8 Eastern Cape Province

SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Buffalo City Metropolitan Municipality (BUF)

Overview of the district The Buffalo City Metropolitan Municipalitya is a Category A municipality situated on the east coast of the Eastern Cape Province. The boundaries of the municipality now include a large area characterised by very different features. Two former municipalities, Transitional Local Councils – that of East London and King William’s Town – have merged into one. Other areas that were previously not included in either of them are now part of Buffalo City. The municipality was established as a local municipality in 2000 after South Africa’s reorganisation of municipal areas and is named after the Buffalo River, at whose mouth lies the only river port in South Africa. On 18 May 2011 it was separated from the Amathole District Municipality and converted into a metropolitan municipality. The area has a well-developed manufacturing base, with the auto industry playing a major role. The climate is mild, with year-round sunshine. Area: 2 750km² Population (2016)b: 836 931 Population density (2016): 304.3 persons per km2 Estimated medical scheme coverage: 17.4% Cities/Towns: Beacon Bay, Berlin, Bisho, Breidbach, Dimbaza, East London, Kidd’s Beach, King William’s Town, Mdantsane, Phakamisa, Potsdam, Zwelitsha. Main Economic Sectors: Community services (25%), finance (24%), manufacturing (24%), trade (12%), transport (12%).

Population distribution 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.

111 Section B: DistrictProfile EasternHealth ProfilesCape Province

DistrictBuﬀalo population City MM pyramid (BUF) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 11 027 20 569 11 803 22 568 60-64 years 8 464 10 701 10 771 15 326 55-59 years 11 670 13 262 13 605 19 066 50-54 years 15 681 19 401 16 194 20 497 45-49 years 18 265 22 864 20 067 23 175 40-44 years 20 440 24 040 24 148 25 830 35-39 years 24 024 27 178 29 839 31 766 30-34 years 27 017 29 745 34 273 36 105 25-29 years 31 137 34 864 39 576 39 509 20-24 years 34 771 37 646 35 534 35 838 15-19 years 39 610 39 721 30 867 30 329 10-14 years 35 768 35 305 42 868 42 121 05-09 years 30 807 29 676 48 534 47 266 00-04 years 43 520 42 548 45 321 44 135

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% 2.8% 2.7% 60-64 years 1.4% 1.8% 55-59 years 1.6% 1.8% 1.6% 2.3% 50-54 years 2.1% 2.6% 1.9% 2.4% 45-49 years 2.5% 3.1% 2.4% 2.8% 40-44 years 2.8% 3.2% 2.9% 3.1% 35-39 years 3.2% 3.7% 3.6% 3.8% 30-34 years 3.7% 4.0% 4.1% 4.3% 25-29 years 4.2% 4.7% 4.7% 4.7% 20-24 years 4.7% 5.1% 4.2% 4.3% 15-19 years 5.4% 5.4% 3.7% 3.6% 10-14 years 4.8% 4.8% 5.1% 5.0% 05-09 years 4.2% 4.0% 5.8% 5.6% 00-04 years 5.9% 5.8% 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 Buﬀalo City MM (BUF) Show history

112 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Social determinants of health

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

113 Section B: DistrictProfile EasternHealth ProfilesCape Province

EC, Buﬀalo City: BUF Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history EC, Buﬀalo City: BUF Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 67% 13% 12% 8% 61% 8% 21% 10% HIV and TB 5-14 22% 19% 25% 34% 17% 16% 26% 41% Comm_mat_peri_nut 15-24 12% 28% 14% 45% 8% 24% 17% 51% 25-64 12% 36% 39% 12% 8% 34% 45% 13% 65+ 8% 7% 81% 3% 7%7% 82% 4% Total 15% 25% 49% 11% 10% 23% 55% 12%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (25.0%) Lower respiratory infections (20.8%) 2 Lower respiratory infections (23.4%) Diarrhoeal diseases (14.2%) according to all the 3 HIV/AIDS (9.2%) Preterm birth complications (8.6%) deaths within the 4 Preterm birth complications (5.3%) HIV/AIDS (5.6%) age/period category of 5 Tuberculosis (4.4%) Protein-energy malnutrition (4.4%) each box, although only 6 Protein-energy malnutrition (3.4%) Birth asphyxia (4.0%) the leading 10 causes are <5 years <5 7 Accidental threats to breathing (2.9%) Congenital heart anomalies (3.1%) displayed. 8 Birth asphyxia (2.4%) Tuberculosis (2.9%) 9 Meningitis/encephalitis (1.9%) Sepsis/other newborn infectious (2.7%) 10 Septicaemia (1.9%) Meningitis/encephalitis (2.5%) 1 Tuberculosis (13.4%) Drowning (17.6%) 2 Drowning (12.7%) Road injuries (10.7%) 3 Road injuries (7.3%) Tuberculosis (9.8%) 4 HIV/AIDS (6.8%) HIV/AIDS (7.3%) 5 Diarrhoeal diseases (6.4%) Meningitis/encephalitis (5.3%)

5-14 6 Lower respiratory infections (4.6%) Accidental threats to breathing (4.9%) 7 Accidental threats to breathing (4.1%) Fires, hot substances (4.1%) 8 Interpersonal violence (3.7%) Lower respiratory infections (3.2%) 9 Fires, hot substances (3.4%) Epilepsy (3.1%) 10 Meningitis/encephalitis (2.7%) Diarrhoeal diseases (2.9%) 1 Interpersonal violence (24.7%) Interpersonal violence (21.3%) 2 Tuberculosis (21.0%) Tuberculosis (12.4%) 3 HIV/AIDS (7.8%) HIV/AIDS (12.3%) 4 Accidental threats to breathing (6.5%) Accidental threats to breathing (8.3%) 5 Mechanical forces (4.5%) Mechanical forces (6.1%) 6 Road injuries (3.9%) Road injuries (5.7%) 15-24 7 Lower respiratory infections (3.5%) Fires, hot substances (4.2%) 8 Fires, hot substances (3.2%) Drowning (2.6%) 9 Diarrhoeal diseases (3.0%) Lower respiratory infections (2.0%) 10 Meningitis/encephalitis (2.4%) Epilepsy (1.7%) 1 Tuberculosis (26.1%) Tuberculosis (18.4%) 2 HIV/AIDS (10.3%) HIV/AIDS (16.0%) 3 Interpersonal violence (4.8%) Cerebrovascular disease (4.7%) 4 Lower respiratory infections (4.7%) Interpersonal violence (3.5%) 5 Cerebrovascular disease (4.3%) Ischaemic heart disease (3.3%) 6 Diarrhoeal diseases (3.6%) Diabetes mellitus (3.0%) 25-64 7 COPD (2.9%) COPD (3.0%) 8 Diabetes mellitus (2.5%) Lower respiratory infections (3.0%) 9 Ischaemic heart disease (2.4%) Nephritis/nephrosis (2.8%) 10 Cardiomyopathy (2.4%) Road injuries (2.5%) 1 Cerebrovascular disease (14.2%) Cerebrovascular disease (14.7%) 2 Ischaemic heart disease (9.0%) Ischaemic heart disease (8.9%) 3 COPD (6.9%) COPD (6.9%) 4 Tuberculosis (6.8%) Hypertensive heart disease (6.5%) 5 Hypertensive heart disease (6.4%) Diabetes mellitus (5.7%)

65+ 6 Diabetes mellitus (4.7%) Tuberculosis (5.7%) 7 Oesophagus (4.6%) Oesophagus (4.3%) 8 Lower respiratory infections (4.4%) Lower respiratory infections (3.9%) 9 Cardiomyopathy (3.8%) Nephritis/nephrosis (3.2%) 10 Nephritis/nephrosis (2.6%) Cardiomyopathy (2.8%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (42.8%) n=23 Indirect maternal (35.9%) n=40 2 Hypertension in pregnancy (20.4%) n=11 Hypertension in pregnancy (31.5%) n=35 3 Other maternal (18.5%) n=10 Other maternal (18.6%) n=21 4 Maternal haemorrhage (12.3%) n=7 Abortion (8.2%) n=9 15-49 Female 5 Abortion (6.1%) n=3 Maternal haemorrhage (5.9%) n=7 6

114 SectionSection B: Profile B: EasternDistrict HealthCape 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.

115 Section B: DistrictProfile EasternHealth ProfilesCape 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.

116 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

HIV

Source: DHIS. 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.

117 Section B: DistrictProfile EasternHealth ProfilesCape 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.

118 SectionSection B: Profile B: EasternDistrict HealthCape 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.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

119 Section B: DistrictProfile EasternHealth ProfilesCape Province

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

Buffalo City

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

Resuscitation room is equipped with functional basic equipment for resuscitation 14

Cold chain procedure for vaccines is maintained 85

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

Oxygen cylinder with pressure a gauge available in resuscitation/ emergency room 94 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

120 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles 2.7% (7.1%) 19.9% (1.6%) 63.7% (4.1%) (12.4%) (57.6%) (18.6%) (16.8%) % Overspent (underspent) 1 755 905 13 48313 938 Provincial Provincial Expenditure Total 2017/18 0 607 103 74 4 42 338 728 28 431 164 850 46 309 298 171 66 224 239 750 64 257 956 953 4 141 076 4 141 8 239 322 72 146 87 72 146 45 73 551 Budget 310 122 4 122 310 248 6 701 201 998 5 227 885 1 Total 2017/18

LG 34 209 055 39 024 096 013 34 174

-35 042 Transfer to LG to Transfer 7 8 8 50 50 09 53 2017/18 Provincial Expenditure 1 755 905 74 103 60 103 74 13 48313 93 42 338 72 298 171 3 298 171 164 431164 8 224 239 7 257 956 9 Provincial

LG 39 048 286 39 048 286 1 076 482 040 -35 042 34 209 055 901 1 157 810 656 053 1 110

-24 19 -24 190 Transfer to LG to Transfer 2017/18 Budget

4 141 076 4 141 8 239 322 72 146 870 72 146 45 734 551 310 122 464 122 310 248 646 701 201 998 528 227 885 166 Provincial 1 118 786 8051 118 al Government. *LG – Loc*LG

BAS,

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

121 Section B: DistrictProfile EasternHealth ProfilesCape Province

Sarah Baartman District Municipality (DC10)

Overview of the district The Sarah Baartman District Municipalitya (previously Cacadu District Municipality) is a Category C municipality situated in the Eastern Cape Province. It stretches from Graaff-Reinet in the north to the Indian Ocean in the south and between the Great Fish River in the east and Bloukrans River in the west. Sarah Baartman is the biggest district in the province, making up approximately a third of its geographical area. It comprises seven local municipalities: Dr Beyers Naudé, Blue Crane Route, Makana, Ndlambe, Sundays River Valley, Kouga and Kou-kamma. The district surrounds one of the largest metropolitan ports in South Africa, Nelson Mandela Bay (Port Elizabeth). Area: 58 245km² Population (2016)b: 508 859 Population density (2016): 8.7 people per km2 Estimated medical scheme coverage: 9.0% Cities/Towns: Aberdeen, Addo, Adendorp, Alexandria, Alicedale, Bathurst, Boknes/Cannon Rocks, Bushmans River, Cape St Francis, Clarkson, Cookhouse, Graaff-Reinet, Grahamstown, Hankey, Humansdorp, Jansenville, Jeffreys Bay, Joubertina, Kareedouw, Kendrew, Kenton-on-Sea, Kirkwood, Klipplaat, Krakeel River, Loerie, Louterwater, Misgund, Nieu-Bethesda, Nompumelelo, Oyster Bay, Patensie, Paterson, Pearston, Petersburg, Port Alfred, Riebeek East, Rietbron, Sanddrif, Seafield, Sidbury, Somerset East, St Francis Bay, Steytlerville, Storms River, Thornhill, Waterford, Willowmore, Woodlands. Main Economic Sectors: Agriculture (mohair), 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.

122 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

S Baartman DM (DC10) District population pyramid and comparison with the national pyramid Year AgeGrp 2006 2016 65+ 10 418 14 979 13 439 18 699 60-64 years 5 965 7 343 6 885 8 411 55-59 years 7 033 8 533 8 324 9 916 50-54 years 8 750 10 145 10 270 11 462 45-49 years 9 945 11 573 12 787 13 448 40-44 years 11 753 13 092 14 513 14 422 35-39 years 13 990 15 024 17 076 16 556 30-34 years 14 734 15 502 21 170 20 268 25-29 years 16 005 16 923 25 248 22 652 20-24 years 18 904 19 920 21 855 20 840 15-19 years 22 446 21 721 19 495 19 187 10-14 years 20 413 20 066 25 780 25 200 05-09 years 18 834 18 649 28 614 27 664 00-04 years 25 430 25 023 27 943 26 735

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+ 2.5% 3.5% 2.6% 3.7% 60-64 years 1.7% 1.7% 55-59 years 1.7% 2.0% 1.6% 1.9% 50-54 years 2.1% 2.4% 2.0% 2.3% 45-49 years 2.4% 2.7% 2.5% 2.6% 40-44 years 2.8% 3.1% 2.9% 2.8% 35-39 years 3.3% 3.6% 3.4% 3.3% 30-34 years 3.5% 3.7% 4.2% 4.0% 25-29 years 3.8% 4.0% 5.0% 4.5% 20-24 years 4.5% 4.7% 4.3% 4.1% 15-19 years 5.3% 5.1% 3.8% 3.8% 10-14 years 4.8% 4.7% 5.1% 5.0% 05-09 years 4.5% 4.4% 5.6% 5.4% 00-04 years 6.0% 5.9% 5.5% 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 S Baartman DM (DC10) Show history

123 Section B: DistrictProfile EasternHealth ProfilesCape Province

Social determinants of health

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

124 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

EC, S Baartman: DC10 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history EC, S Baartman: DC10 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 72% 15% 7%6% 71% 8% 13% 8% HIV and TB 5-14 19% 22% 11% 48% 17% 15% 17% 52% Comm_mat_peri_nut 15-24 9% 38% 9% 44% 6% 32% 11% 51% 25-64 9% 40% 38% 12% 6% 38% 42% 13% 65+ 9% 6% 83% 2% 8%6% 83% 2% Total 15% 27% 47% 11% 10% 25% 54% 11%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Lower respiratory infections (23.1%) Lower respiratory infections (29.3%) 2 Diarrhoeal diseases (22.7%) Diarrhoeal diseases (15.5%) according to all the 3 Preterm birth complications (11.0%) Preterm birth complications (9.8%) deaths within the 4 HIV/AIDS (10.4%) Protein-energy malnutrition (6.3%) age/period category of 5 Protein-energy malnutrition (6.1%) Birth asphyxia (5.6%) each box, although only 6 Tuberculosis (4.8%) HIV/AIDS (4.9%) the leading 10 causes are <5 years <5 7 Tuberculosis (3.9%) Birth asphyxia (4.6%) displayed. 8 Drowning (1.7%) Congenital heart anomalies (2.7%) 9 Sepsis/other newborn infectious (1.6%) Other perinatal conditions (2.4%) 10 Other perinatal conditions (1.4%) Other respiratory (2.2%) 1 Drowning (22.9%) Drowning (35.9%) 2 Road injuries (17.9%) Road injuries (18.2%) 3 HIV/AIDS (13.1%) HIV/AIDS (12.1%) 4 Tuberculosis (12.4%) Tuberculosis (6.9%) 5 Lower respiratory infections (9.7%) Lower respiratory infections (6.7%)

5-14 6 Other unintentional injuries (5.8%) Meningitis/encephalitis (4.7%) 7 Diarrhoeal diseases (4.1%) Accidental threats to breathing (4.1%) 8 Interpersonal violence (3.6%) Exposure to natural forces (2.6%) 9 Epilepsy (3.5%) Diarrhoeal diseases (2.4%) 10 Fires, hot substances (2.5%) Diabetes mellitus (2.2%) 1 Interpersonal violence (25.8%) Interpersonal violence (21.1%) 2 HIV/AIDS (20.8%) HIV/AIDS (17.4%) 3 Tuberculosis (18.7%) Tuberculosis (16.2%) 4 Road injuries (8.6%) Accidental threats to breathing (12.1%) 5 Lower respiratory infections (4.5%) Road injuries (6.4%) 6 Accidental threats to breathing (3.8%) Drowning (5.4%) 15-24 7 Drowning (3.1%) Mechanical forces (3.7%) 8 Mechanical forces (2.0%) Lower respiratory infections (3.5%) 9 Fires, hot substances (1.8%) Fires, hot substances (2.9%) 10 Diarrhoeal diseases (1.6%) Epilepsy (1.5%) 1 Tuberculosis (22.5%) HIV/AIDS (20.0%) 2 HIV/AIDS (18.0%) Tuberculosis (18.5%) 3 Lower respiratory infections (5.6%) Cerebrovascular disease (5.4%) 4 Ischaemic heart disease (5.3%) Ischaemic heart disease (4.9%) 5 Cerebrovascular disease (5.0%) COPD (3.7%) 6 Interpersonal violence (5.0%) Interpersonal violence (3.4%) 25-64 7 Road injuries (3.4%) Road injuries (3.4%) 8 COPD (2.6%) Lower respiratory infections (3.4%) 9 Hypertensive heart disease (2.4%) Diabetes mellitus (2.8%) 10 Trachea/bronchi/lung (2.2%) Trachea/bronchi/lung (2.5%) 1 Cerebrovascular disease (16.5%) Cerebrovascular disease (17.7%) 2 Ischaemic heart disease (14.4%) Ischaemic heart disease (11.7%) 3 Hypertensive heart disease (8.0%) COPD (7.0%) 4 Lower respiratory infections (6.9%) Hypertensive heart disease (6.8%) 5 COPD (6.2%) Tuberculosis (5.3%)

65+ 6 Tuberculosis (5.0%) Diabetes mellitus (5.3%) 7 Trachea/bronchi/lung (4.0%) Lower respiratory infections (5.2%) 8 Diabetes mellitus (3.6%) Nephritis/nephrosis (4.1%) 9 Nephritis/nephrosis (2.6%) Trachea/bronchi/lung (3.3%) 10 Prostate (2.6%) Prostate (2.3%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Other maternal (33.7%) n=8 2 Hypertension in pregnancy (24.8%) n=6 3 Indirect maternal (22.1%) n=5 4 Maternal haemorrhage (19.3%) n=5 15-49 Female 5 6

125 Section B: DistrictProfile EasternHealth ProfilesCape 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.

126 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Child and school health

Source: DHIS.

127 Section B: DistrictProfile EasternHealth ProfilesCape Province

HIV

Source: DHIS.

128 SectionSection B: Profile B: EasternDistrict HealthCape 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.

129 Section B: DistrictProfile EasternHealth ProfilesCape Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

130 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

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

Sarah Baartman Blue Crane LM Route Dr Beyers Naudé LM Kou-Kamma LM LM Kouga LM Makana LM Ndlambe Sundays River Valley LM Resuscitation room is equipped with functional basic equipment for resuscitation 42 17 67 30 44 33 40 50

Restore the emergency trolley daily or after every time it was used 42 0 67 50 56 33 40 17

Cold chain procedure for vaccines is maintained 85 100 92 80 78 100 80 67

Oxygen cylinder with pressure a gauge available in resuscitation/ emergency room 92 83 83 90 100 100 100 83

The temperature of the medicine room/dispensary is recorded daily 95 100 100 100 78 100 100 83 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

131 Section B: DistrictProfile EasternHealth ProfilesCape Province pent (1.6%) (1.0%) 32.6% (5.4%) (3.7%) (4.9%) (0.6%) (16.0%) (35.6%) (66.3%) % Overs (underspent)

7 063 412 2 277 427 170 807 489170 Provincial Provincial Expenditure Total 2017/18 35 68 505 265 29 345 188 15 069 292 116 34 304 157 720 43 338 491 612 43 3 533 647 8 409 453 30 854 24 72 049 89 Budget 117 226 0 117 128 812 1 510 563 3 510 159 926159 5 Total 2017/18

6 545 12 468 27 329 681 9 222 912

-3 322 55 Transfer to LG to Transfer

5 5 92 20 89 38 2017/18 Provincial Expenditure 7 063 412 2 277 427 29 34 188 68 505 26 116 069 2 116 491 612 3 491 612 170 807 4 170 157 304157 7 Provincial

95 37 991 276 -10 661 5 -10 Transfer to LG to Transfer 2017/18 Budget

3 533 647 8 409 453 30 854 245 72 049 893 117 226 015 117 128 812 143 510 563 343510 159 926159 534 Provincial 1 031 375 273 661 595 -10 37 991 276 1 042 828 288 -3 322 556 545 12 468 1 058 704 954 1 052 051 200 al Government. *LG – Loc*LG

BAS,

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

132 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Amathole District Municipality (DC12)

Overview of the district The Amathole District Municipalitya is a Category C municipality situated in the central part of the Eastern Cape. It stretches along the Sunshine Coast from the Fish River Mouth and along the Eastern Seaboard to just south of Hole in the Wall along the Wild Coast. It is bordered to the north by the Amathole Mountain Range. The municipality is comprised of six local municipalities: Mbhashe, Mnquma, Great Kei, Amahlathi, Ngqushwa and Raymond Mhlaba. Four heritage routes have been developed that are named after Xhosa kings and heroes. They are the Maqoma Route, the Makana Route, the Sandile Route and the Phalo Route. These intertwine with the other tourism routes located within the district, namely the Sunshine Coast Route, the Wild Coast Route, the Amathole Mountain Escape Route and the Friendly N6 Route. Area: 21 117km² Population (2016)b: 982 451 Population density (2016): 46.5 persons per km2 Estimated medical scheme coverage: 5.1% Cities/Towns: Adelaide, Alice, Amatola Coastal, Bedford, Butterworth, Cathcart, Dutywa, Elliotdale, Fort Beaufort, Hamburg, Hogsback, Kei Mouth, Kei Road, Keiskammahoek, Kentani, Komga, Middeldrift, Morgan Bay, Ngqamakhwe, Peddie, Seymore, Stutterheim, Willowvale. Main Economic Sectors: Community services (44%), finance (19%), manufacturing (14%), trade (13%), transport (4%), agriculture (3%), construction (2%).

Population distribution, local municipality boundaries and health facility locations

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

133 Section B: DistrictProfile EasternHealth ProfilesCape Province

DistrictAmathole population DM (DC12) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 21 317 41 457 14 619 38 250 60-64 years 9 698 15 054 7 677 15 066 55-59 years 10 742 16 326 9 365 17 524 50-54 years 12 469 19 359 9 802 16 750 45-49 years 14 013 21 860 10 927 16 300 40-44 years 13 857 20 969 14 119 17 125 35-39 years 14 976 21 245 23 235 24 363 30-34 years 18 259 22 661 38 244 39 357 25-29 years 27 974 30 926 55 483 53 443 20-24 years 46 316 49 192 55 829 54 005 15-19 years 70 589 68 610 47 986 45 765 10-14 years 65 825 64 369 54 990 53 906 05-09 years 50 169 48 302 63 061 61 602 00-04 years 56 764 55 739 62 682 60 976

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% 4.5% 3.9% 60-64 years 1.6% 1.5% 55-59 years 1.8% 1.8% 50-54 years 2.1% 1.7% 45-49 years 1.5% 2.4% 1.7% 40-44 years 1.5% 2.3% 1.7% 35-39 years 1.6% 2.3% 2.4% 2.5% 30-34 years 2.0% 2.4% 3.9% 4.0% 25-29 years 3.0% 3.3% 5.6% 5.4% 20-24 years 5.0% 5.3% 5.7% 5.5% 15-19 years 7.6% 7.4% 4.9% 4.7% 10-14 years 7.1% 6.9% 5.6% 5.5% 05-09 years 5.4% 5.2% 6.4% 6.3% 00-04 years 6.1% 6.0% 6.4% 6.2%

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 Amathole DM (DC12) Show history

134 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Social determinants of health

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

135 Section B: DistrictProfile EasternHealth ProfilesCape Province

EC, Amathole: DC12 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history EC, Amathole: DC12 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 71% 12% 10% 6% 67% 9% 14% 10% HIV and TB 5-14 30% 19% 21% 30% 30% 15% 20% 35% Comm_mat_peri_nut 15-24 18% 31% 15% 36% 11% 25% 15% 50% 25-64 19% 40% 32% 9% 12% 39% 37% 12% 65+ 11% 9% 77% 3% 12% 9% 76% 3% Total 19% 27% 45% 8% 15% 25% 50% 11%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (32.0%) Diarrhoeal diseases (26.3%) 2 Lower respiratory infections (17.0%) Lower respiratory infections (19.3%) according to all the 3 HIV/AIDS (8.3%) Protein-energy malnutrition (7.9%) deaths within the 4 Preterm birth complications (6.1%) HIV/AIDS (6.7%) age/period category of 5 Protein-energy malnutrition (5.7%) Preterm birth complications (5.3%) each box, although only 6 Tuberculosis (4.3%) Birth asphyxia (3.2%) the leading 10 causes are <5 years <5 Birth asphyxia (4.1%) 7 Drowning (3.2%) displayed. 8 Meningitis/encephalitis (1.9%) Tuberculosis (2.2%) 9 Asthma (1.7%) Asthma (2.2%) 10 Other respiratory (1.5%) Poisonings (including herbal) (1.8%) 1 Diarrhoeal diseases (11.4%) Drowning (13.6%) 2 Tuberculosis (11.2%) Lower respiratory infections (10.6%) 3 Road injuries (9.5%) HIV/AIDS (9.6%) 4 HIV/AIDS (8.3%) Road injuries (8.3%) 5 Lower respiratory infections (7.8%) Diarrhoeal diseases (8.0%)

5-14 6 Drowning (7.5%) Epilepsy (6.2%) 7 Meningitis/encephalitis (5.7%) Meningitis/encephalitis (5.9%) 8 Epilepsy (4.1%) Tuberculosis (5.4%) 9 Asthma (3.6%) Accidental threats to breathing (3.6%) 10 Exposure to natural forces (3.4%) Fires, hot substances (2.9%) 1 Interpersonal violence (17.2%) Interpersonal violence (20.7%) 2 HIV/AIDS (15.8%) HIV/AIDS (14.1%) 3 Tuberculosis (15.2%) Accidental threats to breathing (10.8%) 4 Road injuries (6.0%) Tuberculosis (10.8%) 5 Lower respiratory infections (5.4%) Road injuries (7.3%) 6 Diarrhoeal diseases (5.4%) Mechanical forces (4.3%) 15-24 7 Accidental threats to breathing (4.5%) Lower respiratory infections (3.7%) 8 Meningitis/encephalitis (3.6%) Epilepsy (3.3%) 9 Mechanical forces (3.2%) Diarrhoeal diseases (3.0%) 10 Epilepsy (3.1%) Drowning (2.7%) 1 Tuberculosis (21.9%) HIV/AIDS (20.4%) 2 HIV/AIDS (18.5%) Tuberculosis (18.3%) 3 Lower respiratory infections (7.8%) Lower respiratory infections (6.3%) 4 Diarrhoeal diseases (6.5%) Cerebrovascular disease (5.0%) 5 Cerebrovascular disease (3.8%) Interpersonal violence (3.3%) 6 Asthma (3.5%) Diarrhoeal diseases (3.1%) 25-64 7 Meningitis/encephalitis (2.9%) Diabetes mellitus (3.0%) 8 Interpersonal violence (2.5%) Asthma (3.0%) 9 Diabetes mellitus (2.3%) Accidental threats to breathing (2.5%) 10 Road injuries (2.3%) Road injuries (2.5%) 1 Cerebrovascular disease (15.2%) Cerebrovascular disease (15.7%) 2 Hypertensive heart disease (9.5%) Hypertensive heart disease (10.2%) 3 Tuberculosis (8.7%) Tuberculosis (8.4%) 4 Asthma (7.1%) Lower respiratory infections (7.5%) 5 COPD (7.1%) Asthma (6.5%)

65+ 6 Lower respiratory infections (7.1%) COPD (6.3%) 7 Diabetes mellitus (5.1%) Diabetes mellitus (5.7%) 8 Oesophagus (3.9%) Ischaemic heart disease (4.2%) 9 Ischaemic heart disease (3.9%) Oesophagus (3.7%) 10 Cardiomyopathy (3.9%) Cardiomyopathy (3.2%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (32.6%) n=12 Indirect maternal (32.7%) n=25 2 Hypertension in pregnancy (22.4%) n=8 Hypertension in pregnancy (27.0%) n=20 3 Other maternal (19.4%) n=7 Abortion (16.4%) n=12 4 Maternal sepsis (12.9%) n=5 Other maternal (14.4%) n=11 15-49 Female 5 Maternal haemorrhage (12.7%) n=5 Maternal haemorrhage (9.5%) n=7 6

136 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Women and maternal health

Source: DHIS.

137 Section B: DistrictProfile EasternHealth ProfilesCape Province

Child and school health

Source: DHIS.

138 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

HIV

Source: DHIS.

139 Section B: DistrictProfile EasternHealth ProfilesCape 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

140 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

141 Section B: DistrictProfile EasternHealth ProfilesCape Province

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

Amathole Amathole Amahlathi LM Great Kei LM LM Mbhashe LM Mnquma LM Ngqushwa Raymond Mhlaba LM

Restore the emergency trolley daily or after every time it was used 22 44 50 13 18 27 11

Resuscitation room is equipped with functional basic equipment for resuscitation 31 56 50 31 21 23 22

Oxygen cylinder with pressure a gauge available in resuscitation/ emergency room 95 96 100 91 89 100 100

Cold chain procedure for vaccines is maintained 95 100 75 91 93 100 94

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 97 100 100 91 96 100 97 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

142 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles 1.0% 6.4% 2.3% 0.3% 47.5% (1.7%) (0.2%) (12.3%) (16.3%) (38.6%) % Overspent (underspent) 3 903 697 14 016 063 016 14 Provincial Provincial Expenditure Total 2017/18 18 787 583 435 79 272 065 981 85 602 526 119 05 99 289 645 33 422 119 136 90 134 387 218 6 359 537 9 503 464 Budget 769 710 0 769 710 387 979 1 127 901 2 127 100 8 976 136 396136 4 269 253 3 Total 2017/18

8 38 304 576 32 049 498 LG

0 32 049 498 1 846 384 687 1 851 848 401 0 32 049 49 Transfer to LG to Transfer 5 3

81 26 22 35 34 2017/18 Provincial Expenditure 3 903 697 14 016 06 016 14 99 289 64 136 119 4 119 136 119 602 5 119 387 218 1 387 218 272 065 9 787 583 4 Provincial

2 548 38 741 -436 97 Transfer to LG to Transfer 2017/18 Budget

6 359 537 9 503 464 769 710 018 769 710 387 979 190 127 901 233127 100 805 976 136 396136 485 269 253 379 Provincial 1 808 080 111 -436 972 548 38 741 798 1 819 903 al Government. *LG – Loc*LG

BAS,

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 Other2.5 Community Services 2.1 District Management 2.1 2.7 Nutrition 2.7 2.9 District Hospitals District 2.9 Local government expenditure Total Grand 2.6 HIV/AIDS 2.6 District health expenditure and budget, 2017/18 Source:

143 Section B: DistrictProfile EasternHealth ProfilesCape Province

Chris Hani District Municipality (DC13)

Overview of the district The Chris Hani District Municipalitya is a Category C municipality situated in the north-eastern part of the Eastern Cape, a linking node to all regions in the province. It is bordered by the Joe Gqabi District to the north, Cacadu and Amathole District to the south, OR Tambo District to the east, and Northern Cape to the west. Chris Hani is the second-largest district in the province, making up almost a third of its geographical area. The municipality comprises six local municipalities: Inxuba Yethemba, Enoch Mgijima, Intsika Yethu, Engcobo, Sakhisizwe and Emalahleni. The area, which is vastly agricultural, provides an ideal investment opportunity for agro-processing, and its proximity to the ports of East London and Port Elizabeth, with links to major routes like the N6 and N10, is an advantage. Area: 36 407km² Population (2016)b: 807 974 Population density (2016): 22.2 persons per km2 Estimated medical scheme coverage: 5.7% Cities/Towns: Cacadu (Lady Frere), Cala, Cofimvaba, Cradock, Dordrecht, Engcobo, Hofmeyr, Indwe, Khowa (Elliot), Komani (Queenstown), Middelburg, Molteno, Mount Zebra National Park, Sada, Sterkstroom, Tarkastad, Tsomo, Whittlesea. Main Economic Sectors: Community services (52%), trade (15%), finance (14%), transport (6%), agriculture (4%), manufacturing (4%), electricity (2%).

Population distribution, local municipality boundaries and health facility locations

144 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

DistrictC Hani population DM (DC13) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 19 867 32 300 21 974 33 683 60-64 years 8 348 11 594 8 441 12 333 55-59 years 9 630 13 254 9 662 14 317 50-54 years 11 089 15 277 9 898 13 849 45-49 years 12 156 17 312 11 236 14 084 40-44 years 12 040 16 743 13 641 15 239 35-39 years 13 312 17 400 19 718 20 366 30-34 years 15 455 18 690 31 679 32 679 25-29 years 21 662 23 856 44 408 42 893 20-24 years 37 327 38 963 43 233 42 628 15-19 years 57 806 54 743 39 592 37 665 10-14 years 52 363 51 365 46 598 44 598 05-09 years 41 055 39 182 46 130 44 676 00-04 years 47 614 45 300 46 978 45 776

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+ 2.6% 4.3% 2.7% 4.2% 60-64 years 1.5% 1.5% 55-59 years 1.8% 1.8% 50-54 years 1.5% 2.0% 1.7% 45-49 years 1.6% 2.3% 1.7% 40-44 years 1.6% 2.2% 1.7% 1.9% 35-39 years 1.8% 2.3% 2.4% 2.5% 30-34 years 2.0% 2.5% 3.9% 4.0% 25-29 years 2.9% 3.2% 5.5% 5.3% 20-24 years 4.9% 5.2% 5.4% 5.3% 15-19 years 7.6% 7.2% 4.9% 4.7% 10-14 years 6.9% 6.8% 5.8% 5.5% 05-09 years 5.4% 5.2% 5.7% 5.5% 00-04 years 6.3% 6.0% 5.8% 5.7%

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 C Hani DM (DC13) Show history

145 Section B: DistrictProfile EasternHealth ProfilesCape Province

Social determinants of health

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

146 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

EC, C Hani: DC13 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history EC, C Hani: DC13 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 75% 9% 9% 7% 67% 8% 15% 10% HIV and TB 5-14 26% 20% 19% 35% 24% 19% 18% 40% Comm_mat_peri_nut 15-24 21% 29% 15% 35% 13% 28% 13% 46% 25-64 24% 36% 32% 8% 13% 39% 36% 11% 65+ 14% 9% 74% 3% 13% 9% 76% 3% Total 24% 25% 43% 8% 16% 26% 48% 10%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (31.1%) Diarrhoeal diseases (21.4%) Percentages are shown 2 Lower respiratory infections (20.0%) Lower respiratory infections (16.0%) according to all the 3 Preterm birth complications (8.1%) Preterm birth complications (9.4%) deaths within the 4 HIV/AIDS (6.2%) Protein-energy malnutrition (8.0%) age/period category of 5 Protein-energy malnutrition (5.4%) HIV/AIDS (5.7%) each box, although only 6 Birth asphyxia (4.0%) Birth asphyxia (5.6%) the leading 10 causes are <5 years <5 7 Tuberculosis (3.1%) Accidental threats to breathing (2.9%) displayed. 8 Sepsis/other newborn infectious (1.9%) Tuberculosis (2.7%) 9 Other respiratory (1.7%) Poisonings (including herbal) (2.4%) 10 Meningitis/encephalitis (1.5%) Sepsis/other newborn infectious (2.1%) 1 Tuberculosis (14.4%) Drowning (17.5%) 2 Drowning (11.0%) Tuberculosis (11.0%) 3 Diarrhoeal diseases (8.8%) Lower respiratory infections (10.3%) 4 Lower respiratory infections (8.5%) HIV/AIDS (9.4%) 5 Road injuries (8.3%) Road injuries (7.7%)

5-14 6 Exposure to natural forces (6.4%) Diarrhoeal diseases (6.7%) 7 HIV/AIDS (6.3%) Accidental threats to breathing (5.1%) 8 Meningitis/encephalitis (4.6%) Meningitis/encephalitis (4.7%) 9 Accidental threats to breathing (4.1%) Exposure to natural forces (3.6%) 10 Epilepsy (3.7%) Interpersonal violence (3.2%) 1 Interpersonal violence (19.2%) Interpersonal violence (22.7%) 2 Tuberculosis (17.0%) HIV/AIDS (16.3%) 3 HIV/AIDS (12.4%) Tuberculosis (12.1%) 4 Lower respiratory infections (7.9%) Accidental threats to breathing (8.3%) 5 Diarrhoeal diseases (6.3%) Road injuries (5.2%) 6 Accidental threats to breathing (5.0%) Lower respiratory infections (4.3%) 15-24 7 Road injuries (4.0%) Meningitis/encephalitis (3.1%) 8 Meningitis/encephalitis (3.5%) Mechanical forces (3.1%) 9 Epilepsy (2.8%) Epilepsy (3.0%) 10 Mechanical forces (2.2%) Diarrhoeal diseases (2.7%) 1 Tuberculosis (22.0%) HIV/AIDS (21.5%) 2 HIV/AIDS (14.1%) Tuberculosis (18.0%) 3 Lower respiratory infections (12.0%) Lower respiratory infections (7.0%) 4 Diarrhoeal diseases (7.3%) Cerebrovascular disease (4.9%) 5 Cerebrovascular disease (3.8%) Interpersonal violence (3.4%) 6 Asthma (2.8%) Diarrhoeal diseases (3.3%) 25-64 7 Interpersonal violence (2.8%) Diabetes mellitus (3.0%) 8 Meningitis/encephalitis (2.6%) Ischaemic heart disease (2.7%) 9 Epilepsy (2.1%) Asthma (2.6%) 10 Road injuries (2.0%) Road injuries (2.3%) 1 Cerebrovascular disease (13.5%) Cerebrovascular disease (15.1%) 2 Lower respiratory infections (9.4%) Hypertensive heart disease (8.8%) 3 Tuberculosis (8.2%) Lower respiratory infections (8.4%) 4 Hypertensive heart disease (8.1%) Tuberculosis (7.5%) 5 Asthma (7.2%) Cardiomyopathy (6.7%)

65+ 6 COPD (5.4%) Diabetes mellitus (6.4%) 7 Diabetes mellitus (4.9%) Asthma (6.0%) 8 Cardiomyopathy (4.7%) COPD (4.8%) 9 Ischaemic heart disease (4.5%) Ischaemic heart disease (3.9%) 10 Oesophagus (3.9%) Oesophagus (2.7%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (58.2%) n=18 Indirect maternal (37.1%) n=26 2 Hypertension in pregnancy (18.3%) n=6 Maternal haemorrhage (22.5%) n=16 3 Abortion (12.8%) n=4 Hypertension in pregnancy (18.1%) n=13 4 Other maternal (10.7%) n=3 Abortion (14.0%) n=10 15-49 Female 5 Other maternal (8.3%) n=6 6

147 Section B: DistrictProfile EasternHealth ProfilesCape Province

Women and maternal health

Source: DHIS.

148 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Child and school health

Source: DHIS.

149 Section B: DistrictProfile EasternHealth ProfilesCape Province

HIV

Source: DHIS.

150 SectionSection B: Profile B: EasternDistrict HealthCape 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.

151 Section B: DistrictProfile EasternHealth ProfilesCape Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

152 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

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

C Hani LM Emalahleni LM Engcobo Enoch Mgijima LM Intsika Yethu LM LM Yethemba Inxuba Sakhisizwe LM

Restore the emergency trolley daily or after every time it was used 19 0 12 25 30 20 14

Resuscitation room is equipped with functional basic equipment for resuscitation 28 4 20 38 30 50 29

The temperature of the medicine room/dispensary is maintained within the safety range 86 68 76 94 84 100 100

The temperature of the medicine room/dispensary is recorded daily 87 76 68 94 89 100 100

90% of the tracer medicines are available 89 96 76 100 76 100 93 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

153 Section B: DistrictProfile EasternHealth ProfilesCape Province - 1.1% 7.4% 7.3% 4.5% 12.5% 28.4% 20.0% (10.2%) (36.6%) % Overspent (underspent) 2 876 472 7 239 234 4 534 896 146 473 836 473 146 Provincial Provincial Expenditure Total 2017/18 1 473 218 71 0 9 625 552 119 29 822 441 640 35 884 678 317 40 252 256 495 140 7 154 6827 154 8 062 087 59 352 44 93 200 89 Budget 140 102 671 163 0 163 671 392 679 8 234 865 8 Total 2017/18

00 2 876 472 2 876 472 1 606 580 954 1 724 365 482

Transfer to LG to Transfer

3 52 95 36 40 84 2017/18 Provincial Expenditure 7 239 234 4 534 896 71 218 47 218 71 119 625 5 119 678 317 8 678 317 146 473 8 473 146 441 822441 6 252 256 4 Provincial

0 1 721 489 010 0

0 0

Transfer to LG to Transfer 2017/18 Budget

7 154 6827 154 8 062 087 59 352 441 93 200 899 140 102 140 671 163 035 163 671 392 679 829 234 865 840 Provincial 1 606 580 954 al Government. *LG – Loc*LG

BAS,

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

154 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Joe Gqabi District Municipality (DC 14)

Overview of the district The Joe Gqabi District Municipalitya (previously Ukhahlamba District Municipality) is a Category C municipality located within the Eastern Cape. It borders the Free State Province and country of Lesotho to the north. The municipality is located to the north of the OR Tambo and Chris Hani District Municipalities, to the east of the Northern Cape, and to the west of Alfred Nzo. Joe Gqabi lies approximately 34km north of Komani (Queenstown) and its northern border is formed by the Orange River, which also forms the southern boundary of the Free State. It consists of three local municipalities: Elundini, Walter Sisulu and Senqu. Aliwal North is the main commercial and tourism centre. Area: 25 617km² Population (2016)b: 365 950 Population density (2016): 14.3 persons per km2 Estimated medical scheme coverage: 5.4% Cities/Towns: Aliwal North, Barkly East, Burgersdorp, Jamestown, Lady Grey, Maclear, Mount Fletcher, Oviston, Rhodes, Rossouw, Sterkspruit, Steynsburg, Ugie, Venterstad. Main Economic Sectors: Community services (55%), finance (12.6%), trade (9.7%), manufacturing (9.6%), agriculture (6.2%).

Population distribution, local municipality boundaries and health facility locations

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

155 Section B: DistrictProfile EasternHealth ProfilesCape Province

DistrictJoe Gqabi population DM (DC14) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 7 022 13 952 5 496 14 049 60-64 years 3 304 4 971 2 725 5 080 55-59 years 3 762 5 712 3 162 5 666 50-54 years 4 283 6 457 3 598 5 563 45-49 years 4 687 6 978 4 640 5 961 40-44 years 4 992 6 896 6 147 7 005 35-39 years 6 032 7 616 10 021 10 729 30-34 years 7 367 8 637 15 370 16 759 25-29 years 11 174 12 378 21 233 22 315 20-24 years 17 282 18 704 20 651 21 281 15-19 years 25 141 25 314 18 302 18 219 10-14 years 22 951 23 016 19 087 18 788 05-09 years 18 410 18 208 21 201 20 713 00-04 years 19 076 18 786 21 369 20 820

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% 4.2% 1.5% 3.8% 60-64 years 1.5% 1.4% 55-59 years 1.7% 1.5% 50-54 years 1.9% 1.5% 45-49 years 2.1% 1.6% 40-44 years 1.5% 2.1% 1.7% 1.9% 35-39 years 1.8% 2.3% 2.7% 2.9% 30-34 years 2.2% 2.6% 4.2% 4.6% 25-29 years 3.4% 3.7% 5.8% 6.1% 20-24 years 5.2% 5.6% 5.6% 5.8% 15-19 years 7.5% 7.6% 5.0% 5.0% 10-14 years 6.9% 6.9% 5.2% 5.1% 05-09 years 5.5% 5.5% 5.8% 5.7% 00-04 years 5.7% 5.6% 5.8% 5.7%

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 Joe Gqabi DM (DC14) Show history

156 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Social determinants of health

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

157 Section B: DistrictProfile EasternHealth ProfilesCape Province

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (31.1%) Diarrhoeal diseases (21.4%) Percentages are shown 2 Lower respiratory infections (20.0%) Lower respiratory infections (16.0%) according to all the 3 Preterm birth complications (8.1%) Preterm birth complications (9.4%) deaths within the 4 HIV/AIDS (6.2%) Protein-energy malnutrition (8.0%) age/period category of 5 Protein-energy malnutrition (5.4%) HIV/AIDS (5.7%) each box, although only 6 Birth asphyxia (4.0%) Birth asphyxia (5.6%) the leading 10 causes are <5 years <5 Tuberculosis (3.1%) Accidental threats to breathing (2.9%) 7 displayed. 8 Sepsis/other newborn infectious (1.9%) Tuberculosis (2.7%) 9 Other respiratory (1.7%) Poisonings (including herbal) (2.4%) 10 Meningitis/encephalitis (1.5%) Sepsis/other newborn infectious (2.1%) 1 Tuberculosis (14.4%) Drowning (17.5%) 2 Drowning (11.0%) Tuberculosis (11.0%) 3 Diarrhoeal diseases (8.8%) Lower respiratory infections (10.3%) 4 Lower respiratory infections (8.5%) HIV/AIDS (9.4%) 5 Road injuries (8.3%) Road injuries (7.7%)

158 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Women and maternal health

Source: DHIS.

159 Section B: DistrictProfile EasternHealth ProfilesCape Province

Child and school health

Source: DHIS.

160 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

HIV

Source: DHIS.

161 Section B: DistrictProfile EasternHealth ProfilesCape 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.

162 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

163 Section B: DistrictProfile EasternHealth ProfilesCape Province

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

Joe Gqabi Elundini LM Senqu LM Walter Sisulu LM

Restore the emergency trolley daily or after every time it was used 19 14 25 18

Resuscitation room is equipped with functional basic equipment for resuscitation 35 29 55 9

90% of the tracer medicines are available 77 57 95 82

Oxygen cylinder with pressure a gauge available in resuscitation/ emergency room 94 100 95 82

Cold chain procedure for vaccines is maintained 94 95 95 91 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

164 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles 1.6% 0.0% 2.5% 3.7% 20.1% (0.4%) 55.3% (5.2%) (59.0%) (98.2%) % Overspent (underspent) 1 514 3 1 197 5591 197 7 245 670 117 176 512 100 310 711 Provincial Provincial Expenditure Total 2017/18 4 44 567 470 41 61 25 375 710 144 55 444 811 182 4 666 513 2 921 289 1 785 363 46 907 17 Budget 1 100 674 114 290 0 114 120 168 6 168 120 437 002 4 Total 2017/18

2 963 13 237 900 13 482

0 900 13 482 842 378 860 873 292 135 0 900 13 48 Transfer to LG to Transfer 7

11 12 10 310 31 514 2017/18 Provincial Expenditure 1 197 5591 197 7 245 670 44 56 470 117 176 5 100 711 144 375 7 144 444 8 182 Provincial

7 LG

0 963 13 237 859 391 653 0 963 13 23 Transfer to LG to Transfer 2017/18 Budget

4 666 513 2 921 289 1 785 363 46 907 174 100 674 141 100 674 114 290 061 114 120 168 625 168 120 828 623 415 437 002 455 Provincial al Government. *LG – Loc*LG

BAS,

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

165 Section B: DistrictProfile EasternHealth ProfilesCape Province

OR Tambo District Municipality (DC15)

Overview of the district The OR Tambo District Municipalitya is a Category C municipality located to the east of the Eastern Cape Province, on the coastline. It is bordered by the Alfred Nzo District Municipality to the north, the Joe Gqabi District Municipality to the north-west, the Amathole District Municipality to the south-west, and the Chris Hani District Municipality to the west. The municipality is formed by five local municipalities: King Sabata Dalindyebo, Nyandeni, Mhlontlo, Port St Johns and Ingquza Hill. It covers about 80% of what used to be marginalised homeland in the Transkei, and is one of the four Integrated Sustainable Rural Development Programme (ISRDP) nodes in the province. Area: 12 141km² Population (2016)b: 1 465 533 Population density (2016): 120.7 persons per km2 Estimated medical scheme coverage: 4.5% Cities/Towns: Flagstaff, Libode, Lusikisiki, Mqanduli, Mthatha (previously Umtata), Ngqeleni, Port St Johns, Qumbu, Tsolo. Main Economic Sectors: Community services (55%), trade (18.5%), finance (16.9%), agriculture (3.5%), transport (3.1%), manufacturing (2.8%), construction (2.7%).

Population distribution, local municipality boundaries and health facility locations

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

166 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

DistrictOR Tambo population DM (DC15) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 22 195 46 090 19 233 47 370 60-64 years 8 775 15 456 7 987 16 809 55-59 years 10 473 18 276 10 267 21 084 50-54 years 12 416 21 253 11 214 21 720 45-49 years 15 002 26 225 13 393 23 157 40-44 years 15 828 27 027 18 630 26 463 35-39 years 18 469 29 998 31 690 37 672 30-34 years 23 958 34 838 51 394 57 638 25-29 years 37 649 47 274 78 995 81 801 20-24 years 61 240 70 786 86 820 88 848 15-19 years 99 401 102 663 79 886 79 570 10-14 years 103 514 105 438 82 667 80 050 05-09 years 85 594 85 706 98 914 95 450 00-04 years 86 401 83 830 100 182 96 629

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% 3.5% 3.2% 60-64 years 55-59 years 1.4% 1.4% 50-54 years 1.6% 1.5% 45-49 years 2.0% 1.6% 40-44 years 2.1% 1.8% 35-39 years 2.3% 2.2% 2.6% 30-34 years 1.8% 2.6% 3.5% 3.9% 25-29 years 2.9% 3.6% 5.4% 5.6% 20-24 years 4.7% 5.4% 5.9% 6.1% 15-19 years 7.6% 7.8% 5.5% 5.4% 10-14 years 7.9% 8.0% 5.6% 5.5% 05-09 years 6.5% 6.5% 6.7% 6.5% 00-04 years 6.6% 6.4% 6.8% 6.6%

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 OR Tambo DM (DC15) Show history

167 Section B: DistrictProfile EasternHealth ProfilesCape Province

Social determinants of health

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

168 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

EC, OR Tambo: DC15 BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history EC, OR Tambo: DC15 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 72% 12% 11% 6% 65% 13% 13% 10% HIV and TB 5-14 28% 22% 21% 29% 27% 25% 20% 28% Comm_mat_peri_nut 15-24 22% 29% 16% 33% 12% 28% 17% 43% 25-64 22% 43% 27% 8% 12% 47% 30% 11% 65+ 15% 14% 68% 3% 12% 14% 71% 3% Total 23% 32% 36% 9% 15% 33% 40% 12%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (35.9%) Diarrhoeal diseases (26.3%) 2 Lower respiratory infections (16.5%) Lower respiratory infections (17.0%) according to all the 3 HIV/AIDS (6.7%) Protein-energy malnutrition (9.4%) deaths within the 4 Protein-energy malnutrition (6.6%) HIV/AIDS (7.1%) age/period category of 5 Tuberculosis (5.3%) Tuberculosis (5.5%) each box, although only 6 Preterm birth complications (3.9%) Preterm birth complications (3.6%) the leading 10 causes are <5 years <5 7 Meningitis/encephalitis (2.7%) Poisonings (including herbal) (2.7%) displayed. 8 Septicaemia (1.9%) Septicaemia (2.5%) 9 Sepsis/other newborn infectious (1.7%) Meningitis/encephalitis (2.1%) 10 Birth asphyxia (1.6%) Drowning (1.8%) 1 Road injuries (14.9%) Tuberculosis (13.7%) 2 Tuberculosis (14.1%) HIV/AIDS (11.9%) 3 HIV/AIDS (8.6%) Road injuries (9.6%) 4 Diarrhoeal diseases (8.4%) Drowning (8.7%) 5 Lower respiratory infections (8.1%) Diarrhoeal diseases (7.6%)

5-14 6 Meningitis/encephalitis (6.7%) Lower respiratory infections (7.0%) 7 Drowning (5.5%) Meningitis/encephalitis (5.4%) 8 Exposure to natural forces (2.9%) Accidental threats to breathing (2.9%) 9 Nephritis/nephrosis (1.9%) Epilepsy (2.5%) 10 Endocrine nutritional,blood, immune (1.7%) Other neurological conditions (2.4%) 1 Tuberculosis (16.0%) HIV/AIDS (16.3%) 2 HIV/AIDS (13.2%) Interpersonal violence (15.7%) 3 Interpersonal violence (10.3%) Tuberculosis (12.4%) 4 Road injuries (9.1%) Road injuries (7.8%) 5 Diarrhoeal diseases (7.2%) Accidental threats to breathing (6.5%) 6 Lower respiratory infections (5.3%) Mechanical forces (4.9%) 15-24 7 Meningitis/encephalitis (4.4%) Lower respiratory infections (3.4%) 8 Accidental threats to breathing (4.1%) Diarrhoeal diseases (2.7%) 9 Mechanical forces (3.8%) Meningitis/encephalitis (2.6%) 10 Nephritis/nephrosis (1.7%) Drowning (2.2%) 1 Tuberculosis (22.6%) HIV/AIDS (27.7%) 2 HIV/AIDS (20.4%) Tuberculosis (19.4%) 3 Lower respiratory infections (7.7%) Lower respiratory infections (4.5%) 4 Diarrhoeal diseases (7.5%) Cerebrovascular disease (3.9%) 5 Meningitis/encephalitis (3.7%) Diarrhoeal diseases (3.3%) 6 Cerebrovascular disease (3.3%) Road injuries (2.9%) 25-64 7 Road injuries (3.0%) Interpersonal violence (2.9%) 8 Asthma (1.9%) Diabetes mellitus (2.6%) 9 Diabetes mellitus (1.8%) Cardiomyopathy (2.1%) 10 Interpersonal violence (1.8%) Nephritis/nephrosis (2.1%) 1 Cerebrovascular disease (13.6%) Cerebrovascular disease (15.7%) 2 Tuberculosis (12.2%) Tuberculosis (11.7%) 3 Lower respiratory infections (8.1%) Hypertensive heart disease (8.9%) 4 COPD (5.2%) Lower respiratory infections (6.9%) 5 Hypertensive heart disease (5.1%) Diabetes mellitus (6.0%)

65+ 6 Diabetes mellitus (4.8%) COPD (3.9%) 7 Asthma (4.5%) Oesophagus (3.4%) 8 Diarrhoeal diseases (4.5%) Cardiomyopathy (3.4%) 9 Oesophagus (3.7%) Ischaemic heart disease (3.2%) 10 Cardiomyopathy (3.2%) Asthma (3.2%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (40.7%) n=41 Indirect maternal (29.9%) n=109 2 Hypertension in pregnancy (21.3%) n=22 Hypertension in pregnancy (20.3%) n=74 3 Other maternal (13.2%) n=13 Other maternal (18.4%) n=67 4 Abortion (10.2%) n=10 Maternal haemorrhage (17.0%) n=62 15-49 Female 5 Maternal sepsis (8.6%) n=9 Abortion (8.2%) n=30 6 Maternal haemorrhage (6.0%) n=6 Maternal sepsis (6.2%) n=23

169 Section B: DistrictProfile EasternHealth ProfilesCape Province

Women and maternal health

Source: DHIS.

170 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Child and school health

Source: DHIS.

171 Section B: DistrictProfile EasternHealth ProfilesCape Province

HIV

Source: DHIS.

172 SectionSection B: Profile B: EasternDistrict HealthCape 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.

173 Section B: DistrictProfile EasternHealth ProfilesCape Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

174 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

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

OR Tambo Ingquza Hill LM King Sabata Dalindyebo LM LM Mhlontlo LM Nyandeni Port St Johns LM

Restore the emergency trolley daily or after every time it was used 24 15 17 41 17 40

Resuscitation room is equipped with functional basic equipment for resuscitation 38 30 35 33 41 50

Cold chain procedure for vaccines is maintained 90 100 77 93 97 100

90% of the tracer medicines are available 93 90 92 85 100 100

The temperature of the medicine room/dispensary is maintained within the safety range 93 100 85 100 97 90 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

175 Section B: DistrictProfile EasternHealth ProfilesCape Province 7.4% 1.0% 6.2% (1.1%) 11.9% 20.7% (11.7%) 774.6% (18.9%) (50.0%) % Overspent (underspent) 4 180 7224 180 Provincial Provincial Expenditure Total 2017/18 7 057 680 11 11 456 388 501 18 207 933 226 67 978 626 416 59 778 604 800 98 483 100 013 34 645 153 898 537 358 4 699 901 8 360 347 13 64213 30 Budget 378 016 9 378 016 733 1 139 205 860 0 101 084101 4 173 966173 6 372 636 3 Total 2017/18

LG 0 4 699 901 1 987 243 598 2 133 502 837

0 4 699 901

Transfer to LG to Transfer 0 18 Provincial18 Expenditure 01 26 26 98 83 00 2017/ 4 180 7224 180 11 057 68 11 416 978 6 416 100 013 4 100 013 153 645153 8 207 933 2 456 388 5 778 604 8 Provincial

0 7 678 278

-7 140 92 140 -7 Transfer to LG to Transfer 2017/18 Budget

8 360 347 13 64213 307 378 016 911 378 016 733 159 139 205 860 018 101 084101 498 173 966173 634 372 636 367 Provincial 1 986 706 240 140 920 -7 7 678 278 2 128 802 936 al Government. *LG – Loc*LG

BAS,

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

176 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Alfred Nzo District Municipality (DC44)

Overview of the district The Alfred Nzo District Municipalitya is a Category C municipality located in the north-eastern corner of the Eastern Cape Province. It stretches from the Drakensberg Mountains, bordering Harry Gwala District Municipality to the north, OR Tambo District Municipality in the south and east, and Lesotho in the west. Alfred Nzo is the smallest district in the province, covering only 6% of the geographical area. The municipality is comprised of the Matatiele, Ntabankulu, Mbizana and Umzimvubu Local Municipalities. Area: 10 731km² Population (2016)b: 850 121 Population density (2016): 79.2 persons per km2 Estimated medical scheme coverage: 3.7% Cities/Towns: Bizana, Cedarville, KwaBhaca (Mount Frere), Matatiele, Tabankulu, eMaxesibeni (Mount Ayliff). Main Economic Sectors: Community services (28%), wholesale/trade (15%), agriculture (12%), manufacturing (10%), transport (6.4%), construction (6%).

Population distribution, local municipality boundaries and health facility locations

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

177 Section B: DistrictProfile EasternHealth ProfilesCape Province

DistrictA Nzo populationDM (DC44) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 12 901 28 645 12 526 30 387 60-64 years 5 591 10 187 4 884 9 987 55-59 years 6 486 11 159 6 041 11 797 50-54 years 7 247 12 354 6 393 12 191 45-49 years 8 571 14 476 6 844 12 301 40-44 years 8 795 15 117 8 959 13 911 35-39 years 9 516 15 996 15 263 20 220 30-34 years 12 116 18 372 25 952 33 216 25-29 years 19 242 25 143 42 731 48 517 20-24 years 33 529 39 849 48 934 52 616 15-19 years 58 341 59 121 47 346 47 662 10-14 years 59 757 60 031 51 814 51 272 05-09 years 49 742 49 233 57 885 56 610 00-04 years 53 431 52 217 57 828 56 034

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% 3.8% 1.5% 3.6% 60-64 years 55-59 years 1.5% 1.4% 50-54 years 1.6% 1.4% 45-49 years 1.9% 1.4% 40-44 years 2.0% 1.6% 35-39 years 2.1% 1.8% 2.4% 30-34 years 1.6% 2.4% 3.1% 3.9% 25-29 years 2.5% 3.3% 5.0% 5.7% 20-24 years 4.4% 5.3% 5.8% 6.2% 15-19 years 7.7% 7.8% 5.6% 5.6% 10-14 years 7.9% 7.9% 6.1% 6.0% 05-09 years 6.6% 6.5% 6.8% 6.7% 00-04 years 7.1% 6.9% 6.8% 6.6%

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 A Nzo DM (DC44) Show history

178 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Social determinants of health

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

179 Section B: DistrictProfile EasternHealth ProfilesCape Province

EC, A Nzo: DC44 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history

EC, A Nzo: DC44 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 74% 10% 11%5% 78% 7% 8%6% HIV and TB 5-14 34% 18% 20% 28% 36% 19% 19% 26% Comm_mat_peri_nut 15-24 23% 31% 16% 30% 13% 34% 14% 39% 25-64 26% 40% 28% 6% 17% 47% 28% 9% 65+ 17% 10% 70% 3% 18% 12% 68% 2% Total 27% 29% 37% 7% 22% 31% 39% 8%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (34.9%) Diarrhoeal diseases (28.0%) 2 Lower respiratory infections (19.0%) Lower respiratory infections (19.4%) according to all the 3 Protein-energy malnutrition (8.2%) Preterm birth complications (10.8%) deaths within the 4 HIV/AIDS (6.3%) Protein-energy malnutrition (10.6%) age/period category of 5 Other respiratory (5.1%) Birth asphyxia (4.6%) each box, although only 6 Preterm birth complications (4.5%) HIV/AIDS (4.5%) the leading 10 causes are <5 years <5 7 Tuberculosis (3.8%) Tuberculosis (3.0%) displayed. 8 Birth asphyxia (3.1%) Poisonings (including herbal) (2.0%) 9 Meningitis/encephalitis (1.6%) Other perinatal conditions (2.0%) 10 Other digestive (1.5%) Other respiratory (1.7%) 1 Road injuries (10.6%) Diarrhoeal diseases (18.2%) 2 Diarrhoeal diseases (10.4%) Lower respiratory infections (11.8%) 3 HIV/AIDS (10.0%) Tuberculosis (10.1%) 4 Meningitis/encephalitis (9.1%) HIV/AIDS (9.5%) 5 Tuberculosis (8.9%) Road injuries (8.2%)

5-14 6 Lower respiratory infections (8.7%) Drowning (7.6%) 7 Epilepsy (6.4%) Epilepsy (4.6%) 8 Drowning (6.0%) Accidental threats to breathing (4.5%) 9 Other respiratory (3.6%) Meningitis/encephalitis (3.3%) 10 Accidental threats to breathing (2.8%) Other respiratory (2.3%) 1 Tuberculosis (19.2%) HIV/AIDS (18.6%) 2 Interpersonal violence (12.7%) Tuberculosis (16.8%) 3 HIV/AIDS (12.4%) Interpersonal violence (16.7%) 4 Diarrhoeal diseases (8.0%) Accidental threats to breathing (9.1%) 5 Lower respiratory infections (6.6%) Road injuries (6.1%) 6 Road injuries (5.6%) Diarrhoeal diseases (4.3%) 15-24 7 Meningitis/encephalitis (5.3%) Lower respiratory infections (3.4%) 8 Other respiratory (4.5%) Meningitis/encephalitis (2.7%) 9 Accidental threats to breathing (4.0%) Mechanical forces (2.6%) 10 Mechanical forces (2.8%) Epilepsy (2.3%) 1 Tuberculosis (22.9%) HIV/AIDS (24.0%) 2 HIV/AIDS (16.8%) Tuberculosis (22.6%) 3 Diarrhoeal diseases (11.0%) Lower respiratory infections (7.3%) 4 Lower respiratory infections (10.0%) Diarrhoeal diseases (5.5%) 5 Other respiratory (8.2%) Cerebrovascular disease (3.7%) 6 Meningitis/encephalitis (3.2%) Meningitis/encephalitis (2.6%) 25-64 7 Cerebrovascular disease (2.7%) Interpersonal violence (2.6%) 8 Interpersonal violence (1.9%) Diabetes mellitus (2.3%) 9 Road injuries (1.6%) Road injuries (2.0%) 10 Asthma (1.6%) Ischaemic heart disease (1.9%) 1 Other respiratory (14.3%) Cerebrovascular disease (15.6%) 2 Cerebrovascular disease (12.2%) Tuberculosis (9.7%) 3 Tuberculosis (9.4%) Hypertensive heart disease (9.3%) 4 Lower respiratory infections (9.3%) Lower respiratory infections (9.0%) 5 Diarrhoeal diseases (5.7%) Diarrhoeal diseases (6.0%)

65+ 6 Hypertensive heart disease (5.6%) Diabetes mellitus (5.5%) 7 Diabetes mellitus (5.0%) Ischaemic heart disease (4.8%) 8 Asthma (4.6%) Other respiratory (3.6%) 9 Ischaemic heart disease (4.5%) Asthma (3.2%) 10 COPD (2.4%) COPD (3.1%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (65.2%) n=13 Other maternal (34.6%) n=17 2 Maternal sepsis (34.8%) n=7 Indirect maternal (24.2%) n=12 3 Maternal sepsis (17.1%) n=8 4 Maternal haemorrhage (12.1%) n=6 15-49 Female 5 Abortion (12.0%) n=6 6

180 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Women and maternal health

Source: DHIS.

181 Section B: DistrictProfile EasternHealth ProfilesCape Province

Child and school health

Source: DHIS.

182 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

HIV

Source: DHIS.

183 Section B: DistrictProfile EasternHealth ProfilesCape 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.

184 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

185 Section B: DistrictProfile EasternHealth ProfilesCape Province

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

Alfred Nzo Matatiele LM LM Mbizana Ntabankulu LM LM Umzimvubu

Restore the emergency trolley daily or after every time it was used 11 0 14 9 19

Resuscitation room is equipped with functional basic equipment for resuscitation 27 30 23 9 38

Cold chain procedure for vaccines is maintained 88 90 82 82 95

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 89 85 86 82 100

The temperature of the medicine room/dispensary is maintained within the safety range 92 95 86 91 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.

186 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles 0.1% 5.4% 0.8% 2.4% 16.7% (5.0%) (2.9%) (15.9%) (44.8%) 1864.1% % Overspent (underspent) 2 978 454 9 228 789 12 766 87612 79 484 453 484 79 243 140 351 639 387 921 Provincial Provincial Expenditure Total 2017/18 9 53 028 747 5 4 170 48 410 76 93 330 213 154 763 650 000 650 7 905 122 5 396 866 63 030 70 49 842 04 83 645 46 Budget 241 419 3 213 115 4 115 213 606 858 606 Total 2017/18

76 LG 12 766 8 12 0 0 766 12 876 1 271 863 838 1 301 966 705

Transfer to LG to Transfer

0 7 21 40 54 2017/18 Provincial Expenditure 2 978 454 9 228 789 48 410 17 48 410 53 028 74 79 484 453 484 79 243 1 351 213 330213 1 639 387 9 Provincial 1 289 199 829

650 000 650 650 000 650 LG 0

Transfer to LG to Transfer 2017/18 Budget

7 905 122 5 396 866 63 030 709 49 842 044 83 645 465 241 419 376 213 115 493 115 213 606 858 763 858 606 Provincial 1 271 838 213 al Government. *LG – Loc*LG

BAS,

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

187 Section B: DistrictProfile EasternHealth ProfilesCape Province

Nelson Mandela Bay Metropolitan (NMA)

Overview of the district The Nelson Mandela Bay Metropolitan Municipalitya is a Category A municipality, established on 5 December 2000. Nelson Mandela Bay was the first city in South Africa to establish a fully integrated democratic local authority and the only city in the world named after Nelson Mandela, who was born and spent his formative years in the Eastern Cape. Nelson Mandela Bay is a major seaport and automotive manufacturing centre located on the south-eastern coast of Africa. It is the economic powerhouse of the Eastern Cape Province and one of eight metropolitan areas in South Africa. Its boundaries are formed by Cassie Mountain View in the north, Cape Recife in the south, Sundays River Mouth in the east, and Van Stadens River Mouth in the west. The city is a holiday hot spot for both national and international tourists. The predominant languages spoken are English, Afrikaans and isiXhosa. The Metropolitan Municipality comprises three health sub-districts, namely Nelson Mandela A, Nelson Mandela B and Nelson Mandela C. Area: 1 957km² Population (2016)b: 1 263 306 Population density (2016): 645.5 persons per km2 Estimated medical scheme coverage: 20.7% Cities/Towns: Bethelsdorp, Bloemendal, Blue Horizon Bay, Clarendon Marine, Despatch, KwaNobuhle, Motherwell, Port Elizabeth, Summerstrand, Swartkops, Uitenhage. Main Economic Sectors: Manufacturing (25%), community services (23%), finance (23%), trade (13%), transport (13%).

Population distribution, sub-district boundaries and health facility locations

188 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

DistrictN Mandela population Bay pyramidMM (NMA) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 19 483 31 224 23 972 43 358 60-64 years 14 055 17 912 18 501 24 190 55-59 years 19 491 23 289 22 901 29 111 50-54 years 25 094 29 063 27 535 32 089 45-49 years 28 893 33 883 33 472 36 796 40-44 years 32 955 36 293 38 383 40 603 35-39 years 37 882 40 826 46 109 47 733 30-34 years 40 433 43 296 51 991 52 290 25-29 years 44 949 48 376 58 718 55 584 20-24 years 48 142 50 950 51 775 49 826 15-19 years 53 021 52 655 45 029 44 043 10-14 years 48 114 47 223 61 637 60 445 05-09 years 43 496 42 712 67 811 65 967 00-04 years 61 619 60 473 67 473 65 964

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% 2.9% 1.9% 3.4% 60-64 years 1.7% 1.5% 1.9% 55-59 years 1.8% 2.2% 1.8% 2.3% 50-54 years 2.3% 2.7% 2.2% 2.5% 45-49 years 2.7% 3.1% 2.6% 2.9% 40-44 years 3.1% 3.4% 3.0% 3.2% 35-39 years 3.5% 3.8% 3.6% 3.8% 30-34 years 3.8% 4.0% 4.1% 4.1% 25-29 years 4.2% 4.5% 4.6% 4.4% 20-24 years 4.5% 4.7% 4.1% 3.9% 15-19 years 4.9% 4.9% 3.6% 3.5% 10-14 years 4.5% 4.4% 4.9% 4.8% 05-09 years 4.0% 4.0% 5.4% 5.2% 00-04 years 5.7% 5.6% 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 N Mandela Bay MM (NMA) Show history

189 Section B: DistrictProfile EasternHealth ProfilesCape Province

Social determinants of health

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

190 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

EC, N Mandela Bay: NMA BurdenPercentage of disease of deaths – leading by causes broad ofcauses death inand district single leading causes Show history EC, N Mandela Bay: NMA Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 68% 14% 14% 5% 67% 7% 19% 7% HIV and TB 5-14 22% 27% 21% 30% 19% 20% 32% 29% Comm_mat_peri_nut 15-24 10% 36% 12% 42% 7% 36% 16% 41% 25-64 9% 39% 41% 10% 5% 36% 47% 12% 65+ 9%5% 84% 3% 7%4% 86% 3% Total 14% 27% 49% 10% 9% 23% 58% 10%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (18.3%) Preterm birth complications (19.7%) Percentages are shown 2 Lower respiratory infections (17.9%) Lower respiratory infections (12.9%) according to all the 3 Preterm birth complications (11.8%) Sepsis/other newborn infectious (7.5%) deaths within the 4 HIV/AIDS (9.2%) Diarrhoeal diseases (7.3%) age/period category of 5 Sepsis/other newborn infectious (6.1%) Birth asphyxia (6.8%) each box, although only 6 Birth asphyxia (5.4%) Congenital heart anomalies (5.3%) the leading 10 causes are <5 years <5 7 Tuberculosis (4.8%) HIV/AIDS (5.0%) displayed. 8 Protein-energy malnutrition (3.2%) Other perinatal conditions (5.0%) 9 Congenital heart anomalies (2.7%) Protein-energy malnutrition (3.8%) 10 Asthma (2.3%) Septicaemia (2.7%) 1 Tuberculosis (16.3%) HIV/AIDS (11.9%) 2 Road injuries (16.2%) Drowning (11.9%) 3 HIV/AIDS (13.2%) Tuberculosis (11.0%) 4 Lower respiratory infections (7.8%) Road injuries (7.6%) 5 Drowning (6.5%) Lower respiratory infections (6.9%)

5-14 6 Diarrhoeal diseases (5.8%) Epilepsy (3.8%) 7 Meningitis/encephalitis (4.9%) Congenital heart anomalies (3.6%) 8 Epilepsy (4.1%) Fires, hot substances (3.4%) 9 Interpersonal violence (2.5%) Accidental threats to breathing (3.1%) 10 Fires, hot substances (2.3%) Endocrine nutritional,blood, immune (3.0%) 1 Tuberculosis (24.4%) HIV/AIDS (21.0%) 2 Interpersonal violence (19.2%) Tuberculosis (16.0%) 3 HIV/AIDS (11.7%) Mechanical forces (13.6%) 4 Road injuries (8.7%) Interpersonal violence (12.2%) 5 Mechanical forces (7.3%) Accidental threats to breathing (5.8%) 6 Lower respiratory infections (3.7%) Road injuries (5.2%) 15-24 7 Accidental threats to breathing (3.3%) Fires, hot substances (2.4%) 8 Diarrhoeal diseases (1.8%) Lower respiratory infections (2.2%) 9 Meningitis/encephalitis (1.6%) Diarrhoeal diseases (1.5%) 10 Epilepsy (1.5%) Epilepsy (1.5%) 1 Tuberculosis (27.4%) HIV/AIDS (19.8%) 2 HIV/AIDS (11.7%) Tuberculosis (15.8%) 3 Cerebrovascular disease (5.4%) Cerebrovascular disease (6.7%) 4 Ischaemic heart disease (5.1%) Ischaemic heart disease (4.4%) 5 Lower respiratory infections (4.3%) Diabetes mellitus (4.1%) 6 Interpersonal violence (3.4%) Nephritis/nephrosis (3.3%) 25-64 7 Diabetes mellitus (3.3%) Mechanical forces (2.8%) 8 Asthma (3.0%) Trachea/bronchi/lung (2.7%) 9 Road injuries (2.9%) Interpersonal violence (2.5%) 10 Nephritis/nephrosis (2.2%) Lower respiratory infections (2.4%) 1 Ischaemic heart disease (15.3%) Cerebrovascular disease (16.5%) 2 Cerebrovascular disease (15.1%) Ischaemic heart disease (13.1%) 3 Diabetes mellitus (6.5%) Diabetes mellitus (7.5%) 4 Lower respiratory infections (6.0%) Nephritis/nephrosis (5.1%) 5 Hypertensive heart disease (4.7%) COPD (5.0%)

65+ 6 Trachea/bronchi/lung (4.2%) Hypertensive heart disease (4.4%) 7 COPD (4.2%) Lower respiratory infections (3.9%) 8 Nephritis/nephrosis (4.2%) Trachea/bronchi/lung (3.6%) 9 Tuberculosis (4.1%) Tuberculosis (3.2%) 10 Asthma (3.5%) Asthma (2.3%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (45.8%) n=13 Hypertension in pregnancy (31.0%) n=22 2 Hypertension in pregnancy (22.9%) n=7 Other maternal (27.6%) n=20 3 Other maternal (20.0%) n=6 Indirect maternal (20.4%) n=15 4 Maternal haemorrhage (11.3%) n=3 Maternal haemorrhage (7.8%) n=6 15-49 Female 5 Abortion (6.6%) n=5 6 Maternal sepsis (6.5%) n=5

191 Section B: DistrictProfile EasternHealth ProfilesCape Province

Women and maternal health

Source: DHIS.

192 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

Child and school health

Source: DHIS.

193 Section B: DistrictProfile EasternHealth ProfilesCape Province

HIV

Source: DHIS.

194 SectionSection B: Profile B: EasternDistrict HealthCape 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.

195 Section B: DistrictProfile EasternHealth ProfilesCape Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

196 SectionSection B: Profile B: EasternDistrict HealthCape Province Profiles

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

Nelson Mandela Bay Nelson Mandela A SD Nelson Mandela B SD Nelson Mandela C SD

Restore the emergency trolley daily or after every time it was used 38 35 43 35

Resuscitation room is equipped with functional basic equipment for resuscitation 48 41 43 59

Cold chain procedure for vaccines is maintained 90 82 86 100

90% of the tracer medicines are available 96 100 93 94

The temperature of the medicine room/dispensary is maintained within the safety range 98 100 100 94 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

197 Section B: DistrictProfile EasternHealth ProfilesCape Province 6.2% (4.7%) (0.9%) (6.8%) (6.2%) (8.3%) (21.6%) (16.2%) (43.3%) (28.3%) % Overspent (underspent) 4 043 270 Provincial Provincial 1 362 255 927 Expenditure Total 2017/18 4 981 85 172 3 024 923 12 2 482 75 568 18 278 673 281 24 270 077 269 62 358 700 424 69 220 894 451 7 131 555 7 131 14 34514 73 90 783 39 80 969 50 Budget 262 1 108 307 477 7 376 243 8 272 422 2 1 485 448 886 448 485 1 Total 2017/18

LG 57 385 459 73 966 730 58 020 924 57 385 459

635 465 635 465 635 Transfer to LG to Transfer

1 8 3 24 73 94 69 2017/18 Provincial Expenditure 4 043 270 85 172 9885 172 12 024 92 12 75 48275 56 278 6 281 220 8 451 270 077 2 358 700 4 Provincial

0 620 75 350

-1 653-1 62 Transfer to LG to Transfer 2017/18 Budget

7 131 555 7 131 14 34514 733 90 783 394 80 969 502 262 118 108 307 477 769 376 243 862 272 422 224 Provincial 1 411 482 1561 411 653 -1 620 75 620 350 1 304 235 003 al Government. *LG – Loc*LG

BAS,

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

198