District Hospital Performance Assessment Limpopo Province 2008-2010
Fiorenza Monticelli, Thokozani Mbatha, Sizulu Moyo, Catherine Ogunmefun, Rene English
District Hospital Performance Assessment
Limpopo Province 2008-2010
Fiorenza Monticelli, Thokozani Mbatha, Sizulu Moyo, Catherine Ogunmefun, Rene English
Published by Health Systems Trust
34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] South Africa http://www.hst.org.za
Published: November 2011
Suggested citation:
Monticelli F, Mbatha T, Moyo S, Ogunmefun C , English R. District Hospital Performance Assessment: Limpopo Province 2008-1010. Health Systems Trust; Durban, 2012
The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes
Acknowledgements
We would like to thank the National Department of Health for providing the data for the report. We are also grateful to Candy Day for assistance with the data. We thank Dr Peter Barron for input and guidance in writing the final report.
District Hospital Performance Assessment: Limpopo Province 2008-2010 i
INTRODUCTION ...... 1 BACKGROUND ...... 3 A A: MOPANI DISTRICT - DC-33 ...... 5 1. Dr C N Phatudi Hospital ...... 5 i: Description ...... 5 ii: Input and process indicators ...... 5 iii: Outcomes indicators ...... 7 iv: Impact indicators ...... 7 v: Conclusions ...... 8 2. Van Velden Memorial Hospital ...... 9 i: Description ...... 9 ii: Input and process indicators ...... 9 iii: Outcomes indicators ...... 10 iv: Impact indicators ...... 11 v: Conclusions ...... 12 3. Kgapane Hospital ...... 13 i: Description ...... 13 ii: Input and process indicators ...... 13 iii: Outcomes indicators ...... 14 iv: Impact indicators ...... 15 v: Conclusions ...... 16 4. Maphutha L. Malatjie Hospital ...... 17 i: Description ...... 17 ii: Input and process indicators ...... 17 iii: Outcomes indicators ...... 18 iv: Impact indicators ...... 19 v: Conclusions ...... 20 5. Nkhensani Hospital ...... 21 i: Description ...... 21 ii: Input and process indicators ...... 21 iii: Outcomes indicators ...... 22 iv: Impact indicators ...... 23 v: Conclusions ...... 24 6. Sekororo Hospital ...... 25 i: Description ...... 25 ii: Input and process indicators ...... 25 iii: Outcomes indicators ...... 26 iv: Impact indicators ...... 27 v: Conclusions ...... 28 B VHEMBE DISTRICT - DC-34 ...... 29 1. Elim Hospital ...... 29 i: Description ...... 29 ii: Input and process indicators ...... 29 iii: Outcomes indicators ...... 31 iv: Impact indicators ...... 31 v: Conclusions ...... 32
District Hospital Performance Assessment: Limpopo Province 2008-2010 ii
2. Louis Trichardt Hospital ...... 33 i: Description ...... 33 ii: Input and process indicators ...... 33 iii: Outcomes indicators ...... 34 iv: Impact indicators ...... 35 v: Conclusions ...... 36 3. Siloam Hospital ...... 37 i: Description ...... 37 ii: Input and process indicators ...... 37 iii: Outcomes indicators ...... 38 iv: Impact indicators ...... 39 v: Conclusions ...... 40 4. Messina Hospital ...... 41 i: Description ...... 41 ii: Input and process indicators ...... 41 iii: Outcomes indicators ...... 42 iv: Impact indicators ...... 43 v: Conclusions ...... 44 5. Donald Fraser Hospital ...... 45 i: Description ...... 45 ii: Input and process indicators ...... 45 iii: Outcomes indicators ...... 46 iv: Impact indicators ...... 47 v: Conclusions ...... 48 6. Malamulele Hospital ...... 49 i: Description ...... 49 ii: Input and process indicators ...... 49 iii: Outcomes indicators ...... 50 iv: Impact indicators ...... 51 v: Conclusions ...... 52 C CAPRICORN DISTRICT - DC-35 ...... 53 1. WF Knodel Hospital...... 53 i: Description ...... 53 ii: Input and process indicators ...... 53 iii: Outcomes indicators ...... 55 iv: Impact indicators ...... 55 v: Conclusions ...... 56 2. Helen Franz Hospital ...... 57 i: Description ...... 57 ii: Input and process indicators ...... 57 iii: Outcomes indicators ...... 58 iv: Impact indicators ...... 59 v: Conclusions ...... 60 3. Lebowakgomo Hospital ...... 61 i: Description ...... 61 ii: Input and process indicators ...... 61 iii: Outcomes indicators ...... 62
District Hospital Performance Assessment: Limpopo Province 2008-2010 iii
iv: Impact indicators ...... 63 v: Conclusions ...... 64 4. Zebediela Hospital ...... 65 i: Description ...... 65 ii: Input and process indicators ...... 65 iii: Outcomes indicators ...... 66 iv: Impact indicators ...... 67 v: Conclusions ...... 68 5. Botlokwa Hospital ...... 69 i: Description ...... 69 ii: Input and process indicators ...... 69 iii: Outcomes indicators ...... 70 iv: Impact indicators ...... 71 v: Conclusions ...... 72 6. Seshego Hospital ...... 73 i: Description ...... 73 ii: Input and process indicators ...... 73 iii: Outcomes indicators ...... 74 iv: Impact indicators ...... 75 v: Conclusions ...... 76 D WATERBERG DISTRICT - DC-36 ...... 77 1. Ellisras Hospital ...... 77 i: Description ...... 77 ii: Input and process indicators ...... 77 iii: Outcomes indicators ...... 79 iv: Impact indicators ...... 79 v: Conclusions ...... 80 2. Witpoort Hospital ...... 81 i: Description ...... 81 ii: Input and process indicators ...... 81 iii: Outcomes indicators ...... 82 iv: Impact indicators ...... 83 v: Conclusions ...... 84 3. Warmbaths Hospital ...... 85 i: Description ...... 85 ii: Input and process indicators ...... 85 iii: Outcomes indicators ...... 86 iv: Impact indicators ...... 87 v: Conclusions ...... 88 4. F H Odendaal Hospital ...... 89 i: Description ...... 89 ii: Input and process indicators ...... 89 iii: Outcomes indicators ...... 90 iv: Impact indicators ...... 91 v: Conclusions ...... 92 5. George Masebe Hospital ...... 93 i: Description ...... 93
District Hospital Performance Assessment: Limpopo Province 2008-2010 iv
ii: Input and process indicators ...... 93 iii: Outcomes indicators ...... 94 iv: Impact indicators ...... 95 v: Conclusions ...... 96 6. Voortrekker Hospital ...... 97 i: Description ...... 97 ii: Input and process indicators ...... 97 iii: Outcomes indicators ...... 98 iv: Impact indicators ...... 99 v: Conclusions ...... 100 7. Thabazimbi Hospital ...... 101 i: Description ...... 101 ii: Input and process indicators ...... 101 iii: Outcomes indicators ...... 102 iv: Impact indicators ...... 103 v: Conclusions ...... 104 E GREATER SEKHUKHUNE DISTRICT - DC-47...... 105 1. Dolokong Hospital ...... 105 i: Description ...... 105 ii: Input and process indicators ...... 105 iii: Outcomes indicators ...... 107 iv: Impact indicators ...... 107 v: Conclusions ...... 108 2. Mecklenburg Hospital ...... 109 i: Description ...... 109 ii: Input and process indicators ...... 109 iii: Outcomes indicators ...... 110 iv: Impact indicators ...... 111 v: Conclusions ...... 112 3. Groblersdal Hospital ...... 113 i: Description ...... 113 ii: Input and process indicators ...... 113 iii: Outcomes indicators ...... 114 iv: Impact indicators ...... 115 v: Conclusions ...... 116 4. Jane Furse Hospital ...... 117 i: Description ...... 117 ii: Input and process indicators ...... 117 iii: Outcomes indicators ...... 118 iv: Impact indicators ...... 119 v: Conclusions ...... 120 5. Matlala Hospital ...... 121 i: Description ...... 121 ii: Input and process indicators ...... 121 iii: Outcomes indicators ...... 122 iv: Impact indicators ...... 123 v: Conclusions ...... 124
District Hospital Performance Assessment: Limpopo Province 2008-2010 v
District Hospital Performance Assessment: Limpopo Province 2008-2010 vi
Introduction
Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.
This report aims to provide health managers at all levels within the health services, with a useful screening tool for assessing District hospital management performance. It provides managers with a snap shot of how a facility is performing in key areas of hospital management. It focuses on individual facilities and assesses seven key hospital performance indicators listed in Table 1. Data on these seven indicators is retrieved primarily from the DHIS. Individual facility data is compared to the national and provincial indicator average values. The hospitals are assessed over a period of three financial years: 2008/2009; 2009/2010 and 2010/2011. These are depicted as 2008, 2009 and 2010 respectively in the graphs and text in the report. The data presented should be viewed with an awareness of problems common to routine data, namely incorrect and missing data, as well as specific contextual factors.
The report should be considered in conjunction with a number of other published documents including; The Guidebook for District hospital Managers- Health Systems Trust-2006, A District hospital Service Package for South Africa – The South African National Department of Health – 2002 and the Negotiated Service Delivery Agreement.
District Hospital Performance Assessment: Limpopo Province 2008-2010 1
Table 1: Selected Hospital performance indicators: definitions and description Indicator Definition Description Numerator Denominator Unit of reporting Average length How long on The average Inpatients days Separations: - Day of stay average each length of time + 1/2 Day Discharges + (ALOS) patient spends in inpatients spend patients Deaths + hospital in hospital Transfers out + Day patients
Cost per The average cost The average cost Total Total patient day Rand patient day per patient day per patient per expenditure on equivalent equivalent seen in a hospital day seen in a health per (CpPDE) hospital hospital
Usable bed The proportion of The number of Total patient Total usable bed Percent utilisation rate beds in hospital patient days days - (Inpatient days (%) (BUR) that were utilised during the days + 1/2 Day or occupied reporting period, patients) x 100 expressed as a percentage of the sum of the daily number of useable beds.
Caesarean The proportion The number of Caesarean All deliveries in Percent section rate deliveries in which caesarean section section the facility (%) (CS rate) a caesarean deliveries, deliveries section is expressed as a performed percentage of all deliveries
Facility crude The proportion of The number of all Total inpatient Total inpatient Percent death rate all inpatient inpatient deaths deaths separations- (%) (FCDR): separations that expressed as a Includes - are deaths. percentage of all inpatient inpatient transfers out, separations day patients, inpatient deaths and inpatient discharges.
Perinatal The number of The sum of still Still births and Total births in Perinatal mortality rate perinatal deaths births + those inpatient early facility deaths/ 1000 (PNMR) per 1000 births. babies dying neonatal deaths births The perinatal within 7 days of in facility period starts at life per 1000 births the beginning of foetal viability (28 weeks gestation or 1000g) and ends at the end of the 7th day after delivery
Still birth rate The number of still The number of The number of The total Still births/ (SBR): births per 1000 babies who are still births number of births 1000 births births “born dead” per 1000 births
District Hospital Performance Assessment: Limpopo Province 2008-2010 2
Background
Limpopo Province is divided into five district municipalities demarcated as shown in Figure 1. In 2010, the province had 30 District hospitals serving an estimated population of 5 248 184 people. Table 2 gives a list of district hospitals in the province by district and sub-district location. The number of useable beds per facility is also listed in Table 2.
Figure 1: Map of Limpopo province depicting District boundaries
District Hospital Performance Assessment: Limpopo Province 2008-2010 3
Table 2: District hospitals in Limpopo Province: Location by District and local municipality
District Name Sub District Hospital Usable hospital Beds Dr CN Phatudi 130 Greater Tzaneen Van Velden Memorial 67 Greater Letaba Kgapane 220 Mopani Ba-Phalaborwa Maphutha L Malatjie 117 Greater Giyani Nkhensani 219 Maruleng Sekororo 132
Elim 328 Makhado L Trichardt 52
Siloam 220 Vhembe Musina Messina 80
Mutale D Fraser 263 Thulamela Malamulele 183 Aganang Knodel Hospital 120
Blouberg Helene Franz 135 Lebowakgomo 220 Capricon Lepelle-Nkumpi Zebediela 74 Molemole Botlokwa 56 Polokwane Seshego 220
Ellisras 82 Lephalale Witpoort 59
Bela-Bela Warmbaths 133 Waterberg Modimolle FO Odendaal 122 G Masebe 113 Mogalakwena Voorttrekker 91 Thabazimbi Thabazimbi 55
Dokolong 186 Greater Tubatse Mecklenburg 74
Greater Sekhukhune E Mostoaledi Groblersdal 40 Makhudumatanga Jane Furse 204 Greater Marble hall Matlala 120
District Hospital Performance Assessment: Limpopo Province 2008-2010 4
A A: Mopani District - DC-33
Mopani district had a population of approximately 1 082 087 people in 2010. It has 91 clinics, 8 CHCs, 27 mobile services, 6 district hospitals, 1 specialised hospital and 1 regional hospital. 1. Dr C N Phatudi Hospital i: Description
Dr C N Phatudi district hospital has 130 beds and lies in the Greater Tzaneen sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was fairly constant between 2008 and 2009 and increased in 2010, when it was then higher than the national and provincial averages. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 5
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010. It was lower than the national and provincial averages throughout this period.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased over the reporting period. It was higher than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 6 iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate fluctuated, increasing between 2008 and 2009 and then decreasing in 2010, when it was then in line with the provincial average.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was constant in 2008 and 2009 and increased in 2010 to a level in line with the national and provincial averages. The increase in the FCDR requires explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 7
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010, when it was then in line with the national and provincial averages. The reasons for the fluctuations should be ascertained.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, increasing between 2008 and 2009 and then decreasing significantly in 2010 to a level lower than the national and provincial averages. The reasons for the fluctuations and the low rates in 2010 should be ascertained.
v: Conclusions
The reasons for the increase in the ALOS and the FCDR should be ascertained. The CS rate, PNMR and SBR should be reviewed to ascertain the reasons for the fluctuations observed.
District Hospital Performance Assessment: Limpopo Province 2008-2010 8
2. Van Velden Memorial Hospital i: Description
Van Velden district hospital has 67 beds and lies in the Greater Tzaneen sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased slightly and was lower than the national and the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE fluctuated, decreasing between 2008 and 2009 and then increasing slightly in 2010. It was lower than the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 9
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased slightly between 2008 and 2009 and then increased by 20% in 2010, to a level higher than the national and provincial averages.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant and was significantly higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 10 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was also relatively constant over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased over the reporting period and was in line with the national and provincial averages in 2010. The reasons for the increase in the PNMR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 11
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased slightly between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages throughout this period.
v: Conclusions
The reasons for the high CS rate, the high FCDR and the increase in the PNMR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 12
3. Kgapane Hospital i: Description
Kgapane district hospital has 178 beds and lies in the Greater Letaba sub-district. ii: Input and process indicators
Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased significantly over the reporting period, and was lower than the national and provincial averages in 2009 and 2010. The reason for the sharp drop should be explained and possible best practices investigated.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period. It was in line with the provincial average in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 13
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased significantly and was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased was relatively constant over the reporting period. It was generally in line with the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 14 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased between 2008 and 2010 and was lower than the national and provincial averages in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant and in line with the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 15
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR was constant in 2008 and 2009 and decreased in 2010. It was lower than the national and provincial averages throughout this period.
v: Conclusions
The reasons for the increase in the CpPDE and the low BUR should be ascertained as well as the drop in the ALOS.
District Hospital Performance Assessment: Limpopo Province 2008-2010 16
4. Maphutha L. Malatjie Hospital i: Description
Maphutha L. Malatjie district hospital has 117 beds and lies in the Ba-Phalaborwa sub- district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant in 2008 and 2009, and increased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010, and was in line with the provincial average in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 17
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages in 2010.
iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the increase in 2010 should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 18 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010, when it was then lower than the national and provincial averages.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased slightly over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high PNMR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 19
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also increased slightly and was higher than the national and provincial averages throughout the reporting period. The reasons for the high SBR should be ascertained.
v: Conclusions
The reasons for the increasing CS rate, the high PNMR and the high SBR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 20
5. Nkhensani Hospital i: Description
Nkhensani district hospital has 219 beds and lies in the Greater Giyani sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and just above the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period, reaching R1448 in 2010. It was lower than the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 21
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased over the reporting period. It was higher than the national and provincial averages throughout this period.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased slightly between 2008 and 2010. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 22 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased over the reporting period and was higher than the national and provincial averages in 2009 and 2010. The reasons for this increase should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased slightly between 2008 and 2009 and then decreased in 2010 when it was then closer to the national and the provincial averages. The reasons for the high PNMR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 23
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was in line with the national average in 2010. The reasons for the fluctuations should be ascertained.
v: Conclusions
The reasons for the high FCDR and the high PNMR and should be ascertained. The SBR data should be reviewed to ascertain the reasons for the fluctuations observed.
District Hospital Performance Assessment: Limpopo Province 2008-2010 24
6. Sekororo Hospital i: Description
Sekororo district hospital has 132 beds and lies in the Maruleng sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased slightly between 2008 and 2009 and then decreased in 2010. It was in line with the national and provincial averages in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010 and was higher than the national and provincial averages in 2009 and 2010. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 25
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased significantly and was lower than the national and provincial averages throughout the reporting period. The reasons for low and declining BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 26 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR increased between 2008 and 2009 and then decreased slightly in 2010. It was higher than national and provincial averages in 2009 and 2010. The reasons for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased slightly between 2008 and 2009 and then increased in 2010. It was generally in line with national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 27
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the provincial average in 2010. The reasons for the fluctuations and the increase in 2010 should be ascertained.
v: Conclusions
The reasons for the high CpPDE, the high FCDR, the increasing CS rate and the low BUR should also be ascertained. The fluctuations and the increase in the SBR should also be investigated.
District Hospital Performance Assessment: Limpopo Province 2008-2010 28
B Vhembe District - DC-34
Vhembe district had a population of approximately 1 293 788 people in 2010. It has 112 clinics, 8 CHCs, 22 mobile services, 6 district hospitals, 1 specialised hospital, and 1 regional hospital. 1. Elim Hospital i: Description
Elim district hospital has 328 beds and lies in the Makhado sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant between 2008 and 2010. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high ALOS should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 29
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period. It was lower than the provincial averages throughout the reporting period.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2010. It was in line with the national and provincial averages in 2010. The reasons for the declining BUR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 30 iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased and was closer to the national and provincial averages in 2010. The reasons for the high CS rate should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant and higher than the national and provincial averages throughout the reporting period. The reasons for the high FCDR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 31
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was well above the national and provincial averages 2010. The reasons for the fluctuations and the high rates should be ascertained.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, decreasing between 2008 and 2009 and then increasing in 2010, when it was higher than the national and provincial averages. The reasons for the fluctuations and the increase in the rate 2010 should be ascertained.
v: Conclusions
The reasons for the high ALOS, CS rate, FCDR and the high and fluctuating PNMR and SBR should be ascertained, as well as the decrease in the BUR.
District Hospital Performance Assessment: Limpopo Province 2008-2010 32
2. Louis Trichardt Hospital i: Description
Louis Trichardt district hospital has 52 beds and lies in the Makhado sub-district. ii: Input and process indicators
Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased marginally and was lower than the national and provincial averages throughout the reporting.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2009 and then decreased marginally in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 33
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the decline should be explained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased over the reporting period. It was significantly higher than the national and provincial averages. The reasons for this should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 34 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and was constant in 2010. It was higher than the national and provincial averages throughout this period. The reasons for this should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was well below the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 35
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased over the reporting period, and was lower than the national and provincial averages. This should be reviewed for best practices.
v: Conclusions
The reasons for the high CpPDE, CS rate, FCDR and the decrease in the BUR should be ascertained. The decreasing PNMR and SBR trends should be confirmed and if accurate they should be maintained and possible best practices shared.
District Hospital Performance Assessment: Limpopo Province 2008-2010 36
3. Siloam Hospital i: Description
Siloam district hospital has 220 beds and lies in the Makhado sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased and was higher than the national and provincial averages throughout the reporting period. The reasons for the increasing ALOS should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased slightly between 2008 and 2010. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 37
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased and was higher than the national and provincial averages throughout the reporting period.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high CS rates should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 38 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was constant in 2008 and 2009 and decreased in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was generally in line with the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 39
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, decreasing between 2008 and 2009 and then increasing in 2010, when it was then in line with the national and provincial averages.
v: Conclusions
The reasons for the increasing ALOS and the high CS rate should be ascertained. The fluctuations in the PNMR and SBR should be investigated.
District Hospital Performance Assessment: Limpopo Province 2008-2010 40
4. Messina Hospital i: Description
Messina district hospital has 80 beds and lies in the Musina sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased and was significantly lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly (by 46%) between 2008 and 2010. It was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 41
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated. It decreased sharply (by 25%) between 2008 and 2009, and then increased slightly in 2010. It was lower than the national and provincial averages in 2009 and 2010. The reasons for the decline should be explained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate fluctuated, increasing between 2008 and 2009 and then decreasing significantly (by more than 50%) in 2010 to a level lower than the national and provincial averages. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 42 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased and was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated significantly. It increased between 2008 and 2009 and then decreased in 2010, when it was then in line with the national and provincial averages. The reasons for the fluctuations should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 43
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated significantly, increasing sharply between 2008 and 2009, followed by a sharp decline in 2010. It was lower than the national and provincial averages in 2010. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
v: Conclusions
The reasons for the high CpPDE, and the decrease in the BUR should be ascertained. The fluctuations in the CS rate, the PNMR and the SBR require explanation. The declining FCDR, and the CS rates and SBR (in 2010) should be maintained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 44
5. Donald Fraser Hospital i: Description
Donald Fraser district hospital has 266 beds and lies in the Mutale sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and slightly higher than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010. It was in line with the national averages and lower than the provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 45
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased and was higher than the national and provincial averages throughout the reporting period.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased over the reporting period. It was generally in line with the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 46 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant and was significantly lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant between 2008 and 2009 and increased in 2010, when it then in line with the national and provincial averages.
District Hospital Performance Assessment: Limpopo Province 2008-2010 47
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated slightly, decreasing between 2008 and 2009 and increasing back to the 2008 level in 2010. It was significantly lower than the national and provincial averages throughout this period.
v: Conclusions
The indicators suggest that this is a well-performing hospital.
The low FCDR SBR should be investigated for possible best practices.
District Hospital Performance Assessment: Limpopo Province 2008-2010 48
6. Malamulele Hospital i: Description
Malamulele district hospital has 180 beds and lies in the Thulamela sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant over the reporting period. It was in line with the national and provincial averages in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased from a low value of R908 in 2008 and was R1359 in 2010. It was closer to the national average in 2010. These data should be confirmed.
District Hospital Performance Assessment: Limpopo Province 2008-2010 49
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased slightly between 2008 and 2009 and then decreased in 2010. It was generally in line with the national and provincial averages throughout this period.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 50 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased over the reporting period, and was in line with the national and provincial averages in 2009 and 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant and lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 51
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR was also relatively constant and lower than the national and provincial averages throughout the reporting period.
v: Conclusions
The CpPDE data should be confirmed, since the 2008 and 2009 values are very low. Generally the stable indicators suggest a relatively well-performing hospital. The decreasing FCDR should be maintained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 52
C Capricorn District - DC-35
Capricorn district had a population of approximately 1205 294 people in 2010. It has 94 clinics, 4 CHCs, 36 mobile services, 6 district hospitals, 1 specialised hospital, and 2 provincial hospitals. 1. WF Knodel Hospital i: Description
WF Knodel district hospital has 120 beds and lies in the Aganang sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased over the reporting period, and was lower than the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 53
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010, and was higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased sharply over the reporting period reaching a low rate of 43% in 2010. It was significantly lower than the national and provincial averages in 2009 and 2010. The reasons for the low BUR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 54 iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased sharply; (by 45%) between 2009 and 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the initial low rates and subsequent increase should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased slightly between 2008 and 2010. It was higher than the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 55
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated. It decreased between 2008 and 2009 and then increased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high PNMR should be ascertained.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased significantly over the reporting period and was lower than the national average and provincial averages in 2010. The reasons for the decrease should be investigated for possible best practices.
v: Conclusions
The reasons for the increasing CpPDE and the increasing CS rate should be ascertained. The high PNMR and the low BUR also require explanation. The reasons for the declining SBR should be investigated for best practices.
District Hospital Performance Assessment: Limpopo Province 2008-2010 56
2. Helen Franz Hospital i: Description
Helen Franz District hospital has 135 beds and lies in the Blouberg sub-district. ii: Input and process indicators
Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period, and was equivalent to the provincial average in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 57
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased and was lower than the national and provincial averages throughout the reporting period. The reasons for the declining BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS increased significantly (a 6-fold increase) over the reporting period, reaching a rate of 10.5% in 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the low rates should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 58 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was constant in 2008 and 2009, and decreased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 59
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, increasing between 2008 and 2009 and the decreasing in 2010.
It was higher than the national and provincial averages throughout the reporting period. The reasons for the high rates and the fluctuations should be ascertained.
v: Conclusions
The reasons for the low BUR, the low CS rate, and the high mortality indicators (high FCDR, high PNMR and high SBR) should be ascertained. The fluctuations in the SBR should also be investigated.
District Hospital Performance Assessment: Limpopo Province 2008-2010 60
3. Lebowakgomo Hospital i: Description
LewbowaKgomo district hospital has 220 beds and lies in the Lepelle-Nkumpi sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and slightly higher than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 61
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the national and provincial averages in 2010.
iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was constant in 2008 and 2009 and increased slightly in 2010, when it was then in line with the provincial average.
District Hospital Performance Assessment: Limpopo Province 2008-2010 62 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was relatively constant over the reporting period, and was generally in line with the national and provincial averages in 2009 and 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased between 2008 and 2009 and was relatively constant in 2010. It was just above the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 63
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased over the reporting period. It was in line with the national and provincial averages in 2010.
v: Conclusions
The reasons for the high CpPDE and the fluctuating BUR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 64
4. Zebediela Hospital i: Description
Zebediela district hospital has 74 beds and lies in the Lempelle-Nkumpi sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS fluctuated decreasing between 2008 and 2009 and then increasing slightly in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the fluctuating ALOS should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 65
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, decreasing between 2008 and 2009 and then increasing slightly in 2010. It was higher than the national and provincial averages in 2010.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS increased significantly (an 8-fold increase) over the reporting period, and was closer to the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 66 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased slightly over the reporting period. It was higher than the national and provincial averages throughout this reporting period. The reasons for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased over the reporting period, and was significantly higher than the national and provincial averages in 2010. The reasons for this sharp increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 67
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also increased sharply over the reporting period and was significantly higher than the national and provincial averages in 2010. The reasons for the increase need investigation.
v: Conclusions
The reasons for the high ALOS, the high CpPDE, and the high FCDR should be ascertained. The sharp increase in the CS rate, the PNMR and the SBR should also be explained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 68
5. Botlokwa Hospital i: Description
Botlokwa district hospital has 56 beds and lies in the Molemole sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was constant and lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 Cost per Patient Day Equivalent and 2009 and then decreased slightly in 2000.0 2010. It was in line with the provincial 1500.0 average in 2010.
Rands 1000.0
500.0
0.0 2008 2009 2010 SA Average 1256.0 1384.4 1543.1 LP Average 1337.8 1494.3 1731.7
Botlokwa 1595.9 1819.3 1751.0
District Hospital Performance Assessment: Limpopo Province 2008-2010 69
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2009 and then increased slightly in 2010. It was higher than the national and provincial averages in 2010.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate fluctuated, decreasing between 2008 and 2009 and then increasing sharply in 2010. It was in line with the national average in 2010. The reasons for the increase and the fluctuations should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 70 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased slightly between 2008 and 2009 and then decreased in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased significantly (almost doubled) over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the sharp increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 71
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased over the reporting period, and was higher than national and provincial averages in 2010. The reasons for the increase should be ascertained.
v: Conclusions
The reasons for the increase and the fluctuations in the CS rate should be ascertained. The sharp increase in the PNMR and the SBR should also be explained. The high FCDR needs explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 72
6. Seshego Hospital i: Description
Seshego district hospital has 175 beds and lies in the Polokwane sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased over the reporting period and was higher than the national and provincial averages in 2010. The reasons for this should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 73
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was constant in 2008 and 2009 and increased in 2010, when it was then higher than the national and provincial averages.
iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period. It was equivalent to the national average, but higher than the provincial average in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 74 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased slightly between 2008 and 2009 and then increased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant and in line with the national and provincial averages throughout the reporting
District Hospital Performance Assessment: Limpopo Province 2008-2010 75
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased over the reporting period and was lower than the national and provincial averages in 2010.
v: Conclusions
The reasons for the increase in the ALOS and the CS rate should be ascertained. The high FCDR and the decrease in the SBR should also be explained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 76
D Waterberg District – DC-36
Waterberg district had a population of approximately 666 664 people in 2010. It has 59 clinics, 1 CHC, 28 mobile services, 7 district hospitals, 1 regional hospital, and 1 specialised hospital. 1. Ellisras Hospital i: Description
Ellisras district hospital has 82 beds and lies in the Lephalale sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased between 2008 and 2010. It was well above the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 77
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE decreased between 2008 and 2010. It was in line with the provincial average in 2010.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased sharply (by 45%) over the reporting period. It was well above the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 78 iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased sharply between 2008 and 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for this sharp increase should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased significantly (by 51%) over the reporting period. It was higher than the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 79
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated. It decreased between 2008 and 2009 and then increased in 2010. It was in line with the national and provincial averages in 2010. The reasons for the fluctuations should be ascertained.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR was relatively constant Still Birth Rate throughout the reporting period and was 30.0 in line with the national and provincial 20.0 averages in 2009 and 2010.
10.0
0.0 Still Births/1000Still births 2008 2009 2010 SA Average 22.2 22.8 23.0 LP Average 21.7 21.7 21.8
Ellisras 24.9 22.4 23.4
v: Conclusions
The reasons for the increasing and high ALOS, CS rate, and FCDR should be ascertained. The fluctuation in the PNMR should also be investigated.
District Hospital Performance Assessment: Limpopo Province 2008-2010 80
2. Witpoort Hospital i: Description
Witpoort district hospital has 59 beds and lies in the Lephalale sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was constant in 2008 and 2009 and increased in 2010, when it was then just above the national and provincial averages.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly (by 55%) between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high values and the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 81
3. Usable bed utilisation rate (BUR): measures occupancy of beds which available for use
The BUR decreased and was significantly lower than the national and provincial averages throughout the reporting period. The reasons for the decline and the low BUR should be investigated.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this reporting period. These low rates require explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 82 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly between 2008 and 2009 and then increased sharply in 2010, when it was then higher than the national and provincial averages. The reasons for the increase should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, increasing sharply between 2008 and 2009 and then decreasing sharply again in 2010. It was lower than the national and provincial averages in 2010. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 83
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated. It increased sharply between 2008 and 2009 and then decreased in 2010. It was significantly lower (almost 50% lower) than the national and provincial averages in 2010. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
v: Conclusions
The data in these indicators are probably indicative of poor data quality or management of the hospital or both. The reasons for the high CpPDE, the increase in the FCDR, the low and declining BUR and the low CS rate should be ascertained. The sharp fluctuations in the PNMR and SBR require explanation. .
District Hospital Performance Assessment: Limpopo Province 2008-2010 84
3. Warmbaths Hospital i: Description
Warmbaths district hospital has 133 beds and lies in Bela-Bela sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased between 2008 and 2009 and then decreased in 2010. It was in line with the national and provincial averages in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased sharply over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 85
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased over the reporting period, and was in line with the national and provincial averages in 2010. The reasons for the decrease in the BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 86 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased between 2008 and 2009 and was largely unchanged in 2010. It was in line with the national and provincial averages in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant and generally in line with the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 87
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.
v: Conclusions
The reasons for the high and increasing CpPDE, the increasing SBR and the decrease in the BUR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 88
4. F H Odendaal Hospital i: Description
F H Odendaal district hospital has 122 beds and lies in the Modimolle sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and generally in line with the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 89
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant and significantly lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 90 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR fluctuated slightly, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated slightly, increasing between 2008 and 2009 and then decreasing in 2010. It was in line with the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 91
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, increasing sharply between 2008 and 2009 and then decreasing in 2010. It was lower than the national and provincial averages in 2010. The reasons for the fluctuations should be ascertained.
v: Conclusions
The reasons for the high CpPDE, the high FCDR and the increasing CS rate should be ascertained. The low BUR requires investigation and the reasons for the fluctuations in the SBR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 92
5. George Masebe Hospital i: Description
George Masebe district hospital has 141 beds and lies in the Mogalakwena sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and higher than the national and provincial averages throughout the reporting period. The reasons for the high ALOS should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE was relatively constant in 2008 and 2009 and increased in 2010. It was in line with the provincial average but higher than the national average in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 93
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant over the reporting period. It was in line with the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 94 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was relatively constant and just above the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing 2010. It was lower than the national provincial averages throughout the reporting period. The reasons for the fluctuations should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 95
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was lower than the national provincial averages throughout the reporting period. The reasons for the fluctuations should be ascertained.
v: Conclusions
The reasons for the high ALOS and the fluctuations in the BUR should be ascertained. The fluctuations in the PNMR and SBR require explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 96
6. Voortrekker Hospital i: Description
Voortrekker district hospital has 91 beds and lies in the Mogalakwena sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant in 2008 and 2009 and decreased slightly in 2010, when it was then lower than the national and provincial averages.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly by more than 50% over the reporting period and was higher than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 97
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant in 2008 and 2009 and decreased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period and was higher the national and provincial averages in 2009 and 2010. The reasons for this increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 98 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased over the reporting period and was equivalent to the national and provincial averages in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased sharply between 2008 and 2009 and was largely unchanged in 2010. It was in line with the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 99
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages in 2010. The reasons for the fluctuations and the high rate in 2010 should be ascertained.
v: Conclusions
The reasons for the high and increasing CpPDE and CS rate should be ascertained. The low BUR requires explanation, and the reasons for the fluctuations and the high SBR (in 2010) should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 100
7. Thabazimbi Hospital i: Description
Thabazimbi district hospital has 55 beds and lies in the Thabazimbi sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was constant and significantly lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly by more than 50% between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 101
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased and was significantly lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased sharply, (by about 50%) between 2009 and 2010. It was significantly lower than the national and provincial averages in 2010. The reasons for this sharp decline should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 102 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant over the reporting period. It was higher than the national and provincial averages in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased sharply between 2008 and 2009 and was largely unchanged in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high PNMR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 103
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, decreasing significantly between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the fluctuations and the high rates should be ascertained.
v: Conclusions
The reasons for the high CpPDE, the high FCDR, the high PNMR and the high SBR should be ascertained. The fluctuations in the SBR should also be investigated. The low BUR and the sharp decrease in the CS rate should also be explained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 104
E Greater Sekhukhune District - DC-47
Greater Sekhukhune district had a population of approximately 1 000 899 people in 2010. It has 83 clinics, 4 CHCs, 21 mobile services, 5 district hospitals and 2 regional hospitals. There are no provincial tertiary or specialised hospitals in the district. 1. Dolokong Hospital i: Description
Dilokong district hospital has 186 beds and lies in the Greater Tubatse sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and higher than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 105
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period. It was lower than the provincial averages throughout this period.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased over the reporting period. It was lower than the national and provincial averages in 2010. The reasons for the decrease should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 106 iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period. The reasons for the low CS rate should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was relatively constant over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high FCDR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 107
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased significantly over the reporting period, and was in line with the national and provincial averages in 2010.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also decreased over the reporting period and was in line with the national and provincial averages in 2010.
v: Conclusions
The reasons for the high ALOS, the high FCDR, the low BUR and the low CS rate should be ascertained. The declining PNMR and SBR levels should be confirmed and if accurate, the trend should be maintained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 108
2. Mecklenburg Hospital i: Description
Mecklenburg district hospital has 74 beds and lies in the Greater Tubatse sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased slightly in 2010. It was lower than the national and provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly between 2008 and 2009 and remained constant in 2010. It was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 109
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, decreasing between 2008 and 2009 and then increasing slightly in 2010. It was lower than the national and provincial averages throughout the reporting period. Reasons for the fluctuations are required.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 110 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased between 2008 and 2009 and then increased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was relatively constant between 2008 and 2009 and increased in 2010. It was in line with the national and provincial averages in 2010. The sharp increase on 2010 requires explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 111
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the national and provincial averages in 2010.
v: Conclusions
The reasons for the high CpPDE, the low CS rate, the low FCDR and the decrease in the BUR should be ascertained. The increases in the PNMR and SBR also require explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 112
3. Groblersdal Hospital i: Description
Groblersdal district hospital has 45 beds and lies in the E. Motsoaledi sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased slightly over the reporting period. It was lower than the national and provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased significantly over the reporting period nearly doubling between 2009 and 2010. It was significantly higher than the national and provincial averages in 2010. The reasons for this sharp increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 113
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was very high. It fluctuated, increasing (from 92% to 102%) between 2008 and 2009 and then decreasing in 2010. It was well above the national and provincial averages throughout the reporting period. The high and fluctuating rates require explanation.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate fluctuated over the reporting period, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the provincial and national averages throughout the reporting period.
District Hospital Performance Assessment: Limpopo Province 2008-2010 114 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period. The increase in 2010 requires explanation.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased over the reporting period and was higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 115
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased between 2008 and 2009 and then decreased slightly in 2010. It was higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.
v: Conclusions
The reasons for the sharp increase and the very high CpPDE in 2010 should be ascertained. The reasons for the high and fluctuating CS rate and BUR; the increasing FCDR; the high PNMR; and SBR should also be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 116
4. Jane Furse Hospital i: Description
Jane Furse district hospital has 200 beds and lies in the Makhudumatanga sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and just above the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE was constant in 2008 and 2009, and increased in 2010. It was lower than the provincial average and higher than the national average in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 117
3. Usable bed utilisation rate (BUR): measures occupancy of beds which available for use
The BUR increased between 2008 and 2009 and was largely unchanged in 2010. It was higher than the national and provincial averages in 2009 and 2010.
iii: Outcomes indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased sharply (a 3-fold increase) between 2008 and 2009 with a further smaller increase in 2010. It was in line with the national average in 2010. The sharp increase in the CS rate between 2008 and 2009 requires explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 118 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR fluctuated, increasing between 2008 and 2009 and then decreasing in2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased between 2008 and 2010, and was closer to the national and provincial averages in 2010.
District Hospital Performance Assessment: Limpopo Province 2008-2010 119
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high SBR should be ascertained.
v: Conclusions
The reasons for the sharp increase in the CS rate, the high PNMR and SBR should be ascertained. The fluctuations in the FCDR and SBR require explanation.
District Hospital Performance Assessment: Limpopo Province 2008-2010 120
5. Matlala Hospital i: Description
Matlala district hospital has 120 beds and lies in the Greater Marble sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
ALOS was relatively constant and generally in line with the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE decreased between 2008 and 2009 and then increased sharply in 2010, by nearly 50%, when it was then higher than the national and provincial averages.
District Hospital Performance Assessment: Limpopo Province 2008-2010 121
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated over the reporting period. It increased between 2008 and2009 and then decreased in 2010. It was in line with the national and provincial averages in 2009 and 2010.
iii: Outcomes indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased significantly (a 1.6-fold increase) over the reporting period. It was higher than the national and provincial averages in 2010.The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 122 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was relatively constant in 2008 and 2009 and decreased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased over the reporting period and was higher than the national and provincial averages in 2009 and 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 123
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased between 2008 and 2010. It was higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.
v: Conclusions
The reasons for the increase in the CpPDE, the CS rate, PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Limpopo Province 2008-2010 124