Diabetes mellitus (4.2%) 8 Alzheimer’s and other dementias (4.0%) Lower respiratory infections (3.2%) 9 Breast (3.9%) Colo-rectal (2.9%) 10 Lower respiratory infections (3.8%) Tuberculosis (2.5%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (34.2%) n=102 HIV/AIDS (32.0%) n=6 401 2 Other maternal (29.9%) n=89 Tuberculosis (14.9%) n=2 975 3 Hypertension in pregnancy (17.4%) n=52 Breast (3.7%) n=743 4 Abortion (10.9%) n=33 Cerebrovascular disease (3.5%) n=699 5 Maternal haemorrhage (5.3%) n=16 Lower respiratory infections (2.5%) n=508

15-49 6 Maternal sepsis (2.3%) n=7 Nephritis/nephrosis (2.4%) n=472 Female 7 Cervix (2.2%) n=444 8 Interpersonal violence (2.1%) n=427 9 Ischaemic heart disease (2.1%) n=419 10 Fires, hot substances (2.0%) n=391

752 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Maternal and Women’s Health

Numerator - 693WC, CPT, City 302of Cape Town4 Metropolitan853 Municipality, 6 570 SEQ 86 287 5 (least deprived) 3 796 Denominator 5 553 698 5 532 8 264 127 093 1 505 700 5 532 800 Measure Names CT Northern SD Indicator - 98.8 5.1 600 66.7 38.0 62.3 198.8 IndValue Maternal Prov_av Numerator - 409 mortality in85 400 2 982 4 543 69 515 3 320 facility ratio ZA_av Denominator 1 668 414 1_Impact 1 670 200 4 471 143 277 1 338 399 1 670 CT Southern SD Indicator - 123.8 5.6 0 64.2 30.7 50.1 33.0 80 Numerator - 369 633 3 888 5 427 81 036 3 761 Denominator 11 568 298 Antenatal11 399 1st 60 6 052 2 124 711 1 942 731 11 399 visit before 20 CT Tygerberg SD Indicator 109.8 66.1 weeks rate5.3 40 69.6 54.3 95.0 43.5

Numerator 18 434health women's and 2_Maternal 878 6 890 9 390 168 143 7 159 20 Denominator 16 393 657 16 443 9 893 207 536 2 123 790 16 443 200 CT Western SD Indicator 119.9 102.6 Couple year3.3 61.2 54.2 80.0 59.5 Numerator 13 782 protection355 rate 5 129 7 520 115 303 6 410 (WHO) 100 Denominator 10 843 762 10 768 8 377 166 485 1 729 275 10 768 WC, CPT, City of Cape Town Metropolitan Municipality, SEQ 5 (least deprived) Cape Town Indicator 59.7 95.9 5.0 66.1 53.0 70.8 61.1 800 Measure Names 15

Numerator 36 5 111 2_Outcome 3 010 39 063 56 371 792 107 36 787 600 IndValue Maternal Delivery in Denominator 60 303 5 328 Prov_av 60 211 10 59 104 1 275 597 13 418 253 60 211 mortality in 400 facility under 18 facility ratio ZA_avyears rate Western1_Impact Cape 200 Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 5 South Africa 0 Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 80 200 Source: DHIS. Mother Antenatal 1st 60 postnatal visit visit before 20 within 6 days 100 Annualweeks trends rate 40 rate WC,health women's and 2_Maternal CPT, City of Cape Town Metropolitan Municipality, SEQ 5 (least deprived) 20 0 800 Measure Names 200 200600 IndValue CoupleMaternal year Prov_avAntenatal client 150 protectionmortality in rate 400 initiated on ART facility ratio ZA_avrate 100 1_Impact (WHO) 100200 50 0 80

15 3_Output 150 2_Outcome Antenatal 1st 60 Cervical cancer Delivery in 100 facilityvisit before under 20 18 10 screening yearsweeks rate rate 40 coverage 50 2_Maternal and women's health women's and 2_Maternal 205 2009 2010 2011 2012 2013 2014 2015 2016 200 200 Year MotherCouple year Measure Names postnatalprotection visit rate IndValue within 6 days 100 (WHO) 100 P rov_av rate ZA_av 0 20015 2_Outcome DeliveryAntenatal in client 150 facilityinitiated under on ART 18 10 yearsrate rate 100 5 50

200

3_Output 150 Mother Cervical cancer postnatal visit 100 withinscreening 6 days 100 ratecoverage 50 0

200 2009 2010 2011 2012 2013 2014 2015 2016 Antenatal client 150 Year initiated on ART rate 100

50 753

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year Section B: NationalProfile Western and District Cape ProfilesProvince

Child and School Health 47.8 50.7 49.5 58.0 45.0 46.0 46.8 54.3 34.8 65.5 46.8 29 874 10 62810 24 073 29 581 34 164 34 670 39 375 37 822 25 345 875 124 717 084 924 186 831 192 547 044 547 254 904 254 660 558 1 0 months Vitamin A dose 12-59 coverage (%) coverage 0 47 57 7.8 1.0 1.3 3.6 0.0 2.0 6.2 2.2 114 142 651 206 19.8 12.6 26.0 4 111 1 647 7 166 5 647 4 370 8 397 836 256 2 864 552 492 6 402 072 8 screening coverage (%) coverage School Grade 3.6 281 57.7 75.7 20.6 52.9 44.9 72.5 33.0 44.2 26.5 68.9 2 111 4 012 5 574 4 041 6 020 7 769 9 067 6 339 4 555 4 7 965 29 419 11 277 786 612 1 screening coverage (%) coverage School Grade Output 91.8 82.7 96.6 96.0 86.9 84.3 88.6 93.8 96.2 7 314 102.1 9 471 5 773 7 285 4 558 8 548 2 053 9 000 9 58 917 79 755 7 953 98 628 7 705 4 807 111 774 106 113 121 158 100 485 100 769 902 dose nd Measles Measles 2 coverage (%) coverage

rd 714 41.6 31.8 91.2 30.1 13.8 24.6 30.4 28.9 45.8 33.3 23.3 35.8 7 516 2 191 5 166 1 183 1 851 7 347 3 401 7 599 87 069 9 990 5 204 7 592 2 308 6 968 4 597 5 888 5 9 492 5 082 64 920 16 788 55 682 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 81.7 83.1 80.7 73.7 80.0 82.3 89.3 82.5 82.8 94.2 76.2 7 161 6 576 4 769 7 295 2 445 7 033 2 695 51 012 96 213 61 980 83 799 83 77 685 77 94 485 94 108 417 117 381 741 855 (%) coverage under 1 year Immunisation Immunisation 5 2 5 4 290 3 7 458 6 6 430 11 11 15 58 1.3 0.7 0.7 0.9 0.4 0.8 0.6 0.5 0.8 0.9 0.2 701 724 835 8 918 2 102 101 895 1 392 1 064 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 7 - - 19 24 23 86 7.4 9.1 4.0 3.4 4.3 8.5 4.2 169 222 12.4 15.6 13.5 (per1K) neonatal neonatal Inpatient Inpatient death rate 7 - - 18 21 24 61 7.1 7.5 3.1 9.9 4.3 3.8 5.3 4.2 170 149 450 550 13.7 10.4 4 779 4 779 1 232 6 693 6 693 5 5535 553 5 2 806 2 806 1 6681 668 1 868 11 568 11 568 10 843 10 843 16 393 16 393 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 8 - - 24 26 25 1.1 1.4 1.3 4.4 0.8 0.5 2.5 0.9 2.0 2.5 177 759 320 3 214 4 716 16 173 54 826 60 303 60 303 20 667 Inpatient Inpatient year rate (%) death under 5 8 - - 24 24 26 1.1 1.9 1.9 1.6 1.2 0.8 6.3 2.6 2.5 3.2 177 179 154 154 139 691 321 321 293 2 337 5 589 7 283 2 985 1 459 2 298 11 107 11 999 11 35 951 Impact Inpatient Inpatient year rate (%) death under 1 ------14 16 25 39 72 0.0 0.6 8.0 241 407 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 1 ------18 10 29 0.4 2.0 0.3 0.5 0.8 0.5 315 196 301 330 2 222 2 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 5 6 ------12 2.0 0.3 0.3 0.3 0.6 0.3 241 160 398 383 948 3 725 5 462 1 595 2 098 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Denominator Indicator Numerator Denominator Indicator Numerator Indicator Numerator Denominator Indicator Indicator Indicator Numerator Denominator Indicator Numerator Denominator Indicator Numerator Numerator Indicator Denominator Denominator Denominator Indicator Numerator Numerator Indicator Denominator D

Cape Town CT Eastern SD CT Western SD Western Cape Western South Africa South CT Khayelitsha SD Khayelitsha CT CT Klipfontein SD CT Mitchells Plain Plain Mitchells CT SD CT Northern SD CT Southern SD Southern CT CT Tygerberg SD Source: HIS.

754 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Annual trends Child and School Health WC, CPT, City of Cape Town Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names 100 IndValue Child under 5 Prov_av years diarrhoea 50 case fatality rate ZA_av

30 Child under 5

3_Child and school health school and 3_Child years 20 pneumonia case fatality rate 10

0 60 1_Impact Child under 5 years severe 40 acute malnutrition 20 case fatality rate 0

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

Infant 80 exclusively breastfed at 60 DTaP-IPV-Hib- HBV 3rd dose 40 rate 20

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

AnnualWC, CPT, Citytrends of Cape HIV Town Metropolitan Municipality, SEQ 5 (least deprived)

60 Measure Names IndValue 4_HIV HIV testing Prov_av coverage 40 (including ANC) ZA_av 20

200

Male condom distribution 100 coverage 4_Process_input

80 60 Medical male circumcision 40 rate 20 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

755 Section B: NationalProfile Western and District Cape ProfilesProvince

HIV 31 7.5 1.2 2.4 3.6 5.0 5.9 3.0 4.5 2.5 0.2 197 641 878 566 545 19.0 1 575 6 073 1 640 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 41.8 47.5 57.4 41.8 51.2 21.8 53.1 40.7 42.8 48.5 33.5 8 578 540 9 088 376 7 602 220 63 010 77763 010 2016/17 distribution distribution Male condom condom Male coverage (No) 25.1 30.1 26.0 32.6 32.9 34.3 26.8 25.2 40.3 30.9 35.9 96 713 76 862 56 938 6 480 101 89 036 520 030 12 86 496 380 5 213 83 658 6 738 830 82 048 6 789 300 681 191 109 440 (%) 27 496 182 070 563 18 266 20 161 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - 3 556 185 2 406 981 874 2 618 - - - 4 253 250 2 829 735 415 3 191 - - - - 2 706 009 - 532 1 910 3 994 158 2 099 652 564 2 871 815 3 172 - - - - 3 053 073 1 932 849 811 2 186 - - - 2 686 509 1 782 213 534 2 010 - - - 3 258 708 1 901 244 402 2 148 - - - - 604 3 674 2 435 445 2 732 763 - 4.5 4.2 8.2 32 060 712 957 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 54.2 54.8 162 704 300 424 2016/17 on ART rate (%) Clients remaining - 74 51 78 84 95 85 53 56 49 38 92 60 99 107 146 105 734 538 81.7 81.0 74.4 67.8 74.5 71.8 73.3 78.5 80.4 55.8 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------74.7 70.9 69.9 70.9 73.0 62.9 69.3 72.2 68.8 65.5 4 518 4 278 1 825 3 862 3 449 3 509 3 965 7 685 7 33 091 33 2015 months (%) on ART after 12 Adult percentageAdult 7 9 - .9 11 17 16 12 31 47 31 57 37 43 32 45 40 36 203 268 77.8 77.5 75.7 75.4 70.6 76.6 73 68.9 68.8 86.5 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------519 987 604 91.1 91.7 91.7 93.1 91.2 92.7 92.0 90.4 92.3 93.8 2 194 1 581 2 579 1 726 1 622 11 812 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load 9 - 17 16 47 57 37 70 32 80 84 45 53 45 48 94 40 268 506 51.1 57.1 28.1 71.3 53.0 35.4 53.6 50.0 69.8 35.6 (%) 2015 Child with viral load completion completion load rate at months 12 ------57.9 31.5 61.5 53.6 52.8 40.9 49.5 68.3 43.9 63.8 2 413 5 211 3 213 1 181 1 916 2 479 2 981 2 639 22 033 (%) 2015 Adult with viral load completion completion load rate at months 12 Numerator Denominator Indicator Numerator Indicator Denominator Indicator Denominator Denominator Numerator Indicator Numerator Indicator Denominator Numerator Indicator Numerator Denominator Denominator Indicator Numerator Indicator Denominator Denominator Indicator Numerator Indicator Indicator Numerator

Cape Town CT Western SD Western Cape Western CT Tygerberg SD CT Southern SD Southern CT CT Northern SD CT Mitchells Plain SD Plain Mitchells CT CT Klipfontein SD CT Eastern SD CT Khayelitsha SD Khayelitsha CT South Africa South Source: HIS.

756 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

TB ------51.6 988 717 961 924 888 765 888 577 333 577 885 966 885 8 277 136 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input - 1 055 965 - - - 1 629 911 ------1 288 555 - - - - - 85.7 72.8 90.0 18 913 17 022 2016 Output rate (%) on treatment treatment on TB client initiated 971 921 875 789 823 594 849 81.1 87.4 74.2 74.6 81.8 75.3 78.9 83.0 83.4 82.2 88.3 1 241 1 911 1 447 1 043 1 207 1 356 1 634 1 064 2 335 2 8 536 10 524 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------799 69.1 73.6 68.0 1 085 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------5.7 5.0 6.2 1 085 18 913 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------495 41.5 39.6 50.5 1 251 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------397 31.7 17.9 30.3 1 251 2014 (EDRWeb) (%) to follow up rate TB DR client loss 81.8 81.0 81.0 81.8 80.7 80.4 85.7 76.5 84.0 80.4 84.2 2 611 2 169 2 192 4 071 2 595 3 427 2 922 2 032 2 094 3 635 1 555 1 1 858 3 625 2 884 2 3 298 2 964 2 19 767 24 165 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 9.6 9.0 9.4 8.3 9.5 6.4 8.3 181 247 397 233 235 352 338 340 11.6 10.9 10.3 10.5 2 611 2 169 4 071 2 595 3 427 2 032 3 635 3 625 2 323 24 165 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------220 17.6 17.8 23.0 1 251 2014 death rate TB DR client (EDRWeb) (%) Impact 94 63 69 3.1 4.1 3.7 3.6 4.0 3.5 3.6 3.9 3.2 6.6 3.9 129 136 146 102 149 888 2 611 2 169 4 071 2 595 3 427 2 032 3 635 3 625 24 165 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Numerator Indicator Denominator D

Cape Town CT Western SD CT Tygerberg SD CT Southern SD Southern CT CT Northern SD CT Mitchells Plain SD Plain Mitchells CT CT Klipfontein SD CT Khayelitsha SD Khayelitsha CT South Africa South CT Eastern SD Western Cape Western Source: HIS.

757 Section B: NationalProfile Western and District Cape ProfilesProvince

Annual trends TB WC, CPT, City of Cape Town Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names 15 IndValue 5_TB Prov_av TB death rate 10 (ETR.net) ZA_av 5

60 1_Impact TB DR client 40 death rate (EDRWeb) 20

0 15

TB client lost to 10 follow up rate (ETR.Net) 5

80 TB client treatment success rate 60 (ETR.net) 40

TB DR client loss to follow up 20 rate (EDRWeb)

60 2_Outcome TB DR treatment 40 success rate (EDRWeb) 20

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

TB/HIV co-infected client on ART 50 rate (ETR.Net)

0 100 TB symptom 5 years and older screened in 50 facility rate

4_Process_input 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

758 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 CT Eastern SD Indicator 0.8 5.6 Numerator 441 1 025 Denominator 6 653 601 2 190 522 CT Khayelitsha SD Indicator 1.0 14.3 Numerator 452 1 567 Denominator 5 454 294 1 312 236 CT Klipfontein SD Indicator 0.6 2.4 Numerator 256 349 Denominator 5 013 462 1 717 800 CT Mitchells Plain SD Indicator 0.8 6.7 Numerator 354 861 Denominator 5 471 040 1 531 254 CT Northern SD Indicator 0.9 6.7 Numerator 380 1 082 Denominator 4 944 387 1 941 603 CT Southern SD Indicator 0.8 4.0 Numerator 510 988 Denominator 7 476 855 2 937 252 CT Tygerberg SD Indicator 3.0 7.2 Numerator 1 997 1 655 Denominator 7 869 831 2 762 196 CT Western SD Indicator 0.8 5.3 Numerator 398 946 Denominator 6 135 564 2 144 373 Cape Town Indicator 1.2 6.1 Numerator 4 788 8 473 Denominator 4 9 019 034 16 537 236 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualWC, CPT, Citytrends of Cape Town Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

Sub-district value in red – improvement strategies are urgently needed Value highlighted in yellow – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country

759 Section B: NationalProfile Western and District Cape ProfilesProvince

West Coast District Municipality (DC1)

The West Coast District in the Western Cape Province comprises five sub-districts, namely Swartland, Bergrivier, Matzikama, Cederberg and Saldanha Bay. The district has a population of 447 580, with a population density of 14.4 persons per km2, and falls into socio-economic Quintile 5, among the wealthiest districts. Estimated medical scheme coverage is 16.3%.

Social determinants of healtha Population per selected category

Unemployment ratea 14.6% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 19.9% under 1 year 8 234 8 528 8 834 9 073 No schooling 3.8% under 5 years 40 813 41 765 42 689 43 553 Matric 29.1% 05-09 years 38 514 39 128 39 747 40 489 Higher education 7.6% 10-14 years 36 176 36 983 37 906 38 789 Households 129 862 15-19 years 37 070 37 066 36 956 36 960 Female-headed households 32.8% 20-24 years 40 322 40 545 40 719 40 783 Formal dwellings 85.8% 25-29 years 42 970 43 438 43 884 44 263 Flush toilet connected to sewerage 85.2% 30-34 years 37 313 39 499 41 795 44 163 Weekly refuse removal 83.4% 35-39 years 31 965 33 006 34 037 34 934 Piped water inside dwellings 79.9% 40-44 years 30 210 30 315 30 525 30 951 Electricity for lighting 93.8% 45-49 years 29 309 29 614 29 786 29 917 Blue Drop water score 59.2% 50-54 years 24 198 25 363 26 495 27 453 55-59 years 19 022 19 712 20 458 21 310 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 14 482 15 114 15 769 16 438 65-69 years 10 541 10 942 11 374 11 849 70-74 years 7 302 7 576 7 859 8 163 75-79 years 4 120 4 443 4 753 5 047 80 years and older 2 368 2 570 2 776 2 988 Total 446 693 457 068 467 528 478 050 Estimated pregnant women* 8 810 9 125 9 452 9 708 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

760 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Bergrivier SD - 3 0 2 0 0 0 Cederberg SD - 6 0 2 0 0 0 Matzikama SD - 5 0 1 0 0 0 Saldanha Bay SD - 8 0 1 0 0 1 Swartland SD - 4 0 1 0 0 2 West Coast - 26 0 7 0 0 3 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology West Coast 293 114 125 211 49 38 7 6 5 2 Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bergrivier SD Indicator 1.6 - - - - - Numerator 113 396 - - - - - Denominator 856 215 - - - - - Cederberg SD Indicator 2.2 - - - - - Numerator 124 505 - - - - - Denominator 686 172 - - - - - Matzikama SD Indicator 2.1 - - - - - Numerator 159 568 - - - - - Denominator 925 764 - - - - - Saldanha Bay SD Indicator 1.7 - - - - - Numerator 198 952 - - - - - Denominator 1 364 691 - - - - - Swartland SD Indicator 1.6 - - - - - Numerator 206 740 - - - - - Denominator 1 567 998 - - - - - West Coast Indicator 1.8 14.8 85.2 1 688 816 381 Numerator 803 161 4 23 632 156 631 305 823 554 305 823 554 Denominator 5 400 840 27 27 374 564 374 564 803 161 Western Cape Indicator 2.3 15.2 70.7 1 742 1 089 379 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

761 Section B: NationalProfile Western and District Cape ProfilesProvince ------2.5 20.3 (%) OPD new client not not client referred rate rate referred ------4.1 5.4 rate (%) Inpatient Inpatient crude death ------85.4 84.3 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 4 227 5 432 day (Rand) equivalent equivalent per patient Expenditure ------6.1 6.9 (Days) Average length of of length stay - total ------5.2 37.2 (%) OPD new client not not client referred rate rate referred ------2.3 rate (%) Inpatient Inpatient crude death ------89.4 78.3 5.0 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------3 024 2 894 day (Rand) equivalent equivalent per patient Expenditure ------4.0 5.3 (Days) Average length of of length stay - total 74 94 6.1 1.5 1.9 165 370 34.1 14.8 18.2 59.3 6 024 4 599 35 926 (%) OPD new client not not client referred rate rate referred 5.1 2.5 2.5 2.6 2.8 2.6 3.0 3.9 2.8 175 248 165 289 7 007 6 526 9 469 9 4 239 4 923 1 062 5 302 10 313 13 483 38 124 rate (%) Inpatient Inpatient crude death 71.1 67.4 87.3 61.4 77.4 92.7 75.0 84.8 11 223 31 028 14 967 27 378 18 840 185 133 605 133 103 430 (%) utilisation rate - total Inpatient bed District Hospital District 1 717 2 013 2 493 2 307 1 683 2 568 2 006 2 045 2 17 176 31 668 31 32 024 49 339 29 568 155 836 day (Rand) 52 412 312 29 495 119 equivalent equivalent per patient 313 735 879313 Expenditure 3.1 2.7 2.7 4.4 2.7 2.5 2.6 3.2 7 007 9 469 9 4 239 7 096 25 628 30 663 7 096 4 970 10 313 11 223 38 124 18 840 23 907 53 909 999 23 907 27 404 98 960 400 27 404 22 058 78 958 049 22 058 103 430 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Denominator Indicator Numerator Denominator Numerator Indicator D

West Coast Swartland SD Saldanha Bay SD Bay Saldanha Matzikama SD Matzikama Cederberg SD Cederberg Western Cape Western South Africa South Bergrivier SD Source: HIS and BAS.

762 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Annual trends Management and efficiency indicators for theWC, service DC1, West Coastdelivery District Municipality,platform, SEQ 2016/17 5 (least deprived)

8 Measure Names IndValue Inpatient crude 6 Prov_av death rate ZA_av

1_Impact 4

1_Management 2 8 6 Average length of stay (district 4 hospitals) 2

2_Outcome Expenditure per patient day 3K equivalent (district 2K hospitals) 1K

Inpatient bed 100 utilisation rate (district hospitals) 50

100 3_Output OPD new client not referred rate 50 (district hospitals)

0 100

Percentage 50 Ideal clinics

Provincial and 3K LG District Health Services 2K expenditure per capita (uninsured) 1K

Provinc ial and 1500

4_Process_input LG PHC expenditure per 1000 capita (uninsured) 500

Provincial and 400 LG PHC expenditure per PHC headcount 200

2008 2010 2012 2014 2016 2018 Year

763 Section B: NationalProfile Western and District Cape ProfilesProvince

Deaths and Patient day equivalent 2014/15 – 2016/17 57 32 155 836 Total District District tertiary Central/ hospital ------2016/17 Hospital Regional Regional 57 32 155 836 District District Hospital - - 1 062 - - 1 062 -- 4 608 - - 4 608 - / MOU PHC / CHC 71 40 1 109 5 001 160 442 Total District District tertiary Central/ Hospital ------2015/16 Hospital Regional Regional 1 - - 1 - 2 - - 2 71 40 1 109 5 001 160 442 District District Hospital - - - 6 - - 6 - 6 - - 6 - 755 - - - 755 - - - - - / MOU PHC / CHC 27 23 84 620 162 395 Total District District tertiary Central/ Hospital ------5--5-1--1 -- 2014/15 Hospital Regional Regional --- 27 23 84 162 395 District District Hospital - - 1 077 - - 1 077 ------1--1------1 - - 1 -1--1------4--4-3--3-6--6 -- 5 079 - - 5 079 - - - -4--4-4--4-2--2 620 / MOU* PHC / CHC

Death in facility months 29 days - 11 Death in facility – 59 months 12 Death in facility 8-28 days Death in facility 0-7days

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata Patient day equivalent day Patient Inpatient death total TB Deaths Severe acute malnutrition death under 5 years Pneumonia death under 5 years Diarrhoea death under 5 years Still birthsStill Live births Maternal deaths deaths Maternal D (Number) Source: HIS. *MOU – Maternal Obstetric Unit.

764 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

WC,Percentage West Coast: of deaths DC1, by 2010broad -cause 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 70% 4% 17% 9% 73% 6% 15% 7% causes and 5-14 20% 11% 23% 46% 17% 9% 14% 60% single leading 15-24 10% 45% 16% 29% 5% 13% 7% 75% causes 25-64 6% 32% 55% 8% 4% 29% 48% 19% 65+ 6%3% 89% 2% 5%6% 86% 3% Broadcause 9% 17% 67% 6% 8% 20% 57% 16% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (26.5%) Preterm birth complications (22.7%) HIV and TB 2 Preterm birth complications (18.7%) Lower respiratory infections (19.7%) Comm_mat_peri_nut 3 Diarrhoeal diseases (12.8%) Diarrhoeal diseases (12.0%) 4 Birth asphyxia (8.2%) Birth asphyxia (9.4%) Prov, District 5 Other congenital abnormalities (4.1%) HIV/AIDS (4.9%) WC, West Coast: DC1 6 Other perinatal conditions (3.7%) Upper respiratory infections (3.9%) Show history

<5 years <5 7 Upper respiratory infections (3.7%) Drowning (3.6%) 8 HIV/AIDS (3.5%) Congenital heart anomalies (3.6%) Percentages are shown 9 Drowning (3.4%) Other respiratory (3.3%) according to all the deaths 10 Congenital heart anomalies (2.4%) Other perinatal conditions (2.7%) within the age/gender 1 Drowning (48.4%) Drowning (65.0%) category of each box, 2 Tuberculosis (18.7%) Accidental threats to breathing (12.6%) although only the leading 3 Fires, hot substances (17.1%) Tuberculosis (9.7%) 10 causes are displayed. 4 Lower respiratory infections (15.9%) Road injuries (7.2%) 5 Meningitis/encephalitis (5.5%)

5-14 6 7 8 9 10 1 Tuberculosis (27.5%) Interpersonal violence (35.0%) 2 HIV/AIDS (23.6%) Mechanical forces (15.2%) 3 Accidental threats to breathing (9.0%) Accidental threats to breathing (11.9%) 4 Interpersonal violence (8.9%) Tuberculosis (9.0%) 5 Mechanical forces (4.2%) Drowning (8.7%)

15-24 6 Lower respiratory infections (4.2%) HIV/AIDS (4.7%) 7 Drowning (3.2%) Fires, hot substances (4.7%) 8 Fires, hot substances (2.8%) Road injuries (3.2%) 9 Epilepsy (2.5%) Other malignant neoplasms (1.5%) 10 Nephritis/nephrosis (2.3%) Lower respiratory infections (1.5%) 1 Tuberculosis (16.6%) Tuberculosis (18.9%) 2 HIV/AIDS (15.4%) HIV/AIDS (10.4%) 3 Cerebrovascular disease (7.5%) Ischaemic heart disease (9.1%) 4 Ischaemic heart disease (6.4%) COPD (6.2%) 5 COPD (4.9%) Interpersonal violence (6.1%)

25-64 6 Breast (4.5%) Trachea/bronchi/lung (5.1%) 7 Trachea/bronchi/lung (3.8%) Cerebrovascular disease (4.9%) 8 Diabetes mellitus (3.6%) Accidental threats to breathing (3.8%) 9 Cervix (2.6%) Drowning (2.6%) 10 Lower respiratory infections (2.6%) Mechanical forces (2.4%) 1 Cerebrovascular disease (17.8%) Ischaemic heart disease (18.6%) 2 Ischaemic heart disease (17.8%) Cerebrovascular disease (12.2%) 3 Hypertensive heart disease (6.8%) COPD (10.4%) 4 Diabetes mellitus (6.4%) Trachea/bronchi/lung (7.0%) 5 COPD (5.4%) Prostate (6.8%)

65+ 6 Nephritis/nephrosis (4.6%) Tuberculosis (5.5%) 7 Trachea/bronchi/lung (4.5%) Diabetes mellitus (3.4%) 8 Lower respiratory infections (3.7%) Lower respiratory infections (3.0%) 9 Breast (3.3%) Hypertensive heart disease (2.7%) 10 Alzheimer’s and other dementias (2.3%) Nephritis/nephrosis (2.6%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (63.1%) n=7 HIV/AIDS (26.5%) n=588 2 Other maternal (36.9%) n=4 Tuberculosis (24.7%) n=549 3 Interpersonal violence (3.7%) n=81 4 Breast (3.4%) n=75 5 Ischaemic heart disease (3.4%) n=75

15-49 6 Cerebrovascular disease (3.1%) n=69 Female 7 Lower respiratory infections (3.0%) n=66 8 Accidental threats to breathing (2.8%) n=63 9 Cervix (2.1%) n=48 10 Drowning (1.8%) n=39

765 Section B: NationalProfile Western and District Cape ProfilesProvince

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bergrivier SD Indicator - 91.1 11.0 77.3 29.9 72.8 65.5 Numerator - 41 55 645 596 15 172 328 Denominator 489 45 501 834 23 929 250 191 501 Cederberg SD Indicator - 83.8 9.1 70.0 50.0 92.7 54.2 Numerator - 57 62 665 765 151 253 371 Denominator 674 68 685 950 18 374 195 756 685 Matzikama SD Indicator - 107.7 9.4 78.7 51.5 76.6 52.2 Numerator - 42 76 759 1 025 16 360 422 Denominator 800 39 809 964 23 897 256 326 809 Saldanha Bay SD Indicator 121.7 93.3 6.9 67.2 39.6 86.4 48.3 Numerator 2 112 98 1 146 1 165 28 997 687 Denominator 1 644 120 1 422 1 706 35 300 402 558 1 422 Swartland SD Indicator - 86.7 9.3 75.6 44.0 68.1 65.1 Numerator - 78 114 1 269 1 513 25 968 802 Denominator 1 221 90 1 232 1 679 41 291 457 689 1 232 West Coast Indicator 41.4 91.2 8.7 73.1 42.6 78.0 56.1 Numerator 2 330 405 4 484 5 064 101 623 2 610 Denominator 4 828 362 4 649 6 133 142 790 1 562 520 4 649 Western Cape Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualWC, trendsDC1, West Coast District Municipality, SEQ 5 (least deprived)

800 Measure Names 600 IndValue Maternal Prov_av mortality in 400 facility ratio ZA_av 1_Impact 200 0 80

Antenatal 1st 60 visit before 20 weeks rate 40 2_Maternal and women's health women's and 2_Maternal 20

200 Couple year protection rate (WHO) 100

15 2_Outcome Delivery in facility under 18 10 years rate 5

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

766 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Child and School Health 41.3 50.7 49.4 53.7 58.0 46.5 38.9 48.5 6 274 4 071 4 221 86 670 104 472 125 592 197 490 696 624 months Vitamin A dose 12-59 coverage (%) coverage 0 26 975 0 0 3 567 0 0 0 8 842 0.0 0.0 0.0 0.0 0.0 0.0 798 584 606 12.6 19.8 1 182 182 400 53 316 8 screening coverage (%) coverage School Grade 931 477 673 520 256 942 233 31.3 14.6 25.0 34.4 50.6 52.9 39.5 33.0 2 159 1 959 1 273 82 812 1 screening coverage (%) coverage School Grade Output 916 920 88.4 86.9 96.8 96.2 111.3 1 211 6 971 104.8 1 697 2 227 24 015 10 488 85 431 15 006 1 315 dose nd Measles Measles 2 coverage (%) coverage

rd 712 12 483 746 197 376 370 329 342 27.7 41.6 27.8 97.9 31.8 91.2 21.2 20.7 50.4 33.7 1 614 1 749 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 823 967 688 97.8 82.4 73.6 85.4 80.0 69.8 80.8 82.3 1 463 1 10 101 11 820 23 124 14 085 1 014 23 850 1 587 23 439 1 754 82 980 5 808 (%) coverage under 1 year Immunisation Immunisation - - 3 5 586 1 1 1 1 645 - - 21 57 82 1.0 1.3 1.8 1.2 0.6 0.8 471 105 206 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 2 4 1 11 15 33 4.1 9.1 5.0 6.8 0.8 8.5 12.4 (per1K) neonatal neonatal Inpatient Inpatient death rate 1 4 1 11 15 32 7.1 9.1 9.9 6.6 5.0 2.0 0.8 674 674 489 489 800 800 16.3 16.3 1 221 1 221 4 828 4 828 1 644 1 644 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 5 8 2 14 16 45 1.1 1.3 0.7 4.4 0.6 0.9 0.8 0.2 656 1 819 6 373 6 1 272 1 259 1 367 Inpatient Inpatient year rate (%) death under 5 3 7 2 12 15 39 1.7 1.9 1.3 1.3 0.9 2.0 0.3 6.3 319 541 591 650 889 2 990 Impact Inpatient Inpatient year rate (%) death under 1 - - 1 ------13 12 10 26 62 0.6 0.0 8.0 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute - - 2 1 1 - - - - 19 83 44 60 1.0 0.4 0.6 2.0 2.3 310 104 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case ------82 0.0 2.0 0.3 172 767 201 106 206 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Numerator Indicator Denominator Indicator Indicator Indicator Denominator Denominator Numerator Indicator Numerator Numerator Indicator Numerator Denominator Indicator Denominator Numerator Denominator Indicator D

Bergrivier SD Western Cape Western South Africa South Cederberg SD Cederberg Matzikama SD Matzikama Saldanha Bay SD Bay Saldanha Swartland SD West Coast Source: HIS.

767 Section B: NationalProfile Western and District Cape ProfilesProvince

AnnualWC, trendsDC1, West Child Coast District and SchoolMunicipality, Health SEQ 5 (least deprived)

Measure Names 100 IndValue Child under 5 Prov_av years diarrhoea 50 case fatality rate ZA_av

30 Child under 5

3_Child and school health school and 3_Child years 20 pneumonia case fatality rate 10

0 60 1_Impact Child under 5 years severe 40 acute malnutrition 20 case fatality rate 0

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

Infant 80 exclusively breastfed at 60 DTaP-IPV-Hib- HBV 3rd dose 40 rate 20

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

AnnualWC, trendsDC1, West HIV Coast District Municipality, SEQ 5 (least deprived)

60 Measure Names IndValue 4_HIV HIV testing Prov_av coverage 40 (including ANC) ZA_av 20

200

Male condom distribution 100 coverage 4_Process_input

80 60 Medical male circumcision 40 rate 20 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

768 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

HIV 52 4.7 4.5 4.8 4.2 6.5 5.2 2.2 131 219 271 183 856 19.0 630 510 336 018 371 058 547 830 547 277 383 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 51.3 61.0 55.1 63.1 54.6 48.0 48.5 249 669 569 988 569 332 655 302 463 302 496 965 496 1 375 600 2 279 600 8 957 800 1 422 800 1 268 600 2016/17 distribution distribution Male condom condom Male coverage (No) 34.1 36.1 29.0 34.0 30.9 35.9 33.9 40.2 19 07519 200 2 611 13 401 14 327 86 651 86 12 849 26 999 26 473 787 506 250 506 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - - - - 896 382 - - - - - 383 265 - 789 759 - - - - - 3.4 4.2 8.2 3 072 90 702 3 049 443 740 1 951 799 2 162 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 54.8 45.3 8 910 19 683 2016/17 on ART rate (%) Clients remaining 5 7 7 4 1 1 - 12 18 12 10 29 48 57.1 74.4 66.7 60.4 50.0 58.3 100.0 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------510 574 191 303 348 67.8 76.7 69.7 75.4 70.9 65.7 62.0 1 926 2015 months (%) on ART after 12 Adult percentageAdult 8 3 3 4 2 2 4 1 1 1 0 - 13 0.0 61.5 50.0 50.0 73.9 100.0 100.0 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------75 118 124 156 109 582 91.7 91.9 91.2 85.6 89.3 86.5 88.8 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load 3 4 4 7 4 2 1 1 1 - 13 12 26 57.1 51.1 25.0 50.0 50.0 100.0 100.0 (%) 2015 Child with viral load completion completion load rate at months 12 ------170 199 138 421 309 37.1 47.0 37.7 79.0 72.9 52.8 38.2 1 237 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Denominator Indicator Numerator Denominator Indicator Numerator Denominator Numerator Indicator Indicator Indicator Denominator Numerator Denominator Numerator Indicator Denominator Numerator Indicator

Western Cape Western South Africa South West Coast Saldanha Bay SD Bay Saldanha Swartland SD Matzikama SD Matzikama Cederberg SD Cederberg Bergrivier SD Source: HIS.

769 Section B: NationalProfile Western and District Cape ProfilesProvince

TB ------51.6 94 771 670 611 104 714 172 193 132 965 165 968 165 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------84.7 85.7 72.8 2 426 2 863 2016 Output rate (%) on treatment treatment on TB client initiated 62 83 84 96 151 913 215 185 163 103 254 483 47.9 51.5 74.6 59.4 64.6 52.9 44.9 88.3 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------60 144 41.7 69.1 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------5.0 5.0 6.2 144 2 863 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------64 123 41.5 52.0 50.5 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------32 123 17.9 26.0 30.3 2014 (EDRWeb) (%) to follow up rate TB DR client loss 641 951 378 795 704 786 706 842 490 536 77.1 76.1 81.0 81.6 81.0 80.4 83.6 83.8 3 773 3 056 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 91 95 55 98 53 6.4 6.3 951 704 786 392 842 490 11.2 10.4 10.0 12.9 10.5 12.5 3 773 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------16 123 17.8 13.0 23.0 2014 death rate TB DR client (EDRWeb) (%) Impact 42 29 32 30 45 6.1 4.7 4.4 3.7 6.6 4.5 3.9 5.3 178 951 704 786 842 490 3 773 2015 TB death rate (ETR.net) (%) Indicator Numerator Numerator Numerator Denominator Indicator Indicator Denominator Denominator Indicator Indicator Indicator Denominator Denominator Numerator Numerator Indicator Numerator Denominator Indicator D

Bergrivier SD Matzikama SD Matzikama SD Bay Saldanha Western Cape Western Africa South Cederberg SD Cederberg Swartland SD West Coast Source: HIS.

770 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Annual trends WC, DC1, West Coast District Municipality, SEQ 5 (least deprived)

Measure Names 15 IndValue 5_TB Prov_av TB death rate 10 (ETR.net) ZA_av 5

60 1_Impact TB DR client 40 death rate (EDRWeb) 20

0 15

TB client lost to 10 follow up rate (ETR.Net) 5

80 TB client treatment success rate 60 (ETR.net) 40

TB DR client loss to follow up 20 rate (EDRWeb)

60 2_Outcome TB DR treatment 40 success rate (EDRWeb) 20

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

TB/HIV co-infected client on ART 50 rate (ETR.Net)

0 100 TB symptom 5 years and older screened in 50 facility rate

4_Process_input 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

771 Section B: NationalProfile Western and District Cape ProfilesProvince

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Bergrivier SD Indicator 0.6 4.5 Numerator 41 116 Denominator 856 215 308 649 Cederberg SD Indicator 1.7 18.5 Numerator 98 370 Denominator 686 172 240 537 Matzikama SD Indicator 0.9 11.1 Numerator 73 296 Denominator 925 764 320 625 Saldanha Bay SD Indicator 1.1 10.5 Numerator 126 391 Denominator 1 364 691 444 873 Swartland SD Indicator 1.3 8.5 Numerator 174 380 Denominator 1 567 998 537 330 West Coast Indicator 1.1 10.1 Numerator 512 1 553 Denominator 5 400 840 1 852 014 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualWC, trendsDC1, West Coast District Municipality, SEQ 5 (least deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

772 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Cape Winelands District Municipality (DC2)

The Cape Winelands District in the Western Cape Province has a population of 864 555 people, with a population density of 40.3 persons per km2. The district consists of five health sub-districts, namely Witzenberg, Drakenstein, Stellenbosch, Breede Valley and Langeberg, and falls into socio-economic Quintile 5, placing it among the wealthiest districts. Estimated medical scheme coverage is 15.9%.

Social determinants of healtha Population per selected category

Unemployment ratea 14.1% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 19.4% under 1 year 15 447 15 734 16 105 16 398 No schooling 2.5% under 5 years 80 018 80 480 81 002 81 530 Matric 30.0% 05-09 years 80 141 80 602 80 884 81 281 Higher education 9.0% 10-14 years 75 199 77 024 78 871 80 427 Households 235 906 15-19 years 74 234 74 961 75 436 75 938 Female-headed households 34.2% 20-24 years 81 175 81 141 81 392 81 850 Formal dwellings 81.0% 25-29 years 87 183 87 438 87 761 87 985 Flush toilet connected to sewerage 93.5% 30-34 years 80 617 83 717 86 820 90 076 Weekly refuse removal 81.8% 35-39 years 71 107 73 348 75 179 76 408 Piped water inside dwellings 77.3% 40-44 years 59 944 61 620 63 678 65 942 Electricity for lighting 94.1% 45-49 years 56 317 56 552 56 575 56 861 Blue Drop water score 81.9% 50-54 years 45 648 47 905 50 164 52 039 55-59 years 35 577 36 667 37 839 39 231 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 26 887 27 958 29 065 30 183 65-69 years 18 906 19 640 20 413 21 238 70-74 years 12 223 12 723 13 244 13 795 75-79 years 6 447 6 867 7 286 7 699 80 years and older 3 323 3 465 3 612 3 767 Total 894 951 912 107 929 218 946 248 Estimated pregnant women* 16 528 16 835 17 232 17 546 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

773 Section B: NationalProfile Western and District Cape ProfilesProvince

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Breede Valley SD - 7 0 0 1 0 4 Drakenstein SD - 14 0 0 1 0 2 Langeberg SD - 7 0 2 0 0 0 Stellenbosch SD - 7 0 1 0 0 1 Witzenberg SD - 9 0 1 0 0 1 Cape Winelands - 44 0 4 2 0 8 Source: DHIS.

Human resources – filled posts, 2016

Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Breede Valley SD Indicator 2.0 - - - - - Numerator 377 036 - - - - - Denominator 2 214 432 - - - - - Drakenstein SD Indicator 2.0 - - - - - Numerator 551 763 - - - - - Denominator 3 330 552 - - - - - Langeberg SD Indicator 1.9 - - - - - Numerator 205 788 - - - - - Denominator 1 296 366 - - - - - Stellenbosch SD Indicator 1.6 - - - - - Numerator 269 856 - - - - - Denominator 2 048 847 - - - - - Witzenberg SD Indicator 1.8 - - - - - Numerator 231 670 - - - - - Denominator 1 543 260 - - - - - Cape Winelands Indicator 1.9 12.8 89.4 1 210 824 366 Numerator 1 636 113 6 42 879 386 954 599 214 226 599 214 226 Denominator 10 433 457 47 47 726 772 726 772 1 636 113 Western Cape Indicator 2.3 15.2 70.7 1 742 1 089 379 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

774 SectionSection B: B: Profile National Western and DistrictCape Province Profiles ------

2.5 Annual trends

20.3 WC, DC2, Cape Winelands District Municipality, SEQ 5 (least deprived)

(%) 8 Measure Names IndValue OPD new client not not client

referred rate rate referred Inpatient crude 6 Prov_av death rate ZA_av 1_Impact ------4 4.1 5.4 1_Management 2 8 6 rate (%)

Inpatient Inpatient Average length crude death of stay (district 4 hospitals) ------2 85.4 84.3 4K 2_Outcome

(%) Expenditure per patient day 3K utilisation rate - total equivalent

Inpatient bed (district 2K hospitals) 1K ------Tertiary/Central Hospital 4 227 5 432 Inpatient bed day 100

(Rand) utilisation rate

equivalent equivalent (district per patient Expenditure hospitals) 50 ------6.1 6.9 100 3_Output OPD new client not referred rate 50 (Days) (district Average length of of length

stay - total hospitals)

0 ------100 7.6 3.1 4.9 5.2 710 37.2 1 135 23 116 14 888 14 38 004 38 Percentage

(%) 50 Ideal clinics OPD new client not not client referred rate rate referred 0 ------Provincial and 3K 2.1 2.6 2.3 3.3 721 583 LG District 1 3041 845 1 Health Services 27 250 49 298 2K expenditure per capita rate (%) Inpatient Inpatient (uninsured)

crude death 1K ------Provinc ial and 1500 4_Process_input 87.9 81.2 89.4 78.3 5.0 93.9 LG PHC expenditure per 98 926 22 048 80 285 80 1000 113 527 212 453 106 547 186 832 capita (%) (uninsured) Hospital

utilisation 500 rate - total Inpatient bed Regional Hospital Regional ------Provincial and 400 LG PHC 3 163 3 024 2 872 3 525 2 894 expenditure per 133 381

107 468 PHC headcount 240 848 day 200 (Rand) 761 847 311 761 equivalent equivalent per patient 378 807 450 383 039 860 Expenditure 2008 2010 2012 2014 2016 2018 Year ------4.0 3.6 5.3 3.9 3.8 Measure Names IndValue 27 250 49 298 80 285 80 22 048 106 547 186 832 P rov_av (Days) Average length of of length stay - total ZA_av ------5.4 487 27.1 18.2 59.3 30.6 39.8 5 351 4 183 9 070 9 10 021 37 041 17 468 10 503 10 (%) OPD new client not not client referred rate rate referred ------5.1 2.6 3.0 2.9 2.9 3.3 224 250 772 298 7 759 7 504 11 283 26 546 rate (%) Inpatient Inpatient crude death ------67.4 74.7 89.1 70.3 84.8 64.5 21 812 93 815 70 041 20 251 31 028 31 393 31 393 (%) utilisation rate - total Inpatient bed District Hospital District ------2 307 1 508 1 949 1 982 2 568 1 806 40 295 37 666 37 115 930 day (Rand) 74 649 85274 73 997 668 equivalent equivalent 209 413 631 209 413 per patient Expenditure ------4.4 2.6 2.6 2.9 2.5 3.2 7 759 7 504 37 969 21 812 11 283 70 041 20 251 27 978 60 766 112 27 978 26 546 (Days) Average length of of length stay - total Indicator Numerator Denominator Indicator Denominator Numerator Indicator Indicator Indicator Denominator Numerator Indicator Denominator Denominator Indicator Numerator Numerator Numerator Denominator Indicator D

Cape Winelands Winelands Cape Witzenberg SD Witzenberg Stellenbosch SD Western Cape Western Africa South Langeberg SD Drakenstein SD Drakenstein Breede Valley SD Valley Breede Source: HIS and BAS.

775 Section B: NationalProfile Western and District Cape ProfilesProvince

Deaths and Patient day equivalent 2014/15 – 2016/17 11 15 80 33 197 11 256 Total 358 555 358 District District ------2 077 tertiary Central/ hospital 11 18 10 44 137 5 941 1 304 1 240 848 2016/17 Hospital Regional Regional 15 59 36 772 115 930 District District Hospital - - 2 7 - 9 ------1 1 1 283 4 032 1 777 1 / MOU PHC / CHC 19 35 112 212 1 170 2 173 11 719 Total 362 845 362 District District ------tertiary Central/ Hospital 14 76 26 141 6 155 1 406 - 236 117 2015/16 Hospital Regional Regional --- 70 33 764 4 174 124 835 District District Hospital - 9 - 3 5 - 8 - 4 - 3 4 - 7 - 1 3 - 4 - - 3 - 3 - 2 2 - 4 1 3 1 170 1 390 1 893 / MOU PHC / CHC 11 16 10 67 62 188 12 244 341 650 Total District District ------tertiary Central/ Hospital 11 25 53 127 6 411 1 259 - 1 993 3 227 561 2014/15 Hospital Regional Regional 14 37 60 734 4 433 4 112 367 District District Hospital --3-3-35-8-1 - 4 3 - 7 - 5 - - - 5 -11-2-11-2--6-6 - 3 8 - - 4 6 - - 1 1 722 1 205 - - - 1 205 1 400 / MOU* PHC / CHC

Death in facility 8-28 days Death in facility 0-7days Death in facility months 29 days - 11 Death in facility – 59 months 12

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata D (Number) Maternal deaths deaths Maternal Still birthsStill Live births Diarrhoea death under 5 years Pneumonia death under 5 years Severe acute malnutrition death under 5 years TB Deaths Inpatient death total Patient day equivalent day Patient Source: HIS. *MOU – Maternal Obstetric Unit.

776 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

PercentageWC, Cape Winelands: of deaths by DC2, broad 2010 cause - and2015 leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 60% 10% 22% 8% 64% 8% 19% 9% causes and 5-14 19% 8% 27% 46% 15% 9% 13% 63% single leading 15-24 7% 47% 13% 32% 3%14% 9% 74% causes 25-64 5% 30% 58% 8% 4% 30% 47% 18% 65+ 6%2% 89% 2% 6%5% 86% 3% Broadcause 8% 17% 69% 6% 7% 20% 57% 16% Total Injury NCD Rank.. Female Male 1 Preterm birth complications (17.5%) Preterm birth complications (14.9%) HIV and TB 2 Diarrhoeal diseases (16.8%) Diarrhoeal diseases (14.7%) Comm_mat_peri_nut 3 Lower respiratory infections (8.6%) Lower respiratory infections (10.8%) 4 HIV/AIDS (8.5%) Birth asphyxia (9.0%) Prov, District 5 Birth asphyxia (7.1%) Other respiratory (7.5%) WC, Cape Winelands: DC2 6 Congenital heart anomalies (5.9%) HIV/AIDS (6.1%) Show history

<5 years <5 7 Other respiratory (5.3%) Protein-energy malnutrition (5.3%) 8 Protein-energy malnutrition (3.8%) Sepsis/other newborn infectious (4.1%) Percentages are shown 9 Accidental threats to breathing (3.7%) Other perinatal conditions (3.6%) according to all the deaths 10 Drowning (2.5%) Accidental threats to breathing (3.2%) within the age/gender 1 Fire s, hot substances (13.3%) Drowning (47.5%) category of each box, 2 Drowning (12.5%) Accidental threats to breathing (11.6%) although only the leading 3 Road injuries (12.1%) Tuberculosis (7.3%) 10 causes are displayed. 4 Accidental threats to breathing (6.5%) Road injuries (6.1%) 5 Brain (6.4%) Mechanical forces (5.7%)

5-14 6 Tuberculosis (5.4%) HIV/AIDS (4.9%) 7 Other congenital abnormalities (5.2%) Meningitis/encephalitis (4.4%) 8 HIV/AIDS (5.1%) Diarrhoeal diseases (3.7%) 9 Other neoplasms (4.8%) Interpersonal violence (3.4%) 10 Other unintentional injuries (3.6%) Other transport accidents (2.8%) 1 HIV/AIDS (36.6%) Interpersonal violence (30.8%) 2 Tuberculosis (16.9%) Mechanical forces (13.0%) 3 Accidental threats to breathing (10.1%) Accidental threats to breathing (10.6%) 4 Interpersonal violence (9.2%) Tuberculosis (10.0%) 5 Road injuries (7.9%) Drowning (7.2%)

15-24 6 Lower respiratory infections (3.7%) Road injuries (5.9%) 7 Fires, hot substances (2.9%) HIV/AIDS (5.3%) 8 Drowning (2.8%) Fires, hot substances (4.6%) 9 Epilepsy (1.4%) Self-inflicted injuries (1.8%) 10 Self-inflicted injuries (1.4%) Other unintentional injuries (1.3%) 1 HIV/AIDS (19.1%) Tuberculosis (16.7%) 2 Tuberculosis (10.7%) HIV/AIDS (13.8%) 3 Cerebrovascular disease (7.3%) COPD (6.3%) 4 Ischaemic heart disease (6.0%) Ischaemic heart disease (6.2%) 5 COPD (5.7%) Trachea/bronchi/lung (6.1%)

25-64 6 Breast (5.0%) Interpersonal violence (5.9%) 7 Trachea/bronchi/lung (3.7%) Cerebrovascular disease (4.7%) 8 Diabetes mellitus (3.6%) Accidental threats to breathing (3.4%) 9 Nephritis/nephrosis (3.0%) Mechanical forces (2.1%) 10 Cervix (2.7%) Road injuries (2.0%) 1 Cerebrovascular disease (18.2%) Ischaemic heart disease (14.5%) 2 Ischaemic heart disease (16.5%) Cerebrovascular disease (12.9%) 3 COPD (6.3%) COPD (10.0%) 4 Diabetes mellitus (5.1%) Trachea/bronchi/lung (7.3%) 5 Nephritis/nephrosis (4.8%) Prostate (6.3%)

65+ 6 Trachea/bronchi/lung (4.0%) Tuberculosis (4.4%) 7 Hypertensive heart disease (3.9%) Nephritis/nephrosis (3.6%) 8 Lower respiratory infections (3.5%) Lower respiratory infections (3.5%) 9 Breast (3.0%) Diabetes mellitus (3.4%) 10 Alzheimer’s and other dementias (2.9%) Colo-rectal (2.2%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (49.5%) n=13 HIV/AIDS (33.1%) n=1 510 2 Other maternal (29.8%) n=8 Tuberculosis (13.9%) n=637 3 Hypertension in pregnancy (20.7%) n=6 Breast (3.8%) n=176 4 Cerebrovascular disease (3.6%) n=162 5 Interpersonal violence (3.2%) n=145

15-49 6 Accidental threats to breathing (2.8%) n=126 Female 7 Fires, hot substances (2.6%) n=121 8 Cervix (2.5%) n=114 9 COPD (2.4%) n=109 10 Ischaemic heart disease (2.4%) n=108

777 Section B: NationalProfile Western and District Cape ProfilesProvince

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Breede Valley SD Indicator 219.8 68.2 6.6 74.3 58.7 86.7 64.4 Numerator 8 146 244 2 124 2 761 45 154 2 364 Denominator 3 640 214 3 671 2 858 56 397 625 158 3 671 Drakenstein SD Indicator 39.3 78.5 5.5 74.7 51.1 100.5 46.7 Numerator 2 172 281 2 794 3 650 79 956 2 396 Denominator 5 095 219 5 132 3 742 85 693 954 495 5 132 Langeberg SD Indicator - 78.0 11.5 75.5 30.9 93.5 93.8 Numerator - 71 158 1 317 853 27 726 1 286 Denominator 1 359 91 1 371 1 745 33 136 355 827 1 371 Stellenbosch SD Indicator 45.1 78.6 4.5 71.4 63.9 83.0 51.3 Numerator 1 143 101 1 637 2 605 44 122 1 142 Denominator 2 216 182 2 228 2 294 48 942 637 977 2 228 Witzenberg SD Indicator - 100.7 8.9 77.2 67.3 108.0 78.5 Numerator - 149 114 1 429 2 069 39 611 1 001 Denominator 1 269 148 1 275 1 851 36 914 440 184 1 275 Cape Winelands Indicator 81.0 79.7 6.6 74.5 54.9 94.2 59.9 Numerator 11 681 898 9 301 11 938 236 571 8 189 Denominator 13 579 854 13 677 12 490 261 082 3 013 641 13 677 Western Cape Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualWC, DC2, trends Cape Winelands District Municipality, SEQ 5 (least deprived)

800 Measure Names 600 IndValue Maternal Prov_av mortality in 400 facility ratio ZA_av 1_Impact 200 0 80

Antenatal 1st 60 visit before 20 weeks rate 40 2_Maternal and women's health women's and 2_Maternal 20

200 Couple year protection rate (WHO) 100

15 2_Outcome Delivery in facility under 18 10 years rate 5

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

778 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Child and School Health 49.7 50.7 52.6 52.6 55.9 58.0 44.5 60.9 7 954 9 777 9 15 240 10 253 20 320 20 192 192 327 018 263 826 263 463 890 463 1 448 790 months Vitamin A dose 12-59 coverage (%) coverage 192 527 467 459 384 17.0 11.3 19.8 12.6 13.5 18.3 18.5 32.8 4 119 2 879 1 401 201 864 1 422 2 029 63 544 142 812 8 screening coverage (%) coverage School Grade 57.7 47.2 77.6 71.6 52.9 80.9 33.0 1 914 2 016 3 491 140.5 1 525 2 254 2 053 1 885 10 538 1 screening coverage (%) coverage School Grade Output 87.7 79.6 78.9 95.8 93.5 85.2 96.2 1 749 4 479 2 576 2 653 1 530 2 690 12 987 39 975 24 630 23 283 57 489 4 778 32 259 2 645 2 080 177 636 176 556 dose nd Measles Measles 2 coverage (%) coverage

rd 751 195 899 432 835 41.6 41.6 31.8 91.2 62.7 39.9 40.9 42.2 2 671 2 160 1 198 7 921 1 057 1 067 3 344 3 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 61.6 74.5 53.4 23.4 80.0 69.5 64.3 85.9 82.3 3 502 3 10 008 24 048 30 837 22 584 56 406 39 045 39 172 920 (%) coverage under 1 year Immunisation Immunisation 9 2 1 005 2 2 004 2 2 208 3 1 289 18 1.8 1.9 1.5 1.3 0.7 0.7 2.3 0.8 110 158 290 294 389 1 241 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 4 15 19 19 32 89 1.8 3.7 6.6 8.8 8.5 11.0 12.4 15.0 (per1K) neonatal neonatal Inpatient Inpatient death rate 4 17 17 15 27 80 7.1 7.4 1.8 9.9 5.9 3.3 11.0 13.4 2 216 2 216 1 359 1 359 13 579 13 579 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 9 51 29 26 22 1.1 1.9 1.8 1.3 0.7 1.2 4.4 0.8 137 1 176 1 173 2 348 1 269 1 269 11 532 Inpatient Inpatient year rate (%) death under 5 6 26 25 22 43 1.0 1.0 1.9 1.9 2.7 4.3 6.3 2.5 512 122 589 6 273 2 588 4 032 5 095 5 095 1 584 2 803 3 640 3 640 1 000 1 Impact Inpatient Inpatient year rate (%) death under 1 1 2 4 2 1 - - - - 18 24 61 31 5.6 0.6 8.0 3.3 2.9 3.2 136 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 1 3 4 ------91 1.1 0.4 0.4 0.8 2.0 155 103 276 398 1 023 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 2 4 6 ------1.3 0.4 0.6 2.0 0.3 318 162 165 297 434 1 376 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Denominator Numerator Indicator Indicator Numerator Denominator Denominator Indicator Numerator Numerator Numerator Indicator Denominator Denominator Numerator Denominator Indicator Indicator Indicator Indicator D

Drakenstein SD Drakenstein Langeberg SD Stellenbosch SD Breede Valley SD Valley Breede Witzenberg SD Witzenberg Winelands Cape South Africa South Western Cape Western Source: HIS.

779 Section B: NationalProfile Western and District Cape ProfilesProvince

Annual trends Child and School Health WC, DC2, Cape Winelands District Municipality, SEQ 5 (least deprived)

Measure Names 100 IndValue Child under 5 Prov_av years diarrhoea 50 case fatality rate ZA_av

30 Child under 5

3_Child and school health school and 3_Child years 20 pneumonia case fatality rate 10

0 60 1_Impact Child under 5 years severe 40 acute malnutrition 20 case fatality rate 0

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

Infant 80 exclusively breastfed at 60 DTaP-IPV-Hib- HBV 3rd dose 40 rate 20

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

AnnualWC, DC2, trends Cape Winelands HIV District Municipality, SEQ 5 (least deprived)

60 Measure Names IndValue 4_HIV HIV testing Prov_av coverage 40 (including ANC) ZA_av 20

200

Male condom distribution 100 coverage 4_Process_input

80 60 Medical male circumcision 40 rate 20 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

780 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

HIV 4.8 4.5 5.0 6.4 5.0 4.5 2.3 712 190 168 277 345 19.0 1 692 508 374 862 842 836 346 836 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 73.0 59.8 65.5 62.9 48.5 56.3 72.2 763 767 593 106 659 610 764 277 447 360 7 251 172 7 251 3 608 500 3 585 685 585 3 2 344 800 20 593 957 2016/17 distribution distribution Male condom condom Male coverage (No) 31.1 27.5 31.3 19.5 30.9 35.9 26.8 28.8 24 152 15 676 19 953 45 831 32 577 3 803 800 138 189 702 585 702 6 024 711 3 773 115 4 207 311 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - 927 354 - - - 1 258 590 ------1 907 262 1 204 605 1 340 139 - - - 1 228 920 - - 4.2 4.2 8.2 6 046 145 001 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 54.8 56.2 27 162 48 348 48 2016/17 on ART rate (%) Clients remaining 8 8 - 14 19 10 24 93 42 25 22 34 113 57.1 74.4 81.0 86.4 80.0 82.3 96.0 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------449 71.0 61.3 76.4 70.9 69.4 78.0 70.8 1 178 1 162 5 503 5 1 049 1 665 1 2015 months (%) on ART after 12 Adult percentageAdult 4 2 3 6 5 3 6 3 - 17 13 24 38 50.0 76.5 73.9 50.0 50.0 60.0 63.2 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------318 128 428 292 492 81.3 91.2 88.1 89.0 89.8 90.3 90.8 1 658 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load 7 4 8 6 5 6 - 17 19 91 24 38 33 57.1 51.1 41.8 75.0 15.2 25.0 89.5 (%) 2015 Child with viral load completion completion load rate at months 12 ------747 771 598 332 39.1 45.4 52.8 40.9 38.6 55.5 53.2 3 651 1 203 (%) 2015 Adult with viral load completion completion load rate at months 12 Numerator Denominator Indicator Indicator Denominator Indicator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Numerator Indicator Denominator Numerator

Western Cape Western Africa South Cape Winelands Winelands Cape Witzenberg SD Witzenberg Stellenbosch SD Langeberg SD Drakenstein SD Drakenstein Breede Valley SD Valley Breede Source: HIS.

781 Section B: NationalProfile Western and District Cape ProfilesProvince

TB Annual trends WC, DC2, Cape Winelands District Municipality, SEQ 5 (least deprived)

Measure Names ------15 IndValue 5_TB 51.6 Prov_av TB death rate 10 187 810 165 005 222 499 222 (ETR.net) ZA_av 1 329 179 5 2016/17

screened in 60 TB symptom 5 facility rate (%) rate facility years and older Process & input 1_Impact TB DR client 40 - - 300 662 ------453 203 - - - - - death rate (EDRWeb) 20 85.7 82.4 72.8 6 144 5 060 0 15 2016 Output rate (%) TB client lost to 10 on treatment treatment on follow up rate TB client initiated (ETR.Net) 5

0 197 271 201 208 403 398 500 640 338 344 74.6 74.2 80.6 52.3 63.0 58.3 53.8 88.3 2 147 1 353 80 TB client treatment 2016 success rate 60 Net) (%) Net)

TB/HIV co- (ETR.net)

ART rate (ETR. 40 infected client on 40 ------146 234 69.1 62.4 68.0 TB DR client loss to follow up 20 rate (EDRWeb)

2016 0 treatment treatment

TB Rifampicin Rifampicin TB 60 resistant clients clients resistant 2_Outcome initiation rate (%) rate initiation TB DR treatment 40 ------success rate 5.0 3.8 6.2

234 (EDRWeb) 20 6 144 0 2016

rate (%) TB Rifampicin 20 resistance resistance resistance TB Rifampicin Rifampicin TB

confirmed client confirmed client confirmed client 10 rate ------0 115 220 41.5 50.5 52.3 100

TB/HIV co-infected 50 2014 client on ART

Outcome rate (ETR.Net) success rate rate success (EDRWeb) (%)

TB DR treatment treatment DR TB 0 100 ------

58 TB symptom 5 220 17.9 26.4 30.3 years and older screened in 50 facility rate 4_Process_input 2014 0 2009 2010 2011 2012 2013 2014 2015 2016 (EDRWeb) (%)

to follow up rate Year TB DR client loss Measure Names IndValue 910 842 790 999 77.4 74.4 81.0 77.8 71.8 80.4 84.3 65.5 P rov_av 1 176 2 173 1 100 7 482 1 332 5 564 2 034 1 690 ZA_av 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 86 6.4 8.6 151 312 276 206 999 14.4 18.7 13.6 10.5 12.8 13.8 1 176 2 173 1 031 1 100 7 482 2 034 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------33 220 17.8 15.0 23.0 2014 death rate TB DR client (EDRWeb) (%) 41 Impact 57 37 89 38 4.1 4.1 1.9 3.4 6.6 4.8 3.9 3.5 262 999 1 176 2 173 1 100 7 482 2 034 2015 TB death rate (ETR.net) (%) Numerator Denominator Indicator Denominator Indicator Indicator Indicator Numerator Numerator Denominator Numerator Indicator Denominator Numerator Numerator Indicator Indicator Denominator Indicator Denominator D

South Africa South Drakenstein SD Drakenstein Western Cape Western Breede Valley SD Valley Breede Langeberg SD Witzenberg SD Witzenberg Stellenbosch SD Cape Winelands Winelands Cape Source: HIS.

782 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Breede Valley SD Indicator 1.1 9.5 Numerator 211 538 Denominator 2 214 432 676 206 Drakenstein SD Indicator 1.2 10.2 Numerator 337 909 Denominator 3 330 552 1 066 260 Langeberg SD Indicator 1.0 11.8 Numerator 112 409 Denominator 1 296 366 414 546 Stellenbosch SD Indicator 1.0 9.2 Numerator 178 450 Denominator 2 048 847 587 241 Witzenberg SD Indicator 0.8 13.1 Numerator 100 484 Denominator 1 543 260 443 682 Cape Winelands Indicator 1.1 10.5 Numerator 938 2 790 Denominator 10 433 457 3 187 935 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualWC, DC2, trends Cape Winelands District Municipality, SEQ 5 (least deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

783 Section B: NationalProfile Western and District Cape ProfilesProvince

Overberg District Municipality (DC3)

Overberg District is situated in the Western Cape Province and has four health sub-districts, namely Overstrand, Theewaterskloof, Swellendam and Cape Agulhas. The district has a population of 292 494, with a population density of 23.9 persons per km2 and falls into socio-economic Quintile 5, among the wealthiest districts. Estimated medical scheme coverage is 16.8%.

Social determinants of healtha Population per selected category

Unemployment ratea 17.0% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 22.9% under 1 year 4 602 4 664 4 742 4 792 No schooling 3.2% under 5 years 23 823 23 964 24 070 24 141 Matric 27.7% 05-09 years 23 551 23 817 24 027 24 252 Higher education 9.7% 10-14 years 21 988 22 530 23 152 23 722 Households 91 835 15-19 years 22 753 22 672 22 513 22 457 Female-headed households 31.9% 20-24 years 24 304 24 598 24 838 24 939 Formal dwellings 81.8% 25-29 years 26 182 26 376 26 623 26 895 Flush toilet connected to sewerage 86.7% 30-34 years 23 705 24 826 26 020 27 279 Weekly refuse removal 87.1% 35-39 years 21 486 21 948 22 354 22 662 Piped water inside dwellings 78.6% 40-44 years 20 179 20 355 20 561 20 847 Electricity for lighting 93.9% 45-49 years 18 970 19 277 19 514 19 715 Blue Drop water score 70.5% 50-54 years 15 771 16 477 17 174 17 787 55-59 years 12 732 13 192 13 661 14 168 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 10 047 10 468 10 936 11 421 65-69 years 8 023 8 179 8 376 8 625 70-74 years 6 266 6 393 6 518 6 647 75-79 years 4 047 4 274 4 494 4 698 80 years and older 2 518 2 736 2 959 3 184 Total 286 343 292 077 297 792 303 441 Estimated pregnant women* 4 924 4 990 5 074 5 127 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

784 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Cape Agulhas SD - 3 0 1 0 0 0 Overstrand SD - 4 0 1 0 0 1 Swellendam SD - 5 0 1 0 0 0 Theewaterskloof SD - 6 0 1 0 0 0 Overberg - 18 0 4 0 0 1 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Overberg 255 86 71 168 41 41 4 2 3 2 Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Cape Agulhas SD Indicator 2.7 - - - - - Numerator 100 649 - - - - - Denominator 453 495 - - - - - Overstrand SD Indicator 2.8 - - - - - Numerator 254 018 - - - - - Denominator 1 091 877 - - - - - Swellendam SD Indicator 2.4 - - - - - Numerator 100 348 - - - - - Denominator 493 668 - - - - - Theewaterskloof SD Indicator 2.2 - - - - - Numerator 276 754 - - - - - Denominator 1 491 681 - - - - - Overberg Indicator 2.5 42.1 84.2 1 796 1 009 335 Numerator 731 769 8 16 436 727 432 245 402 675 245 402 675 Denominator 3 530 721 19 19 243 211 243 211 731 769 Western Cape Indicator 2.3 15.2 70.7 1 742 1 089 379 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

785 Section B: NationalProfile Western and District Cape ProfilesProvince ------

2.5 Annual trends

20.3 WC, DC3, Overberg District Municipality, SEQ 5 (least deprived)

(%) 8 Measure Names OPD new client not not client IndValue referred rate rate referred Inpatient crude 6 Prov_av ------death rate ZA_av 4.1 5.4 1_Impact 4

1_Management 2 8 rate (%) Inpatient Inpatient

crude death 6 Average length ------of stay (district 4 hospitals) 85.4 84.3 2 (%) 4K utilisation rate - total Inpatient bed

2_Outcome Expenditure per patient day 3K ------equivalent Tertiary/Central Hospital (district 2K 4 227 5 432 hospitals)

day 1K (Rand) equivalent equivalent per patient Expenditure

Inpatient bed ------100 6.1

6.9 utilisation rate (district hospitals) 50 (Days) Average length of of length stay - total 100 3_Output ------OPD new client 5.2 37.2 not referred rate 50 (district

(%) hospitals) OPD new client not not client 0 referred rate rate referred 100 ------2.3 Percentage 50 Ideal clinics rate (%) Inpatient Inpatient

crude death 0 ------Provincial and 3K 89.4 78.3LG 5.0 District Health Services 2K (%) expenditure per

Hospital capita utilisation rate - total (uninsured) Inpatient bed 1K Regional Hospital Regional ------Provinc ial and 1500 3 024 2 894

4_Process_input LG PHC

day expenditure per

(Rand) 1000 capita equivalent equivalent per patient

Expenditure (uninsured) 500 ------4.0 5.3

Provincial and 400 LG PHC (Days) Average length of of length expenditure per stay - total PHC headcount 200 28 4.6 8.7 0.8 210 292 44.1 14.5 18.2 59.3 2008 2010 2012 2014 2016 2018 4 139 1 827 2 357 2 420 6 304 6 3 444 3 16 307 Year (%) Measure Names OPD new client not not client

referred rate rate referred IndValue P rov_av 84 5.1 1.9 2.4 3.0 3.5 3.0 113 139 447 ZA_av 3 744 2 431 4 885 18 528 rate (%) Inpatient Inpatient crude death 67.4 64.4 84.8 68.9 66.5 63.8 82.2 2.3 51 172 18 617 11 073 11 878 111 74 225 18 252 16 930 14 996 (%) utilisation rate - total Inpatient bed District Hospital District 2 512 2 621 2 188 1 957 2 307 3 260 2 568 12 224 17 372 17 78 533 day (Rand) 52 576 139 38 012 43938 012 91 29991 543 205 813020 205 equivalent equivalent per patient Expenditure 3.1 4.4 3.0 2.8 2.3 3.2 3.2 3 744 2 431 7 369 23 924 900 7 369 7 468 28 008 26 283 7 468 4 885 20 928 51 172 11 878 18 528 16 930 14 996 (Days) Average length of of length stay - total Indicator Numerator Numerator Denominator Indicator Denominator Indicator Indicator Numerator Denominator Indicator Numerator Denominator Numerator Denominator Indicator D

Cape Agulhas SD South Africa South Western Cape Western Overstrand SD Overstrand Swellendam SD Swellendam Theewaterskloof SD Indicator Overberg Source: HIS and BAS.

786 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 21 34 447 3 061 78 946 78 Total District District tertiary Central/ hospital ------2016/17 Hospital Regional Regional 21 33 447 2 734 - - 78 533 - - District District Hospital ------3 - - 3 1 413 327 / MOU PHC / CHC 41 14 10 34 220 468 3 187 Total District District tertiary Central/ Hospital ------2015/16 Hospital Regional Regional --- 14 10 40 34 468 2 830 - - 83 020 - - 83 493 District District Hospital - - - 1 473 220 357 / MOU PHC / CHC 24 25 33 184 438 Total District District tertiary Central/ Hospital ------2014/15 Hospital Regional Regional --- 24 29 25 438 2 907 - - 3 250 85 352 - - 85 839 District District Hospital ------1--1-1--1------3--3 ------1--1-2--2-1--1- - 1 - - 1 - 4 184 487 343 / MOU* PHC / CHC

Death in facility 0-7days Death in facility 8-28 days Death in facility months 29 days - 11 Death in facility – 59 months 12

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata Patient day equivalent day Patient Inpatient death total TB Deaths Severe acute malnutrition death under 5 years Pneumonia death under 5 years Live births Still birthsStill Maternal deaths deaths Maternal D (Number) Diarrhoea death under 5 years Source: HIS. *MOU – Maternal Obstetric Unit.

787 Section B: NationalProfile Western and District Cape ProfilesProvince

PercentageWC, Overberg: of deaths DC3, by 2010 broad - 2015cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 64% 8% 16% 13% 67% 6% 12% 15% causes and 5-14 15% 9% 31% 45% 16% 3%12% 69% single leading 15-24 11% 36% 20% 33% 4% 14% 10% 72% causes 25-64 5% 24% 61% 9% 4% 23% 50% 23% 65+ 6%1% 90% 3% 5%3% 89% 3% Broadcause 9% 12% 72% 7% 7% 14% 61% 18% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (18.7%) Lower respiratory infections (19.3%) HIV and TB 2 Preterm birth complications (15.8%) Preterm birth complications (16.8%) Comm_mat_peri_nut 3 Diarrhoeal diseases (12.3%) Diarrhoeal diseases (15.6%) 4 Protein-energy malnutrition (7.7%) Birth asphyxia (8.8%) Prov, District 5 HIV/AIDS (7.3%) Accidental threats to breathing (6.1%) WC, Overberg: DC3 6 Accidental threats to breathing (6.5%) HIV/AIDS (5.9%) Show history

<5 years <5 7 Birth asphyxia (6.1%) Protein-energy malnutrition (4.8%) 8 Congenital heart anomalies (5.1%) Congenital heart anomalies (4.0%) Percentages are shown 9 Sepsis/other newborn infectious (4.9%) Drowning (3.0%) according to all the deaths 10 Fires, hot substances (4.0%) Fires, hot substances (2.9%) within the age/gender 1 Road injuries (64.3%) Drowning (63.6%) category of each box, 2 Drowning (35.7%) Road injuries (28.1%) although only the leading 3 Diarrhoeal diseases (8.3%) 10 causes are displayed. 4 5

5-14 6 7 8 9 10 1 HIV/AIDS (35.3%) Interpersonal violence (31.3%) 2 Road injuries (21.8%) Road injuries (20.8%) 3 Tuberculosis (17.6%) Tuberculosis (11.4%) 4 Accidental threats to breathing (9.0%) Fires, hot substances (7.0%) 5 Interpersonal violence (9.0%) Accidental threats to breathing (6.5%)

15-24 6 Diarrhoeal diseases (4.4%) Drowning (6.5%) 7 Self-inflicted injuries (2.9%) Self-inflicted injuries (5.6%) 8 HIV/AIDS (4.0%) 9 Mechanical forces (2.9%) 10 Epilepsy (1.8%) 1 HIV/AIDS (14.9%) Tuberculosis (13.4%) 2 Tuberculosis (9.8%) HIV/AIDS (9.4%) 3 Cerebrovascular disease (7.3%) Is chaemic heart disease (9.1%) 4 Ischaemic heart disease (6.8%) Road injuries (7.4%) 5 Breast (5.7%) Trachea/bronchi/lung (7.0%)

25-64 6 COPD (5.0%) Interpersonal violence (6.7%) 7 Trachea/bronchi/lung (5.0%) COPD (5.4%) 8 Diabetes mellitus (3.7%) Cerebrovascular disease (4.2%) 9 Road injuries (3.5%) Lower respiratory infections (2.5%) 10 Cervix (2.9%) Self-inflicted injuries (2.1%) 1 Cerebrovascular disease (16.0%) Ischaemic heart disease (17.5%) 2 Ischaemic heart disease (15.4%) Cerebrovascular disease (10.9%) 3 COPD (5.6%) Trachea/bronchi/lung (8.0%) 4 Hypertensive heart disease (5.4%) COPD (7.6%) 5 Nephritis/nephrosis (4.6%) Prostate (6.1%)

65+ 6 Trachea/bronchi/lung (4.6%) Lower respiratory infections (3.5%) 7 Diabetes mellitus (4.5%) Alzheimer’s and other dementias (3.5%) 8 Breast (4.2%) Nephritis/nephrosis (3.1%) 9 Alzheimer’s and oth er dementias (4.1%) Diabetes mellitus (3.0%) 10 Lower respiratory infections (4.1%) Colo-rectal (2.8%)

Rank.. Maternal conditions All other causes 1 Hypertension in pregnancy (38.4%) n=5 HIV/AIDS (27.6%) n=319 2 Indirect maternal (34.8%) n=4 Tuberculosis (15.3%) n=177 3 Other maternal (26.7%) n=3 Road injuries (6.9%) n=80 4 Interpersonal violence (4.7%) n=54 5 Ischaemic heart disease (4.1%) n=47

15-49 6 Breast (3.5%) n=40 Female 7 Cerebrovascular disease (3.4%) n=40 8 Cervix (3.1%) n=36 9 Lower respiratory infections (2.5%) n=29 10 COPD (2.3%) n=27

788 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother Antenatal 1st Couple year mortality in client initiated facility under cancer postnatal visit visit before 20 protection rate facility ratio on ART rate 18 years rate screening within 6 days weeks rate (%) (WHO) (%) (per100K) (%) (%) coverage (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Cape Agulhas SD Indicator - 96.7 10.5 88.3 72.7 89.9 67.7 Numerator - 29 42 444 746 9 009 270 Denominator 393 30 399 503 12 308 120 282 399 Overstrand SD Indicator 156 92.3 4.7 76.2 45.2 100.2 65.2 Numerator 2 169 54 974 1 160 23 443 745 Denominator 1 270 183 1 143 1 279 30 777 280 758 1 143 Swellendam SD Indicator - 87.5 12.5 82.2 52.4 97.2 52.3 Numerator - 21 44 402 545 10 546 184 Denominator 358 24 352 489 12 483 130 167 352 Theewaterskloof SD Indicator 85.3 77.1 8.4 75.5 53.3 92.0 80.3 Numerator 1 168 99 1 490 1 575 31 441 945 Denominator 1 172 218 1 177 1 973 35 474 410 013 1 177 Overberg Indicator 94.0 85.1 7.8 78.0 53.1 94.9 69.8 Numerator 3 387 239 3 310 4 026 74 439 2 144 Denominator 3 193 455 3 071 4 244 91 043 941 220 3 071 Western Cape Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trends WC, DC3, Overberg District Municipality, SEQ 5 (least deprived)

800 Measure Names 600 IndValue Maternal Prov_av mortality in 400 facility ratio ZA_av 1_Impact 200 0 80

Antenatal 1st 60 visit before 20 weeks rate 40 2_Maternal and women's health women's and 2_Maternal 20

200 Couple year protection rate (WHO) 100

15 2_Outcome Delivery in facility under 18 10 years rate 5

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

789 Section B: NationalProfile Western and District Cape ProfilesProvince

Child and School Health Annual trends WC, DC3, Overberg District Municipality, SEQ 5 (least deprived)

Measure Names 100 IndValue 51.4 52.1 52.1 50.7 58.0 53.3 65.2 8 610 2 878 5 782 2 850 Child under 5

20 120 20 Prov_av 52 962 65 694 65 133 188

452 688 452 years diarrhoea 50 case fatality rate ZA_av months Vitamin A dose 12-59 coverage (%) coverage 0 511 215 792 482 404 30 81.1 78.1 12.6 19.8 79.9

1 159 Child under 5 2 527 106.0

3_Child and school health school and 3_Child years 20 pneumonia case fatality rate 10 8 screening coverage (%) coverage School Grade 0 60 1_Impact 199 825 642 629 550 87.8 31.6 74.3 52.9 33.0 83.3 53.2 68.8 Child under 5 1 199 3 324 2 097 1 484 200 844 1 842 years severe 40 acute malnutrition 20

1 screening case fatality rate coverage (%) coverage School Grade 0 Output 624 565 458 91.2 93.0 92.5 96.2 1 817 101.8 8 214 4 313 6 657 1 307 20 24 228 16 869 Inpatient early

dose neonatal death nd Measles Measles 2 rate 10 coverage (%) coverage 0

rd 150 437 738 288 264 206 460 47.1 27.1 57.4 41.6 31.8 91.2 55.0 90.0 45.3 1 064 Immunisation coverage under

Infant Infant 100 1 year DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 50 453 440 71.5 65.1 78.0 80.0 80.6 65.6 82.3 Infant 80 1 138 6 771 8 292 exclusively 16 947 23 280 1 342 55 290 3 303 55 968 53 700 37 944

(%) breastfed at 60 DTaP-IPV-Hib- coverage HBV 3rd dose 40 under 1 year Immunisation Immunisation rate 20 - 3 294 1 496 - - - 1 263 - - - - - 17 29 1.3 0.0 0.8 190 258 494

3_Output 150

(%) Measles 2nd dose coverage 100 Outcome around 10 Infant PCR weeks rate test positive positive test

50 6 6 6 4 22 5.1 6.9 8.5 11.2 12.4 100 School Grade 1 screening (per1K) 50 neonatal neonatal Inpatient Inpatient

death rate cover age 6 5 6 4 0 21 7.1 4.7 4.7 9.9 6.6 4.3 393 393 358 358 11.2 15.3 15.3 2009 2010 2011 2012 2013 2014 2015 2016 1 172 1 172 3 193 3 193 Year

early Measure Names (per1K) neonatal neonatal Inpatient Inpatient

death rate IndValue P rov_av 6 8 6 5 ZA_av 25 1.1 4.4 0.6 0.9 2.0 0.9 575 730 294 1 039 1 270 1 270 2 638 Inpatient Inpatient year rate (%) death under 5 6 8 6 5 25 1.4 1.9 1.3 6.3 3.8 2.5 2.2 2.2 157 441 324 229 1 151 Impact Inpatient Inpatient year rate (%) death under 1 5 5 6 ------16 32 0.6 0.0 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute ------70 77 0.4 0.0 163 236 546 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case ------15 75 87 0.0 2.0 2.0 8.0 0.3 115 292 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Numerator Indicator Numerator Denominator Numerator Denominator Indicator Denominator Numerator Indicator Denominator Indicator Numerator Denominator Indicator D

Cape Agulhas SD South Africa South Western Cape Western Overstrand SD Overstrand Overberg Theewaterskloof SD Indicator Swellendam SD Swellendam Source: HIS.

790 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

HIV Annual trends WC, DC3, Overberg District Municipality, SEQ 5 (least deprived)

60 Measure Names 74 71 5.0 4.9 4.3 5.6 4.5 4.5 213 616 IndValue 258 19.0 4_HIV HIV testing 40 Prov_av 204 417 632 514

189 036 coverage 457 494 (including ANC) ZA_av 20 (per1K) 2016/17 Medical male male Medical

circumcision rate rate circumcision 200

Male condom distribution 47.5 57.5 61.3 59.7 54.6 58.6 48.5 100 coverage 181 545 181 169 446 169 927 200 771 000 771 568 353 4_Process_input 2 012 700 2 012 2 825 400 6 536 300

2016/17 80 distribution distribution

Male condom condom Male 60 coverage (No) Medical male circumcision 40 rate 20 40.4 36.0 30.9 40.3 35.9 36.8 35.3 8 861 8 043 17 216 25 213

59 333 59 0 856 410 239 613 573 183 420 180

1 932 435 1 339 524 1 483 461 2009 2010 2011 2012 2013 2014 2015 2016 (%)

90-90-90 Year 2016/17 coverage st HIV testing 1 Measure Names Process & input (including ANC) IndValue P rov_av - - - - - 263 229 ------4.3 4.2 8.2 ZA_av 2 672 61 941 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------82.7 55.0 54.8 10 397 12 569 2016/17 on ART rate (%) Clients remaining 9 4 4 2 1 8 - 13 10 29 22 74.4 75.9 50.0 80.0 69.2 100.0 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------174 146 927 996 77.4 74.6 76.4 70.9 80.0 85.9 2 243 2015 months (%) on ART after 12 Adult percentageAdult 2 2 7 5 2 0 1 1 4 - 10 0.0 70.0 80.0 73.9 100.0 100.0 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------76 114 816 196 430 91.2 94.9 94.9 92.3 83.3 84.2 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load 2 4 7 2 1 1 5 - 10 10 22 51.1 71.4 20.0 50.0 45.5 100.0 (%) 2015 Child with viral load completion completion load rate at months 12 ------110 125 552 649 77.9 69.1 91.2 52.8 56.8 30.2 1 436 (%) 2015 Adult with viral load completion completion load rate at months 12 Denominator Numerator Indicator Numerator Denominator Indicator Denominator Indicator Denominator Numerator Indicator Indicator Numerator Denominator Numerator Indicator

Western Cape Western Overberg Theewaterskloof SD Indicator South Africa South Swellendam SD Swellendam Overstrand SD Overstrand Cape Agulhas SD Source: HIS.

791 Section B: NationalProfile Western and District Cape ProfilesProvince

TB Annual trends WC, DC3, Overberg District Municipality, SEQ 5 (least deprived) ------Measure Names 15 IndValue 5_TB 51.6 85 119 83 173 TB death rate Prov_av 617 425 617 219 435 219 229 698 229 10 (ETR.net) ZA_av

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact ------TB DR client 40 70.1 85.7 72.8 1 110

1 583 death rate (EDRWeb) 20 2016 Output rate (%) 0

on treatment treatment on 15 TB client initiated TB client lost to 10 31 56 44 45 follow up rate 121 146 332 229 662 342 51.7 74.6 78.6 44.0 52.8 68.9 88.3 (ETR.Net) 5

0 2016 Net) (%) Net)

TB/HIV co- 80

ART rate (ETR. TB client infected client on treatment success rate 60 ------74 42 (ETR.net) 69.1 56.8 68.0 40

40 2016

treatment treatment TB DR client TB Rifampicin Rifampicin TB

resistant clients clients resistant loss to follow up initiation rate (%) rate initiation 20 rate (EDRWeb) ------74 4.7 5.0 6.2 0 1 583

60 2_Outcome

2016 TB DR

rate (%) treatment 40 resistance resistance success rate TB Rifampicin Rifampicin TB confirmed client confirmed client (EDRWeb) 20 ------0 19 59 41.5 32.2 50.5

TB Rifampicin 20 resistance 2014 confirmed client Outcome 10

success rate rate success rate (EDRWeb) (%) TB DR treatment treatment DR TB 0 ------100 19 59 17.9 32.2 30.3 TB/HIV co-infected client on ART 50 2014 rate (ETR.Net)

(EDRWeb) (%) 0 to follow up rate TB DR client loss 100 TB symptom 5 241 217 189 155 587 638 81.0 92.0 80.4 90.9 90.0 92.0 82.0 1 013 1 101 2 169 1 972 years and older screened in 50 facility rate 2015 4_Process_input TB client client TB

treatment treatment 0 success rate rate success (ETR.net) (%) 2009 2010 2011 2012 2013 2014 2015 2016 Year Measure Names 10 15 22 22 69 4.1 7.9 2.0 3.4 6.4 3.2 241 189 638

10.5 IndValue 1 101 2 169 P rov_av ZA_av 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------19 59 17.8 23.0 32.2 2014 death rate TB DR client (EDRWeb) (%) 6 17 Impact 10 36 69 4.1 2.7 3.3 6.6 3.2 3.9 3.2 241 189 638 1 101 2 169 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Numerator Indicator Denominator Indicator DHIS.

Overberg Theewaterskloof SD Indicator Swellendam SD Swellendam Overstrand SD Overstrand Cape Agulhas SD Western Cape Western South Africa South Source:

792 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Cape Agulhas SD Indicator 2.0 11.6 Numerator 76 172 Denominator 453 495 178 020 Overstrand SD Indicator 1.1 9.5 Numerator 100 333 Denominator 1 091 877 420 978 Swellendam SD Indicator 1.1 10.8 Numerator 46 157 Denominator 493 668 174 567 Theewaterskloof SD Indicator 1.4 7.9 Numerator 178 315 Denominator 1 491 681 476 067 Overberg Indicator 1.4 9.4 Numerator 400 977 Denominator 3 530 721 1 249 632 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualWC, trends DC3, Overberg District Municipality, SEQ 5 (least deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

793 Section B: NationalProfile Western and District Cape ProfilesProvince

Eden District Municipality (DC4)

Eden District in the Western Cape Province has a population of 615 400 people, with a population density of 26.4 persons per km2. The district incorporates seven health sub-districts, namely George, Mossel Bay, Knysna, Bitou, Oudtshoorn, Hessequa and Kannaland, and falls into socio-economic Quintile 4, among the second-wealthiest districts. Estimated medical scheme coverage is 17.5%. Eden is one of the 11 National Health Insurance (NHI) pilot districts.

Social determinants of healtha Population per selected category

Unemployment ratea 22.5% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 29.9% under 1 year 10 498 10 640 10 761 10 770 No schooling 2.9% under 5 years 53 066 53 443 53 637 53 668 Matric 33.9% 05-09 years 51 691 52 116 52 539 53 062 Higher education 9.0% 10-14 years 49 587 50 213 51 079 51 911 Households 189 345 15-19 years 52 451 51 464 50 433 49 815 Female-headed households 36.1% 20-24 years 53 332 53 538 53 687 53 521 Formal dwellings 85.7% 25-29 years 55 484 55 276 55 015 54 751 Flush toilet connected to sewerage 88.7% 30-34 years 48 818 51 070 53 280 55 438 Weekly refuse removal 88.8% 35-39 years 41 480 42 729 43 960 44 894 Piped water inside dwellings 75.8% 40-44 years 40 063 39 710 39 534 39 712 Electricity for lighting 95.6% 45-49 years 40 312 40 269 40 014 39 685 Blue Drop water score 64.5% 50-54 years 34 442 35 718 36 920 37 840 55-59 years 28 179 28 921 29 704 30 584 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 22 898 23 576 24 280 24 994 65-69 years 18 064 18 482 18 952 19 471 70-74 years 13 842 14 106 14 379 14 683 75-79 years 8 891 9 403 9 876 10 296 80 years and older 6 178 6 653 7 137 7 634 Total 618 784 626 685 634 437 641 957 Estimated pregnant women* 11 233 11 385 11 514 11 524 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

794 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Bitou SD - 4 0 0 0 0 0 George SD - 10 0 1 1 0 2 Hessequa SD - 4 0 1 0 0 0 Kannaland SD - 4 0 1 0 0 0 Knysna SD - 5 0 1 0 0 2 Mossel Bay SD - 4 0 1 0 0 1 Oudtshoorn SD - 5 0 1 0 0 1 Eden - 36 0 6 1 0 6 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Eden 474 276 223 473 120 99 6 7 10 2 Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bitou SD Indicator 2.2 - - - - - Numerator 117 353 - - - - - Denominator 634 335 - - - - - George SD Indicator 2.2 - - - - - Numerator 464 646 - - - - - Denominator 2 501 667 - - - - - Hessequa SD Indicator 2.2 - - - - - Numerator 126 335 - - - - - Denominator 680 646 - - - - - Kannaland SD Indicator 2.9 - - - - - Numerator 76 295 - - - - - Denominator 319 584 - - - - - Knysna SD Indicator 2.4 - - - - - Numerator 177 969 - - - - - Denominator 884 907 - - - - - Mossel Bay SD Indicator 2.6 - - - - - Numerator 248 925 - - - - - Denominator 1 155 780 - - - - - Oudtshoorn SD Indicator 2.1 - - - - - Numerator 216 361 - - - - - Denominator 1 239 246 - - - - - Eden Indicator 2.3 19.5 97.6 1 860 1 105 393 Numerator 1 427 884 8 40 944 026 694 560 541 306 560 541 306 Denominator 7 416 165 41 41 507 427 507 427 1 427 884 Western Cape Indicator 2.3 15.2 70.7 1 742 1 089 379 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

795 Section B: NationalProfile Western and District Cape ProfilesProvince ------2.5 20.3 (%) OPD new client not not client referred rate rate referred ------4.1 5.4 rate (%) Inpatient Inpatient crude death ------85.4 84.3 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 4 227 5 432 day (Rand) equivalent equivalent per patient Expenditure ------6.1 6.9 (Days) Average length of of length stay - total ------7.9 7.9 5.2 37.2 1 831 1 831 23 270 23 270 (%) OPD new client not not client referred rate rate referred ------3.4 3.4 2.3 750 750 21 897 21 897 rate (%) Inpatient Inpatient crude death ------89.4 79.5 79.5 78.3 5.0 78 978 78 78 978 78 99 291 99 291 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------3 024 2 894 3 488 3 488 115 340 115 340 day (Rand) equivalent equivalent per patient 402 284 044 402 284 044 Expenditure ------4.0 3.6 3.6 5.3 78 978 78 21 897 78 978 78 21 897 (Days) Average length of of length stay - total 2 2 0.1 1.2 2.6 0.5 130 156 428 26.1 24.4 16.0 18.2 59.3 4 147 3 525 1 853 13 515 10 935 16 990 (%) OPD new client not not client referred rate rate referred 41 92 4.1 3.1 5.1 3.1 2.9 4.0 2.8 3.0 3.3 370 287 293 203 4 932 6 083 1 026 1 286 7 962 2 777 2 10 159 12 688 40 928 49 804 rate (%) Inpatient Inpatient crude death 289 87.1 67.4 81.9 88.6 85.2 84.8 83.0 60.9 4 746 38 241 10 921 15 891 18 252 24 902 44 900 44 119 959 144 525 (%) utilisation rate - total Inpatient bed District Hospital District 1 831 2 378 75.8 1 737 1 1 846 2 307 2 020 2 285 2 568 1 983 1 13 167 21 855 54 383 54 45 086 32 854 177 998 177 day (Rand) 44 141 974 44 141 91 723 373 723 91 100 412 872 100 412 equivalent equivalent per patient 352 963 581 Expenditure 2.7 3.0 4.4 2.9 2.9 2.8 3.2 3.2 3.2 4 932 1 026 4 929 9 346 38 578 32 854 9 346 2 777 2 8 944 22 873 741 8 944 2 889 262 630 11 10 159 38 241 15 891 12 688 24 902 29 093 82 548 991 29 093 40 928 119 959 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator D

Eden Oudtshoorn SD Oudtshoorn Mossel Bay SD Knysna SD Kannaland SD Kannaland Hessequa SD Hessequa Western Cape Western George SD George South Africa South Source: HIS and BAS.

796 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Annual trends Management and efficiency Deaths and Patient day equivalent 2014/15 – 2016/17 indicators for the service delivery platform, 13 15 63 2016/17 WC, DC4, Eden District Municipality, SEQ 4 (well off) 161 Total District District 8 Measure Names IndValue - - - 7 788 - 293 338 Inpatient crude 6 Prov_av death rate ZA_av

1_Impact 4 tertiary Central/ hospital 1_Management 2 8 76 32

6 2 724 Average length 115 340

of stay (district 2016/17 Hospital 4 Regional hospitals) 2 31 85 4K 177 998 177 2_Outcome Expenditure per District Hospital patient day 3K - - equivalent - 6 9 - (district 2K hospitals) 1K / MOU PHC / CHC

Inpatient bed 64 100 22 utilisation rate 184 (district Total

hospitals) District 50 - - - - 297 788 - 100 - 1 997 - 1 286 750 - 2 036 3_Output OPD new client

not referred rate tertiary Central/ 50 Hospital (district hospitals) 16 30 69 0 718 100 2 848 - 8 037 - 5 064 116 248 2015/16 Hospital Regional Regional

Percentage 50 Ideal clinics 34 115 5 189 181 540 District District

0 Hospital 3K - - 6 - - - 9 - 9 - 2 7 - 9 - Provincial and - 1 279 LG District

Health Services 1 820 - - - 1 820 - - - - - 2K expenditure per capita / MOU PHC / CHC (uninsured) 1K 11 31 65 156 1 519 Provinc ial and 1500 1 768 287 731 Total 4_Process_input

LG PHC District expenditure per 1000 capita ------(uninsured) 500 tertiary Central/ Hospital

Provincial and 400 LG PHC 11 24 29 65

expenditure per 643

PHC headcount 2 907 - 8 295 -

200 110 940 2014/15 Hospital Regional Regional

2008 2010 2012 2014 2016 2018 --- 91 Year 36 1 125 Measure Names 388 5 176 791 District District

IndValue Hospital P rov_av -24-6-16-7-21-3 - -11-2--4-4-76- - 7 ------2-2------1-1 ----1-24-6------1--1-1--1--1-1 - - ZA_av 1 519 / MOU* PHC / CHC

Death in facility 0-7days Death in facility 8-28 days Death in facility months 29 days - 11 Death in facility – 59 months 12

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata Maternal deaths deaths Maternal D (Number) Live births Still birthsStill Diarrhoea death under 5 years Pneumonia death under 5 years Severe acute malnutrition death under 5 years Patient day equivalent day Patient TB Deaths Inpatient death total Source: HIS. *MOU – Maternal Obstetric Unit.

797 Section B: NationalProfile Western and District Cape ProfilesProvince

WC,Percentage Eden: ofDC4, deaths 2010 by -broad 2015 cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 69% 7% 18% 6% 69% 5% 18% 8% causes and 5-14 24% 9% 22% 44% 16% 5% 20% 59% single leading 15-24 10% 43% 18% 29% 3% 19% 13% 65% causes 25-64 5% 29% 59% 7% 5% 28% 50% 17% 65+ 7%3% 87% 3% 6%4% 86% 4% Broadcause 10% 16% 69% 6% 8% 18% 61% 13% Total Injury NCD Rank.. Female Male 1 Preterm birth complications (22.3%) Preterm birth complications (20.6%) HIV and TB 2 Lower respiratory infections (19.9%) Lower respiratory infections (19.3%) Comm_mat_peri_nut 3 Diarrhoeal diseases (10.9%) Diarrhoeal diseases (9.9%) 4 HIV/AIDS (5.4%) Birth asphyxia (8.3%) Prov, District 5 Birth asphyxia (5.1%) Sepsis/other newborn infectious (5.3%) WC, Eden: DC4 6 Congenital heart anomalies (4.7%) Other respiratory (4.9%) Show history

<5 years <5 7 Sepsis/other newborn infectious (4.7%) HIV/AIDS (4.0%) 8 Other congenital abnormalities (3.0%) Congenital heart anomalies (3.5%) Percentages are shown 9 Other perinatal conditions (2.9%) Other perinatal conditions (2.9%) according to all the deaths 10 Tuberculosis (2.3%) Protein-energy malnutrition (2.7%) within the age/gender 1 Road injuries (22.4%) Drowning (32.7%) category of each box, 2 Drowning (21.8%) Road injuries (18.2%) although only the leading 3 Meningitis/encephalitis (10.3%) Fires, hot substances (6.1%) 10 causes are displayed. 4 Cardiomyopathy (8.7%) Accidental threats to breathing (5.2%) 5 Fires, hot substances (8.4%) Interpersonal violence (4.2%)

5-14 6 HIV/AIDS (7.3%) Epilepsy (3.9%) 7 Tuberculosis (5.8%) Cardiomyopathy (3.5%) Diarrhoeal diseases (3.5%) 8 Accidental threats to breathing (5.7%) 9 Endocrine nutritional,blood, immune (5.0%) Tuberculosis (3.3%) 10 Lower respiratory infections (4.6%) Other neurological conditions (3.0%) 1 HIV/AIDS (28.4%) Interpersonal violence (25.8%) 2 Tuberculosis (21.2%) Road injuries (15.4%) 3 Road injuries (8.2%) Tuberculosis (12.5%) 4 Interpersonal violence (7.4%) Accidental threats to breathing (8.4%) 5 Accidental threats to breathing (5.2%) Drowning (8.3%)

15-24 6 Lower respiratory infections (4.9%) HIV/AIDS (8.1%) 7 Self-inflicted injuries (4.5%) Self-inflicted injuries (3.9%) 8 Fires, hot substances (2.8%) Mechanical forces (3.4%) 9 Nephritis/nephrosis (2.2%) Epilepsy (2.9%) 10 Adverse effects medical/surgical (2.2%) Fires, hot substances (2.6%) 1 HIV/AIDS (18.0%) Tuberculosis (15.8%) 2 Tuberculosis (11.3%) HIV/AIDS (12.4%) 3 Cerebrovascular disease (7.2%) Ischaemic heart disease (7.8%) 4 Ischaemic heart disease (6.3%) Trachea/bronchi/lung (5.7%) 5 COPD (4.4%) Cerebrovascular disease (5.6%)

25-64 6 Breast (4.3%) COPD (5.0%) 7 Trachea/bronchi/lung (4.2%) Interpersonal violence (4.4%) 8 Diabetes mellitus (3.5%) Road injuries (4.4%) 9 Cervix (2.8%) Lower respiratory infections (2.8%) 10 Nephritis/nephrosis (2.7%) Diabetes mellitus (2.1%) 1 Cerebrovascular disease (17.2%) Ischaemic heart disease (17.3%) 2 Ischaemic heart disease (16.3%) Cerebrovascular disease (12.0%) 3 Hypertensive heart disease (5.5%) COPD (8.3%) 4 COPD (5.3%) Prostate (6.8%) 5 Diabetes mellitus (4.9%) Trachea/bronchi/lung (6.0%)

65+ 6 Lower respiratory infections (4.7%) Lower respiratory infections (3.9%) 7 Trachea/bronchi/lung (4.1%) Tuberculosis (3.6%) 8 Nephritis/nephrosis (4.0%) Nephritis/nephrosis (3.2%) 9 Breast (3.5%) Diabetes mellitus (2.6%) 10 Alzheimer’s and other dementias (2.6%) Colo-rectal (2.5%)

Rank.. Maternal conditions All other causes 1 Other maternal (63.4%) n=11 HIV/AIDS (30.2%) n=1 013 2 Indirect maternal (36.6%) n=6 Tuberculosis (16.1%) n=541 3 Cerebrovascular disease (4.5%) n=151 4 Road injuries (3.3%) n=111 5 Interpersonal violence (3.0%) n=101

15-49 6 Breast (2.9%) n=98 Female 7 Lower respiratory infections (2.9%) n=97 8 Cervix (2.8%) n=92 9 Ischaemic heart disease (2.7%) n=89 10 Nephritis/nephrosis (2.0%) n=65

798 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Maternal and Women’s Health

Denominator 589 28 587 800 733 19 989 175 185 587 Measure Names Kannaland SD Indicator - 78.6 9.1 600 77.3 92.2 91.2 109.7 IndValue Maternal Prov_av Numerator - 11 mortality in 16 400 338 639 6 446 192 facility ratio ZA_av Denominator 177 14 1_Impact 175 200 437 8 319 84 783 175 Knysna SD Indicator - 64.8 5.0 0 79.2 85.1 101.8 31.0 80 Numerator - 68 71 831 1 670 20 842 439 Antenatal 1st 60 Denominator 1 534 105 visit before1 418 20 1 049 23 562 245 769 1 418 Mossel Bay SD Indicator 72.6 55.6 weeks rate5.1 40 81.9 65.8 83.0 71.7 2_Maternal and women's health women's and 2_Maternal Numerator 1 65 71 20 1 145 1 811 21 658 991 Denominator 1 377 117 1 382 1 398 33 008 313 197 1 382 200 Oudtshoorn SD Indicator 54.7 71.2 Couple year9.9 75.2 68.7 94.8 41.0 protection rate Numerator 1 37 (WHO) 170 100 1 104 1 862 26 798 701 WC, DC4, Eden DistrictDenominator Municipality, SEQ 4 (well off)1 828 52 1 711 1 468 32 510 339 102 1 711

Eden 800 Indicator 33.5 73.3Measure Names 6.7 79.1 71.3 88.9 52.9 15 IndValue 600 Numerator 3 477 2_Outcome 590 6 852 11 751 151 777 4 639 Maternal Prov_avDelivery in mortality in 400 facility under 18 10 Denominator 8 964 651 ZA_av 8 765 8 663 197 823 2 049 192 8 765 facility ratio years rate Western1_Impact Cape 200 Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 5 South Africa 0 Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 80 200 Source: Antenatal DHIS. 1st 60 Mother visit before 20 postnatal visit 100 weeks rate 40 within 6 days rate Annualhealth women's and 2_Maternal trendsWC, DC4, Eden District Municipality, SEQ 4 (well off) 20 0 800 Measure Names 200 200 600 IndValue CoupleMaternal year Prov_avAntenatal client 150 protectionmortality in rate 400 initiated on ART ZA_av (WHO)facility ratio 100 rate 100 1_Impact 200 0 50 80 15

3_Output 150 2_Outcome DeliveryAntenatal in 1st 60 Cervical cancer facilityvisit before under 20 18 10 screening 100 yearsweeks rate rate 40 coverage 50 2_Maternal and women's health women's and 2_Maternal 5 20 200 2009 2010 2011 2012 2013 2014 2015 2016 200 Mother Year Couple year postnatal visit Measure Names protection rate 100 within 6 days IndValue rate(WHO) 100 P rov_av 0 ZA_av 20015 2_Outcome DeliveryAntenatal in client 150 facilityinitiated under on ART 18 10 yearsrate rate 100

505

200 3_Output 150 MotherCervical cancer postnatalscreening visit 100 100 withincoverage 6 days rate 50 0 200 2009 2010 2011 2012 2013 2014 2015 2016 Year Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50 799

2009 2010 2011 2012 2013 2014 2015 2016 Year Section B: NationalProfile Western and District Cape ProfilesProvince

Child and School Health 70.1 71.5 63.1 50.7 69.6 73.0 69.6 69.3 58.0 82.3 7 811 7 818 2 541 4 672 4 780 9 735 17 192 76 848 82 422 42 666 42 54 549 54 134 814 113 844 166 554 326 760 943 908 943 months Vitamin A dose 12-59 coverage (%) coverage 94 5.6 476 781 370 244 252 204 498 392 633 304 41.0 77.6 25.1 14.5 21.2 12.6 19.8 60.9 38.5 1 683 92 784 8 screening coverage (%) coverage School Grade 871 575 678 483 906 74.8 79.8 59.5 84.0 52.9 33.0 95.3 84.2 118.3 1 914 1 131 2 179 1 718 1 189 1 701 1 030 129 300 1 screening coverage (%) coverage School Grade Output 417 579 638 87.6 87.3 87.5 81.3 68.7 92.9 88.9 92.3 92.9 96.2 5 424 1 072 1 078 1 273 1 446 2 927 9 420 1 558 8 464 8 595 1 944 10 113 20 133 14 694 14 16 452 40 077 3 660 2 556 116 313 dose nd Measles Measles 2 coverage (%) coverage 81 70 414 142 183 924 661 401 525 789 492 41.6 27.3 31.8 91.2 19.8 13.3 12.3 32.7 29.6 32.7 35.4 2 171 7 951 1 266 2 668 2 1 506 dose rd Infant Infant rate (%) exclusively exclusively breastfed at HBV 3 DTaP-IPV-Hib- 378 627 582 942 71.0 74.9 80.0 84.9 90.6 80.3 80.5 83.8 82.3 92.8 1 477 9 372 9 2 766 5 637 7 998 7 9 843 15 861 15 087 19 569 39 108 114 477 (%) coverage under 1 year Immunisation Immunisation 3 3 2 1 2 2 1 226 2 15 27 26 86 1.1 7.7 7.4 1.4 1.4 1.8 1.3 1.2 2.6 0.8 114 819 144 138 284 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 5 1 6 9 - - - 17 76 38 4.4 5.6 9.3 5.9 8.5 8.5 8.5 11.0 12.4 (per1K) neonatal neonatal Inpatient Inpatient death rate 4 1 4 9 - - - 13 32 63 7.1 7.1 7.0 9.3 5.6 9.9 5.9 6.8 2.9 177 177 589 589 1 828 1 828 3 459 3 459 8 9648 964 8 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 8 2 6 - - - 11 19 54 1.1 1.1 1.7 1.0 1.3 4.4 0.5 0.8 0.3 413 100 737 3 146 1 759 1 377 1 377 1 991 1 337 1 534 1 534 9 383 Inpatient Inpatient year rate (%) death under 5 8 1 6 - - - 11 18 47 91 1.9 1.9 1.5 0.7 0.7 2.7 2.0 3.0 6.3 136 867 736 296 1 571 4 555 4 Impact Inpatient Inpatient year rate (%) death under 1 1 1 3 5 7 8 ------32 949 0.6 0.6 0.8 8.0 175 120 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 9 6 ------73 20 50 0.4 0.0 2.0 392 550 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 1 ------76 72 45 86 0.1 0.7 2.0 0.3 145 670 246 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Numerator Indicator Numerator Indicator Indicator Denominator Denominator Denominator Numerator Indicator Indicator Denominator Numerator Indicator Denominator Indicator Numerator Indicator Numerator Denominator Denominator Indicator Numerator Numerator Indicator Denominator D

en Ed Bitou SD Bitou George SD George Western Cape Western Kannaland SD Kannaland Hessequa SD Hessequa South Africa South Oudtshoorn SD Oudtshoorn Knysna SD Mossel Bay SD Source: HIS.

800 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Annual trendsWC, DC4, Child Eden District and School Municipality, Health SEQ 4 (well off)

Measure Names 100 IndValue Child under 5 Prov_av years diarrhoea 50 case fatality rate ZA_av

30 Child under 5

3_Child and school health school and 3_Child years 20 pneumonia case fatality rate 10

0 60 1_Impact Child under 5 years severe 40 acute malnutrition 20 case fatality rate 0

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

Infant 80 exclusively breastfed at 60 DTaP-IPV-Hib- HBV 3rd dose 40 rate 20

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trendsWC, DC4, HIV Eden District Municipality, SEQ 4 (well off)

60 Measure Names IndValue 4_HIV HIV testing Prov_av coverage 40 (including ANC) ZA_av 20

200

Male condom distribution 100 coverage 4_Process_input

80 60 Medical male circumcision 40 rate 20 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

801 Section B: NationalProfile Western and District Cape ProfilesProvince

HIV 68 7.1 9.0 4.5 6.4 5.4 4.5 6.5 119 743 137 146 427 596 19.0 10.7 18.9 2 236 361 710 275 010 471 534 125 706 262 575 4 782 24 1 013 292 1 013 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 41.8 60.1 61.9 45.4 53.4 48.5 64.3 55.2 103.4 110 115 418 389 590 184 246 288 908 190 908 239 232239 329 433 329 430 380 430 1 629 020 3 164 340 2 095 040 1 698 460 698 1 1 095 800 2 060 600 12 33312 444 2016/17 distribution distribution Male condom condom Male coverage (No) 33.1 31.5 36.4 30.9 35.9 32.9 34.6 26.9 38.3 45.5 5 236 8 960 8 14 185 19 784 17 085 14 097 31 400 110 747 618 762 341 079 164 037 491 706 371 904 652 806 652 4 042 281 2 682 027 2 988 051 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) ------1 401 987 - - - 3.1 4.2 8.2 3 665 3 117 411 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------51.8 55.0 54.8 20 127 38 886 38 2016/17 on ART rate (%) Clients remaining - 3 7 8 7 0 1 19 17 13 17 16 12 81 97 26 32 0.0 74.4 87.5 81.3 42.9 83.5 92.3 84.2 100.0 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------745 178 102 375 679 533 74.4 74.5 70.9 78.7 70.4 75.8 78.9 69.3 80.5 4 278 1 666 1 2015 months (%) on ART after 12 Adult percentageAdult - 4 6 3 2 8 7 4 2 7 7 9 - - - 31 12 40 87.5 77.5 66.7 66.7 73.9 75.0 50.0 100.0 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------33 94 113 253 330 546 333 87.9 57.6 81.4 91.2 89.4 78.8 90.6 94.9 88.5 1 702 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 3 6 3 8 6 4 7 - - - 11 16 12 16 75 40 23 51.1 37.5 72.7 66.7 75.0 30.4 53.3 100.0 (%) 2015 Child with viral load completion completion load rate at months 12 ------67 133 238 546 480 405 47.5 57.3 70.7 52.8 49.3 49.5 46.3 68.8 82.2 2 971 1 102 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Indicator Denominator Numerator Indicator Denominator Denominator Indicator Numerator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Denominator Denominator Indicator Numerator Indicator Numerator Indicator

Source: DHIS. South Africa South Western Cape Western Eden Oudtshoorn SD Oudtshoorn Mossel Bay SD Knysna SD Kannaland SD Kannaland Hessequa SD Hessequa George SD George Bitou SD Bitou Source: HIS.

802 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

TB ------63 766 174 345 212 905 107 087 152 854 100 858 388 464 388 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------85.7 72.8 78.2 4 328 3 384 3 2016 Output rate (%) on treatment treatment on TB client initiated 21 78 43 44 118 112 412 173 218 123 180 271 140 591 71.1 74.6 71.0 69.7 80.4 65.6 56.4 80.0 48.8 88.3 1 476 1 048 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------120 159 69.1 75.5 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------3.7 5.0 6.2 159 4 328 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------55 157 41.5 35.0 50.5 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------44 157 17.9 28.0 30.3 2014 (EDRWeb) (%) to follow up rate TB DR client loss 412 574 781 187 687 587 859 225 377 349 296 398 77.9 74.4 77.0 71.8 81.0 83.1 80.0 75.2 92.6 80.4 4 913 3 827 1 699 1 1 309 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 17 10 97 86 34 7.6 2.7 6.4 8.5 574 101 781 276 859 621 225 377 398 11.0 11.8 12.6 16.9 10.5 16.2 4 913 1 699 1 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------37 157 17.8 23.6 23.0 2014 death rate TB DR client (EDRWeb) (%) 14 14 Impact 48 50 38 79 28 7.0 8.7 5.6 4.9 3.7 5.5 4.6 6.6 6.2 3.9 574 781 271 859 225 377 398 4 913 1 699 1 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Denominator Indicator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Indicator Numerator Denominator Numerator Indicator D

Eden Oudtshoorn SD Oudtshoorn Mossel Bay SD Knysna SD Kannaland SD Kannaland Hessequa SD Hessequa George SD George South Africa South Western Cape Western Bitou SD Bitou Source: HIS.

803 Section B: NationalProfile Western and District Cape ProfilesProvince

Annual trends TB WC, DC4, Eden District Municipality, SEQ 4 (well off)

Measure Names 15 IndValue 5_TB Prov_av TB death rate 10 (ETR.net) ZA_av 5

60 1_Impact TB DR client 40 death rate (EDRWeb) 20

0 15

TB client lost to 10 follow up rate (ETR.Net) 5

80 TB client treatment success rate 60 (ETR.net) 40

TB DR client loss to follow up 20 rate (EDRWeb)

60 2_Outcome TB DR treatment 40 success rate (EDRWeb) 20

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

TB/HIV co-infected client on ART 50 rate (ETR.Net)

0 100 TB symptom 5 years and older screened in 50 facility rate

4_Process_input 0 2009 2010 2011 2012 2013 2014 2015 2016 Year

804 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Bitou SD Indicator 0.9 11.4 Numerator 48 191 Denominator 634 335 200 733 George SD Indicator 0.9 10.2 Numerator 184 716 Denominator 2 501 667 838 503 Hessequa SD Indicator 0.6 4.0 Numerator 33 96 Denominator 680 646 286 413 Kannaland SD Indicator 0.9 15.6 Numerator 23 148 Denominator 319 584 114 009 Knysna SD Indicator 1.1 15.5 Numerator 81 397 Denominator 884 907 306 483 Mossel Bay SD Indicator 1.3 10.9 Numerator 126 404 Denominator 1 155 780 445 953 Oudtshoorn SD Indicator 0.9 8.4 Numerator 96 293 Denominator 1 239 246 418 425 Eden Indicator 1.0 10.3 Numerator 591 2 245 Denominator 74 161 65 2 610 519 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual trendsWC, DC4, Eden District Municipality, SEQ 4 (well off)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

805 Section B: NationalProfile Western and District Cape ProfilesProvince

Central Karoo District Municipality (DC5)

The Central Karoo District in the Western Cape Province comprises three health sub-districts, namely Laingsburg, Prince Albert and Beaufort West. The district has a population of 74 453 (the smallest in the country by a large margin), with a very low population density of 1.9 persons per km2. It falls into socio-economic Quintile 4 and is therefore among the second- wealthiest districts and has an estimated medical scheme coverage of 13.3%.

Social determinants of healtha Population per selected category

Unemployment ratea 23.1% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 30.9% under 1 year 1 313 1 336 1 386 1 437 No schooling 5.8% under 5 years 7 093 7 100 7 138 7 198 Matric 29.5% 05-09 years 7 247 7 260 7 247 7 242 Higher education 3.2% 10-14 years 6 792 6 891 7 046 7 185 Households 21 980 15-19 years 7 626 7 354 7 061 6 858 Female-headed households 40.8% 20-24 years 7 388 7 490 7 590 7 612 Formal dwellings 97.8% 25-29 years 7 477 7 426 7 339 7 265 Flush toilet connected to sewerage 93.7% 30-34 years 5 763 6 210 6 665 7 085 Weekly refuse removal 90.8% 35-39 years 4 495 4 642 4 793 4 945 Piped water inside dwellings 73.8% 40-44 years 4 062 4 053 4 077 4 139 Electricity for lighting 95.1% 45-49 years 4 157 4 095 4 014 3 943 Blue Drop water score 49.9% 50-54 years 3 544 3 659 3 769 3 842 55-59 years 3 049 3 063 3 078 3 110 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 2 508 2 565 2 622 2 672 65-69 years 1 956 1 986 2 015 2 047 70-74 years 1 380 1 428 1 471 1 505 75-79 years 822 859 897 939 80 years and older 516 549 584 619 Total 75 870 76 634 77 411 78 205 Estimated pregnant women* 1 405 1 430 1 483 1 538 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

a Statistics South Africa. Census 2011 Municipal fact sheet. Report No. 03-01-58. Pretoria: Statistics SA; 2012.

806 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Beaufort West SD - 5 0 2 0 0 1 Laingsburg SD - 1 0 1 0 0 0 Prince Albert SD - 2 0 1 0 0 0 Central Karoo - 8 0 4 0 0 1 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Central Karoo 78 52 30 81 16 19 1 1 1 0 Source: Persal, DHIS.

Management and efficiency indicators for the service delivery platform, 2016/17

807 Section B: NationalProfile Western and District Cape ProfilesProvince ------Annual trends 2.5 WC, DC5, Central Karoo District Municipality, SEQ 4 (well off) 20.3

(%) 8 Measure Names OPD new client not not client IndValue referred rate rate referred Inpatient crude 6 Prov_av ------death rate ZA_av 4.1 5.4 1_Impact 4

1_Management 2

rate (%) 8 Inpatient Inpatient crude death 6 Average length ------of stay (district 4 85.4 84.3 hospitals)

(%) 2 utilisation rate - total

Inpatient bed 4K

2_Outcome Expenditure per ------patient day 3K Tertiary/Central Hospital equivalent 4 227 5 432 (district 2K day

(Rand) hospitals) 1K equivalent equivalent per patient Expenditure ------6.1 6.9 Inpatient bed 100 utilisation rate (district (Days) Average length of of length hospitals) stay - total 50 ------100 5.2 3_Output 37.2 OPD new client (%) not referred rate 50 OPD new client not not client (district

referred rate rate referred hospitals) ------0 2.3 100 rate (%)

Inpatient Inpatient Percentage

crude death 50 Ideal clinics ------89.4 78.3 5.0 0

(%) Provincial and 3K

Hospital LG District utilisation rate - total

Inpatient bed Health Services 2K Regional Hospital Regional expenditure per ------capita (uninsured) 3 024 2 894 1K day (Rand) equivalent equivalent per patient Provinc ial and Expenditure 1500

4_Process_input LG PHC ------expenditure per 4.0

5.3 1000 capita (uninsured) 500 (Days) Average length of of length stay - total

Provincial and 2 400 45 0.4 3.3 8.2

3.2 LG PHC 571 231 278 552 18.2 59.3 7 324 8 447 expenditure per PHC headcount (%) 200 OPD new client not not client referred rate rate referred 2008 2010 2012 2014 2016 2018 50 43 Year 5.1 3.1 3.0 2.3 2.8 2.9 216 309 2 130 7 071 1 546 Measure Names 10 747 IndValue rate (%)

Inpatient Inpatient P rov_av crude death ZA_av 67.4 69.7 73.9 84.8 53.2 7 301 19 516 25 918 10 586 43 805 43 30 548 30 (%) utilisation rate - total Inpatient bed District Hospital District 7 169 1 981 2 276 2 427 75.3 2 307 1 938 6 665 6 2 568 42 798 28 964 28 day (Rand) 70 292 548 97 408 680 equivalent equivalent per patient Expenditure 4.4 2.6 3.5 2.8 2.8 3.2 2 130 7 071 5 636 675 199 14 5 636 1 546 5 396 458 916 12 5 396 10 747 19 516 30 548 30 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Indicator Denominator Denominator Numerator Numerator Indicator D

Central Karoo Karoo Central Prince Albert SD Albert Prince Western Cape Western Laingsburg SD Laingsburg South Africa South Beaufort West SD Beaufort West Source: HIS and BAS.

808 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 10 28 931 309 Total District District tertiary Central/ hospital ------2016/17 Hospital Regional Regional 10 28 931 309 District District Hospital ------42 798 - - 42 798 - / MOU PHC / CHC 24 66 982 304 45 311 Total District District tertiary Central/ Hospital ------2015/16 Hospital Regional Regional --- 24 982 304 45 311 District District Hospital - 9 - - 9 - - - - 66 / MOU PHC / CHC 16 22 96 261 45 043 45 Total District District tertiary Central/ Hospital ------2014/15 Hospital Regional Regional --- 16 22 261 45 043 45 District District Hospital -4--4------2--2-3--3 - 1 078 - - 1 078 - -3--3-5--5-2--2 - -2--2-2--2-1--1 -2--2-2--2------96 / MOU* PHC / CHC

Death in facility 0-7days Death in facility 8-28 days Death in facility months 29 days - 11 Death in facility – 59 months 12

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

years) Child (under 5 5 (under Child ata Element ata (Number) D Maternal deaths deaths Maternal Live births Still birthsStill Diarrhoea death under 5 years Pneumonia death under 5 years Severe acute malnutrition death under 5 years TB Deaths Inpatient death total Patient day equivalent day Patient Source: HIS. *MOU – Maternal Obstetric Unit.

809 Section B: NationalProfile Western and District Cape ProfilesProvince

PercentageWC, Central of Karoo:deaths byDC5, broad 2010 cause - 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 69% 2% 15% 15% 55% 9% 25% 11% causes and 5-14 4%10% 13% 72% 6% 12%3% 79% single leading 15-24 12% 31% 11% 46% 1%12% 12% 74% causes 25-64 4% 31% 53% 12% 4% 26% 45% 25% 65+ 7%2% 88% 3% 6%5% 86% 3% Broadcause 10% 17% 62% 10% 7% 18% 54% 21% Total Injury NCD Rank.. Female Male 1 Preterm birth complications (29.0%) Preterm birth complications (23.5%) HIV and TB 2 Lower respiratory infections (22.2%) Lower respiratory infections (15.6%) Comm_mat_peri_nut 3 Diarrhoeal diseases (14.6%) Other respiratory (10.9%) 4 Road injuries (12.2%) Diarrhoeal diseases (9.9%) Prov, District 5 Birth asphyxia (6.8%) Road injuries (8.5%) WC, Central Karoo: DC5 6 Congenital heart anomalies (5.8%) HIV/AIDS (7.7%) Show history

<5 years <5 7 Other perinatal conditions (3.2%) Congenital heart anomalies (7.2%) 8 Other respiratory (3.1%) Birth asphyxia (5.9%) Percentages are shown 9 Protein-energy malnutrition (3.1%) Protein-energy malnutrition (4.0%) according to all the deaths 10 Other congenital abnormalities (3.9%) within the age/gender 1 Road injuries (85.0%) Road injuries (88.0%) category of each box, 2 HIV/AIDS (15.0%) Drowning (12.0%) although only the leading 3 10 causes are displayed. 4 5

5-14 6 7 8 9 10 1 Road injuries (39.4%) Interpersonal violence (43.3%) 2 Tuberculosis (22.3%) Road injuries (31.4%) 3 HIV/AIDS (18.5%) Tuberculosis (11.9%) 4 Interpersonal violence (12.4%) Accidental threats to breathing (8.8%) 5 Epilepsy (7.4%) HIV/AIDS (4.6%)

15-24 6 7 8 9 10 1 HIV/AIDS (16.8%) Tuberculosis (15.4%) 2 Tuberculosis (15.2%) Road injuries (13.8%) 3 Road injuries (9.3%) HIV/AIDS (11.7%) 4 Ischaemic heart disease (7.0%) COPD (7.6%) 5 COPD (7.0%) Interpersonal violence (6.9%)

25-64 6 Cerebrovascular disease (5.7%) Ischaemic heart disease (6.3%) 7 Breast (3.6%) Trachea/bronchi/lung (5.4%) 8 Trachea/bronchi/lung (3.3%) Cerebrovascular disease (4.3%) 9 Diabetes mellitus (3.1%) Epilepsy (3.2%) 10 Cervix (2.6%) Lower respiratory infections (2.0%) 1 Cerebrovascular disease (19.1%) COPD (14.2%) 2 Ischaemic heart disease (14.7%) Ischaemic heart disease (14.1%) 3 Hypertensive heart disease (10.6%) Cerebrovascular disease (13.1%) 4 COPD (9.0%) Trachea/bronchi/lung (8.3%) 5 Trachea/bronchi/lung (4.9%) Prostate (8.2%)

65+ 6 Nephritis/nephrosis (4.9%) Hypertensive heart disease (4.6%) 7 Diabetes mellitus (4.9%) Tuberculosis (4.5%) 8 Lower respiratory infections (4.6%) Lower respiratory infections (3.6%) 9 Breast (2.9%) Nephritis/nephrosis (2.8%) 10 Alzheimer’s and other dementias (2.1%) Diabetes mellitus (2.5%)

Rank.. Maternal conditions All other causes 1 Other maternal (100.0%) n=3 HIV/AIDS (26.5%) n=157 2 Tuberculosis (22.1%) n=131 3 Road injuries (16.8%) n=99 4 Interpersonal violence (3.4%) n=20 5 Cerebrovascular disease (3.2%) n=19

15-49 6 COPD (3.0%) n=18 Female 7 Cervix (2.9%) n=17 8 Breast (2.8%) n=16 9 Lower respiratory infections (2.7%) n=16 10 Ischaemic heart disease (2.4%) n=14

810 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/s17 Beaufort West SD Indicator - 23.5 7.1 71.2 73.6 122.6 39.5 Numerator - 12 53 605 955 18 144.025 295 Denominator 734 51 746 850 15 578.1 177 522 746 Laingsburg SD Indicator - 50.0 14.6 82.3 74.2 96.5 69.8 Numerator - 1 14 102 179 2 381.0333 67 Denominator 92 2 96 124 2 893.2 29 616 96 Prince Albert SD Indicator - 83.3 8.4 76.3 50.3 91.5 79.4 Numerator - 10 9 184 170 3 587.8 85 Denominator 105 12 107 241 4 056.9 47 070 107 Central Karoo Indicator 0.0 35.4 8.0 73.3 69.5 113.8 47.1 Numerator - 23 76 891 1 304 24 112.858 447 Denominator 931 65 949 1 215 22 528.2 254 208 949 Western Cape Indicator 59.9 90.8 5.7 69.6 54.5 78.0 60.0 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trends WC, DC5, Central Karoo District Municipality, SEQ 4 (well off)

800 Measure Names 600 IndValue Maternal Prov_av mortality in 400 facility ratio ZA_av 1_Impact 200 0 80

Antenatal 1st 60 visit before 20 weeks rate 40 2_Maternal and women's health women's and 2_Maternal 20

200 Couple year protection rate (WHO) 100

15 2_Outcome Delivery in facility under 18 10 years rate 5

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

811 Section B: NationalProfile Western and District Cape ProfilesProvince

Annual trends Child and School Health WC, DC5, Central Karoo District Municipality, SEQ 4 (well off)

Measure Names

597 100 51.1 70.7 50.7 58.0 56.3 IndValue 1 245 21 144 12 732 87 828 Child under 5

121 704 Prov_av years diarrhoea 50 months ZA_av

Vitamin A case fatality rate dose 12-59 coverage (%) coverage 0 0 0 3 738 0 5 580 0 0.0 0.0 0.0 0.0 55.0 160 106 878 12.6 19.8

13 728 30 Child under 5

3_Child and school health school and 3_Child years 20

8 screening pneumonia coverage (%) coverage School Grade case fatality rate 10 12 9.1 143 132 978 823 0 52.0 73.0 52.9 33.0 63.8 1 127 60 18 408 1_Impact Child under 5 years severe 40 1 screening coverage (%) coverage School Grade acute malnutrition 20

Output case fatality rate 157 756 209 83.7 90.8 96.2 121.2 102.7 1 122 2 442 275 1 554 0 14 832 10 836 dose nd Measles Measles 2

coverage (%) coverage Inpatient early 20 neonatal death

50 rd rate 177 132 108 401 559 806 10 41.6 37.9 50.1 31.8 91.2 49.8 1 115 0 Infant Infant DTaP-IPV-

exclusively exclusively 150 Hib-HBV 3 breastfed at dose rate (%) Immunisation coverage under 170 106 623 899 91.6 61.0

75.7 100 80.0 85.0 82.3 1 year 14 253 10 530 (%) 50 coverage under 1 year Immunisation Immunisation Infant 80 6 2 226 7 1 497 1 1 - - - - exclusively 57 70 1.4 1.3 1.8 71.0 0.8 breastfed at 60 DTaP-IPV-Hib-

(%) HBV 3rd dose 40

Outcome rate around 10 Infant PCR weeks rate

test positive positive test 20 2 4 7 3_Output 13 92 150 9.5 8.5 14.0 12.4 Measles 2nd dose coverage 100 (per1K) neonatal neonatal Inpatient Inpatient death rate

50 2 4 4 10 92 7.1 5.4 9.9 105 105 931 931 734 734 10.7 19.0 19.0 43.5 43.5 100 School Grade 1

(per1K) screening

Inpatient Inpatient 50 death rate cover age early neonatal neonatal early 3 4 9

16 0 1.6 1.3 1.2 1.2 4.4 0.9 249 756 322

1 327 2009 2010 2011 2012 2013 2014 2015 2016 Year Measure Names Inpatient Inpatient year rate (%)

death under 5 IndValue P rov_av 3 4 8 15 2.1 1.9 2.7 2.6 6.3 3.5 115 310 140 565 ZA_av Impact Inpatient Inpatient year rate (%) death under 1

------17 12 29 0.6 0.0 8.0 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 4 ------26 52 22 0.4 0.0 2.0 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case ------41 26 95 0.0 2.0 0.3 162 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Denominator Numerator Indicator Indicator Indicator Denominator Numerator Numerator Denominator Indicator Indicator Indicator Numerator Denominator D

Central Karoo Karoo Central Laingsburg SD Laingsburg Prince Albert SD Albert Prince South Africa South Beaufort West SD Beaufort West Western Cape Western Source: HIS.

812 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

HIV Annual trends WC, DC5, Central Karoo District Municipality, SEQ 4 (well off)

Measure Names 15 21 7.3 3.7 4.5 8.8 4.2 60 214 178 19.0 IndValue 4_HIV 43 281 67 830 HIV testing 242 109

353 220 353 Prov_av coverage 40 (including ANC) ZA_av (per1K) 2016/17 20 Medical male male Medical circumcision rate rate circumcision

200 71.1 47.5 97.8 69.6 89.2 48.5 Male condom 61 071 39 639 39 317 040 216 330 229 800 362 000 362 distribution 100 2 355 590 coverage 2016/17 distribution distribution 4_Process_input Male condom condom Male coverage (No) 80 60 70.7 30.7 30.9 35.9 34.5 58.8 Medical male 2 428 1 699 1

59 151 40 24 527 95 007 20 400 1 763 790 circumcision 346 101 500 259 rate

(%) 20 90-90-90 2016/17 coverage st HIV testing

1 0 Process & input (including ANC) 2009 2010 2011 2012 2013 2014 2015 2016 ------Year 1.5 4.2 8.2 367 Measure Names 25 171 IndValue

(%) P rov_av

2016/17 ZA_av and older rate client years 15 (including ANC) HIV test positive ------55.0 54.8 88.6 1 631 1 842 2016/17 on ART rate (%) Clients remaining 1 1 6 5 - - - - 11 12 74.4 50.0 45.5 100.0 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage - - - - - 79 46 378 253 81.0 74.3 70.4 70.9 84.8 2015 months (%) on ART after 12 Adult percentageAdult 1 1 2 1 0 1 - - - - 0.0 50.0 73.9 100.0 (%) 2015 rate months 12 Child with viral load suppressed suppressed load

- - - - 15 75 23 113 91.2 78.3 60.0 62.8 53.3 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 1 1 6 2 1 5 - - - 51.1 20.0 33.3 100.0 (%) 2015 Child with viral load completion completion load rate at months 12 - - - - - 62 36 171 269 24.2 42.0 52.8 63.9 43.9 (%) 2015 Adult with viral load completion completion load rate at months 12 Numerator Denominator Indicator Indicator Indicator Denominator Indicator Denominator Indicator Numerator Numerator Denominator Indicator Numerator

Western Cape Western Africa South Central Karoo Karoo Central Prince Albert SD Albert Prince Beaufort West SD Beaufort West Laingsburg SD Laingsburg Source: HIS.

813 Section B: NationalProfile Western and District Cape ProfilesProvince

TB Annual trends WC, DC5, Central Karoo District Municipality, SEQ 4 (well off) ------Measure Names 15

51.6 IndValue 5_TB 27 193 19 082 TB death rate Prov_av 122 631 168 906 10 (ETR.net) ZA_av

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact ------40 415 513 TB DR client 85.7 72.8 80.9 death rate (EDRWeb) 20 2016 Output rate (%) 0 on treatment treatment on 15 TB client initiated

TB client lost to 10 16 16 64 25 26 175 105 133

74.6 follow up rate 48.1 60.0 88.3 96.2 100.0 (ETR.Net) 5

2016 0 Net) (%) Net) TB/HIV co-

ART rate (ETR. 80 infected client on TB client - -

- treatment ------19 21 success rate 60 69.1 68.0 90.5 (ETR.net) 40

2016 40 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant

initiation rate (%) rate initiation TB DR client loss to follow up 20 ------rate (EDRWeb) 21 4.1 5.0 6.2 513

2016 60 2_Outcome rate (%)

resistance resistance TB DR

TB Rifampicin Rifampicin TB treatment

confirmed client confirmed client 40 success rate (EDRWeb) 20 ------15 28 41.5 50.5 53.6 0

2014 TB Rifampicin 20

Outcome resistance success rate rate success

(EDRWeb) (%) confirmed client

TB DR treatment treatment DR TB 10 rate 7 ------

28 0 17.9 25.0 30.3 100

TB/HIV

2014 co-infected client on ART 50

(EDRWeb) (%) rate (ETR.Net) to follow up rate TB DR client loss 0 70 56 96 112 415

315 100 597 467 81.0 75.9 80.4 85.7 80.0 78.2 TB symptom 5 years and older 50 2015 screened in TB client client TB treatment treatment facility rate success rate rate success (ETR.net) (%) 4_Process_input 0

4 2009 2010 2011 2012 2013 2014 2015 2016 10 78 70 92 5.7 6.4 8.9 112 415 597 15.4 10.5 18.8 Year Measure Names IndValue 2015 P rov_av TB client loss (ETR.Net) (%) (ETR.Net) ZA_av to follow up rate 2 ------28 7.1 17.8 23.0 2014 death rate TB DR client (EDRWeb) (%) 7 4 11 Impact 70 22 2.7 6.6 3.7 3.9 3.6 112 415 597 10.0 2015 TB death rate (ETR.net) (%) Indicator Numerator Denominator Indicator Numerator Indicator Denominator Indicator Numerator Denominator Indicator Numerator Denominator Indicator D

Beaufort West SD Beaufort West Western Cape Western South Africa South Laingsburg SD Laingsburg Prince Albert SD Albert Prince Central Karoo Karoo Central Source: HIS.

814 SectionSection B: B: Profile National Western and DistrictCape Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Beaufort West SD Indicator 0.5 15.7 Numerator 24 254 Denominator 625 140 194 418 Laingsburg SD Indicator 0.3 3.8 Numerator 3 12 Denominator 105 099 37 632 Prince Albert SD Indicator 1.0 13.1 Numerator 14 58 Denominator 166 533 53 223 Central Karoo Indicator 0.5 13.6 Numerator 41 324 Denominator 896 772 285 273 Western Cape Indicator 1.1 7.6 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualWC, trends DC5, Central Karoo District Municipality, SEQ 4 (well off)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

815