9 Free State Province

Home , Allanridge, Bethulie, Boshof, Brandfort, Bultfontein, Dealesville

SectionSection B: Profile B: District Free HealthState Province Profiles

Xhariep District Municipality (DC16)

Overview of the district The Xhariep District Municipalitya is a Category C municipality situated in the southern part of the Free State. It is bordered by the Mangaung Metro to the north, Eastern Cape to the south, Lesotho to the east, and Northern Cape to the west. It is the largest district in the province, making up just more than a third of its geographical area. It is comprised of three local municipalities: Letsemeng, Kopanong and Mohokare, which include 21 towns. Its administrative headquarters are in Trompsburg, which lies 125km south of Bloemfontein. The towns in this district boast abundant natural resources such as water and agricultural land. The largest dam in South Africa is situated at the southern tip of the district. Three national roads (N1 – Gauteng to Cape Town, N6 – Eastern Cape to Bloemfontein and N8 – Bloemfontein to Kimberley) pass through this area. Area: 34 250km² Population (2016)b: 153 612 Population density (2016): 4.5 persons per km2 Estimated medical scheme coverage: 12.7% Cities/Towns: Bethulie, Edenburg, Fauresmith, Gariep Dam, Jacobsdal, Jagersfontein, Koffiefontein, Luckhoff, Oppermansgronde, Petrusburg, Philippolis, Reddersburg, Rouxville, Smithfield, Springfontein, Trompsburg, Waterkloof, Zastron. Main Economic Sectors: Agriculture, construction, mining, transport and communication.

Population distribution, local municipality boundaries and health facility locations

Source: Mid-Year Population Estimates 2016, Stats SA. a The Local Government Handbook South Africa 2017. A complete guide to municipalities in South Africa. Seventh edition. Accessible at: www. municipalities.co.za. b Mid-Year Population Estimates 2016, Stats SA.

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DistrictXhariep population DM (DC16) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 3 374 5 228 4 335 6 627 60-64 years 2 074 2 398 2 214 2 556 55-59 years 2 551 2 955 2 549 2 881 50-54 years 3 071 3 228 3 121 3 207 45-49 years 3 391 3 593 3 886 3 829 40-44 years 4 036 4 027 4 288 4 297 35-39 years 4 840 4 787 5 211 5 226 30-34 years 4 995 5 093 6 404 6 234 25-29 years 5 625 5 886 7 902 7 626 20-24 years 6 834 6 964 7 585 7 517 15-19 years 8 807 9 022 7 253 7 471 10-14 years 8 368 8 519 6 804 6 987 05-09 years 7 585 7 797 7 081 7 229 00-04 years 7 022 7 107 6 689 6 603

500 000 0 500 000 500 000 0 500 000 Population Population

2006 2016

South Africa % of total population [Male | Female] - lines South Africa % of total population [Male | Female] - lines

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 2.3% 3.5% 2.8% 4.3% 60-64 years 1.6% 1.7% 55-59 years 1.7% 2.0% 1.7% 1.9% 50-54 years 2.1% 2.2% 2.0% 2.1% 45-49 years 2.3% 2.4% 2.5% 2.5% 40-44 years 2.7% 2.7% 2.8% 2.8% 35-39 years 3.2% 3.2% 3.4% 3.4% 30-34 years 3.3% 3.4% 4.2% 4.1% 25-29 years 3.8% 3.9% 5.1% 5.0% 20-24 years 4.6% 4.7% 4.9% 4.9% 15-19 years 5.9% 6.0% 4.7% 4.9% 10-14 years 5.6% 5.7% 4.4% 4.5% 05-09 years 5.1% 5.2% 4.6% 4.7% 00-04 years 4.7% 4.8% 4.4% 4.3%

8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% District % of total population [Male | Female] - bars District % of total population [Male | Female] - bars

Gender male female

Source: Mid-Year Population Estimates 2016, Stats SA.

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa Xhariep DM (DC16) Show history

200 SectionSection B: Profile B: District Free HealthState Province Profiles

Social determinants of health

Source: Stats SA (Local Government Handbook), 2014 Blue Drop Report.

201 Section B: DistrictProfile FreeHealth State Profiles Province

FS, Xhariep: DC16 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history FS, Xhariep: DC16 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 81% 9% 6%4% 70% 5% 15% 10% HIV and TB 5-14 30% 25% 15% 31% 19% 15% 24% 42% Comm_mat_peri_nut 15-24 26% 28% 13% 32% 10% 29% 15% 46% 25-64 29% 32% 29% 10% 15% 34% 39% 13% 65+ 22% 3% 73% 3% 14% 4% 79% 2% Total 32% 23% 37% 9% 18% 22% 49% 11%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (31.6%) Diarrhoeal diseases (22.0%) Percentages are shown 2 Lower respiratory infections (26.8%) Lower respiratory infections (18.8%) according to all the 3 Protein-energy malnutrition (8.4%) Preterm birth complications (10.0%) deaths within the 4 Preterm birth complications (7.4%) Protein-energy malnutrition (9.3%) age/period category of 5 HIV/AIDS (7.3%) Birth asphyxia (4.6%) each box, although only 6 Birth asphyxia (3.1%) HIV/AIDS (3.7%) the leading 10 causes are <5 years <5 Sepsis/other newborn infectious (2.3%) Sepsis/other newborn infectious (2.8%) 7 displayed. 8 Tuberculosis (2.2%) Other congenital abnormalities (2.6%) 9 Other congenital abnormalities (1.0%) Accidental threats to breathing (2.6%) 10 Other perinatal conditions (1.0%) Septicaemia (2.5%) 1 Drowning (22.0%) Drowning (19.3%) 2 HIV/AIDS (18.7%) Road injuries (12.7%) 3 Lower respiratory infections (18.7%) Tuberculosis (11.1%) 4 Tuberculosis (15.0%) HIV/AIDS (9.7%) 5 Diarrhoeal diseases (11.6%) Lower respiratory infections (9.3%)

5-14 6 Meningitis/encephalitis (4.4%) Meningitis/encephalitis (5.1%) 7 Road injuries (3.9%) Other malignant neoplasms (4.9%) 8 Interpersonal violence (3.0%) Other unintentional injuries (4.8%) 9 Epilepsy (2.7%) Fires, hot substances (4.8%) 10 Diarrhoeal diseases (4.0%) 1 Interpersonal violence (18.4%) Interpersonal violence (18.8%) 2 Tuberculosis (17.8%) HIV/AIDS (16.4%) 3 Lower respiratory infections (15.8%) Tuberculosis (14.0%) 4 HIV/AIDS (13.5%) Accidental threats to breathing (8.3%) 5 Diarrhoeal diseases (6.6%) Road injuries (7.2%) 6 Accidental threats to breathing (6.2%) Drowning (7.1%) 15-24 7 Mechanical forces (2.9%) Lower respiratory infections (6.0%) 8 Meningitis/encephalitis (2.4%) Mechanical forces (3.0%) 9 Fires, hot substances (2.2%) Fires, hot substances (2.0%) 10 Other infectious diseases (1.8%) Meningitis/encephalitis (1.6%) 1 Tuberculosis (19.5%) HIV/AIDS (17.8%) 2 Lower respiratory infections (17.7%) Tuberculosis (15.9%) 3 HIV/AIDS (13.1%) Lower respiratory infections (8.8%) 4 Diarrhoeal diseases (7.1%) Cerebrovascular disease (5.8%) 5 Cerebrovascular disease (4.6%) Ischaemic heart disease (4.2%) 6 Interpersonal violence (3.4%) Diarrhoeal diseases (3.4%) 25-64 7 Ischaemic heart disease (2.2%) Interpersonal violence (3.1%) 8 Hypertensive heart disease (1.9%) Hypertensive heart disease (2.7%) 9 COPD (1.7%) Road injuries (2.6%) 10 Meningitis/encephalitis (1.4%) Nephritis/nephrosis (2.1%) 1 Cerebrovascular disease (17.1%) Cerebrovascular disease (17.3%) 2 Lower respiratory infections (14.2%) Ischaemic heart disease (13.3%) 3 Ischaemic heart disease (11.4%) Lower respiratory infections (9.5%) 4 Hypertensive heart disease (7.6%) Hypertensive heart disease (9.2%) 5 Diarrhoeal diseases (5.1%) COPD (4.7%)

65+ 6 COPD (4.7%) Diabetes mellitus (3.9%) 7 Diabetes mellitus (3.5%) Tuberculosis (3.2%) 8 Nephritis/nephrosis (3.3%) Diarrhoeal diseases (2.8%) 9 Tuberculosis (2.5%) Nephritis/nephrosis (2.4%) 10 Prostate (2.0%) Asthma (2.2%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (100.0%) n=6 Indirect maternal (58.8%) n=5 2 Hypertension in pregnancy (41.2%) n=4 3 4 15-49 Female 5 6

202 SectionSection B: Profile B: District Free HealthState Province Profiles

Women and maternal health

Source: DHIS.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country Value highlighted in orange – performance of the local municipality is possibly below the performance of the district.

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Child and school health

Source: DHIS.

204 SectionSection B: Profile B: District Free HealthState Province Profiles

HIV

Source: DHIS.

205 Section B: DistrictProfile FreeHealth State Profiles Province

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country.

206 SectionSection B: Profile B: District Free HealthState Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

207 Section B: DistrictProfile FreeHealth State Profiles Province

Vital ideal clinic elements in Primary Health Care facilities score (%)

Xhariep LM Kopanong Letsemeng LM Mohokare LM

Restore the emergency trolley daily or after every time it was used 47 33 80 33

Resuscitation room is equipped with functional basic equipment for resuscitation 71 67 60 100

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 94 89 100 100

The temperature of the medicine room/dispensary is recorded daily 94 94 89 100

The temperature of the medicine room/dispensary is maintained within the safety range 94 89 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

208 SectionSection B: Profile B: District Free HealthState Province Profiles - (4.1%) (7.4%) 13.5% (0.4%) (7.2%) (4.6%) (17.1%) (25.7%) % Overspent (underspent) 9 643 24 290 8 6 235 011 69 584 729 Provincial Provincial Expenditure Total 2017/18 4 464 16 285 3 680 31 146 0 2 4 80 903 700 74 00 748 247 102 1 109 0001 109 7 523 000 74 959 8 14 50514 59 81 23481 68 33 029 86 Budget 110 438 0 110 Total 2017/18

0 29 643 322 800 016 307 969 551 0 29 643 Transfer to LG to Transfer 18 Provincial18 Expenditure 5 9 6

0 48 2017/ 824 290 6 235 011 31 68031 14 16 46416 28 69 584 72 80 903 70 102 247 7 247 102 Provincial

0 307 939 908 0 LG

0 0 Transfer to LG to Transfer 2017/18 Budget

1 109 0001 109 7 523 000 74 959 874 14 50514 594 81 23481 684 33 029 863 110 438 000110 322 800 016 Provincial al Government. *LG – Loc*LG

BAS,

2.1 District Management 2.1 2.2 Community Health Clinics Community2.2 Health 2.3 Community Health Centres Community Health 2.3 2.4 Community-based Services Community-based 2.4 Grand Total Grand 2.6 HIV/AIDS 2.6 Nutrition 2.7 Local government expenditure 2.9 District Hospitals District 2.9 District health expenditure and budget, 2017/18 Source:

209 Section B: DistrictProfile FreeHealth State Profiles Province

Lejweleputswa District Municipality (DC18)

Overview of the district The Lejweleputswa District Municipalitya is a Category C municipality situated in the north-western part of the Free State. It borders the North West Province to the north, Fezile Dabi and Thabo Mofutsanyana to the north-east and east respectively, Mangaung and Xhariep to the south, and the Northern Cape Province to the west. The district makes up almost a third of the province, and consists of the following five local municipalities, with approximately 18 towns distributed throughout: Masilonyana, Tokologo, Tswelopele, Matjhabeng and Nala. It is accessible from Johannesburg, Cape Town, Klerksdorp and Kimberley along the N1, one of the country’s main national roads. Area: 32 287km² Population (2016)b: 662 866 Population density (2016): 20.5 people per km2 Estimated medical scheme coverage: 11.8% Cities/Towns: Allanridge, Boshof, Bothaville, Brandfort, Bultfontein, Dealesville, Hennenman, Hertzogville, Hoopstad, Odendaalsrus, Soutpan, Theunissen, Ventersburg, Verkeerdevlei, Virginia, Welkom, Wesselsbron, Winburg. Main Economic Sectors: Mining (31%), construction, transport, electricity, trade.

Population distribution, local municipality boundaries and health facility locations

Source: Mid-Year Population Estimates 2016, Stats SA.

a The Local Government Handbook South Africa 2017. A complete guide to municipalities in South Africa. Seventh edition. Accessible at: www. municipalities.co.za. b Mid-Year Population Estimates 2016, Stats SA.

210 SectionSection B: Profile B: District Free HealthState Province Profiles

DistrictLejweleputswa population pyramidDM (DC18) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 9 532 14 095 13 295 18 928 60-64 years 7 687 8 167 10 566 10 742 55-59 years 10 877 10 437 14 015 13 475 50-54 years 15 207 13 843 16 541 16 200 45-49 years 19 149 16 937 17 449 18 413 40-44 years 21 481 20 117 18 732 20 105 35-39 years 21 594 22 734 23 487 23 243 30-34 years 21 634 23 801 28 053 26 763 25-29 years 24 786 25 878 34 358 31 377 20-24 years 27 997 28 624 31 134 29 609 15-19 years 34 778 33 472 30 600 29 994 10-14 years 31 753 30 862 29 562 29 924 05-09 years 31 455 30 672 31 658 31 722 00-04 years 30 579 30 577 31 619 31 302

500 000 0 500 000 500 000 0 500 000 Population Population

2006 2016

South Africa % of total population [Male | Female] - lines South Africa % of total population [Male | Female] - lines

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.5% 2.3% 2.0% 2.9% 60-64 years 1.6% 1.6% 55-59 years 1.8% 1.7% 2.1% 2.0% 50-54 years 2.5% 2.2% 2.5% 2.4% 45-49 years 3.1% 2.7% 2.6% 2.8% 40-44 years 3.5% 3.3% 2.8% 3.0% 35-39 years 3.5% 3.7% 3.5% 3.5% 30-34 years 3.5% 3.8% 4.2% 4.0% 25-29 years 4.0% 4.2% 5.2% 4.7% 20-24 years 4.5% 4.6% 4.7% 4.5% 15-19 years 5.6% 5.4% 4.6% 4.5% 10-14 years 5.1% 5.0% 4.5% 4.5% 05-09 years 5.1% 5.0% 4.8% 4.8% 00-04 years 4.9% 4.9% 4.8% 4.7%

8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% District % of total population [Male | Female] - bars District % of total population [Male | Female] - bars

Gender male female

Source: Mid-Year Population Estimates 2016, Stats SA.

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa Lejweleputswa DM (DC18) Show history

211 Section B: DistrictProfile FreeHealth State Profiles Province

Social determinants of health

Source: Stats SA (Local Government Handbook), 2014 Blue Drop Report.

212 SectionSection B: Profile B: District Free HealthState Province Profiles

FS, Lejweleputswa: DC18 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history FS, Lejweleputswa: DC18 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 86% 7%4%2% 84% 5%7%4% HIV and TB 5-14 41% 22% 15% 22% 33% 22% 17% 28% Comm_mat_peri_nut 15-24 34% 25% 13% 27% 21% 23% 15% 42% 25-64 35% 32% 26% 6% 23% 30% 36% 11% 65+ 20% 5% 73% 2% 19% 4% 75% 2% Total 39% 24% 31% 6% 28% 21% 42% 10%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Lower respiratory infections (30.7%) Lower respiratory infections (24.4%) 2 Diarrhoeal diseases (28.7%) Diarrhoeal diseases (22.5%) according to all the 3 Preterm birth complications (8.4%) Preterm birth complications (11.0%) deaths within the 4 Protein-energy malnutrition (6.8%) Protein-energy malnutrition (9.4%) age/period category of 5 HIV/AIDS (4.4%) Birth asphyxia (7.2%) each box, although only 6 Birth asphyxia (4.2%) Sepsis/other newborn infectious (4.3%) the leading 10 causes are <5 years <5 HIV/AIDS (3.5%) 7 Sepsis/other newborn infectious (2.3%) displayed. 8 Tuberculosis (2.3%) Other perinatal conditions (2.5%) 9 Septicaemia (2.0%) Tuberculosis (1.6%) 10 Other perinatal conditions (1.3%) Septicaemia (1.5%) 1 Lower respiratory infections (20.1%) Lower respiratory infections (15.7%) 2 Tuberculosis (14.6%) Road injuries (14.3%) 3 Diarrhoeal diseases (13.7%) Diarrhoeal diseases (13.3%) 4 Road injuries (13.0%) Tuberculosis (13.0%) 5 HIV/AIDS (8.5%) HIV/AIDS (12.3%)

5-14 6 Meningitis/encephalitis (4.5%) Drowning (6.2%) 7 Drowning (3.6%) Fires, hot substances (5.1%) 8 Endocrine nutritional,blood, immune (2.4%) Epilepsy (3.5%) 9 Epilepsy (2.0%) Accidental threats to breathing (3.2%) 10 Accidental threats to breathing (1.5%) Meningitis/encephalitis (2.5%) 1 Lower respiratory infections (19.6%) Interpersonal violence (21.8%) 2 Tuberculosis (16.6%) Lower respiratory infections (11.9%) 3 Interpersonal violence (12.5%) HIV/AIDS (11.9%) 4 HIV/AIDS (9.2%) Tuberculosis (11.7%) 5 Diarrhoeal diseases (7.8%) Road injuries (8.6%) 6 Road injuries (7.7%) Diarrhoeal diseases (4.3%) 15-24 7 Meningitis/encephalitis (3.4%) Mechanical forces (3.8%) 8 Endocrine nutritional,blood, immune (3.0%) Accidental threats to breathing (3.7%) 9 Accidental threats to breathing (2.6%) Epilepsy (2.2%) 10 Mechanical forces (1.6%) Meningitis/encephalitis (2.1%) 1 Lower respiratory infections (21.7%) HIV/AIDS (15.2%) 2 Tuberculosis (20.6%) Tuberculosis (15.2%) 3 HIV/AIDS (11.1%) Lower respiratory infections (14.9%) 4 Diarrhoeal diseases (8.9%) Cerebrovascular disease (4.7%) 5 Cerebrovascular disease (3.4%) Diarrhoeal diseases (4.2%) 6 Ischaemic heart disease (3.2%) Ischaemic heart disease (4.1%) 25-64 7 Endocrine nutritional,blood, immune (2.8%) Road injuries (3.5%) 8 Meningitis/encephalitis (2.8%) Nephritis/nephrosis (2.8%) 9 Road injuries (2.7%) Interpersonal violence (2.8%) 10 Hypertensive heart disease (1.8%) Diabetes mellitus (2.8%) 1 Cerebrovascular disease (14.7%) Cerebrovascular disease (14.9%) 2 Ischaemic heart disease (13.8%) Ischaemic heart disease (13.4%) 3 Lower respiratory infections (13.7%) Lower respiratory infections (13.1%) 4 Hypertensive heart disease (9.5%) Hypertensive heart disease (9.1%) 5 Diarrhoeal diseases (4.7%) Diabetes mellitus (5.7%)

65+ 6 Diabetes mellitus (4.6%) COPD (4.3%) 7 COPD (4.0%) Diarrhoeal diseases (3.6%) 8 Tuberculosis (3.8%) Nephritis/nephrosis (3.2%) 9 Nephritis/nephrosis (2.6%) Tuberculosis (2.8%) 10 Cardiomyopathy (2.2%) Cardiomyopathy (2.4%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (38.3%) n=12 Hypertension in pregnancy (28.0%) n=26 2 Hypertension in pregnancy (23.2%) n=7 Indirect maternal (27.0%) n=25 3 Other maternal (19.5%) n=6 Other maternal (18.9%) n=18 4 Maternal haemorrhage (19.1%) n=6 Abortion (16.0%) n=15 15-49 Female 5 Maternal haemorrhage (6.3%) n=6 6 Maternal sepsis (3.8%) n=4

213 Section B: DistrictProfile FreeHealth State Profiles Province

Women and maternal health

Source: DHIS.

214 SectionSection B: Profile B: District Free HealthState Province Profiles

Child and school health

Source: DHIS.

215 Section B: DistrictProfile FreeHealth State Profiles Province

HIV

Source: DHIS.

216 SectionSection B: Profile B: District Free HealthState Province Profiles

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country.

217 Section B: DistrictProfile FreeHealth State Profiles Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

218 SectionSection B: Profile B: District Free HealthState Province Profiles

Vital ideal clinic elements in Primary Health Care facilities score (%)

Lejweleputswa Lejweleputswa LM Masilonyana Matjhabeng LM Nala LM LM Tokologo LM Tswelopele

Restore the emergency trolley daily or after every time it was used 30 43 37 0 0 0

Resuscitation room is equipped with functional basic equipment for resuscitation 41 43 41 25 67 33

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 93 86 93 100 100 100

The temperature of the medicine room/dispensary is maintained within the safety range 93 100 93 100 67 100

Cold chain procedure for vaccines is maintained 93 100 93 100 67 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

219 Section B: DistrictProfile FreeHealth State Profiles Province 2.5% 1.2% (1.4%) 13.5% (1.0%) 29.2% (56.4%) (23.7%) (8859.6%) % Overspent (underspent) 1 949 845 4 005 205 -2 796 145 Provincial Provincial Expenditure Total 2017/18 8 22 068 729 6 97 997 310 15 206 539 876 38 551 257 218 00 200 699 916 31 921 4 475 0004 475 5 251 0005 251 17 081 23 17 86 356 76 Budget 208 669 5 195 936195 0 260 978 9 778 780 379 787 900 068 Total 2017/18

12 885 12 885 LG

0 -2 809 03 Transfer to LG to Transfer 9 0

51 76 99 2017/18 Provincial Expenditure 1 949 845 4 005 205 97 997 31 22 068 72 257 218 5 257 218 200 6 916 206 539 8 Provincial

31 921 LG

0 31 921 790 696 213 -2 809 030 0 Transfer to LG to Transfer 2017/18 Budget

4 475 0004 475 5 251 0005 251 17 081 23817 86 356 766 208 669 515 195 936195 000 260 978 938 778 458 748 Provincial al Government. *LG – Loc*LG

BAS,

2.7 Nutrition 2.7 2.2 Community Health Clinics Community2.2 Health Centres Community Health 2.3 HIV/AIDS 2.6 2.1 District Management 2.1 2.4 Community-based Services Community-based 2.4 2.9 District Hospitals District 2.9 Grand Total Grand Local government expenditure District health expenditure and budget, 2017/18 Source:

220 SectionSection B: Profile B: District Free HealthState Province Profiles

Thabo Mofutsanyana District Municipality (DC19)

Overview of the district The Thabo Mofutsanyana District Municipalitya is a Category C municipality located in the eastern Free State Province, and borders on Lesotho and the provinces of KwaZulu-Natal and Mpumalanga. The district makes up almost a third of the geographical area of the province. It comprises six local municipalities: Setsoto, Dihlabeng, Nketoana, Maluti-A-Phofung, Phumelela and Mantsopa. It is named after Edwin Thabo Mofutsanyana, a stalwart of the communist party. Despite all the socio-economic challenges facing this district, the area has huge potential for tourism development because of its scenic beauty and its rich cultural heritage. The N3 and N5 National Roads pass through the district, and the famous Golden Gate is found in the area on the slopes of the Drakensberg Mountains. Area: 32 734km² Population (2016)b: 783 402 Population density (2016): 23.9 persons per km2 Estimated medical scheme coverage: 9.5% Cities/Towns: Arlington, Bethlehem, Clarens, Clocolan, Excelsior, Ficksburg, Fouriesburg, Golden Gate Highlands National Park, Harrismith, Hobhouse, Kestell, Ladybrand, Lindley, Marquard, Memel, Paul Roux, Petrus Steyn, Phuthaditjhaba, Reitz, Rosendal, Senekal, Thaba Patchoa, Tweespruit, Vrede, Warden. Main Economic Sectors: Agriculture, tourism.

Population distribution, local municipality boundaries and health facility locations

Source: Mid-Year Population Estimates 2016, Stats SA a The Local Government Handbook South Africa 2017. A complete guide to municipalities in South Africa. Seventh edition. Accessible at: www. municipalities.co.za. b Mid-Year Population Estimates 2016, Stats SA.

221 Section B: DistrictProfile FreeHealth State Profiles Province

DistrictT Mofutsanyana population pyramid DM (DC19) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 11 771 22 300 13 098 26 775 60-64 years 7 453 10 762 7 965 12 579 55-59 years 10 005 13 566 9 519 13 887 50-54 years 12 278 16 349 11 507 15 730 45-49 years 13 911 17 986 14 198 18 497 40-44 years 16 344 20 587 18 002 21 683 35-39 years 19 466 24 536 24 596 28 338 30-34 years 22 703 27 744 32 573 35 798 25-29 years 28 285 33 767 41 825 42 892 20-24 years 36 839 40 607 40 218 41 651 15-19 years 48 323 48 115 37 937 38 303 10-14 years 43 901 44 370 36 158 36 228 05-09 years 38 903 38 926 40 782 40 687 00-04 years 37 207 36 957 41 393 40 583

500 000 0 500 000 500 000 0 500 000 Population Population

2006 2016

South Africa % of total population [Male | Female] - lines South Africa % of total population [Male | Female] - lines

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.6% 3.0% 1.7% 3.4% 60-64 years 1.4% 1.6% 55-59 years 1.8% 1.8% 50-54 years 1.7% 2.2% 1.5% 2.0% 45-49 years 1.9% 2.4% 1.8% 2.4% 40-44 years 2.2% 2.8% 2.3% 2.8% 35-39 years 2.6% 3.3% 3.1% 3.6% 30-34 years 3.1% 3.7% 4.2% 4.6% 25-29 years 3.8% 4.5% 5.3% 5.5% 20-24 years 5.0% 5.5% 5.1% 5.3% 15-19 years 6.5% 6.5% 4.8% 4.9% 10-14 years 5.9% 6.0% 4.6% 4.6% 05-09 years 5.2% 5.2% 5.2% 5.2% 00-04 years 5.0% 5.0% 5.3% 5.2%

8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% District % of total population [Male | Female] - bars District % of total population [Male | Female] - bars

Gender male female

Source: Mid-Year Population Estimates 2016, Stats SA.

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa T Mofutsanyana DM (DC19) Show history

222 SectionSection B: Profile B: District Free HealthState Province Profiles

Social determinants of health

Source: Stats SA (Local Government Handbook), 2014 Blue Drop Report.

223 Section B: DistrictProfile FreeHealth State Profiles Province

FS, T Mofutsanyana: DC19 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history FS, T Mofutsanyana: DC19 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 82% 9% 6%3% 77% 9% 8% 7% HIV and TB 5-14 39% 25% 15% 21% 28% 24% 17% 31% Comm_mat_peri_nut 15-24 31% 30% 15% 23% 20% 32% 18% 30% 25-64 33% 31% 30% 6% 19% 37% 35% 9% 65+ 18% 4% 75% 2% 15% 5% 77% 3% Total 37% 23% 35% 6% 24% 25% 43% 8%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (27.9%) Diarrhoeal diseases (20.2%) Percentages are shown 2 Lower respiratory infections (25.9%) Lower respiratory infections (18.4%) according to all the 3 Preterm birth complications (10.6%) Preterm birth complications (12.8%) deaths within the 4 HIV/AIDS (7.2%) Protein-energy malnutrition (9.6%) age/period category of 5 Birth asphyxia (6.8%) HIV/AIDS (7.6%) each box, although only 6 Protein-energy malnutrition (5.2%) Birth asphyxia (7.4%) the leading 10 causes are <5 years <5 Tuberculosis (2.0%) Other perinatal conditions (3.6%) 7 displayed. 8 Other perinatal conditions (1.6%) Sepsis/other newborn infectious (2.1%) 9 Other respiratory (1.4%) Accidental threats to breathing (2.1%) 10 Sepsis/other newborn infectious (1.4%) Poisonings (including herbal) (1.7%) 1 Lower respiratory infections (17.5%) HIV/AIDS (14.6%) 2 HIV/AIDS (13.7%) Road injuries (12.1%) 3 Diarrhoeal diseases (13.5%) Lower respiratory infections (10.7%) 4 Tuberculosis (12.0%) Tuberculosis (10.6%) 5 Road injuries (10.5%) Drowning (9.2%)

5-14 6 Drowning (4.9%) Diarrhoeal diseases (7.7%) 7 Meningitis/encephalitis (3.8%) Accidental threats to breathing (5.6%) 8 Accidental threats to breathing (3.0%) Meningitis/encephalitis (4.9%) 9 Other respiratory (2.6%) Fires, hot substances (2.9%) 10 Other interstitial lung disease (1.6%) Epilepsy (2.6%) 1 Tuberculosis (16.1%) HIV/AIDS (20.2%) 2 HIV/AIDS (14.8%) Tuberculosis (13.0%) 3 Lower respiratory infections (14.6%) Interpersonal violence (9.1%) 4 Diarrhoeal diseases (8.8%) Lower respiratory infections (8.9%) 5 Road injuries (7.8%) Road injuries (7.5%) 6 Interpersonal violence (7.3%) Accidental threats to breathing (5.7%) 15-24 7 Accidental threats to breathing (3.3%) Diarrhoeal diseases (4.1%) 8 Meningitis/encephalitis (3.2%) Meningitis/encephalitis (3.2%) 9 Endocrine nutritional,blood, immune (1.9%) Epilepsy (3.1%) 10 Mechanical forces (1.6%) Drowning (2.8%) 1 Lower respiratory infections (18.3%) HIV/AIDS (22.6%) 2 Tuberculosis (17.2%) Tuberculosis (14.0%) 3 HIV/AIDS (13.9%) Lower respiratory infections (10.6%) 4 Diarrhoeal diseases (9.9%) Cerebrovascular disease (5.3%) 5 Cerebrovascular disease (3.9%) Diarrhoeal diseases (5.3%) 6 Road injuries (2.5%) Ischaemic heart disease (3.6%) 25-64 7 Ischaemic heart disease (2.4%) Road injuries (3.3%) 8 Meningitis/encephalitis (2.4%) Hypertensive heart disease (3.2%) 9 Cardiomyopathy (2.2%) Diabetes mellitus (3.0%) 10 Diabetes mellitus (2.1%) Nephritis/nephrosis (2.0%) 1 Cerebrovascular disease (16.1%) Cerebrovascular disease (16.1%) 2 Ischaemic heart disease (11.6%) Hypertensive heart disease (11.7%) 3 Lower respiratory infections (11.0%) Ischaemic heart disease (11.5%) 4 Hypertensive heart disease (10.7%) Lower respiratory infections (9.4%) 5 Diabetes mellitus (5.9%) Diabetes mellitus (6.6%)

65+ 6 Diarrhoeal diseases (5.6%) Diarrhoeal diseases (4.1%) 7 COPD (4.0%) COPD (3.8%) 8 Cardiomyopathy (3.7%) Tuberculosis (3.5%) 9 Tuberculosis (3.0%) Nephritis/nephrosis (3.3%) 10 Nephritis/nephrosis (2.5%) Cardiomyopathy (2.0%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (61.0%) n=27 Indirect maternal (31.6%) n=42 2 Hypertension in pregnancy (17.1%) n=8 Other maternal (24.3%) n=32 3 Maternal haemorrhage (12.2%) n=5 Hypertension in pregnancy (20.7%) n=27 4 Other maternal (9.7%) n=4 Maternal haemorrhage (16.7%) n=22 15-49 Female 5 Abortion (6.8%) n=9 6

224 SectionSection B: Profile B: District Free HealthState Province Profiles

Women and maternal health

Source: DHIS.

225 Section B: DistrictProfile FreeHealth State Profiles Province

Child and school health

Source: DHIS.

226 SectionSection B: Profile B: District Free HealthState Province Profiles

HIV

Source: DHIS.

227 Section B: DistrictProfile FreeHealth State Profiles Province

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country

228 SectionSection B: Profile B: District Free HealthState Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

229 Section B: DistrictProfile FreeHealth State Profiles Province

Vital ideal clinic elements in Primary Health Care facilities score (%)

Thabo Mofutsanyane Dihlabeng LM Maluti-a-Phofung LM Mantsopa LM LM Nketoana LM Phumelela Setsoto LM

Restore the emergency trolley daily or after every time it was used 71 89 44 100 100 80 92

Resuscitation room is equipped with functional basic equipment for resuscitation 81 100 63 100 100 80 92

90% of the tracer medicines are available 99 100 100 100 100 100 92

The temperature of the medicine room/dispensary is recorded daily 100 100 100 100 100 100 100

The temperature of the medicine room/dispensary is maintained within the safety range 100 100 100 100 100 100 100

Cold chain procedure for vaccines is maintained 100 100 100 100 100 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

230 SectionSection B: Profile B: District Free HealthState Province Profiles 9.8% 3.6% 32.1% (2.1%) 14.3% (1.2%) 412.9% (14.2%) (10.2%) % Overspent (underspent) 3 378 897 36 568 490 Provincial Provincial Expenditure Total 2017/18 9 98 542 357 9 0 876 253 12 76 533 241 281 32 395 383 711 83 326 843 824 553 440 2 838 373 3 939 000 14 341 00 341 14 27 682 82 27 89 758 96 Budget 246 142 2 246 142 403 778 3 330 880 3 Total 2017/18

00 2 838 373 2 838 373 076 229 1 117 1 157 673 437 Transfer to LG to Transfer

0 3 7 11 24 33 2017/18 Provincial Expenditure 3 378 897 12 876 25 12 98 542 35 36 568 49 281 241 5 241 281 395 383 7 326 843 8 Provincial 1 154 835 064

553 440 553 LG

00 553 440 Transfer to LG to Transfer 2017/18 Budget

3 939 000 14 341 000 341 14 27 682 829 27 89 758 969 246 142 276 246 142 403 778 332 330 880 383 Provincial 1 116 522 7891 116 al Government. *LG – Loc*LG

BAS,

2.6 HIV/AIDS 2.6 2.3 Community Health Centres Community Health 2.3 Nutrition 2.7 2.2 Community Health Clinics Community2.2 Health Services Community-based 2.4 Hospitals District 2.9 Local government expenditure Total Grand 2.1 District Management 2.1 District health expenditure and budget, 2017/18 Source:

231 Section B: DistrictProfile FreeHealth State Profiles Province

Fezile Dabi District Municipality (DC20)

Overview of the district The Fezile Dabi District Municipalitya is a Category C municipality, formerly known as the Northern Free State District Municipality, situated in the north of the Free State. It is bordered by the North West, Gauteng and Mpumalanga Provinces to the north, Thabo Mofutsanyana District to the south, and Lejweleputswa District to the west. The municipality is the smallest district in the province, making up 16% of its geographical area. It consists of four local municipalities: Moqhaka, Metsimaholo, Ngwathe and Mafube. The main attraction, the Vredefort Dome, the third-largest meteorite site in the world, is located within the district. Area: 20 668km² Population (2016)b: 498 904 Population density (2016): 24.1 persons per km2 Estimated medical scheme coverage: 13.3% Cities/Towns: Cornelia, Deneysville, Edenville, Frankfort, Heilbron, Koppies, Kragbron, Kroonstad, Oranjeville, Parys, Renovaal, Sasolburg, Steynsrus, Tweeling, Vierfontein, Viljoenskroon, Villiers, Vredefort. Main Economic Sectors: Trade (22%), community services (20%), manufacturing (13%), households (13%), agriculture (12%), finance (7%), construction (6%), transport (5%).

Population distribution, local municipality boundaries and health facility locations

232 SectionSection B: Profile B: District Free HealthState Province Profiles

DistrictFezile populationDabi DM pyramid(DC20) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 9 777 15 121 12 108 19 409 60-64 years 7 019 7 882 7 986 8 689 55-59 years 9 040 9 422 9 606 9 733 50-54 years 11 299 11 008 11 279 10 748 45-49 years 12 768 12 035 13 606 12 520 40-44 years 14 545 13 389 15 546 14 805 35-39 years 16 914 15 666 18 628 17 656 30-34 years 17 939 17 695 21 462 20 091 25-29 years 19 960 19 719 25 193 23 395 20-24 years 22 403 21 845 22 877 22 052 15-19 years 27 039 26 312 22 673 22 056 10-14 years 24 479 23 989 21 238 21 233 05-09 years 23 373 22 595 23 737 23 729 00-04 years 21 615 21 542 23 562 23 287

500 000 0 500 000 500 000 0 500 000 Population Population

2006 2016

South Africa % of total population [Male | Female] - lines South Africa % of total population [Male | Female] - lines

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 2.1% 3.2% 2.4% 3.9% 60-64 years 1.5% 1.7% 1.6% 1.7% 55-59 years 1.9% 2.0% 1.9% 2.0% 50-54 years 2.4% 2.3% 2.3% 2.2% 45-49 years 2.7% 2.5% 2.7% 2.5% 40-44 years 3.1% 2.8% 3.1% 3.0% 35-39 years 3.6% 3.3% 3.7% 3.5% 30-34 years 3.8% 3.7% 4.3% 4.0% 25-29 years 4.2% 4.1% 5.0% 4.7% 20-24 years 4.7% 4.6% 4.6% 4.4% 15-19 years 5.7% 5.5% 4.5% 4.4% 10-14 years 5.1% 5.0% 4.3% 4.3% 05-09 years 4.9% 4.7% 4.8% 4.8% 00-04 years 4.5% 4.5% 4.7% 4.7%

8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% District % of total population [Male | Female] - bars District % of total population [Male | Female] - bars

Gender male female

Source: Mid-Year Population Estimates 2016, Stats SA.

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa Fezile Dabi DM (DC20) Show history

233 Section B: DistrictProfile FreeHealth State Profiles Province

Social determinants of health

Source: Stats SA (Local Government Handbook), 2014 Blue Drop Report.

234 SectionSection B: Profile B: District Free HealthState Province Profiles

FS, Fezile Dabi: DC20 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history FS, Fezile Dabi: DC20 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 84% 8%5%3% 78% 5%10%6% HIV and TB 5-14 40% 21% 15% 24% 27% 18% 18% 37% Comm_mat_peri_nut 15-24 27% 25% 16% 31% 17% 25% 16% 42% 25-64 30% 30% 31% 8% 19% 31% 38% 11% 65+ 18% 4% 76% 3% 14% 5% 79% 3% Total 33% 21% 38% 8% 22% 20% 48% 10%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (27.4%) Lower respiratory infections (22.7%) Percentages are shown 2 Lower respiratory infections (26.9%) Diarrhoeal diseases (18.4%) according to all the 3 Preterm birth complications (13.7%) Preterm birth complications (16.4%) deaths within the 4 HIV/AIDS (5.9%) Birth asphyxia (8.0%) age/period category of 5 Birth asphyxia (5.9%) Protein-energy malnutrition (6.3%) each box, although only 6 Protein-energy malnutrition (5.1%) HIV/AIDS (3.9%) the leading 10 causes are <5 years <5 7 Tuberculosis (1.7%) Sepsis/other newborn infectious (3.3%) displayed. 8 Other perinatal conditions (1.4%) Road injuries (2.3%) 9 Sepsis/other newborn infectious (1.3%) Other perinatal conditions (1.7%) 10 Road injuries (1.2%) Endocrine nutritional,blood, immune (1.4%) 1 Lower respiratory infections (18.3%) Drowning (15.6%) 2 Diarrhoeal diseases (14.2%) Lower respiratory infections (14.4%) 3 Tuberculosis (14.0%) Road injuries (14.3%) 4 Road injuries (11.2%) Tuberculosis (11.8%) 5 HIV/AIDS (9.5%) HIV/AIDS (9.2%)

5-14 6 Drowning (6.2%) Diarrhoeal diseases (8.8%) 7 Meningitis/encephalitis (5.9%) Accidental threats to breathing (5.1%) 8 Accidental threats to breathing (5.5%) Fires, hot substances (4.4%) 9 Endocrine nutritional,blood, immune (2.3%) Endocrine nutritional,blood, immune (2.4%) 10 Epilepsy (2.2%) Epilepsy (2.2%) 1 Tuberculosis (16.6%) Road injuries (17.0%) 2 Lower respiratory infections (12.9%) HIV/AIDS (13.3%) 3 Road injuries (10.8%) Tuberculosis (13.1%) 4 Interpersonal violence (10.6%) Interpersonal violence (10.9%) 5 HIV/AIDS (9.1%) Lower respiratory infections (9.2%) 6 Diarrhoeal diseases (8.2%) Accidental threats to breathing (6.4%) 15-24 7 Accidental threats to breathing (4.0%) Diarrhoeal diseases (3.3%) 8 Endocrine nutritional,blood, immune (3.1%) Drowning (2.9%) 9 Mechanical forces (2.6%) Mechanical forces (2.5%) 10 Meningitis/encephalitis (2.4%) Meningitis/encephalitis (2.3%) 1 Tuberculosis (17.5%) Tuberculosis (16.5%) 2 Lower respiratory infections (17.2%) HIV/AIDS (14.9%) 3 HIV/AIDS (12.9%) Lower respiratory infections (12.7%) 4 Diarrhoeal diseases (8.2%) Cerebrovascular disease (5.2%) 5 Road injuries (4.1%) Road injuries (5.2%) 6 Cerebrovascular disease (4.0%) Ischaemic heart disease (4.6%) 25-64 7 Ischaemic heart disease (3.6%) Hypertensive heart disease (3.6%) 8 Hypertensive heart disease (3.2%) Diarrhoeal diseases (3.4%) 9 Endocrine nutritional,blood, immune (2.8%) Diabetes mellitus (3.1%) 10 Meningitis/encephalitis (2.4%) Nephritis/nephrosis (3.0%) 1 Cerebrovascular disease (14.7%) Cerebrovascular disease (14.7%) 2 Ischaemic heart disease (13.6%) Ischaemic heart disease (13.3%) 3 Hypertensive heart disease (12.3%) Hypertensive heart disease (9.6%) 4 Lower respiratory infections (10.4%) Lower respiratory infections (8.5%) 5 Diabetes mellitus (6.3%) Diabetes mellitus (6.8%)

65+ 6 Diarrhoeal diseases (5.0%) Nephritis/nephrosis (4.2%) 7 COPD (2.9%) Tuberculosis (3.5%) 8 Tuberculosis (2.9%) COPD (3.4%) 9 Nephritis/nephrosis (2.8%) Diarrhoeal diseases (3.2%) 10 Asthma (2.0%) Prostate (2.4%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (45.5%) n=7 Indirect maternal (36.0%) n=19 2 Other maternal (33.8%) n=5 Other maternal (26.3%) n=14 3 Hypertension in pregnancy (20.7%) n=3 Hypertension in pregnancy (15.8%) n=8 4 Maternal haemorrhage (8.0%) n=4 15-49 Female 5 Abortion (8.0%) n=4 6 Maternal sepsis (6.0%) n=3

235 Section B: DistrictProfile FreeHealth State Profiles Province

Women and maternal health

Source: DHIS.

236 SectionSection B: Profile B: District Free HealthState Province Profiles

Child and school health

Source: DHIS.

237 Section B: DistrictProfile FreeHealth State Profiles Province

HIV

Source: DHIS.

238 SectionSection B: Profile B: District Free HealthState Province Profiles

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country.

239 Section B: DistrictProfile FreeHealth State Profiles Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

240 SectionSection B: Profile B: District Free HealthState Province Profiles

Vital ideal clinic elements in Primary Health Care facilities score (%)

Fezile Dabi Mafube LM Metsimaholo LM Moqhaka LM LM Ngwathe

Restore the emergency trolley daily or after every time it was used 46 13 38 45 71

Resuscitation room is equipped with functional basic equipment for resuscitation 71 50 75 73 79

Cold chain procedure for vaccines is maintained 95 88 88 100 100

The temperature of the medicine room/dispensary is recorded daily 100 100 100 100 100

The temperature of the medicine room/dispensary is maintained within the safety range 100 100 100 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

241 Section B: DistrictProfile FreeHealth State Profiles Province - 9.4% 4.8% 3.0% 4.6% 11.1% 46.1% (1.3%) 207.5% % Overspent (underspent) 0 7 014 90 3 796 877 3 Provincial Provincial Expenditure Total 2017/18 1 20 059 701 9 78 058 298 0 71 206 890 638 70 341 615 133 00 239 229 089 295 000 295 14 171 39 171 14 74 485 2574 30 900 000 900 30 Budget 209 531 1 120 309120 9 232 0 195 Total 2017/18

0 0 681 887 791 198 713 316 LG

0 0 Transfer to LG to Transfer 9 7 8 41 89 38 2017/18 Provincial Expenditure 907 014 20 05 701 33 796 87 78 058 29 133 615 3 615 133 239 229 0 206 890 6 Provincial

0 0 198 713 316 LG

0 0 Transfer to LG to Transfer 2017/18 Budget

295 000 295 14 171 391 171 14 74 485 25974 30 900 000 900 30 209 531 171 120 309120 970 232 000 195 681 887 791 Provincial al Government. *LG – Loc*LG

tal BAS,

2.1 District Management 2.1 2.2 Community Health Clinics Community2.2 Health 2.3 Community Health Centres Community Health 2.3 2.7 Nutrition 2.7 2.9 District Hospitals District 2.9 Local government expenditure To Grand 2.4 Community-based Services Community-based 2.4 HIV/AIDS 2.6 District health expenditure and budget, 2017/18 Source:

242 SectionSection B: Profile B: District Free HealthState Province Profiles

Mangaung Metropolitan Municipality (MAN)

Overview of the district The Mangaung Metropolitan Municipalitya is a Category A municipality. It is situated in the Free State Province, in the central interior of South Africa. The Free State is bordered by the Gauteng, Eastern Cape, Northern Cape, KwaZulu-Natal and North West Provinces, as well as by the neighbouring country of Lesotho. Mangaung, meaning ‘Place of the Cheetahs’’. The economy is strongly driven by the government sector, which has seen the fastest growth in the last five years as a result of increased government programmes in livelihood improvement interventions. The finance sector is the second- fastest growing sector due to very active estate and construction activities. Small businesses have a major role to play in the South African economy and, especially in Mangaung, in terms of employment-creation, income-generation and output growth. It is estimated that more than 12 million people in South Africa are actively involved in the Small, Medium and Micro Enterprise (SMME) sector, which accounts for approximately 60% of all employment in the economy and 40% of output. In an area such as Mangaung, with its relatively high levels of unemployment and poverty, it can be expected that the SMME sector plays an even more important role in job-creation and poverty-alleviation. The informal economy makes an important contribution to the economic and social life of Mangaung. Due to the decline in formal employment and consequent increase in unemployment, many people have sought an alternative means of earning an income. Mangaung Metropolitan Municipality comprises four health sub-districts, namely, Bloemfontein, Botshabelo, Naledi and Thaba N’chu. Area: 9 886km² Population (2016)b: 767 854 Population density (2016): 77.7 persons per km2 Estimated medical scheme coverage: 20.7% Cities/Towns: Bloemfontein, Botshabelo, Dewetsdorp, Mangaung, Soutpan, Thaba Nchu, Van Stadensrus, Wepener. Main Economic Sectors: Community services (35.3%), finance (26.8%), trade (16%), transport (11.8%), manufacturing (3.5%).

Population distribution, sub-district boundaries and health facility locations

243 Section B: DistrictProfile FreeHealth State Profiles Province

DistrictMangaung population MM pyramid (MAN) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 12 618 21 841 17 525 30 790 60-64 years 9 217 11 266 10 843 14 190 55-59 years 11 578 14 072 13 594 16 415 50-54 years 14 798 17 406 16 209 19 300 45-49 years 17 766 19 772 20 265 23 122 40-44 years 20 753 23 253 22 754 25 318 35-39 years 25 377 27 804 26 307 29 107 30-34 years 26 946 29 432 29 837 31 714 25-29 years 29 348 32 463 36 812 36 092 20-24 years 32 793 34 713 37 162 36 510 15-19 years 38 836 37 234 33 678 32 662 10-14 years 37 114 35 482 33 281 33 258 05-09 years 34 005 32 254 35 603 35 208 00-04 years 34 250 33 867 35 608 34 690

500 000 0 500 000 500 000 0 500 000 Population Population

2006 2016

South Africa % of total population [Male | Female] - lines South Africa % of total population [Male | Female] - lines

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.8% 3.0% 2.3% 4.0% 60-64 years 1.6% 1.8% 55-59 years 1.6% 2.0% 1.8% 2.1% 50-54 years 2.1% 2.4% 2.1% 2.5% 45-49 years 2.5% 2.8% 2.6% 3.0% 40-44 years 2.9% 3.2% 3.0% 3.3% 35-39 years 3.5% 3.9% 3.4% 3.8% 30-34 years 3.8% 4.1% 3.9% 4.1% 25-29 years 4.1% 4.5% 4.8% 4.7% 20-24 years 4.6% 4.8% 4.8% 4.8% 15-19 years 5.4% 5.2% 4.4% 4.3% 10-14 years 5.2% 5.0% 4.3% 4.3% 05-09 years 4.7% 4.5% 4.6% 4.6% 00-04 years 4.8% 4.7% 4.6% 4.5%

8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% District % of total population [Male | Female] - bars District % of total population [Male | Female] - bars

Gender male female

Source: Mid-Year Population Estimates 2016, Stats SA.

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa Mangaung MM (MAN) Show history

244 SectionSection B: Profile B: District Free HealthState Province Profiles

Social determinants of health

Source: Stats SA (Local Government Handbook), 2014 Blue Drop Report.

245 Section B: DistrictProfile FreeHealth State Profiles Province

FS, Mangaung: MAN Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history FS, Mangaung: MAN Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 72% 15% 10%3% 70% 6% 19% 5% HIV and TB 5-14 28% 29% 22% 21% 25% 18% 29% 28% Comm_mat_peri_nut 15-24 24% 32% 14% 30% 13% 30% 17% 40% 25-64 25% 36% 32% 7% 15% 34% 41% 10% 65+ 16% 4% 78% 3% 14% 4% 79% 3% Total 28% 26% 39% 7% 19% 22% 50% 9%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (20.8%) Preterm birth complications (13.8%) Percentages are shown 2 Lower respiratory infections (19.6%) Lower respiratory infections (13.3%) according to all the 3 HIV/AIDS (11.2%) Diarrhoeal diseases (11.7%) deaths within the 4 Preterm birth complications (9.1%) Protein-energy malnutrition (8.8%) age/period category of 5 Protein-energy malnutrition (7.5%) Birth asphyxia (7.0%) each box, although only 6 Birth asphyxia (5.1%) Sepsis/other newborn infectious (6.0%) the leading 10 causes are <5 years <5 Tuberculosis (3.7%) Septicaemia (4.8%) 7 displayed. 8 Sepsis/other newborn infectious (3.4%) HIV/AIDS (4.4%) 9 Septicaemia (2.6%) Congenital heart anomalies (4.4%) 10 Meningitis/encephalitis (1.9%) Other perinatal conditions (2.5%) 1 Tuberculosis (16.1%) HIV/AIDS (10.8%) 2 HIV/AIDS (14.3%) Tuberculosis (8.0%) 3 Lower respiratory infections (13.1%) Lower respiratory infections (7.2%) 4 Diarrhoeal diseases (8.3%) Fires, hot substances (6.5%) 5 Drowning (6.6%) Drowning (6.4%)

5-14 6 Meningitis/encephalitis (3.9%) Accidental threats to breathing (4.8%) 7 Leukaemia (2.8%) Diarrhoeal diseases (4.5%) 8 Interpersonal violence (2.8%) Road injuries (4.5%) 9 Road injuries (2.7%) Other neurological conditions (3.0%) 10 Accidental threats to breathing (2.7%) Meningitis/encephalitis (2.9%) 1 Tuberculosis (19.8%) HIV/AIDS (16.6%) 2 Interpersonal violence (16.7%) Interpersonal violence (15.4%) 3 HIV/AIDS (12.1%) Tuberculosis (14.2%) 4 Lower respiratory infections (11.5%) Accidental threats to breathing (7.2%) 5 Diarrhoeal diseases (4.4%) Mechanical forces (6.9%) 6 Accidental threats to breathing (4.0%) Lower respiratory infections (5.2%) 15-24 7 Mechanical forces (3.8%) Road injuries (4.3%) 8 Meningitis/encephalitis (2.6%) Fires, hot substances (4.2%) 9 Endocrine nutritional,blood, immune (1.7%) Diarrhoeal diseases (2.2%) 10 Fires, hot substances (1.5%) Meningitis/encephalitis (1.7%) 1 Tuberculosis (22.8%) HIV/AIDS (18.1%) 2 Lower respiratory infections (14.8%) Tuberculosis (15.8%) 3 HIV/AIDS (13.0%) Lower respiratory infections (8.5%) 4 Diarrhoeal diseases (6.0%) Cerebrovascular disease (6.0%) 5 Cerebrovascular disease (4.1%) Nephritis/nephrosis (3.1%) 6 Interpersonal violence (2.6%) Ischaemic heart disease (3.0%) 25-64 7 Ischaemic heart disease (2.2%) Diarrhoeal diseases (2.9%) 8 Meningitis/encephalitis (2.1%) Interpersonal violence (2.7%) 9 Nephritis/nephrosis (2.0%) Diabetes mellitus (2.3%) 10 Diabetes mellitus (1.7%) Hypertensive heart disease (1.9%) 1 Cerebrovascular disease (14.4%) Cerebrovascular disease (15.4%) 2 Ischaemic heart disease (10.1%) Ischaemic heart disease (10.1%) 3 Lower respiratory infections (9.4%) Lower respiratory infections (8.4%) 4 Hypertensive heart disease (7.7%) Hypertensive heart disease (7.0%) 5 Diabetes mellitus (4.4%) Nephritis/nephrosis (5.2%)

65+ 6 COPD (3.9%) Diabetes mellitus (5.0%) 7 Nephritis/nephrosis (3.9%) COPD (4.3%) 8 Tuberculosis (3.1%) Tuberculosis (2.6%) 9 Diarrhoeal diseases (3.0%) Septicaemia (2.5%) 10 Trachea/bronchi/lung (2.6%) Trachea/bronchi/lung (2.3%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (39.5%) n=20 Indirect maternal (42.8%) n=52 2 Other maternal (28.9%) n=15 Other maternal (25.7%) n=31 3 Hypertension in pregnancy (15.9%) n=8 Hypertension in pregnancy (19.2%) n=23 4 Maternal sepsis (9.2%) n=5 Maternal sepsis (4.9%) n=6 15-49 Female 5 Abortion (6.6%) n=3 Maternal haemorrhage (4.3%) n=5 6 Abortion (3.1%) n=4

246 SectionSection B: Profile B: District Free HealthState Province Profiles

Women and maternal health

Source: DHIS.

247 Section B: DistrictProfile FreeHealth State Profiles Province

Child and school health

Source: DHIS.

248 SectionSection B: Profile B: District Free HealthState Province Profiles

HIV

Source: DHIS.

249 Section B: DistrictProfile FreeHealth State Profiles Province

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

Value highlighted in green – performance is ranked among the 10 best in the country Value highlighted in red – performance is ranked among the 10 worst in the country.

250 SectionSection B: Profile B: District Free HealthState Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database

251 Section B: DistrictProfile FreeHealth State Profiles Province

Vital ideal clinic elements in Primary Health Care facilities score (%)

Mangaung Mangaung Bloemfontein SD Botshabelo SD Naledi SD Thaba N’chu SD

Restore the emergency trolley daily or after every time it was used 57 42 85 67 50

Resuscitation room is equipped with functional basic equipment for resuscitation 66 53 92 100 50

The temperature of the medicine room/dispensary is recorded daily 87 95 92 100 67

The temperature of the medicine room/dispensary is maintained within the safety range 87 95 92 100 67

Cold chain procedure for vaccines is maintained 94 100 100 100 75 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

252 SectionSection B: Profile B: District Free HealthState Province Profiles 6.4% 0.8% 1.8% (1.3%) 26.5% 49.3% (3.3%) (27.7%) (29.3%) % Overspent (underspent) 3 130 0913 130 29 000 916 220 131 931 435 490 935 490 435 Provincial Provincial Expenditure Total 2017/18 03 90 270 108 767 89 011 7 24 292 245 179 68 64 4 332 000 19 418 94 70 371 14 70 371 13 831 67013 9 784 334 84 811 00 84 811 Budget 296 8 198 227 591 3 431 964 6 Total 2017/18

0 9 784 334 0 9 784 334 616 1 148 519 1 169 065 260 Transfer to LG to Transfer 8 7

6 79 35 931 2017/18 Provincial Expenditure 3 130 0913 130 89 011 76 89 011 90 270 10 29 000 91 220 131 292 245 1 435 490 9 490 435 Provincial

0 LG

00 831 67 13 831 13 670 1 159 280 926 Transfer to LG to Transfer 2017/18 Budget

4 332 000 19 418 947 70 371 143 70 371 84 811 000 84 811 296 824 198 227 591 364 431 964 668 Provincial 1 134 687 946 al Government. *LG – Loc*LG

BAS,

2.3 Community Health Centres Community Health 2.3 Services Community-based 2.4 2.2 Community Health Clinics Community2.2 Health 2.1 District Management 2.1 2.6 HIV/AIDS 2.6 Nutrition 2.7 Hospitals District 2.9 Local government expenditure Total Grand District health expenditure and budget, 2017/18 Source:

253