SectionSection B: B:Profile District Health Province Profiles

12 Limpopo Province

Mopani District Municipality (DC33)

Overview of the district The Mopani District Municipalitya is a Category C municipality located within the north-eastern quadrant of the Limpopo Province. It is bordered in the north by and Vhembe District Municipality, in the south by the Province through Ehlanzeni District Municipality, in the south-west by Sekhukhune District Municipality, in the east by , and in the west by the Capricorn and Vhembe District Municipalities. The district consists of five local municipalities: Ba-, Greater , Greater Letaba, Greater and Maruleng. The seat of Mopani is Giyani, and the district is part of the Great Limpopo Transfrontier Park. Area: 20 011km² Population (2016)b: 1 197 021 Population density (2016): 59.8 persons per km2 Estimated medical scheme coverage: 6.7% Cities/Towns: Giyani, Gravelotte, , , , , Tzaneen. Main Economic Sectors: Mining (30.1%), community services (22.6%), trade (14.6%), finance (14.6%), transport (8.2%), agriculture (3.2%), electricity (2.8%), construction (2%).

Population distribution, local municipality boundaries and health facility locations

Source: Mid-Year Population Estimates 2016, Stats SA. a The Local Government Handbook 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.

433 Section B: DistrictProfile LimpopoHealth Profiles Province

DistrictMopani population DM (DC33) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 13 100 30 154 18 069 38 199 60-64 years 9 274 11 457 11 296 19 326 55-59 years 11 931 15 968 13 163 22 116 50-54 years 14 584 21 829 16 040 25 920 45-49 years 16 208 25 024 20 748 29 762 40-44 years 19 292 29 493 26 567 35 388 35-39 years 24 041 34 023 35 527 43 212 30-34 years 28 805 39 639 44 697 50 815 25-29 years 36 957 46 394 59 715 63 054 20-24 years 49 396 55 417 61 479 63 884 15-19 years 73 064 74 376 57 587 58 693 10-14 years 69 520 72 344 59 293 58 609 05-09 years 58 572 60 162 64 362 63 153 00-04 years 60 977 59 727 68 954 67 393

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+ 2.8% 1.5% 3.2% 60-64 years 1.6% 55-59 years 1.5% 1.8% 50-54 years 2.1% 2.2% 45-49 years 1.5% 2.4% 1.7% 2.5% 40-44 years 1.8% 2.8% 2.2% 3.0% 35-39 years 2.3% 3.2% 3.0% 3.6% 30-34 years 2.7% 3.7% 3.7% 4.2% 25-29 years 3.5% 4.4% 5.0% 5.3% 20-24 years 4.7% 5.2% 5.1% 5.3% 15-19 years 6.9% 7.0% 4.8% 4.9% 10-14 years 6.5% 6.8% 5.0% 4.9% 05-09 years 5.5% 5.7% 5.4% 5.3% 00-04 years 5.7% 5.6% 5.8% 5.6%

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 Mopani DM (DC33) Show history

434 SectionSection B: B:Profile District Limpopo Health Province Profiles

Social determinants of health

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

435 Section B: DistrictProfile LimpopoHealth Profiles Province

LP, Mopani: DC33 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history LP, Mopani: DC33 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 80% 9% 7%4% 79% 6% 9% 6% HIV and TB 5-14 41% 19% 19% 21% 42% 20% 18% 20% Comm_mat_peri_nut 15-24 33% 21% 19% 27% 27% 22% 19% 31% 25-64 39% 28% 27% 7% 27% 34% 32% 8% 65+ 23% 5% 69% 3% 26% 6% 66% 2% Total 39% 19% 35% 6% 33% 21% 39% 7%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (34.3%) Lower respiratory infections (21.3%) 2 Lower respiratory infections (22.2%) Diarrhoeal diseases (21.0%) according to all the 3 Preterm birth complications (6.7%) Preterm birth complications (11.6%) deaths within the 4 Protein-energy malnutrition (6.6%) Protein-energy malnutrition (7.1%) age/period category of 5 HIV/AIDS (5.5%) Birth asphyxia (6.4%) each box, although only 6 Birth asphyxia (3.9%) Meningitis/encephalitis (6.1%) the leading 10 causes are <5 years <5 7 Tuberculosis (3.6%) HIV/AIDS (4.1%) displayed. 8 Meningitis/encephalitis (2.8%) Poisonings (including herbal) (2.6%) 9 Sepsis/other newborn infectious (1.3%) Tuberculosis (2.2%) 10 Septicaemia (1.2%) Other perinatal conditions (2.1%) 1 Diarrhoeal diseases (16.7%) Diarrhoeal diseases (14.9%) 2 Lower respiratory infections (14.3%) Lower respiratory infections (12.7%) 3 Tuberculosis (12.5%) Tuberculosis (11.4%) 4 Road injuries (9.5%) HIV/AIDS (10.1%) 5 HIV/AIDS (7.9%) Meningitis/encephalitis (9.0%)

5-14 6 Meningitis/encephalitis (5.1%) Drowning (7.5%) 7 Drowning (4.7%) Road injuries (5.3%) 8 Septicaemia (2.4%) Accidental threats to breathing (3.4%) 9 Nephritis/nephrosis (2.2%) Nephritis/nephrosis (3.0%) 10 Other unintentional injuries (1.8%) Epilepsy (2.1%) 1 Tuberculosis (13.2%) Tuberculosis (12.6%) 2 Diarrhoeal diseases (12.2%) HIV/AIDS (10.4%) 3 Lower respiratory infections (12.0%) Road injuries (9.1%) 4 Road injuries (10.6%) Lower respiratory infections (7.8%) 5 HIV/AIDS (8.4%) Diarrhoeal diseases (7.5%) 6 Interpersonal violence (5.8%) Meningitis/encephalitis (7.3%) 15-24 7 Accidental threats to breathing (4.3%) Accidental threats to breathing (7.1%) 8 Meningitis/encephalitis (3.7%) Interpersonal violence (6.7%) 9 Self-inflicted injuries (2.1%) Mechanical forces (2.4%) 10 Nephritis/nephrosis (1.9%) Drowning (2.2%) 1 Tuberculosis (16.7%) Tuberculosis (17.3%) 2 Diarrhoeal diseases (16.5%) HIV/AIDS (16.4%) 3 Lower respiratory infections (14.4%) Lower respiratory infections (10.5%) 4 HIV/AIDS (10.8%) Diarrhoeal diseases (8.1%) 5 Meningitis/encephalitis (3.7%) Meningitis/encephalitis (5.7%) 6 Cerebrovascular disease (3.3%) Diabetes mellitus (4.1%) 25-64 7 Road injuries (3.0%) Cerebrovascular disease (3.9%) 8 Diabetes mellitus (3.0%) Nephritis/nephrosis (3.7%) 9 Nephritis/nephrosis (2.4%) Road injuries (2.4%) 10 Septicaemia (1.9%) Ischaemic heart disease (2.0%) 1 Cerebrovascular disease (21.6%) Cerebrovascular disease (16.6%) 2 Lower respiratory infections (11.0%) Lower respiratory infections (11.0%) 3 Diarrhoeal diseases (8.3%) Diabetes mellitus (9.3%) 4 Diabetes mellitus (6.8%) Meningitis/encephalitis (7.0%) 5 Cardiomyopathy (6.5%) Hypertensive heart disease (6.3%)

65+ 6 Ischaemic heart disease (4.4%) Diarrhoeal diseases (5.9%) 7 Hypertensive heart disease (4.0%) Nephritis/nephrosis (5.8%) 8 Tuberculosis (4.0%) Tuberculosis (4.4%) 9 Nephritis/nephrosis (3.6%) Ischaemic heart disease (4.2%) 10 Asthma (2.0%) Other respiratory (2.8%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (46.6%) n=18 Indirect maternal (25.0%) n=27 2 Hypertension in pregnancy (23.3%) n=9 Other maternal (21.9%) n=23 3 Other maternal (16.6%) n=6 Hypertension in pregnancy (18.3%) n=20 4 Abortion (13.5%) n=5 Abortion (17.9%) n=19 15-49 Female 5 Maternal haemorrhage (16.8%) n=18 6

436 SectionSection B: B:Profile District Limpopo Health 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.

437 Section B: DistrictProfile LimpopoHealth Profiles Province

Child and school 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.

438 SectionSection B: B:Profile District Limpopo Health Province Profiles

HIV

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.

439 Section B: DistrictProfile LimpopoHealth 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.

440 SectionSection B: B:Profile District Limpopo Health Province Profiles

Non-communicable diseases

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.

Numbers of deaths in facilities

Source: DHIS

Percentage ideal clinics

Source: Ideal Clinic database.

441 Section B: DistrictProfile LimpopoHealth Profiles Province

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

Mopani Mopani Ba-Phalaborwa LM Greater Giyani LM Greater Letaba LM Greater Tzaneen LM Maruleng LM

Restore the emergency trolley daily or after every time it was used 14 80 11 14 3 0

Resuscitation room is equipped with functional basic equipment for resuscitation 28 80 21 38 17 9

90% of the tracer medicines are available 70 100 36 62 83 100

Cold chain procedure for vaccines is maintained 75 100 64 86 71 73

Oxygen cylinder with pressure a gauge available in resuscitation/ emergency room 87 90 75 90 89 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

442 SectionSection B: B:Profile District Limpopo Health Province Profiles (1.1%) (1.1%) (0.1%) (1.3%) (2.7%) (0.6%) (2.6%) (1.9%) (28.4%) (43.8%) % Overspent (underspent) 1 117 455 1 117 Provincial Provincial Expenditure Total 2017/18 4 39 359 031 7 20 266 052 41 646 545 403 28 688 743 118 35 458 1 185 188 44 083 136 147 44 267 793 482 1 560 521 40 77 470 20 802 07 Budget 120 324 7 120 147 205 3 147 650 730 6 270 730 2 1 199 124 0 124 1 199 Total 2017/18

LG 30 566 278 54 356 681 30 542 920 30 566 278 2 505 305 046 2 456 909 355

-23 358 -23 358 -23 Transfer to LG to Transfer 1

2 82 36 03 88 88 2017/18 Provincial Expenditure 1 117 455 1 117 39 359 03 20 266 05 118 743 6 743 118 147 083 1 147 267 793 4 646 545 4 Provincial 1 185 4581 185 1

381 681 LG 54 54 381 681 2 426 366 435

-25 000 -25 -25 000 -25 Transfer to LG to Transfer 2017/18 Budget

1 560 521 40 774 470 20 802 077 120 324 728120 147 205 344147 650 730 641 270 730 244 Provincial 1 199 124 035 124 1 199 2 450 948 365 al Government. *LG – Loc*LG

BAS,

2.1 District Management 2.1 2.2 Community Health Clinics Community2.2 Health 2.4 Community-based Services Community-based 2.4 2.3 Community Health Centres Community Health 2.3 2.6 HIV/AIDS 2.6 Local government expenditure 2.5 Other2.5 Community Services Nutrition 2.7 Hospitals District 2.9 Grand Total Grand Source: District health expenditure and budget, 2017/18

443 Section B: DistrictProfile LimpopoHealth Profiles Province

Vhembe District Municipality (DC34)

Overview of the district The Vhembe District Municipalitya is a Category C municipality located in the northern part of the Limpopo Province. It shares borders with Zimbabwe and in the north-west and Mozambique in the south-east through the . The valley forms the border between the district and its international neighbours. It is comprised of four local municipalities: , Thulamela, Makhado and Collins Chabane. The district municipal offices are located in the town of . It covers a geographical area that is predominantly rural. Area: 25 596km² Population (2016)b: 1 415 907 Population density (2016): 55.3 persons per km2 Estimated medical scheme coverage: 6.4% Cities/Towns: Makhado, , Musina, Thohoyandou. Main Economic Sectors: Mining, community services, finance.

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.

444 SectionSection B: B:Profile District Limpopo Health Province Profiles

DistrictVhembe population DM (DC34) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 15 582 41 880 16 914 45 738 60-64 years 7 604 12 535 10 049 19 296 55-59 years 10 583 17 231 13 145 23 496 50-54 years 13 141 22 090 18 015 27 520 45-49 years 16 061 26 655 22 678 32 178 40-44 years 20 887 31 038 29 696 40 580 35-39 years 24 971 36 136 41 155 49 965 30-34 years 30 992 44 485 52 183 57 897 25-29 years 41 392 52 712 68 556 72 169 20-24 years 56 460 62 158 74 245 76 311 15-19 years 83 856 84 333 71 145 69 739 10-14 years 84 250 86 101 73 534 72 020 05-09 years 71 956 71 146 84 623 82 343 00-04 years 74 765 72 900 86 537 84 180

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+ 3.5% 3.2% 60-64 years 55-59 years 1.4% 1.7% 50-54 years 1.8% 1.9% 45-49 years 2.2% 1.6% 2.3% 40-44 years 1.7% 2.6% 2.1% 2.9% 35-39 years 2.1% 3.0% 2.9% 3.5% 30-34 years 2.6% 3.7% 3.7% 4.1% 25-29 years 3.4% 4.3% 4.8% 5.1% 20-24 years 4.7% 5.1% 5.2% 5.4% 15-19 years 6.9% 6.9% 5.0% 4.9% 10-14 years 6.9% 7.1% 5.2% 5.1% 05-09 years 5.9% 5.9% 6.0% 5.8% 00-04 years 6.2% 6.0% 6.1% 5.9%

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 Vhembe DM (DC34) Show history

445 Section B: DistrictProfile LimpopoHealth Profiles Province

Social determinants of health

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

446 SectionSection B: B:Profile District Limpopo Health Province Profiles

LP, Vhembe: DC34 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history LP, Vhembe: DC34 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 81% 8% 6%4% 74% 9% 10% 7% HIV and TB 5-14 35% 19% 22% 24% 35% 25% 18% 23% Comm_mat_peri_nut 15-24 24% 21% 20% 35% 20% 23% 20% 38% 25-64 32% 30% 30% 8% 22% 34% 35% 9% 65+ 21% 5% 71% 3% 18% 5% 74% 2% Total 34% 19% 41% 7% 26% 20% 46% 8%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (29.4%) Diarrhoeal diseases (21.9%) 2 Lower respiratory infections (20.7%) Protein-energy malnutrition (15.1%) according to all the 3 Preterm birth complications (9.7%) Lower respiratory infections (13.8%) deaths within the 4 Protein-energy malnutrition (9.3%) Preterm birth complications (9.2%) age/period category of 5 Birth asphyxia (6.7%) HIV/AIDS (7.4%) each box, although only 6 HIV/AIDS (5.4%) Birth asphyxia (7.0%) the leading 10 causes are <5 years <5 Tuberculosis (3.1%) 7 Accidental threats to breathing (2.2%) displayed. 8 Septicaemia (1.5%) Septicaemia (2.1%) 9 Sepsis/other newborn infectious (1.3%) Tuberculosis (2.0%) 10 Accidental threats to breathing (1.3%) Poisonings (including herbal) (2.0%) 1 Diarrhoeal diseases (13.7%) HIV/AIDS (13.9%) 2 Tuberculosis (13.2%) Diarrhoeal diseases (12.4%) 3 Road injuries (12.2%) Tuberculosis (11.9%) 4 Lower respiratory infections (9.5%) Road injuries (8.8%) 5 Meningitis/encephalitis (6.3%) Lower respiratory infections (6.9%)

5-14 6 HIV/AIDS (6.1%) Drowning (6.0%) 7 Drowning (4.6%) Meningitis/encephalitis (4.1%) 8 Accidental threats to breathing (2.9%) Septicaemia (3.4%) 9 Epilepsy (2.3%) Accidental threats to breathing (3.2%) 10 Asthma (2.1%) Fires, hot substances (2.7%) 1 Road injuries (15.8%) Accidental threats to breathing (14.2%) 2 Tuberculosis (15.0%) Road injuries (13.4%) 3 Accidental threats to breathing (9.2%) HIV/AIDS (12.0%) 4 Diarrhoeal diseases (7.5%) Tuberculosis (11.2%) 5 Lower respiratory infections (7.3%) Lower respiratory infections (5.7%) 6 HIV/AIDS (6.6%) Diarrhoeal diseases (4.9%) 15-24 7 Interpersonal violence (6.4%) Interpersonal violence (3.9%) 8 Meningitis/encephalitis (3.3%) Meningitis/encephalitis (3.4%) 9 Endocrine nutritional,blood, immune (2.1%) Drowning (2.2%) 10 Epilepsy (1.9%) Epilepsy (2.2%) 1 Tuberculosis (22.5%) Tuberculosis (17.1%) 2 Diarrhoeal diseases (14.4%) HIV/AIDS (17.0%) 3 Lower respiratory infections (10.9%) Lower respiratory infections (8.3%) 4 HIV/AIDS (7.7%) Diarrhoeal diseases (7.8%) 5 Road injuries (3.9%) Diabetes mellitus (5.6%) 6 Diabetes mellitus (3.9%) Cerebrovascular disease (4.6%) 25-64 7 Cerebrovascular disease (3.2%) Nephritis/nephrosis (3.9%) 8 Meningitis/encephalitis (2.5%) Road injuries (3.7%) 9 Nephritis/nephrosis (2.4%) Accidental threats to breathing (2.3%) 10 Endocrine nutritional,blood, immune (2.2%) Meningitis/encephalitis (2.0%) 1 Cerebrovascular disease (17.3%) Cerebrovascular disease (17.1%) 2 Lower respiratory infections (10.0%) Diabetes mellitus (11.4%) 3 Diabetes mellitus (9.7%) Lower respiratory infections (8.4%) 4 Diarrhoeal diseases (7.6%) Hypertensive heart disease (7.2%) 5 Hypertensive heart disease (4.8%) Nephritis/nephrosis (6.8%)

65+ 6 Tuberculosis (4.5%) Diarrhoeal diseases (5.7%) 7 Cardiomyopathy (4.5%) Tuberculosis (3.5%) 8 Ischaemic heart disease (3.4%) Ischaemic heart disease (3.4%) 9 Nephritis/nephrosis (3.4%) Septicaemia (2.9%) 10 Other digestive (3.1%) Endocrine nutritional,blood, immune (2.6%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (38.0%) n=13 Indirect maternal (27.5%) n=35 2 Abortion (24.7%) n=9 Other maternal (21.2%) n=27 3 Maternal haemorrhage (23.7%) n=8 Maternal haemorrhage (20.5%) n=26 4 Other maternal (13.5%) n=5 Abortion (15.7%) n=20 15-49 Female 5 Hypertension in pregnancy (15.0%) n=19 6

447 Section B: DistrictProfile LimpopoHealth Profiles Province

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.

448 SectionSection B: B:Profile District Limpopo Health Province Profiles

Child and school 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.

449 Section B: DistrictProfile LimpopoHealth Profiles Province

HIV

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.

450 SectionSection B: B:Profile District Limpopo Health 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.

451 Section B: DistrictProfile LimpopoHealth Profiles Province

Non-communicable diseases

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.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

452 SectionSection B: B:Profile District Limpopo Health Province Profiles

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

Vhembe Vhembe Chabane LM Collins LM Makhado LM Musina LM Thulamela

Restore the emergency trolley daily or after every time it was used 24 24 29 22 21

Resuscitation room is equipped with functional basic equipment for resuscitation 44 30 58 56 40

90% of the tracer medicines are available 69 69 67 89 67

Cold chain procedure for vaccines is maintained 85 88 82 100 84

The temperature of the medicine room/dispensary is maintained within the safety range 97 94 95 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

453 Section B: DistrictProfile LimpopoHealth Profiles Province - 4.4% 0.2% (1.4%) (4.7%) (5.6%) (2.0%) (0.5%) (15.9%) (26.2%) % Overspent (underspent) 99 927 99 5 1 643 877 24 771 713 Provincial Provincial Expenditure Total 2017/18 8 8 46 909 521 0 28 602 132 575 93 1 578 954 561 99 244 203 172 05 623 370 314 83 840 646 548 2 228 000 47 871 21 871 47 25 062 08 Budget 157 755 6 157 182 509182 3 330 275 8 805 545 7 3 127 120 014 938 353 3 112 1 575 872 0 Total 2017/18

599 927 599 927 599 LG

0 0 Transfer to LG to Transfer 1

71 61 75 70 03 48 2017/18 Provincial Expenditure 1 643 877 24 7 713 46 909 52 314 623 3 314 172 244 2 172 132 602132 5 840 646 5 Provincial 1 578 954 5

0 338 426 3 112 0 LG

0 0 Budget Transfer to LG to Transfer 2017/18

2 228 000 47 871 218 871 47 25 062 088 157 755 628157 182 509182 399 330 275 805 805 545 783 Provincial 3 127 120 014 1 575 872 093 al Government. *LG – Loc*LG

BAS,

2.3 Community Health Centres Community Health 2.3 2.4 Community-based Services Community-based 2.4 Other2.5 Community Services 2.1 District Management 2.1 2.2 Community Health Clinics Community2.2 Health 2.6 HIV/AIDS 2.6 Nutrition 2.7 Total Grand 2.9 District Hospitals District 2.9 Local government expenditure District health expenditure and budget, 2017/18 Source:

454 SectionSection B: B:Profile District Limpopo Health Province Profiles

Capricorn District Municipality (DC35)

Overview of the district The Capricorn District Municipalitya is a Category C municipality situated in the Limpopo Province. The municipality’s location is an ideal stopover between and the northern areas of Limpopo, and between the north-western areas and the Kruger National Park. It also forms a gateway to Botswana, Zimbabwe and Mozambique. It consists of the following four local municipalities: , Lepelle-Nkumpi, Molemole and . It derives its name from the , along which it is situated. Limpopo’s capital, Polokwane (previously Pietersburg), lies in the heart of the Capricorn region. The district has an international airport, and is linked to Gauteng by one of the best stretches of the in South Africa. It has the third-largest district economy in the province, and is predominantly rural in nature. Area: 21 705km² Population (2016)b: 1 317 444 Population density (2016): 60.7 persons per km2 Estimated medical scheme coverage: 8.7% Cities/Towns: Alldays, Dendron, Morebeng (), Polokwane, . Main Economic Sectors: Community services (30.9%), finance (27.6%), trade (14%), transport (13.2%), manufacturing (4.3%), construction (3.3%), agriculture (3.1%), electricity (2.9%).

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.

455 Section B: DistrictProfile LimpopoHealth Profiles Province

DistrictCapricorn population DM (DC35) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 20 899 44 225 24 190 55 701 60-64 years 10 977 16 913 12 486 19 910 55-59 years 14 050 19 833 15 064 22 556 50-54 years 16 672 22 908 18 473 26 873 45-49 years 19 065 25 763 22 559 30 301 40-44 years 22 417 30 898 28 359 35 337 35-39 years 26 129 35 344 38 656 43 428 30-34 years 30 628 40 357 50 052 53 564 25-29 years 39 823 47 570 66 037 66 837 20-24 years 56 233 60 978 70 909 70 304 15-19 years 86 672 84 927 69 438 67 799 10-14 years 85 672 84 317 63 789 62 848 05-09 years 72 780 71 345 71 161 69 685 00-04 years 65 784 64 489 71 470 69 658

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+ 1.7% 3.6% 1.8% 4.2% 60-64 years 1.4% 1.5% 55-59 years 1.6% 1.7% 50-54 years 1.9% 2.0% 45-49 years 1.6% 2.1% 1.7% 2.3% 40-44 years 1.8% 2.5% 2.2% 2.7% 35-39 years 2.1% 2.9% 2.9% 3.3% 30-34 years 2.5% 3.3% 3.8% 4.1% 25-29 years 3.3% 3.9% 5.0% 5.1% 20-24 years 4.6% 5.0% 5.4% 5.3% 15-19 years 7.1% 7.0% 5.3% 5.1% 10-14 years 7.0% 6.9% 4.8% 4.8% 05-09 years 6.0% 5.9% 5.4% 5.3% 00-04 years 5.4% 5.3% 5.4% 5.3%

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 Capricorn DM (DC35) Show history

456 SectionSection B: B:Profile District Limpopo Health Province Profiles

Social determinants of health

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

457 Section B: DistrictProfile LimpopoHealth Profiles Province

LP, Capricorn: DC35 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history LP, Capricorn: DC35 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 81% 6% 8%5% 75% 6% 13% 7% HIV and TB 5-14 42% 13% 23% 21% 35% 15% 30% 20% Comm_mat_peri_nut 15-24 33% 17% 17% 32% 23% 19% 21% 37% 25-64 32% 27% 33% 8% 21% 33% 36% 10% 65+ 19% 4% 74% 3% 19% 5% 74% 3% Total 34% 17% 42% 8% 25% 20% 46% 9%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (34.4%) Lower respiratory infections (22.3%) Percentages are shown 2 Lower respiratory infections (23.4%) Diarrhoeal diseases (21.2%) according to all the 3 Preterm birth complications (7.3%) Preterm birth complications (8.9%) deaths within the 4 Birth asphyxia (4.2%) Birth asphyxia (6.2%) age/period category of 5 HIV/AIDS (3.8%) HIV/AIDS (3.9%) each box, although only 6 Meningitis/encephalitis (3.2%) Protein-energy malnutrition (3.6%) the leading 10 causes are <5 years <5 7 Protein-energy malnutrition (2.7%) Sepsis/other newborn infectious (3.6%) displayed. 8 Tuberculosis (2.4%) Other perinatal conditions (3.5%) 9 Sepsis/other newborn infectious (1.8%) Meningitis/encephalitis (2.6%) 10 Septicaemia (1.6%) Poisonings (including herbal) (2.2%) 1 Diarrhoeal diseases (18.6%) Lower respiratory infections (15.0%) 2 Lower respiratory infections (13.5%) Diarrhoeal diseases (10.9%) 3 Road injuries (13.3%) Road injuries (9.8%) 4 Tuberculosis (9.1%) Tuberculosis (8.3%) 5 Meningitis/encephalitis (4.6%) HIV/AIDS (7.2%)

5-14 6 HIV/AIDS (4.3%) Drowning (4.0%) 7 Drowning (3.4%) Meningitis/encephalitis (3.8%) 8 Epilepsy (3.0%) Leukaemia (3.7%) 9 Leukaemia (2.4%) Other neoplasms (3.0%) 10 Nephritis/nephrosis (1.9%) Septicaemia (2.9%) 1 Road injuries (17.4%) Road injuries (17.2%) 2 Lower respiratory infections (16.0%) HIV/AIDS (11.3%) 3 Tuberculosis (11.5%) Lower respiratory infections (8.6%) 4 Diarrhoeal diseases (9.6%) Tuberculosis (8.4%) 5 HIV/AIDS (5.6%) Accidental threats to breathing (7.9%) 6 Accidental threats to breathing (4.7%) Diarrhoeal diseases (6.3%) 15-24 7 Interpersonal violence (4.5%) Interpersonal violence (3.6%) 8 Meningitis/encephalitis (2.6%) Mechanical forces (2.8%) 9 Mechanical forces (2.3%) Meningitis/encephalitis (2.6%) 10 Epilepsy (1.8%) Epilepsy (1.9%) 1 Tuberculosis (17.0%) HIV/AIDS (19.1%) 2 Lower respiratory infections (15.9%) Tuberculosis (13.8%) 3 Diarrhoeal diseases (11.1%) Lower respiratory infections (10.3%) 4 HIV/AIDS (9.9%) Diarrhoeal diseases (6.2%) 5 Road injuries (5.2%) Road injuries (5.3%) 6 Cerebrovascular disease (4.5%) Diabetes mellitus (4.6%) 25-64 7 Diabetes mellitus (2.9%) Cerebrovascular disease (4.2%) 8 Ischaemic heart disease (2.8%) Hypertensive heart disease (3.5%) 9 Hypertensive heart disease (2.8%) Nephritis/nephrosis (2.2%) 10 Meningitis/encephalitis (2.0%) Ischaemic heart disease (1.9%) 1 Cerebrovascular disease (15.3%) Cerebrovascular disease (14.8%) 2 Lower respiratory infections (11.7%) Hypertensive heart disease (13.1%) 3 Hypertensive heart disease (10.1%) Lower respiratory infections (11.5%) 4 Ischaemic heart disease (7.5%) Diabetes mellitus (9.7%) 5 Diabetes mellitus (7.4%) Ischaemic heart disease (5.2%)

65+ 6 Diarrhoeal diseases (5.7%) Diarrhoeal diseases (5.1%) 7 Cardiomyopathy (5.2%) Tuberculosis (3.4%) 8 COPD (3.9%) Nephritis/nephrosis (3.4%) 9 Tuberculosis (3.2%) COPD (2.9%) 10 Nephritis/nephrosis (2.9%) Cardiomyopathy (1.7%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (44.2%) n=26 Hypertension in pregnancy (28.5%) n=100 2 Hypertension in pregnancy (17.1%) n=10 Other maternal (24.2%) n=85 3 Maternal sepsis (15.7%) n=9 Indirect maternal (18.5%) n=65 4 Other maternal (11.5%) n=7 Maternal haemorrhage (14.3%) n=50 15-49 Female 5 Maternal haemorrhage (11.5%) n=7 Abortion (8.3%) n=29 6 Maternal sepsis (6.2%) n=22

458 SectionSection B: B:Profile District Limpopo Health 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.

459 Section B: DistrictProfile LimpopoHealth Profiles Province

Child and school 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.

460 SectionSection B: B:Profile District Limpopo Health Province Profiles

HIV

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.

461 Section B: DistrictProfile LimpopoHealth 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.

462 SectionSection B: B:Profile District Limpopo Health Province Profiles

Non-communicable diseases

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.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

463 Section B: DistrictProfile LimpopoHealth Profiles Province

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

Capricorn Capricorn Blouberg LM Lepelle-Nkumpi LM Molemole LM Polokwane Lm

Restore the emergency trolley daily or after every time it was used 12 4 22 11 12

Resuscitation room is equipped with functional basic equipment for resuscitation 48 42 48 56 50

90% of the tracer medicines are available 76 77 78 67 76

Cold chain procedure for vaccines is maintained 77 77 83 67 76

The temperature of the medicine room/dispensary is recorded daily 92 92 96 100 88 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

464 SectionSection B: B:Profile District Limpopo Health Province Profiles 9.9% (2.1%) 36.4% (2.7%) (0.8%) (2.8%) (3.2%) (0.4%) 268.3% (44.2%) % Overspent (underspent) 1 026 999 144 111 438 Provincial Provincial Expenditure Total 2017/18 50 638 43 318 22 528 402 2 98 079 171 59 307 040 066 93 622 267 937 60 63 339 1 310 841 1 841 6591 841 71 89871 14 23 187 24 23 187 44 542 22 Budget 131 106 8 131 309 428 0 642 938 0 1 338 973 5 Total 2017/18

LG

3 272 497 17 2 284 999 284 8 416 -8 856 21 Transfer to LG to Transfer 8 2

1 41 37 38 66 2017/18 Provincial Expenditure 1 026 999 98 079 17 43 318 6343 318 22 528 40 144 111 4 622 267 9 307 040 0 Provincial 1 310 3391 310 8

LG

32 988 18 031 -16 703 0 -16 Transfer to LG to Transfer 2017/18 Budget

1 841 6591 841 71 89871 142 23 187 24023 187 44 542 225 131 106 860131 309 428 059 642 938 093 Provincial 1 338 973 563 2 563 840 915 703 -16 032 988 18 031 2 548 492 712 -8 856 213 272 17 497 2 566 200 839 2 557 128 776 al Government. *LG – Loc*LG

BAS,

2.2 Community Health Clinics Community2.2 Health Services Community-based 2.4 Other2.5 Community Services HIV/AIDS 2.6 Nutrition 2.7 Hospitals District 2.9 Local government expenditure 2.1 District Management 2.1 2.3 Community Health Centres Community Health 2.3 Grand Total Grand Source: District health expenditure and budget, 2017/18

465 Section B: DistrictProfile LimpopoHealth Profiles Province

Waterberg District Municipality (DC36)

Overview of the district The Waterberg District Municipalitya is a Category C municipality located in the western part of the Limpopo Province. It is strategically located in that it shares its borders with Capricorn District Municipality in the north and Sekhukhune District Municipality in the east. The south-western boundary abuts the North West, while the Gauteng Province lies on the south- eastern side. The municipality is the biggest district in the province, making up just more than a third of its geographical area. It shares its five-border control points with Botswana, namely Groblersbrug, Stockpoort, Derdepoort, Zanzibar and Platjan. It is comprised of five local municipalities: Bela-Bela, , -, Mogalakwena and . The region, as we know it today, is more than three million years old. With its great variety of wildlife, birds and scenic splendour. It is one of South Africa’s prime ecotourism destinations. Area: 44 913km² Population (2016): 694 863 Population density (2016)b: 15.5 persons per km2 Estimated medical scheme coverage: 8.7% Cities/Towns: Mine Town, Bela-Bela, Lephalale, Modimolle, (Potgietersrus), Mookgophong (Naboomspruit), , Thabazimbi, . Main Economic Sectors: Mining, 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.

466 SectionSection B: B:Profile District Limpopo Health Province Profiles

DistrictWaterberg population DM pyramid(DC36) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 10 534 17 593 10 349 21 565 60-64 years 6 253 7 148 7 614 9 597 55-59 years 8 215 8 828 10 249 11 008 50-54 years 10 549 11 190 12 849 13 466 45-49 years 13 022 12 664 16 203 15 855 40-44 years 15 484 15 363 21 330 19 770 35-39 years 18 170 17 964 27 834 24 168 30-34 years 21 824 21 733 34 001 28 317 25-29 years 25 282 24 488 39 810 32 522 20-24 years 28 884 27 085 36 227 31 221 15-19 years 35 939 33 272 32 338 30 267 10-14 years 36 484 33 765 31 484 31 241 05-09 years 33 204 31 274 36 299 36 001 00-04 years 31 990 31 513 36 757 36 521

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% 3.1% 60-64 years 55-59 years 1.5% 1.5% 1.6% 50-54 years 1.8% 1.9% 1.8% 1.9% 45-49 years 2.2% 2.1% 2.3% 2.3% 40-44 years 2.6% 2.6% 3.1% 2.8% 35-39 years 3.1% 3.0% 4.0% 3.5% 30-34 years 3.7% 3.7% 4.9% 4.1% 25-29 years 4.3% 4.2% 5.7% 4.7% 20-24 years 4.9% 4.6% 5.2% 4.5% 15-19 years 6.1% 5.6% 4.7% 4.4% 10-14 years 6.2% 5.7% 4.5% 4.5% 05-09 years 5.6% 5.3% 5.2% 5.2% 00-04 years 5.4% 5.3% 5.3% 5.3%

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 Waterberg DM (DC36) Show history

467 Section B: DistrictProfile LimpopoHealth Profiles Province

Social determinants of health

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

468 SectionSection B: B:Profile District Limpopo Health Province Profiles

Burden of disease – leading causes of death in district LP, Waterberg: DC36 Percentage of deaths by broad causes and single leading causes Show history LP, Waterberg: DC36 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 79% 11%5%5% 75% 9% 9% 7% HIV and TB 5-14 38% 24% 14% 24% 33% 21% 19% 27% Comm_mat_peri_nut 15-24 31% 25% 13% 31% 20% 29% 17% 35% 25-64 28% 33% 28% 11% 17% 38% 32% 12% 65+ 14% 5% 79% 3% 15% 5% 77% 2% Total 31% 22% 38% 9% 22% 24% 43% 10%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (31.2%) Diarrhoeal diseases (21.4%) 2 Lower respiratory infections (24.2%) Lower respiratory infections (20.1%) according to all the 3 Preterm birth complications (8.3%) Preterm birth complications (11.4%) deaths within the 4 HIV/AIDS (7.9%) Birth asphyxia (7.0%) age/period category of 5 Birth asphyxia (5.2%) Protein-energy malnutrition (6.4%) each box, although only 6 Protein-energy malnutrition (4.2%) HIV/AIDS (6.2%) the leading 10 causes are <5 years <5 Meningitis/encephalitis (3.8%) 7 Tuberculosis (3.1%) displayed. 8 Meningitis/encephalitis (1.8%) Poisonings (including herbal) (3.2%) 9 Poisonings (including herbal) (1.3%) Other perinatal conditions (2.9%) 10 Other perinatal conditions (1.3%) Tuberculosis (2.9%) 1 Lower respiratory infections (20.1%) Road injuries (15.4%) 2 Road injuries (16.4%) Diarrhoeal diseases (14.1%) 3 Diarrhoeal diseases (15.2%) HIV/AIDS (12.6%) 4 Tuberculosis (14.8%) Lower respiratory infections (11.8%) 5 HIV/AIDS (11.9%) Tuberculosis (10.8%)

5-14 6 Meningitis/encephalitis (4.0%) Drowning (4.6%) 7 Drowning (3.1%) Meningitis/encephalitis (3.5%) 8 Accidental threats to breathing (3.0%) Epilepsy (3.3%) 9 Epilepsy (2.9%) Poisonings (including herbal) (2.7%) 10 Asthma (1.7%) Accidental threats to breathing (2.6%) 1 Road injuries (17.9%) HIV/AIDS (16.9%) 2 Lower respiratory infections (15.5%) Road injuries (15.3%) 3 Tuberculosis (13.3%) Tuberculosis (13.7%) 4 HIV/AIDS (12.7%) Lower respiratory infections (9.5%) 5 Diarrhoeal diseases (9.4%) Accidental threats to breathing (7.5%) 6 Interpersonal violence (4.9%) Diarrhoeal diseases (5.8%) 15-24 7 Accidental threats to breathing (3.2%) Interpersonal violence (5.0%) 8 Meningitis/encephalitis (2.4%) Meningitis/encephalitis (2.2%) 9 Mechanical forces (1.8%) Epilepsy (2.1%) 10 Endocrine nutritional,blood, immune (1.7%) Drowning (1.9%) 1 Tuberculosis (19.2%) HIV/AIDS (21.1%) 2 Lower respiratory infections (14.4%) Tuberculosis (17.2%) 3 HIV/AIDS (13.9%) Lower respiratory infections (9.1%) 4 Diarrhoeal diseases (9.2%) Road injuries (7.1%) 5 Road injuries (6.7%) Diarrhoeal diseases (4.5%) 6 Ischaemic heart disease (4.9%) Cerebrovascular disease (4.0%) 25-64 7 Cerebrovascular disease (4.1%) Ischaemic heart disease (3.9%) 8 Diabetes mellitus (2.3%) Diabetes mellitus (3.1%) 9 Meningitis/encephalitis (2.1%) Hypertensive heart disease (2.4%) 10 Hypertensive heart disease (1.8%) Nephritis/nephrosis (2.4%) 1 Cerebrovascular disease (16.2%) Cerebrovascular disease (14.9%) 2 Ischaemic heart disease (15.0%) Ischaemic heart disease (11.7%) 3 Hypertensive heart disease (9.7%) Hypertensive heart disease (9.2%) 4 Lower respiratory infections (7.8%) Lower respiratory infections (8.7%) 5 Diabetes mellitus (6.0%) Diabetes mellitus (8.4%)

65+ 6 Diarrhoeal diseases (4.6%) Nephritis/nephrosis (4.8%) 7 Tuberculosis (4.1%) Diarrhoeal diseases (4.7%) 8 COPD (3.4%) Tuberculosis (3.6%) 9 Nephritis/nephrosis (3.3%) COPD (3.3%) 10 Prostate (2.0%) Prostate (2.2%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (44.4%) n=12 Indirect maternal (32.8%) n=21 2 Other maternal (20.6%) n=5 Other maternal (27.4%) n=18 3 Hypertension in pregnancy (20.2%) n=5 Hypertension in pregnancy (17.0%) n=11 4 Abortion (14.8%) n=4 Abortion (13.8%) n=9 15-49 Female 5 Maternal haemorrhage (9.0%) n=6 6

469 Section B: DistrictProfile LimpopoHealth Profiles Province

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.

470 SectionSection B: B:Profile District Limpopo Health Province Profiles

Child and school 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.

471 Section B: DistrictProfile LimpopoHealth Profiles Province

HIV

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.

472 SectionSection B: B:Profile District Limpopo Health 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.

473 Section B: DistrictProfile LimpopoHealth Profiles Province

Non-communicable diseases

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.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

474 SectionSection B: B:Profile District Limpopo Health Province Profiles

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

Waterberg Bela-Bela LM Lephalale LM Mogalakwena LM LM Mookgophong Thabazimbi LM

Restore the emergency trolley daily or after every time it was used 2 0 0 0 0 10

Resuscitation room is equipped with functional basic equipment for resuscitation 15 0 0 9 43 30

90% of the tracer medicines are available 78 78 100 43 75 100

Cold chain procedure for vaccines is maintained 93 93 100 86 91 100

The temperature of the medicine room/dispensary is maintained within the safety range 98 100 100 97 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

475 Section B: DistrictProfile LimpopoHealth Profiles Province 7.4% 3.2% (4.1%) 24.7% (1.1%) 18.0% (1.8%) (2.5%) (8.3%) (12.3%) % Overspent (underspent) 9 974 627 9 974 1 422 578 2 053 882 1 5 Provincial Provincial Expenditure Total 2017/18 8 827 103 904 7 392 44 018 07 218 161 1 144 30 327 269 347 48 828 714 181 1 205 180 83 277 41 48 453 024 453 48 50 203 43 20 333 509 333 20 Budget 176 078 3 176 341 290341 2 1 173 0481 173 3 Total 2017/18

9 20 909 673 309 177 19

LG

0 30 177 19 0 177 309 19 799 1 914 127 1 893 620 086 Transfer to LG to Transfer 2

7 2 18 47 28 04 2017/18 Provincial Expenditure 1 422 578 19 974 62 974 19 44 018 3944 018 52 053 88 181 714 8 714 181 327 269 3 103 827103 9 Provincial 1 144 161 2 161 1 144

3

LG

0 20 909 673 442 1 874 777 0 20 909 67 Transfer to LG to Transfer 2017/18 Budget

1 205 180 83 277 418 48 453 024 453 48 50 203 437 20 333 509 333 20 176 078 348176 341 290341 230 Provincial 1 173 0481 173 307 1 893 889 454 al Government. *LG – Loc*LG

BAS,

2.2 Community Health Clinics Community2.2 Health Centres Community Health 2.3 2.1 District Management 2.1 2.4 Community-based Services Community-based 2.4 Grand Total Grand 2.5 Other2.5 Community Services HIV/AIDS 2.6 2.7 Nutrition 2.7 Hospitals District 2.9 Local government expenditure District health expenditure and budget, 2017/18 Source:

476 SectionSection B: B:Profile District Limpopo Health Province Profiles

Sekhukhune District Municipality (DC47)

Overview of the district The Sekhukhune District Municipalitya is a Category C municipality and is located in the Limpopo Province, the northernmost part of South Africa. It lies in the south-eastern part of the province, bordering on the Capricorn and Mopani Districts in the north, Mpumalanga in the south and east, and the Waterberg District in the west. The district is the smallest in the province, making up 11% of its geographical area. It is comprised of four local municipalities: Elias Motsoaledi, Ephraim Mogale, Makhuduthamaga and Fetakgomo-Greater Tubatse. The area’s towns and villages are serviced by its major river – the Olifants. Area: 13 528km² Population (2016)b: 1 197 198 Population density (2016): 88.5 persons per km2 Estimated medical scheme coverage: 5.9% Cities/Towns: , , , , , Schuinsdraai , . Main Economic Sectors: Community services, mining (15–20%), trade (17%), financial and business services (10–12%), agriculture (9.7%).

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.

477 Section B: DistrictProfile LimpopoHealth Profiles Province

DistrictSekhukhune population DM pyramid (DC47) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 14 781 35 212 11 940 43 449 60-64 years 7 183 14 509 7 450 16 138 55-59 years 9 461 17 457 8 984 16 760 50-54 years 11 266 18 754 10 894 19 508 45-49 years 12 198 19 581 13 966 21 497 40-44 years 14 163 23 246 19 942 27 164 35-39 years 17 019 26 045 33 527 39 641 30-34 years 21 878 31 925 50 911 53 822 25-29 years 34 048 43 453 66 612 66 666 20-24 years 52 827 57 357 67 303 67 561 15-19 years 74 811 74 017 62 714 61 984 10-14 years 73 369 73 260 60 069 59 162 05-09 years 63 498 62 597 71 789 70 164 00-04 years 60 096 58 902 74 767 72 814

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+ 1.4% 3.4% 3.6% 60-64 years 1.4% 55-59 years 1.7% 1.4% 50-54 years 1.8% 1.6% 45-49 years 1.9% 1.8% 40-44 years 2.3% 1.7% 2.3% 35-39 years 1.7% 2.5% 2.8% 3.3% 30-34 years 2.1% 3.1% 4.3% 4.5% 25-29 years 3.3% 4.2% 5.6% 5.6% 20-24 years 5.2% 5.6% 5.6% 5.6% 15-19 years 7.3% 7.2% 5.2% 5.2% 10-14 years 7.2% 7.2% 5.0% 4.9% 05-09 years 6.2% 6.1% 6.0% 5.9% 00-04 years 5.9% 5.8% 6.2% 6.1%

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 Sekhukhune DM (DC47) Show history

478 SectionSection B: B:Profile District Limpopo Health Province Profiles

Social determinants of health

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

479 Section B: DistrictProfile LimpopoHealth Profiles Province

LP, Sekhukhune: DC47 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history LP, Sekhukhune: DC47 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 85% 6%6%4% 78% 8% 8% 7% HIV and TB 5-14 49% 12% 16% 23% 46% 14% 15% 24% Comm_mat_peri_nut 15-24 38% 20% 14% 27% 30% 21% 18% 32% 25-64 39% 25% 29% 7% 28% 33% 29% 10% 65+ 23% 3% 72% 2% 30% 4% 63% 2% Total 39% 16% 38% 7% 33% 20% 39% 8%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (40.3%) Diarrhoeal diseases (29.0%) Percentages are shown 2 Lower respiratory infections (26.7%) Lower respiratory infections (25.5%) according to all the 3 Preterm birth complications (5.3%) Preterm birth complications (6.6%) deaths within the 4 Protein-energy malnutrition (4.8%) Protein-energy malnutrition (6.0%) age/period category of 5 HIV/AIDS (3.9%) HIV/AIDS (5.9%) each box, although only 6 Birth asphyxia (3.2%) Birth asphyxia (4.7%) the leading 10 causes are <5 years <5 7 Meningitis/encephalitis (1.7%) Poisonings (including herbal) (2.5%) displayed. 8 Tuberculosis (1.6%) Septicaemia (1.9%) 9 Adverse effects medical/surgical (0.9%) Meningitis/encephalitis (1.9%) 10 Septicaemia (0.9%) Tuberculosis (1.7%) 1 Lower respiratory infections (24.6%) Diarrhoeal diseases (20.5%) 2 Diarrhoeal diseases (17.5%) Lower respiratory infections (19.7%) 3 Road injuries (14.6%) Road injuries (12.8%) 4 Tuberculosis (7.1%) HIV/AIDS (8.7%) 5 HIV/AIDS (5.3%) Tuberculosis (6.2%)

5-14 6 Meningitis/encephalitis (5.1%) Drowning (5.4%) 7 Drowning (3.9%) Accidental threats to breathing (3.3%) 8 Epilepsy (2.6%) Epilepsy (3.3%) 9 Asthma (2.6%) Septicaemia (3.0%) 10 Adverse effects medical/surgical (1.4%) Meningitis/encephalitis (2.5%) 1 Lower respiratory infections (23.4%) Road injuries (16.0%) 2 Road injuries (14.5%) Lower respiratory infections (14.6%) 3 Tuberculosis (11.4%) HIV/AIDS (13.6%) 4 Diarrhoeal diseases (9.2%) Diarrhoeal diseases (8.6%) 5 HIV/AIDS (9.2%) Tuberculosis (8.2%) 6 Accidental threats to breathing (3.9%) Accidental threats to breathing (7.4%) 15-24 7 Interpersonal violence (3.5%) Epilepsy (2.9%) 8 Meningitis/encephalitis (2.3%) Mechanical forces (2.5%) 9 Mechanical forces (1.8%) Meningitis/encephalitis (2.4%) 10 Epilepsy (1.8%) Septicaemia (2.4%) 1 Lower respiratory infections (24.3%) HIV/AIDS (20.7%) 2 Tuberculosis (14.1%) Lower respiratory infections (16.0%) 3 Diarrhoeal diseases (11.2%) Tuberculosis (12.8%) 4 HIV/AIDS (10.5%) Diarrhoeal diseases (7.6%) 5 Cerebrovascular disease (4.5%) Road injuries (5.2%) 6 Road injuries (4.2%) Cerebrovascular disease (5.0%) 25-64 7 Diabetes mellitus (2.9%) Diabetes mellitus (3.9%) 8 Ischaemic heart disease (2.5%) Hypertensive heart disease (2.5%) 9 Hypertensive heart disease (2.4%) Septicaemia (2.3%) 10 Meningitis/encephalitis (1.9%) Nephritis/nephrosis (1.9%) 1 Cerebrovascular disease (22.1%) Cerebrovascular disease (20.6%) 2 Lower respiratory infections (16.4%) Lower respiratory infections (18.2%) 3 Cardiomyopathy (11.4%) Hypertensive heart disease (10.3%) 4 Hypertensive heart disease (8.8%) Diarrhoeal diseases (7.4%) 5 Diabetes mellitus (5.6%) Diabetes mellitus (7.1%)

65+ 6 Diarrhoeal diseases (4.7%) Ischaemic heart disease (3.3%) 7 Ischaemic heart disease (4.6%) Septicaemia (3.2%) 8 COPD (3.2%) Nephritis/nephrosis (3.0%) 9 Tuberculosis (2.8%) Tuberculosis (3.0%) 10 Nephritis/nephrosis (2.0%) Cardiomyopathy (2.7%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (60.3%) n=19 Indirect maternal (26.6%) n=29 2 Maternal haemorrhage (16.5%) n=5 Hypertension in pregnancy (22.8%) n=25 3 Other maternal (13.3%) n=4 Other maternal (22.7%) n=25 4 Maternal sepsis (9.9%) n=3 Maternal haemorrhage (16.0%) n=17 15-49 Female 5 Abortion (8.0%) n=9 6 Maternal sepsis (4.0%) n=4

480 SectionSection B: B:Profile District Limpopo Health 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.

481 Section B: DistrictProfile LimpopoHealth Profiles Province

Child and school 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.

482 SectionSection B: B:Profile District Limpopo Health Province Profiles

HIV

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.

483 Section B: DistrictProfile LimpopoHealth 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.

484 SectionSection B: B:Profile District Limpopo Health Province Profiles

Non-communicable diseases

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.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

485 Section B: DistrictProfile LimpopoHealth Profiles Province

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

Sekhukhune LM Motsoaledi Elias LM Mogale Ephraim Fetakgomo-Greater LM Tubatse LM Makhuduthamaga

Restore the emergency trolley daily or after every time it was used 31 60 29 24 24

Resuscitation room is equipped with functional basic equipment for resuscitation 51 53 50 54 43

Cold chain procedure for vaccines is maintained 83 87 86 76 90

90% of the tracer medicines are available 93 100 86 92 95

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 94 100 86 95 95 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

486 SectionSection B: B:Profile District Limpopo Health Province Profiles 1.2% 0.6% (1.4%) (1.5%) (1.8%) (2.7%) (6.6%) (1.7%) (2.3%) (10.1%) % Overspent (underspent) 1 651 8481 651 Provincial Provincial Expenditure Total 2017/18 9 39 577 616 8 968 89 213 6 20 204 416 52 497 336 453 02 997 652 136 65 786 541 117 44 282 883 211 4 273 618 4 209 477 1 632 640 99 268 67 40 689 75 20 682 08 Budget 126 101 3 101 126 494 465 2 287 955 5 1 011 386 0 1 011 Total 2017/18

LG

0 4 209 477 0 4 209 477 2 086 454 945 2 050 000 182 Transfer to LG to Transfer

8 6 6 11 41 52 53 2017/18 Provincial Expenditure 1 651 8481 651 20 204 41 39 577 61 89 213 9689 213 117 786 5 117 282 883 2 997 6 136 497 336 4 Provincial

LG

0 4 273 618 0 4 273 618 2 045 790 705 Transfer to LG to Transfer 2017/18 Budget

1 632 640 99 268 678 40 689 759 20 682 086 126 101 365 101 126 494 465 252 287 955 544 Provincial 1 011 386 0021 011 2 082 327 181 al Government. *LG – Loc*LG

BAS,

2.2 Community Health Clinics Community2.2 Health Centres Community Health 2.3 Services Community-based 2.4 2.1 District Management 2.1 2.9 District Hospitals District 2.9 2.5 Other2.5 Community Services HIV/AIDS 2.6 Nutrition 2.7 Local government expenditure Grand Total Grand District health expenditure and budget, 2017/18 Source:

487