17 Free State Province

Home , Free state (polity), Free State (province)

SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Xhariep is the southern-most district in the Free State Province and is divided into four health sub-districts, namely Letsemeng, Kopanong, Naledi and Mohokare. Geographically it is the largest of the five districts in the province, but it has the smallest population, at 135 036, with a population density of only 3.6 people per km2. The district falls into socio- economic Quintile 3. Estimated medical scheme coverage is 12.7%.

Social determinants of health Population per selected category

a Unemployment rate 26.8% Population category 2017 2018 2019 2020 a Youth unemployment rate (15-34 years) 33.8% under 1 year 1 950 1 985 2 071 2 164 No schooling 10.6% under 5 years 10 773 10 663 10 642 10 683 Matric 26.2% 05-09 years 11 805 11 646 11 428 11 218 Higher education 5.6% 10-14 years 11 386 11 518 11 681 11 779 Households 44 767 15-19 years 11 781 11 452 11 192 11 079 Female-headed households 37.6% 20-24 years 12 417 12 229 12 001 11 718 Formal dwellings 89.1% 25-29 years 13 204 13 079 12 892 12 659 Flush toilet connected to sewerage 79.2% 30-34 years 10 931 11 466 12 008 12 518 Weekly refuse removal 67.7% 35-39 years 9 072 9 337 9 560 9 736 Piped water inside dwellings 34.7% 40-44 years 7 387 7 547 7 747 7 978 Electricity for lighting 94.2% 45-49 years 6 714 6 736 6 740 6 768 Blue Drop water score 65.1% 50-54 years 5 487 5 638 5 791 5 916 55-59 years 4 538 4 550 4 575 4 625 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 4 001 3 995 3 987 3 982 65-69 years 3 264 3 279 3 286 3 283 70-74 years 2 441 2 489 2 532 2 559 75-79 years 11 385 12 014 12 605 13 152 80 years and older 6 479 6 747 7 027 7 320 Total 1 279 035 1 298 412 1 316 391 1 333 124 Estimated pregnant women* 28 655 28 308 27 103 25 316 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

323 Section B: NationalProfile Free and State District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Kopanong SD 8 10 0 1 0 0 0 Letsemeng SD 4 4 1 0 0 0 0 Naledi SD 2 3 0 0 0 0 0 MohokareSD 2 3 0 3 0 0 0 Xhariep 16 20 1 4 0 0 0 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Xhariep 194 96 23 88 10 26 2 5 1 0 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Kopanong SD Indicator 3.7 - - - - - Numerator 168 935 - - - - - Denominator 545 250 - - - - - Letsemeng SD Indicator 3.5 - - - - - Numerator 124 522 - - - - - Denominator 428 502 - - - - - Mohokare SD Indicator 2.5 - - - - - Numerator 78 219 - - - - - Denominator 371 187 - - - - - Naledi SD Indicator 3.5 - - - - - Numerator 76 060 - - - - - Denominator 263 961 - - - - - Xhariep Indicator 3.3 72.2 100.0 2 499 1 679 442 Numerator 447 736 13 17 294 681 809 198 012 537 198 012 537 Denominator 1 608 900 18 17 117 905 117 905 447 736 Free State Indicator 2.2 34.8 78.5 1 665 1 046 403 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

324 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles ------Annual trends 20.3 28.3 FS, DC16, Xhariep District Municipality, SEQ 3 (%) 8 Measure Names OPD new client not not client IndValue referred rate rate referred Inpatient crude 6 Prov_av ------death rate ZA_av 5.4 3.6

1_Impact 4

1_Management 2 rate (%)

Inpatient Inpatient 8 crude death 6 ------Average length of stay (district

84.3 4 hospitals)

(%) 2 utilisation rate - total

Inpatient bed 4K 2_Outcome ------Expenditure per 3K

Tertiary/Central Hospital patient day 5 122 4 227 equivalent (district 2K day

(Rand) hospitals)

equivalent equivalent 1K per patient Expenditure ------6.9 6.2 Inpatient bed 100 utilisation rate (district (Days) Average length of of length

stay - total hospitals) 50 ------100 29.1 37.2 3_Output OPD new client (%) not referred rate 50 OPD new client not not client (district referred rate rate referred hospitals) 5 ------0 6.3 100 rate (%) Inpatient Inpatient Percentage

crude death 50 Ideal clinics ------

78.3 0

(%) 3K ospital Provincial and H utilisation rate - total LG District

Inpatient bed Health Services

Regional Hospital Regional 2K expenditure per ------capita 2 951 2 894 (uninsured) 1K day (Rand) equivalent equivalent per patient

Expenditure Provinc ial and 1500

4_Process_input LG PHC ------expenditure per 5.1 5.3 1000 capita (uninsured) 500 (Days) Average length of of length stay - total

Provincial and 400 LG PHC 57.9 71.2 72.0 49.0 59.3 7 171 3 710 3 461 7 578 expenditure per 12 383 PHC headcount (%) 200 OPD new client not not client referred rate rate referred 2008 2010 2012 2014 2016 2018 7.5 5.1

6.7 Year 6.3 6.6 128 255 383

4 061 Measure Names IndValue rate (%) Inpatient Inpatient

crude death P rov_av ZA_av - 1 697 4 805 - - 5 758 67.4 60.7 53.5 72.8 4 561 107.0 15 631 20 191 (%) utilisation rate - total Inpatient bed District Hospital District 2 148 5 094 2 858 2 568 2 538 19 900 26 226 26 day (Rand) 74 96474 931 32 219 94832 219 42 744 98342 744 equivalent equivalent per patient Expenditure 2.7 4.4 3.8 3.5 3.3 4 561 1 697 6 325 4 061 5 758 15 631 20 191 (Days) Average length of of length stay - total Indicator Numerator Denominator Indicator Numerator Denominator Indicator Numerator Denominator Indicator Indicator

Kopanong SD Kopanong Mohokare SD Mohokare Xhariep Free State Africa South Source: HIS and BAS.

325 Section B: NationalProfile Free and State District Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 11 768 383 26 226 26 Total District District - tertiary Central/ hospital ------2016/17 Hospital Regional Regional 11 762 383 26 226 26 District District Hospital ------6 / MOU PHC / CHC 23 741 372 356 23 924 Total District District - tertiary Central/ Hospital ------2015/16 Hospital Regional Regional 1 - - 1 - 1 - - 1 48 22 730 356 23 924 District District Hospital - - 1 11 324 / MOU PHC / CHC 20 504 356 866 29 721 Total District District - tertiary Central/ Hospital ------2014/15 Hospital Regional Regional 19 92 852 356 29 721 District District Hospital - - -8--8-2--2-4--4-1--1-1--1------1--1-3--3-1--1-1--1------1--1-1--1------1--1-1--1- 5 - - 5 -1--1-2--2----- 1 14 412 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

326 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

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

PercentageFS, Xhariep: of deathsDC16, by2010 broad - 2015 cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 72% 6% 14% 8% 73% 7% 12% 8% causes and 5-14 29% 22% 21% 28% 17% 18% 22% 43% single leading 15-24 18% 42% 20% 20% 9% 17% 14% 59% causes 25-64 19% 32% 42% 6% 17% 33% 35% 16% 65+ 15% 2% 81% 2% 17% 6% 75% 3% Broadcause 22% 20% 52% 6% 20% 23% 42% 14% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (25.7%) Diarrhoeal diseases (24.3%) HIV and TB 2 Diarrhoeal diseases (21.4%) Lower respiratory infections (16.8%) Comm_mat_peri_nut 3 Protein-energy malnutrition (8.8%) Preterm birth complications (11.0%) 4 Preterm birth complications (8.5%) Protein-energy malnutrition (10.8%) Prov, District 5 HIV/AIDS (4.9%) HIV/AIDS (5.6%) FS, Xhariep: DC16 6 Birth asphyxia (4.4%) Sepsis/other newborn infectious (4.3%) Show history

<5 years <5 7 Road injuries (2.5%) Birth asphyxia (4.1%) 8 Sepsis/other newborn infectious (2.3%) Septicaemia (2.7%) Percentages are shown 9 Septicaemia (2.2%) Other congenital abnormalities (2.4%) according to all the deaths 10 Accidental threats to breathing (2.1%) Accidental threats to breathing (2.3%) within the age/gender 1 HIV/AIDS (16.9%) Drowning (26.7%) category of each box, 2 Lower respiratory infections (16.2%) HIV/AIDS (13.3%) although only the leading 3 Tuberculosis (16.0%) Tuberculosis (9.7%) 10 causes are displayed. 4 Drowning (10.6%) Road injuries (8.3%) 5 Road injuries (9.6%) Lower respiratory infections (6.6%)

5-14 6 Other malignant neoplasms (9.1%) Meningitis/encephalitis (5.6%) 7 Diarrhoeal diseases (7.5%) Other unintentional injuries (5.0%) 8 Leukaemia (7.1%) Diarrhoeal diseases (4.5%) 9 Fires, hot substances (7.0%) Accidental threats to breathing (3.8%) 10 Mechanical forces (3.7%) 1 HIV/AIDS (26.3%) Interpersonal violence (27.2%) 2 Tuberculosis (21.6%) Accidental threats to breathing (13.8%) 3 Lower respiratory infections (9.4%) Tuberculosis (12.1%) 4 Interpersonal violence (6.2%) Drowning (8.6%) 5 Accidental threats to breathing (4.6%) HIV/AIDS (7.3%)

15-24 6 Road injuries (4.2%) Road injuries (6.3%) 7 Diarrhoeal diseases (3.8%) Lower respiratory infections (6.2%) 8 Endocrine nutritional,blood, immune (2.6%) Mechanical forces (4.1%) 9 Drowning (2.4%) Fires, hot substances (3.4%) 10 Fires, hot substances (2.3%) Meningitis/encephalitis (2.7%) 1 HIV/AIDS (16.9%) Tuberculosis (17.8%) 2 Tuberculosis (15.8%) HIV/AIDS (15.0%) 3 Lower respiratory infections (10.3%) Lower respiratory infections (10.8%) 4 Cerebrovascular disease (6.7%) Cerebrovascular disease (5.0%) 5 Diarrhoeal diseases (5.1%) Ischaemic heart disease (4.9%)

25-64 6 Hypertensive heart disease (3.2%) Interpersonal violence (4.6%) 7 Cervix (2.5%) Diarrhoeal diseases (3.7%) 8 Ischaemic heart disease (2.4%) Accidental threats to breathing (2.8%) 9 Diabetes mellitus (2.3%) Mechanical forces (2.5%) 10 Nephritis/nephrosis (2.3%) Road injuries (2.4%) 1 Cerebrovascular disease (21.4%) Ischaemic heart disease (14.1%) 2 Ischaemic heart disease (12.1%) Lower respiratory infections (11.8%) 3 Hypertensive heart disease (10.3%) Cerebrovascular disease (11.5%) 4 Lower respiratory infections (9.7%) COPD (6.7%) 5 Diabetes mellitus (4.1%) Hypertensive heart disease (5.3%)

65+ 6 COPD (3.0%) Prostate (5.0%) 7 Diarrhoeal diseases (3.0%) Tuberculosis (4.5%) 8 Nephritis/nephrosis (2.6%) Nephritis/nephrosis (3.5%) 9 Breast (2.2%) Diabetes mellitus (3.4%) 10 Cervix (2.0%) Diarrhoeal diseases (3.0%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (45.5%) n=12 HIV/AIDS (22.1%) n=630 2 Abortion (21.6%) n=5 Tuberculosis (19.8%) n=565 3 Hypertension in pregnancy (19.2%) n=5 Lower respiratory infections (11.9%) n=340 4 Other maternal (13.7%) n=3 Diarrhoeal diseases (5.7%) n=163 5 Cerebrovascular disease (3.0%) n=86

15-49 6 Interpersonal violence (2.1%) n=61 Female 7 Cervix (2.1%) n=61 8 Road injuries (2.1%) n=60 9 Meningitis/encephalitis (1.9%) n=55 10 Fires, hot substances (1.9%) n=53

327 Section B: NationalProfile Free and State District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Kopanong SD Indicator - 100.0 9.5 80.5 116.0 97.7 118.8 Numerator - 64 38 617 1 183 10 478 475 Denominator 400 64 400 766 12 237 128 712 400 Letsemeng SD Indicator - 102.5 - 74.2 111.4 89.0 6 833 Numerator - 81 - 525 818 7 354 410 Denominator 6 79 6 708 8 810 99 114 6 Mohokare SD Indicator - 100.0 4.9 73.2 120.8 84.1 119.5 Numerator - 73 18 398 818 6 421 441 Denominator 362 73 369 544 8 124 91 659 369 Naledi SD Indicator - 95.2 - 77.6 123.8 100.9 - Numerator - 60 - 349 627 5 559 210 Denominator - 63 - 450 6 076 66 096 - Xhariep Indicator 0.0 99.6 7.2 76.5 117.3 92.8 198.2 Numerator - 278 56 1 889 3 446 29 811 1 536 Denominator 768 279 775 2 468 35 247 385 581 775 Free State Indicator 152.8 94.2 5.9 65.8 54.2 66.8 71.2 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trendsFS, DC16, Xhariep District Municipality, SEQ 3

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

328 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Child and School Health Annual trends FS, DC16, Xhariep District Municipality, SEQ 3

Measure Names 100 IndValue 97.1 57.1 67.4 58.0 127.5 131.3 2 473 108.4 4 959 6 300 Child under 5 Prov_av 16 281 59 316 31 500 44 034 44 45 306 45

180 156 years diarrhoea 50 case fatality rate ZA_av months Vitamin A dose 12-59

coverage (%) coverage 0

75 2 549 30 557 427 729 607 642 897 659 13.5 19.8 Child under 5 94.5 58.6 62.6 73.5 30.3 1 768 3_Child and school health school and 3_Child years 20 33 900 pneumonia case fatality rate 10 8 screening coverage (%) coverage

School Grade 0 60 1_Impact Child under 5 831 200 809 332 986

24.7 40 33.1 58.4 84.3 30.5 80.9 33.0 years severe 2 517 1 154 acute 51 720 malnutrition 20 case fatality rate

1 screening 0 coverage (%) coverage School Grade

Output 20

961 Inpatient early 640 945 96.2 167.1 3 741 137.6 197.9 152.1 2 975 168.4 5 730 5 049 1 088 105.8 6 846 1 427 neonatal death 21 366 rate 10 dose nd Measles Measles 2 0 coverage (%) coverage 150

Immunisation 411 740 232 429 520 285 222 654 380 41.6 51.4 48.1 56.4 54.8 33.9 46.2 coverage under 1 119

2 325 100 dose 1 year rd Infant Infant

rate (%) 50 exclusively exclusively breastfed at HBV 3 DTaP-IPV-Hib- Infant 80 exclusively breastfed at

474 60 341 506 663 82.3 84.2 115.7 6 117

119.4 DTaP-IPV-Hib- 130.1 126.5 3 537 4 497 105.0 5 784

19 935 HBV 3rd dose 40

(%) rate 20 coverage under 1 year Immunisation Immunisation 3_Output 150 1 2 3 1 984 - - - - 76 62 97 Measles 2nd 1.6 1.3 1.3 2.6 0.8 127 362 dose coverage 100

(%) 50 Outcome around 10 Infant PCR weeks rate

test positive positive test 100 School Grade 1 - - 4 6 4 - - - - - screening

5.2 50 12.4 14.3 cover age

0 (per1K) neonatal neonatal Inpatient Inpatient

death rate 2009 2010 2011 2012 2013 2014 2015 2016 Year 4 6 4 ------Measure Names 9.9 5.2 768 768 362 362 400 400 11.0 11.0 11.4 IndValue P rov_av ZA_av (per1K) Inpatient Inpatient death rate early neonatal neonatal early 6

6 ------45 1.4 1.3 4.4 5.5 476 431 Inpatient Inpatient year rate (%) death under 5 5

5 ------12 3.1 6.3 2.9 8.3 175 163 mpact I Inpatient Inpatient year rate (%) death under 1 1

9 1 ------33 42 9.6 3.0 2.4 8.0 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 1

6 1 ------49 55 1.8 2.0 2.0 3.2 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case

------24 97 0.0 2.0 2.8 121 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Denominator Numerator Indicator Numerator Indicator

Xhariep Xhariep Naledi SD Mohokare SD Mohokare Letsemeng SD Letsemeng South Africa South Free State Kopanong SD Kopanong Source: HIS.

329 Section B: NationalProfile Free and State District Province Profiles

HIV Annual trends FS, DC16, Xhariep District Municipality, SEQ 3

60 Measure Names 8.9 125 282 328 253 988

11.6 IndValue 27.4 19.0 15.6 15.5 33.8 4_HIV HIV testing 40 Prov_av 116 529 261 177 216 399 168 840 762 945 coverage (including ANC) ZA_av 20 (per1K) 2016/17 Medical male male Medical

circumcision rate rate circumcision 200

Male condom distribution 47.8 47.5 40.4 43.0 40.3 42.5 34.2 100 coverage 701 841 105 375 816 000 816 242 325 242 154 059 570 000 570 200 082 420 000 420 552 000 552 4_Process_input 2 358 000

2016/17 80

distribution distribution 60 Male condom condom Male coverage (No) Medical male circumcision 40 rate 90-90-90 20 st 41.3 44.1 44.1 42.7 26.8 35.9 35.2 1 5 191 7 145 7 182 0 30 424 10 906 Process & input 141 399 243 549 202 002 202 883 689 2009 2010 2011 2012 2013 2014 2015 2016 (%) Year 2016/17 coverage HIV testing Measure Names

(including ANC) IndValue P rov_av ------296 739 4.5 9.5 8.2 ZA_av 1 539 1 34 157 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------87.8 55.0 58.6 14 063 12 344 12 90-90-90 Output 2016/17 nd 2 on ART rate (%) Clients remaining - 17 18 23 25 26 93 22 82 22 22 77.8 81.8 73.9 96.2 88.2 100.0 2015 months (%) on ART after 12 Child percentage ------705 552 696 544 72.1 70.7 79.3 75.5 78.6 72.2 2 497 2015 months (%) on ART after 12 Adult percentageAdult 7 2 9 5 - 17 13 13 13 29 50 68.1 76.5 28.6 58.0 69.2 38.5 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------90-90-90 Outcome 245 258 329 322 rd 91.5 85.1 92.9 89.5 88.3 83.3 3 1 154 (%) 2015 rate months 12 Adult with viral load suppressed suppressed load - 7 17 17 13 18 13 23 50 22 80 59.1 59.7 76.5 73.9 62.5 38.9 (%) 2015 Child with viral load completion completion load rate at months 12 ------510 475 424 356 65.7 75.9 65.4 54.3 64.5 68.8 1 765 (%) 2015 Adult with viral load completion completion load rate at months 12 Denominator Indicator Indicator Numerator Denominator Numerator Numerator Indicator Denominator Denominator Indicator Indicator Indicator Numerator Indicator Numerator Denominator

Naledi SD Naledi Xhariep Mohokare SD Mohokare Free State Kopanong SD Kopanong Letsemeng SD Letsemeng South Africa South Source: HIS.

330 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

TB Annual trends FS, DC16, Xhariep District Municipality, SEQ 3

Measure Names 15 51.6 67.8 53.0 88.6 90.3 82.2 IndValue 5_TB 111.2 70 912 52 745 64 183 65 778 65 58 290 Prov_av 341 114 143 124 159 167

377 619 TB death rate 104 534 10 (ETR.net) ZA_av

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact ------TB DR client 40 792 664 88.7 72.8 death rate 119.3 (EDRWeb) 20

2016 0 Output rate (%) 15 on treatment treatment on

TB client initiated TB client lost to 10 follow up rate

61 61 (ETR.Net) 112 151 151 151 472 180 109 504 5 97.3 89.7 93.7 83.9 88.3 100.0 100.0 0

2016 80 Net) (%) Net) TB client TB/HIV co- treatment ART rate (ETR.

infected client on success rate 60 (ETR.net) ------31 21 40 67.7 74.4 68.0 40

TB DR client 2016 loss to follow up 20 treatment treatment rate (EDRWeb) TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation 0 ------31 4.7 5.2 6.2 664 60 2_Outcome TB DR treatment 40 success rate 2016 (EDRWeb) 20 rate (%) resistance resistance

TB Rifampicin Rifampicin TB 0 confirmed client confirmed client ------TB Rifampicin 20 21 40 50.5 52.5 45.8 resistance confirmed client 10 rate

2014 0 Outcome 100 success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB TB/HIV co-infected ------50 11

40 client on ART 17.9 27.5 23.5 rate (ETR.Net)

0 100 2014 TB symptom 5

(EDRWeb) (%) years and older to follow up rate TB DR client loss screened in 50 facility rate 4_Process_input 173 177 122 243 244 782 293 304 300 57.7 81.0 80.1 79.9 72.8 68.9 83.3 0 1 074 2009 2010 2011 2012 2013 2014 2015 2016 Year 2015

TB client client TB Measure Names treatment treatment success rate rate success (ETR.net) (%) IndValue P rov_av

6 ZA_av 10 20 20 56 6.7 6.4 3.4 3.4 5.6 6.6 5.2 177 293 304 300 1 074 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate 7 ------40 17.5 23.0 25.3 2014 death rate TB DR client (EDRWeb) (%) mpact 17 I 31 21 27 96 9.6 6.6 6.9 8.9 9.2 177 293 304 300 10.3 10.5 1 074 2015 TB death rate (ETR.net) (%) Indicator Numerator Indicator Denominator Denominator Numerator Indicator Numerator Numerator Denominator Indicator Denominator Indicator Denominator Indicator Indicator Numerator

South Africa South Mohokare SD Mohokare Letsemeng SD Letsemeng Free State Naledi SD Kopanong SD Kopanong Xhariep Xhariep Source: HIS.

331 Section B: NationalProfile Free and State District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Kopanong SD Indicator 1.7 31.2 Numerator 75 537 Denominator 545 250 206 403 Indicator 1.4 8.0 Letsemeng SD Numerator 49 101 Denominator 428 502 152 409 Mohokare SD Indicator 4.6 24.7 Numerator 143 261 Denominator 371 187 126 909 Naledi SD Indicator 1.3 44.6 Numerator 29 335 Denominator 263 961 90 219 Indicator 2.2 25.7 Xhariep Numerator 296 1 234 Denominator 1 608 900 575 940 Free State Indicator 2.4 26.4 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual trendsFS, DC16, Xhariep District Municipality, SEQ 3

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

332 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Lejweleputswa District Municipality (DC18)

Lejweleputswa District is located in the north-western part of the Free State Province. The district is divided into five health sub-districts, namely Masilonyana, Tokologo, Tswelopele, Matjhabeng and Nala, with a population of 589 013 and a population density of 18.4 people per km2. The district falls in socio-economic Quintile 4, among the wealthier districts. Estimated medical scheme coverage is 11.8%.

Social determinants of healtha Population per selected category

Unemployment ratea 36.5% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 48.7% under 1 year 11 903 11 902 11 909 11 825 No schooling 4.6% under 5 years 62 268 61 721 61 075 60 342 Matric 30.3% 05-09 years 63 143 63 039 62 783 62 562 Higher education 7.4% 10-14 years 59 680 60 639 61 658 62 420 Households 217 911 15-19 years 59 711 59 036 58 440 58 311 Female-headed households 39.4% 20-24 years 59 988 59 864 59 844 59 640 Formal dwellings 83.2% 25-29 years 65 256 64 191 62 936 61 746 Flush toilet connected to sewerage 81.7% 30-34 years 56 430 59 183 62 005 64 638 Weekly refuse removal 72.1% 35-39 years 47 471 48 567 49 439 50 114 Piped water inside dwellings 43.5% 40-44 years 39 032 39 842 40 850 41 969 Electricity for lighting 94.0% 45-49 years 35 522 35 298 35 144 35 180 Blue Drop water score 66.3% 50-54 years 32 686 32 723 32 656 32 512 55-59 years 27 670 28 056 28 400 28 662 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 21 669 22 215 22 698 23 135 65-69 years 14 884 15 478 16 076 16 645 70-74 years 9 580 9 796 10 058 10 388 75-79 years 5 361 5 636 5 860 6 023 80 years and older 3 078 3 131 3 182 3 241 Total 663 420 668 413 673 104 677 535 Estimated pregnant women* 12 736 12 735 12 743 12 653 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

333 Section B: NationalProfile Free and State District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Masilonyana SD 5 9 0 1 0 0 0 Matjhabeng SD 13 25 2 2 1 0 5 Nala SD 2 4 0 1 0 0 0 Tokologo SD 1 4 0 0 0 0 0 Tswelopele SD 1 3 0 1 0 0 0 Lejweleputswa 22 45 2 5 1 0 5 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Lejweleputswa 271 173 205 375 66 45 6 7 5 0 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Masilonyana SD Indicator 3.1 - - - - - Numerator 183 914 - - - - - Denominator 713 163 - - - - - Matjhabeng SD Indicator 2.3 - - - - - Numerator 876 549 - - - - - Denominator 4 588 533 - - - - - Nala SD Indicator 2.5 - - - - - Numerator 186 593 - - - - - Denominator 909 063 - - - - - Tokologo SD Indicator 2.5 - - - - - Numerator 67 799 - - - - - Denominator 326 295 - - - - - Tswelopele SD Indicator 2.6 - - - - - Numerator 115 524 - - - - - Denominator 528 015 - - - - - Lejweleputswa Indicator 2.4 22.7 75.0 1 392 983 357 Numerator 1 430 379 10 33 722 864 858 510 570 966 510 570 966 Denominator 7 065 069 44 44 519 261 519 261 1 430 379 Free State Indicator 2.2 34.8 78.5 1 665 1 046 403 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

334 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles ------AnnualFS, DC18,trends Lejweleputswa District Municipality, SEQ 4 (well off) 20.3 28.3 Measure Names

(%) 8 IndValue OPD new client not not client

referred rate rate referred Inpatient crude 6 Prov_av death rate ZA_av ------1_Impact 4 5.4 3.6 1_Management 2 8 rate (%) Inpatient Inpatient 6 crude death Average length of stay (district 4 ------hospitals)

84.3 2

(%) 4K utilisation rate - total 2_Outcome Expenditure per Inpatient bed patient day 3K equivalent ------(district 2K Tertiary/Central Hospital 5 122

4 227 hospitals) 1K day (Rand) equivalent equivalent per patient Expenditure Inpatient bed 100 - -

- utilisation rate ------6.9 6.2 (district hospitals) 50 (Days) Average length of of length 100 stay - total 3_Output OPD new client ------not referred rate 50 57.1 57.1 29.1 37.2 (district

16 977 hospitals) 16 977 29 725 29 725 (%) 0 OPD new client not not client 100 referred rate rate referred 5 ------8.4 8.4 6.3 Percentage 50 1 318 1 318 Ideal clinics 15 694 15 15 694 15 rate (%)

Inpatient Inpatient 0 crude death Provincial and 3K 0

0 ------LG District

78.3 Health Services 2K 93 161 93 161 expenditure per

(%) capita ospital (uninsured) H 1K utilisation rate - total Inpatient bed Regional Hospital Regional ------Provinc ial and 1500

4_Process_input LG PHC 2 818 2 818 2 951 2 894 expenditure per 114 701 114 701 1000

day capita

(Rand) (uninsured) equivalent equivalent 323 268 418 per patient 323 268 418

Expenditure 500 ------5.1 5.9 5.9 5.3 Provincial and 400 93 161

93 161 LG PHC 15 694 15 15 694 15 expenditure per (Days)

Average PHC headcount length of of length

stay - total 200

2008 2010 2012 2014 2016 2018 57.4 86.1 71.2 75.4 76.0 59.3 46.9 Year 2 576 1 942 7 225 2 634 29 517 13 832 44 658 (%) Measure Names OPD new client not not client IndValue referred rate rate referred P rov_av 78 5.1 5.7 5.7 6.6 5.8 6.2 5.2 ZA_av 166 227 784 1 491 3 061 1 255 25 633 13 674 21 816 rate (%) Inpatient Inpatient crude death - 3 984 9 504 - - 0 2 667 0 67.4 78.4 76.5 59.3 60.7 82.3 30.8 5 147 6 674 61 743 41 083 (%) utilisation rate - total Inpatient bed District Hospital District 2 271 2 593 7 235 2 337 2 548 2 334 2 568 2 538 55 610 13 204 85 046 day (Rand) 18 761 041 761 18 22 923 716 equivalent equivalent per patient 126 286126 565 198 785198 306 Expenditure 4.4 3.0 2.5 2.8 3.3 3.5 2.2 5 147 6 674 1 491 2 667 8 996 3 984 8 840 984 30 813 8 840 13 674 21 816 61 743 41 083 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Indicator Numerator Denominator

Lejweleputswa Lejweleputswa Tswelopele SD Tswelopele Nala SD Matjhabeng SD Matjhabeng Masilonyana SD Masilonyana Free State South Africa South Source: HIS and BAS.

335 Section B: NationalProfile Free and State District Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 14 15 31 47 28 33 35 147 250 199 747 Total District District - - 2 573 ------tertiary Central/ hospital 18 18 10 23 99 34 34 2016/17 154 1 318 3 268 - 8 739 114 701 Hospital Regional Regional 13 15 13 48 96 5 471 District District Hospital ------1 255 - 5 - - 5 - - - - 1 - - 5 9 - / MOU PHC / CHC 11 41 14 18 27 34 34 107 297 2 581 8 958 8 1 665 1 232 087 - 85 046 Total District District ------tertiary Central/ Hospital 14 12 10 21 76 26 29 100 238 5 044 - 151 579 2015/16 Hospital Regional Regional 13 13 15 31 59 155 3 914 District District Hospital - - 80 508 - 8 - 5 6 - - - - - 5 - 2 - 1 410 / MOU PHC / CHC 13 16 21 28 26 44 64 313 134 Total 226 896 226 District District - 1 875 ------tertiary Central/ Hospital 6 - 5 - 11 15 18 18 25 98 33 257 4 594 - 9 949 - 150 800 2014/15 Hospital Regional Regional 11 10 31 26 23 56 36 155 4 781 76 096 District District Hospital - - 1 294 1 364 - 2 658 - 1 223 1 358 ------2 - - - - 3 574 1 695 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

336 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

PercentageFS, Lejweleputswa: of deaths byDC18, broad 2010 cause - 2015and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 85% 5%6%3% 84% 6%6%4% causes and 5-14 38% 25% 15% 21% 31% 21% 17% 30% single leading 15-24 35% 34% 16% 15% 12% 14% 13% 62% causes 25-64 28% 30% 37% 5% 24% 31% 32% 14% 65+ 19% 3% 76% 2% 20% 6% 72% 3% Broadcause 31% 20% 45% 4% 28% 22% 36% 13% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (28.8%) Diarrhoeal diseases (23.8%) HIV and TB 2 Diarrhoeal diseases (24.5%) Lower respiratory infections (23.2%) Comm_mat_peri_nut 3 Preterm birth complications (9.3%) Preterm birth complications (11.7%) 4 Protein-energy malnutrition (8.9%) Protein-energy malnutrition (9.3%) Prov, District 5 Birth asphyxia (6.7%) Birth asphyxia (7.0%) FS, Lejweleputswa: DC18 6 Sepsis/other newborn infectious (3.8%) Sepsis/other newborn infectious (4.4%) Show history

<5 years <5 7 HIV/AIDS (3.3%) HIV/AIDS (4.2%) 8 Other perinatal conditions (2.2%) Tuberculosis (2.1%) Percentages are shown 9 Tuberculosis (1.8%) Other perinatal conditions (2.1%) according to all the deaths 10 Septicaemia (1.5%) Septicaemia (1.5%) within the age/gender 1 Lower respiratory infections (19.7%) Road injuries (16.5%) category of each box, 2 Tuberculosis (17.8%) Lower respiratory infections (16.3%) although only the leading 3 Diarrhoeal diseases (15.1%) HIV/AIDS (12.5%) 10 causes are displayed. 4 HIV/AIDS (12.4%) Diarrhoeal diseases (12.1%) 5 Road injuries (10.7%) Tuberculosis (12.0%)

5-14 6 Fires, hot substances (4.7%) Drowning (6.8%) 7 Meningitis/encephalitis (3.6 %) Accidental threats to breathing (4.3%) 8 Endocrine nutritional,blood, immune (2.9%) Fires, hot substances (4.1%) 9 Epilepsy (2.9%) Epilepsy (4.1%) 10 Drowning (2.9%) Meningitis/encephalitis (2.6%) 1 Lower respiratory infections (19.9%) Interpersonal violence (35.1%) 2 Tuberculosis (19.0%) Road injuries (11.2%) 3 HIV/AIDS (16.0%) Tuberculosis (7.3%) 4 Diarrhoeal diseases (7.7%) HIV/AIDS (6.7%) 5 Road injuries (5.8%) Lower respiratory infections (6.4%)

15-24 6 Interpersonal violence (3.8%) Mechanical forces (5.6%) 7 Meningitis/encephalitis (3.4%) Accidental threats to breathing (4.9%) 8 Endocrine nutritional,blood, immune (3.0%) Drowning (2.5%) 9 Epilepsy (1.8%) Epilepsy (2.2%) 10 Accidental threats to breathing (1.8%) Diarrhoeal diseases (2.2%) 1 Lower respiratory infections (17.5%) Tuberculosis (17.6%) 2 HIV/AIDS (15.6%) Lower respiratory infections (15.4%) 3 Tuberculosis (14.5%) HIV/AIDS (13.0%) 4 Diarrhoeal diseases (5.8%) Road injuries (4.5%) 5 Cerebrovascular disease (5.1%) Diarrhoeal diseases (4.5%)

25-64 6 Hypertensive heart disease (3.9%) Ischaemic heart disease (4.5%) 7 Ischaemic heart disease (3.4%) Interpersonal violence (4.1%) 8 Diabetes mellitus (3.1%) Cerebrovascular disease (4.0%) 9 Nephritis/nephrosis (2.9%) Nephritis/nephrosis (2.4%) 10 Endocrine nutritional,blood, immune (2.7%) Diabetes mellitus (2.1%) 1 Cerebrovascular disease (17.7%) Lower respiratory infections (15.2%) 2 Ischaemic heart disease (12.3%) Ischaemic heart disease (14.7%) 3 Lower respiratory infections (12.0%) Cerebrovascular disease (11.5%) 4 Hypertensive heart disease (11.5%) Hypertensive heart disease (6.4%) 5 Diabetes mellitus (6.9%) COPD (6.3%)

65+ 6 Diarrhoeal diseases (4.2%) Tuberculosis (4.4%) 7 Cardiomyopathy (3.3%) Prostate (4.2%) 8 Nephritis/nephrosis (2.9%) Diabetes mellitus (4.0%) 9 COPD (2.3%) Nephritis/nephrosis (3.1%) 10 Endocrine nutritional,blood, immune (2.2%) Diarrhoeal diseases (3.0%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (29.5%) n=37 Lower respiratory infections (20.0%) n=1 815 2 Hypertension in pregnancy (26.6%) n=33 HIV/AIDS (19.3%) n=1 751 3 Other maternal (18.9%) n=24 Tuberculosis (18.5%) n=1 678 4 Abortion (11.9%) n=15 Diarrhoeal diseases (6.6%) n=597 5 Maternal haemorrhage (9.3%) n=12 Meningitis/encephalitis (3.1%) n=286

15-49 6 Maternal sepsis (3.8%) n=5 Endocrine nutritional,blood, immune (3.0%) n=272 Female 7 Road injuries (2.7%) n=248 8 Nephritis/nephrosis (2.5%) n=224 9 Cerebrovascular disease (2.3%) n=206 10 Ischaemic heart disease (1.6%) n=149

337 Section B: NationalProfile Free and State District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Masilonyana SD Indicator - 92.5 4.4 66.1 55.3 80.6 421.4 Numerator - 149 7 622 852 12 450 670 Denominator 159 161 159 941 18 491 185 388 159 Matjhabeng SD Indicator 176.7 94.8 6.4 64.2 53.6 71.8 59.7 Numerator 13 1 150 479 4 106 5 534 78 141 4 452 Denominator 7 359 1 213 7 454 6 396 123 793 1 306 212 7 454 Nala SD Indicator 172.7 97.3 4.4 67.4 51.2 70.2 158.2 Numerator 1 249 26 1 005 1 031 14 199 932 Denominator 579 256 589 1 491 24 166 242 751 589 Tokologo SD Indicator - 108.3 - 73.5 61.6 79.8 - Numerator - 52 - 305 438 5 720 275 Denominator - 48 - 415 8 530 86 073 - Tswelopele SD Indicator - 104.2 9.8 66.6 55.2 82.0 70.6 Numerator - 123 65 566 623 9 734 468 Denominator 642 118 663 850 13 537 142 512 663 Lejweleputswa Indicator 160.2 95.9 6.5 65.4 54.0 73.5 76.7 Numerator 14 1 723 577 6 604 8 478 120 245 6 797 Denominator 8 739 1 796 8 865 10 093 188 517 1 962 936 8 865 Free State Indicator 152.8 94.2 5.9 65.8 54.2 66.8 71.2 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualFS, trends DC18, Lejweleputswa District Municipality, SEQ 4 (well off)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

338 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Child and School Health 57.1 87.2 73.7 50.4 58.0 82.5 85.5 4 631 4 758 4 828 2 488 36 180 50 750 78 588 34 045 34 65 004 113 256 468 414 761 442 months Vitamin A dose 12-59 coverage (%) coverage 272 525 856 580 849 77.5 19.8 56.0 80.0 39.3 78.8 32.0 56.9 30.3 6 010 1 105 1 337 128 748 8 screening coverage (%) coverage School Grade 572 457 772 694 434 47.0 33.1 34.7 82.4 52.8 33.0 43.5 53.2 1 461 1 252 6 695 8 800 6 858 171 096 1 screening coverage (%) coverage School Grade Output 517 959 96.2 153.1 1 144 143.7 159.9 153.4 146.2 105.8 143.2 6 582 3 825 3 900 8 583 7 503 7 4 053 1 534 1 092 12 807 2 051 10 736 55 158 88 104 88 dose nd Measles Measles 2 coverage (%) coverage 219 749 941 164 522 849 463 51.1 51.7 41.6 62.7 35.4 55.5 29.2 46.2 3 013 4 767 1 353 5 830 dose rd Infant Infant rate (%) exclusively exclusively breastfed at HBV 3 DTaP-IPV-Hib- 315 616 774 82.3 84.2 114.5 127.5 116.0 125.1 7 781 1 183 7 284 4 893 3 594 105.2 106.2 6 960 6 11 349 51 288 (%) coverage under 1 year Immunisation Immunisation 5 2 2 - - 15 24 85 54 1.3 1.3 1.3 1.2 3.7 2.4 2.8 180 236 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 6 1 2 - - - 1.7 3.1 173 182 14.3 12.4 20.8 23.5 (per1K) neonatal neonatal Inpatient Inpatient death rate 6 1 2 - - - 1.7 3.1 9.9 147 159 159 138 579 579 642 642 11.4 37.7 37.7 16.8 18.8 7 359 7 359 1 228 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 7 7 6 - - - 95 3.1 4.4 9.0 5.6 9.8 5.5 6.3 126 242 262 227 2 478 2 926 8 739 8 739 1 783 80 475 9 336 Inpatient Inpatient year rate (%) death under 5 7 3 2 - - - 59 54 3.7 2.4 6.3 8.3 217 125 229 11.9 13.0 14.2 1 764 1 526 mpact I Inpatient Inpatient year rate (%) death under 1 3 3 3 - - - - - 18 31 25 20 9.6 8.0 155 196 16.1 16.7 15.0 15.8 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute

------13 28 28 59 35 4.6 2.0 5.5 3.2 612 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 1 1 - - - 15 12 28 72 45 1.4 2.7 3.6 2.0 3.0 2.8 2.2 547 402 505 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Numerator Indicator Denominator Numerator Denominator Numerator Indicator Indicator Denominator Denominator Indicator Numerator Indicator Indicator Numerator Indicator Denominator Denominator Indicator Numerator

Masilonyana SD Masilonyana Nala SD Tokologo SD Tokologo Matjhabeng SD Matjhabeng Free State Africa South Tswelopele SD Tswelopele Lejweleputswa Source: HIS.

339 Section B: NationalProfile Free and State District Province Profiles

Annual trends Child and School Health FS, DC18, Lejweleputswa District Municipality, SEQ 4 (well off)

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

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

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

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trends HIV FS, DC18, Lejweleputswa District Municipality, SEQ 4 (well off)

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

200

Male condom distribution 100 coverage 4_Process_input

80 60 Medical male circumcision 40 rate 20

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

340 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

HIV 410 199 723 305 17.7 16.1 27.4 41.9 19.0 10.3 25.5 28.5 4 631 6 268 207 111 135 081 135 304 656 304 356 964 356 1 950 504 950 1 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.1 47.5 41.9 51.8 40.1 42.5 42.9 43.9 474 000 474 318 999 318 120 882 182 004 275 454 786 000 786 1 781 811 1 140 0001 140 9 360 000 1 008 000 008 1 2016/17 distribution distribution Male condom condom Male coverage (No) 90-90-90 st 18.6 24.3 25.8 26.8 30.0 35.9 30.3 40.2 1 9 249 4 379 6 005 11 715 84 371 53 023 5 952 000 Process & input 173 502 173 386 901 (%) 2016/17 coverage HIV testing (including ANC) ------531 2 613 - - - - 468 225 - - - - - 275 901 9.5 9.9 8.2 9 487 95 859 060 3 918 2 679 150 2 954 316 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 58.6 50.8 52 136 102 689 90-90-90 Output 2016/17 nd 2 on ART rate (%) Clients remaining - 8 8 51 24 42 27 20 30 145 199 261 105 74.1 77.8 72.4 82.4 80.0 76.2 100.0 2015 months (%) on ART after 12 Child percentage ------981 366 866 68.1 70.7 76.6 75.9 75.3 73.0 64.3 1 487 7 400 11 100 2015 months (%) on ART after 12 Adult percentageAdult 4 5 9 - 11 14 10 10 31 93 20 64 43 71.4 72.1 81.8 68.1 50.0 80.0 68.8 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------90-90-90 Outcome 163 rd 639 443 406 87.3 85.1 89.0 89.5 90.6 90.3 93.2 3 2 701 4 352 (%) 2015 rate months 12 Adult with viral load suppressed suppressed load 5 6 - 11 14 18 37 93 20 22 99 43 182 51.1 61.1 54.1 59.7 43.4 63.6 83.3 (%) 2015 Child with viral load completion completion load rate at months 12 ------713 624 252 62.1 61.0 65.1 65.7 64.7 60.0 60.9 7 138 4 499 1 050 (%) 2015 Adult with viral load completion completion load rate at months 12 Numerator Denominator Numerator Indicator Indicator Indicator Denominator Indicator Numerator Indicator Denominator Numerator Denominator Indicator Numerator Denominator Numerator Indicator Denominator Indicator

Masilonyana SD Masilonyana Free State South Africa South Matjhabeng SD Matjhabeng Nala SD Tokologo SD Tokologo Tswelopele SD Tswelopele Lejweleputswa Source: HIS.

341 Section B: NationalProfile Free and State District Province Profiles

TB Annual trends FS, DC18, Lejweleputswa District Municipality, SEQ 4 (well off)

Measure Names 15 IndValue 5_TB 51.6 31.4 42.1 48.1 39.8 39.3 53.0 44.2 TB death rate Prov_av 99 971 26 771 61 892 31 362 55 623 63 392 10 514 739 159 132 157 324 749 680 749 331 322 (ETR.net) ZA_av 5 2016/17

screened in 60 TB symptom 5 facility rate (%) rate facility 1_Impact years and older Process & input TB DR client 40 ------death rate (EDRWeb) 20 86.1 88.7 72.8 2 620 1 221 730 2 256 0 15 2016 Output rate (%) TB client lost to 10

on treatment treatment on follow up rate (ETR.Net) TB client initiated 5

0 68 68 112 215 126 126 150 200 74.7 89.7 93.0 83.0 88.3 85.2 1 124 1 913 100.0 100.0 1 630 1 354 80 TB client treatment success rate 60 2016 (ETR.net) Net) (%) Net)

TB/HIV co- 40 ART rate (ETR.

infected client on 40 ------TB DR client 127 108

74.4 loss to follow up 85.0 68.0 20 rate (EDRWeb)

0 2016

treatment treatment 60 2_Outcome TB DR TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation treatment 40 success rate ------(EDRWeb) 20 4.8 5.2 6.2 127 0 2 620

TB Rifampicin 20

2016 resistance rate (%) confirmed client resistance resistance 10 rate TB Rifampicin Rifampicin TB confirmed client confirmed client 0 100 ------88 198 44.4 50.5 45.8 TB/HIV co-infected client on ART 50 rate (ETR.Net) 2014 0 Outcome

success rate rate success 100 (EDRWeb) (%) TB DR treatment treatment DR TB TB symptom 5 years and older ------50

55 screened in 198 17.9 27.8

23.5 facility rate

4_Process_input 0 2009 2010 2011 2012 2013 2014 2015 2016 2014 Year Measure Names (EDRWeb) (%) to follow up rate TB DR client loss IndValue P rov_av 127 153 246 357 323 408 438 343 81.0 77.8 84.1 80.1 81.5 78.8 76.2 83.0 ZA_av 3 418 3 015 4 337 2 345 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 9 19 18 31 4.1 4.7 6.4 9.6 6.4 5.6 5.9 6.2 193 153 270 323 408 438 3 015 4 337 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------47 198 23.7 23.0 25.3 2014 death rate TB DR client (EDRWeb) (%) mpact I 12 31 25 36 7.8 5.7 8.7 9.6 6.6 8.4 8.8 153 261 323 408 365 438 10.5 3 015 4 337 2015 TB death rate (ETR.net) (%) Indicator Numerator Denominator Indicator Indicator Indicator Numerator Denominator Indicator Indicator Denominator Numerator Numerator Denominator Numerator Denominator Indicator Numerator Denominator Indicator

South Africa South Nala SD SD Tokologo Free State Matjhabeng SD Matjhabeng Masilonyana SD Masilonyana Tswelopele SD Tswelopele Lejweleputswa Source: HIS.

342 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Masilonyana SD Indicator 1.0 15.1 Numerator 59 325 Denominator 713163 25708 Matjhabeng SD Indicator 1.2 10.5 Numerator 466 1 457 Denominator 4 588 533 1 668 897 Nala SD Indicator 1.0 18.3 Numerator 72 481 Denominator 909 063 314 787 Tokologo SD Indicator 0.2 17.8 Numerator 6 168 Denominator 326 295 113 349 Tswelopele SD Indicator 1.1 20.2 Numerator 49 293 Denominator 528 015 174 252 Lejweleputswa Indicator 1.1 12.9 Numerator 652 2 724 Denominator 7 065 069 2 529 993 Free State Indicator 2.4 26.4 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualFS, trends DC18, Lejweleputswa District Municipality, SEQ 4 (well off)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

343 Section B: NationalProfile Free and State District Province Profiles

Thabo Mofutsanyana District Municipality (DC19)

Thabo Mofutsanyana District is located in the eastern Free State Province and borders Lesotho and KwaZulu-Natal. It includes six health sub-districts, namely Setsoto, Dihlabeng, Nketoana, Maluti-a-Phofung, Phumelela and Mantsopa. The district has a population of 709 909, with a population density of 21.3 people per km2, and falls in socio-economic Quintile 3. Estimated medical scheme coverage is 9.5%. It is one of 11 National Health Insurance (NHI) pilot districts.

Social determinants of healtha Population per selected category

Unemployment ratea 35.1% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 45.8% under 1 year 15 022 14 939 15 058 15 166 No schooling 6.6% under 5 years 81 237 80 276 79 385 78 568 Matric 29.4% 05-09 years 82 232 82 613 82 474 82 163 Higher education 8.0% 10-14 years 73 324 75 384 77 785 79 855 Households 246 029 15-19 years 74 438 72 545 71 208 70 934 Female-headed households 46.3% 20-24 years 80 235 78 277 76 315 74 346 Formal dwellings 77.7% 25-29 years 84 638 83 543 82 043 80 177 Flush toilet connected to sewerage 54.4% 30-34 years 70 955 74 368 77 675 80 719 Weekly refuse removal 48.8% 35-39 years 54 780 57 044 59 008 60 533 Piped water inside dwellings 25.6% 40-44 years 40 619 42 086 43 767 45 626 Electricity for lighting 91.7% 45-49 years 32 965 33 316 33 746 34 361 Blue Drop water score 64.5% 50-54 years 27 445 27 769 28 102 28 400 55-59 years 23 313 23 249 23 255 23 315 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 20 504 20 332 20 099 19 873 65-69 years 15 932 16 149 16 310 16 383 70-74 years 11 005 11 190 11 359 11 510 75-79 years 7 041 7 109 7 171 7 224 80 years and older 6 263 6 241 6 225 6 211 Total 786 925 791 490 795 927 800 201 Estimated pregnant women* 16 074 15 985 16 112 16 228 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

344 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Dihlabeng SD 16 14 0 1 1 0 3 Maluti a Phofung SD 15 34 0 2 1 0 2 Mantsopa SD 7 9 0 1 0 0 0 Nketoana SD 6 6 0 1 0 0 0 Phumelela SD 5 6 0 1 0 0 0 Setsoto SD 9 13 1 3 0 0 1 Thabo Mofutsanyana 58 82 1 9 2 0 6 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Thabo Mofutsanyana 526 406 127 410 96 67 14 7 11 1 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Dihlabeng SD Indicator 2.0 - - - - - Numerator 248 541 - - - - - Denominator 1 502 079 - - - - - Maluti a Phofung SD Indicator 2.9 - - - - - Numerator 922 965 - - - - - Denominator 3 859 305 - - - - - Mantsopa SD Indicator 2.6 - - - - - Numerator 128 271 - - - - - Denominator 591 123 - - - - - Nketoana SD Indicator 2.0 - - - - - Numerator 113 466 - - - - - Denominator 695 625 - - - - - Phumelela SD Indicator 2.0 - - - - - Numerator 91 592 - - - - - Denominator 553 206 - - - - - Setsoto SD Indicator 2.3 - - - - - Numerator 249 952 - - - - - Denominator 1 300 875 - - - - - Thabo Mofutsanyana Indicator 2.5 47.3 94.4 1 706 1 024 375 Numerator 1 754 787 35 68 1 096 639 145 658 393 169 658 393 169 Denominator 8 502 213 74 72 642 737 642 737 1 754 787 Free State Indicator 2.2 34.8 78.5 1 665 1 046 403 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

345 Section B: NationalProfile Free and State District Province Profiles ------20.3 28.3 (%) OPD new client not not client referred rate rate referred ------5.4 3.6 rate (%) Inpatient Inpatient crude death ------84.3 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 5 122 4 227 day (Rand) equivalent equivalent per patient Expenditure ------6.9 6.2 (Days) Average length of of length stay - total ------6.4 5.8 6.2 486 29.1 37.2 2 131 1 645 8 388 8 34 166 25 778 (%) OPD new client not not client referred rate rate referred 5 ------6.3 3.8 3.2 715 267 448 10 247 18 650 rate (%) Inpatient Inpatient crude death - - 0 0 0 8 403 ------4 - 78.3 51 310 41 332 (%) ospital H utilisation rate - total Inpatient bed Regional Hospital Regional ------2 951 2 782 3 087 2 894 35 120 49 135 69 795 118 931 day (Rand) equivalent equivalent 194 176 472 176 194 per patient Expenditure ------5.1 5.0 4.9 5.0 5.3 1247 5310 4 332 931 291 172 8 403 18 650 92 642 367 763 107 92 642 (Days) Average length of of length stay - total 57.1 81.3 71.2 88.4 94.9 59.3 68.8 90.0 80.9 3 170 4 401 3 586 9 639 51 474 21 158 10 154 63 277 38 387 38 34 559 124 401 153 860 (%) OPD new client not not client referred rate rate referred 78 6.1 5.1 7.2 4.8 4.9 6.6 8.6 3.8 6.9 117 130 436 368 1 624 5 129 2 186 12 226 31 882 rate (%) Inpatient Inpatient crude death - 7 203 30 754 - - 3 058 - 2 642 7 702 - - - 67.4 49.9 55.8 52.2 47.4 74.6 60.7 53.0 69.4 7 981 17 946 17 (%) utilisation rate - total Inpatient bed District Hospital District 2 513 3 831 2 496 5 838 2 495 2 260 2 229 2 568 4 033 2 538 12 413 11 395 35 571 32 607 64 942 162 766 day (Rand) 72 669 247 50 057 701 equivalent equivalent per patient Expenditure 2.1 3.1 3.0 4.4 2.9 2.5 3.0 3.3 3.5 1 624 5 129 7 981 7 203 4 095 22 366 885 4 095 6 495 28 435 378 6 495 3 058 2 642 12 226 17 946 17 31 882 20 655 88 777 315 20 655 38 327 900 744 146 38 327 1 057 95 498 409 426 051 95 498 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Indicator Numerator Denominator Indicator Denominator Numerator Numerator Indicator

Thabo Mofutsanyana Mofutsanyana Thabo Setsoto SD Phumelela SD Phumelela Nketoana SD Nketoana Mantsopa SD Mantsopa Free State Africa South Maluti a Phofung SD Dihlabeng SD Dihlabeng Source: HIS and BAS.

346 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Annual trends Management and efficiency Deaths and Patient day equivalent 2014/15 – 2016/17 indicators for the service delivery 13 12 24 37 52 33 110 platform, 2016/17 296 2 901 281 697 FS, DC19, Thabo Mofutsanyana District Municipality, SEQ 3 Total District District

Measure Names -- 752 11 ------8 - IndValue Inpatient crude 6 Prov_av death rate ZA_av tertiary Central/ hospital 1_Impact 4

1_Management 2 14 12 15 75 - 20 2016/17 715 8 186 4 512

6 118 931

Average length Hospital Regional Regional of stay (district 4 hospitals) 17 19 26 26 35

2 107 2 186 6 250

4K 162 766 District District Hospital

2_Outcome Expenditure per 3K - 1 - - 3 9 - - 9 - - patient day - 3 equivalent (district 2K 990 hospitals) 1K / MOU PHC / CHC 13 57 59 20 29 26 65

Inpatient bed 290 100 utilisation rate 304 117 304 Total

(district District hospitals) 50 - - - 775 11 - - - - 2 508 ------2 982 -

100 3_Output

OPD new client tertiary Central/ Hospital not referred rate 50 (district -- 9 - 11 14 27 42 46 hospitals) 38 163 869 0 4 711 132 325 132

100 2015/16 Hospital Regional Regional 11 19 15 12 Percentage 21 122 50 462

Ideal clinics 2 113 6 145 171 792 District District Hospital 0 - 2 - - 2 - 2 6 - 8 - 1 2 - 3 ------Provincial and 3K 5 LG District 919 Health Services

2K / MOU expenditure per capita PHC / CHC (uninsured) 1K 24 21 27 52 29 39 113 101 327 3 441 12 654 301 970 Provinc ial and 1500 Total District District

4_Process_input LG PHC expenditure per ------2 826 2 004 - - 1000 - capita (uninsured) 500 tertiary Central/ Hospital

Provincial and 400 9 - 18 15 20 42 69 22 66 LG PHC 22 188

expenditure per 1 118

PHC headcount 130 442

200 2014/15 Hospital Regional Regional 14 12 19 47 32 2008 2010 2012 2014 2016 2018 30 131 Year 504 6 723 4 969 -

Measure Names 171 528 District District IndValue Hospital - - 2 ------2 323 P rov_av - 8 2 7

ZA_av 962 2 280 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

347 Section B: NationalProfile Free and State District Province Profiles

PercentageFS, T Mofutsanyana: of deaths by DC19, broad 2010 cause - and2015 leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 77% 9% 8% 6% 78% 9% 7%6% causes and 5-14 33% 24% 17% 26% 28% 24% 16% 32% single leading 15-24 27% 42% 18% 13% 17% 18% 16% 49% causes 25-64 23% 35% 38% 4% 21% 35% 32% 12% 65+ 15% 4% 80% 2% 17% 7% 72% 4% Broadcause 26% 23% 47% 4% 26% 26% 37% 11% Total Injury NCD Rank.. Female Male 1 Diarrhoeal diseases (22.6%) Diarrhoeal diseases (22.0%) HIV and TB 2 Lower respiratory infections (20.3%) Lower respiratory infections (18.1%) Comm_mat_peri_nut 3 Preterm birth complications (11.8%) Preterm birth complications (13.2%) 4 Protein-energy malnutrition (7.8%) Protein-energy malnutrition (10.1%) Prov, District 5 HIV/AIDS (7.1%) HIV/AIDS (7.7%) FS, T Mofutsanyana: DC19 6 Birth asphyxia (6.7%) Birth asphyxia (7.6%) Show history

<5 years <5 7 Other perinatal conditions (3.0%) Other perinatal conditions (3.0%) 8 Sepsis/other newborn infectious (2.2%) Sepsis/other newborn infectious (1.9%) Percentages are shown 9 Tuberculosis (2.1%) Tuberculosis (1.7%) according to all the deaths 10 Accidental threats to breathing (1.8%) Accidental threats to breathing (1.7%) within the age/gender 1 HIV/AIDS (17.0%) Drowning (13.1%) category of each box, 2 Lower respiratory infections (14.2%) HIV/AIDS (13.1%) although only the leading 3 Diarrhoeal diseases (12.3%) Tuberculosis (12.8%) 10 causes are displayed. 4 Road injuries (12.0%) Lower respiratory infections (11.0%) 5 Tuberculosis (9.4%) Road injuries (10.6%)

5-14 6 Accidental threats to breathing (7.1%) Diarrhoeal diseases (7.1%) 7 Drowning (5.4%) Meningitis/encephalitis (6.7%) 8 Meningitis/encephalitis (3.6%) Accidental threats to breathing (4.9%) 9 Other respiratory (2.6%) Fires, hot substances (2.9%) 10 Epilepsy (2.4%) Epilepsy (2.2%) 1 HIV/AIDS (25.6%) Interpersonal violence (17.0%) 2 Tuberculosis (17.8%) Road injuries (12.5%) 3 Lower respiratory infections (12.3%) HIV/AIDS (10.4%) 4 Diarrhoeal diseases (6.0%) Lower respiratory infections (8.8%) 5 Road injuries (4.6%) Tuberculosis (8.7%)

15-24 6 Meningitis/encephalitis (2.9%) Accidental threats to breathing (8.0%) 7 Accidental threats to breathing (2.8%) Drowning (5.3%) 8 Endocrine nutritional,blood, immune (2.8%) Epilepsy (3.8%) 9 Epilepsy (2.2%) Meningitis/encephalitis (3.7%) 10 Cardiomyopathy (1.8%) Mechanical forces (3.2%) 1 HIV/AIDS (22.9%) HIV/AIDS (19.3%) 2 Tuberculosis (12.4%) Tuberculosis (16.1%) 3 Lower respiratory infections (11.6%) Lower respiratory infections (12.3%) 4 Diarrhoeal diseases (7.3%) Diarrhoeal diseases (5.2%) 5 Cerebrovascular disease (6.0%) Cerebrovascular disease (4.5%)

25-64 6 Diabetes mellitus (4.0%) Road injuries (4.3%) 7 Hypertensive heart disease (3.8%) Ischaemic heart disease (3.6%) 8 Ischaemic heart disease (3.3%) Interpersonal violence (2.5%) 9 Endocrine nutritional,blood, immune (2.3%) Hypertensive heart disease (2.2%) 10 Cervix (2.2%) Diabetes mellitus (2.0%) 1 Cerebrovascular disease (18.9%) Cerebrovascular disease (12.4%) 2 Hypertensive heart disease (13.4%) Lower respiratory infections (11.4%) 3 Ischaemic heart disease (12.4%) Ischaemic heart disease (11.3%) 4 Lower respiratory infections (8.5%) Hypertensive heart disease (8.0%) 5 Diabetes mellitus (7.9%) COPD (6.4%)

65+ 6 Diarrhoeal diseases (4.6%) Tuberculosis (5.1%) 7 Nephritis/nephrosis (3.0%) Diabetes mellitus (4.4%) 8 Cardiomyopathy (2.4%) Prostate (4.0%) 9 Tuberculosis (2.2%) Diarrhoeal diseases (4.0%) 10 COPD (2.1%) Nephritis/nephrosis (3.5%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (37.8%) n=69 HIV/AIDS (28.4%) n=3 281 2 Other maternal (19.9%) n=36 Tuberculosis (15.6%) n=1 795 3 Hypertension in pregnancy (19.1%) n=35 Lower respiratory infections (13.4%) n=1 541 4 Maternal haemorrhage (15.0%) n=28 Diarrhoeal diseases (8.0%) n=926 5 Abortion (6.3%) n=11 Cerebrovascular disease (2.8%) n=329

15-49 6 Maternal sepsis (1.8%) n=3 Endocrine nutritional,blood, immune (2.4%) n=282 Female 7 Road injuries (2.3%) n=268 8 Meningitis/encephalitis (2.2%) n=248 9 Ischaemic heart disease (1.7%) n=197 10 Diabetes mellitus (1.7%) n=195

348 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Dihlabeng SD Indicator 215.3 98.2 7.3 68.0 53.6 81.4 37.9 Numerator 7 384 238 1 408 1 571 28 956 1 227 Denominator 3 251 391 3 240 2 071 35 156 426 735 3 240 Maluti a Phofung SD Indicator 96.6 88.9 6.4 67.1 62.6 60.1 73.3 Numerator 6 1 029 404 3 872 4 472 56 548 4 613 Denominator 6 213 1 158 6 297 5 773 85 784 1 129 665 6 297 Mantsopa SD Indicator - 97.2 8.6 65.2 68.6 80.7 107.1 Numerator - 140 45 586 741 10 832 558 Denominator 516 144 521 899 12 963 161 112 521 Nketoana SD Indicator - 95.5 7.1 64.0 55.1 85.9 143.2 Numerator - 148 26 501 696 13 397 524 Denominator 343 155 366 783 15 171 187 215 366 Phumelela SD Indicator - 97.6 5.6 71.8 64.6 76.7 148.6 Numerator - 83 16 513 637 9 279 428 Denominator 250 85 288 714 11 840 145 107 288 Setsoto SD Indicator - 95.2 4.9 60.0 54.2 47.7 125.3 Numerator - 358 58 1 141 1 330 14 456 1 489 Denominator 1 179 376 1 188 1 902 29 448 363 582 1 188 Thabo Mofutsanyana Indicator 110.6 92.8 6.6 66.1 59.6 66.4 74.3 Numerator 13 2 142 787 8 021 9 447 133 468 8 839 Denominator 11 752 2 309 11 900 12 142 190 362 2 413 416 11 900 Free State Indicator 152.8 94.2 5.9 65.8 54.2 66.8 71.2 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualFS, trends DC19, Thabo Mofutsanyana District Municipality, SEQ 3

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

349 Section B: NationalProfile Free and State District Province Profiles

Child and School Health 57.1 61.4 56.4 60.4 59.8 48.4 58.0 64.8 65.5 5 413 4 248 3 650 8 883 59 214 73 188 99 180 83 058 188 976 184 878 547 440 months Vitamin A dose 12-59 coverage (%) coverage 44 3.9 912 615 927 368 604 47.6 19.1 25.1 19.8 40.4 30.3 65.2 1 115 6 971 4 052 1 089 7 458 8 screening coverage (%) coverage School Grade 758 597 37.1 27.6 74.6 33.1 63.1 16.9 64.7 46.7 33.0 32.2 7 181 1 715 1 310 9 246 1 755 2 650 2 286 1 856 232 260 932 175 720 1 176 1 screening coverage (%) coverage School Grade Output 961 832 609 97.0 83.1 84.6 96.2 112.8 103.1 1 774 124.2 102.0 105.8 8 637 1 202 5 537 1 564 1 332 29 562 2 456 1 237 12 015 12 169 10 227 65 130 23 727 2 646 2 450 21 945 141 681 dose nd Measles Measles 2 coverage (%) coverage

rd 541 199 758 793 392 398 804 346 41.6 18.3 49.4 42.6 44.9 38.6 45.6 36.8 46.2 2 174 2 120 1 791 4 259 4 980 11 037 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 514 733 669 97.1 81.5 75.5 76.2 82.3 92.3 80.3 84.2 107.9 8 172 2 152 4 958 4 11 538 10 423 10 10 002 23 937 61 290 20 577 135 516 (%) coverage under 1 year Immunisation Immunisation 2 5 6 9 1 397 1 3 26 93 1.1 3.1 1.3 1.3 1.5 0.6 4.5 0.8 2.2 112 315 138 286 738 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 3 9 2 10 73 25 7.7 7.6 5.8 122 11.7 14.3 12.4 10.4 12.0 (per1K) neonatal neonatal Inpatient Inpatient death rate 3 9 2 19 10 67 7.6 9.4 9.9 5.8 5.8 516 516 250 250 343 343 11.4 19.4 19.4 12.0 10.8 6 213 6 213 1 179 1 179 3 251 3 251 11 75211 752 11 1 682 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 5 2 2 16 57 28 60 8.1 4.4 4.4 4.5 4.3 3.6 5.5 8.3 211 110 103 198 788 4 707 4 100.0 1 289 Inpatient Inpatient year rate (%) death under 5 3 2 2 13 25 22 83 44 90 7.8 6.4 6.3 5.3 8.3 5.5 174 416 561 15.7 12.0 2 724 100.0 1 637 2 370 mpact I Inpatient Inpatient year rate (%) death under 1 2 7 1 1 - - - - 11 14 15 72 33 94 6.1 6.7 9.6 8.0 115 299 11.0 14.9 15.3 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute - - - 3 2 3 1 1 - - - - - 75 67 56 1.0 1.5 2.0 2.0 3.2 101 303 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 2 1 6 2 - - - - 11 14 24 36 1.6 9.0 2.0 5.6 4.5 2.8 5.2 127 156 133 464 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Indicator Numerator Indicator Denominator Numerator Denominator Indicator Denominator Indicator Indicator Indicator Numerator Numerator Indicator Denominator Numerator Denominator Numerator Denominator Denominator Indicator Numerator

Free State South Africa South Dihlabeng SD Dihlabeng Maluti a Phofung SD Setsoto SD Thabo Thabo Mofutsanyana Phumelela SD Phumelela Mantsopa SD Mantsopa Nketoana SD Nketoana Source: HIS.

350 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

AnnualFS, trends DC19, Thabo Child Mofutsanyana and School District Health Municipality, SEQ 3

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

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

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

3_Output 150

Measles 2nd dose coverage 100

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trends HIV FS, DC19, Thabo Mofutsanyana District Municipality, SEQ 3

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

200

Male condom distribution 100 coverage 4_Process_input

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

351 Section B: NationalProfile Free and State District Province Profiles

HIV 9.4 277 225 800 344 14.1 27.4 19.0 18.3 16.8 40.7 36.2 4 525 102.9 5 457 11 628 245 049 245 636 570 285 738 523 533 235 395 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 25.1 55.4 40.0 36.4 45.0 42.5 46.8 53.2 219 111 572 133 209 820 209 972 000 972 972 000 972 254 958 254 786 000 786 465 435 465 1 176 0001 176 2 232 000 10 130 000 130 10 2016/17 distribution distribution Male condom condom Male coverage (No) 34.4 26.6 30.0 26.8 30.3 35.9 30.8 33.9 32.5 7 970 8 842 11 368 21 239 24 488 49 636 3 992 000 315 420 123 543 396 441 903 261 344 262 344 4 948 449 3 036 174 3 425 628 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - - - - - 563 751 ------2 237 502 717 1 314 1 499 343 - - - 9.7 9.5 8.2 13 685 13 140 983 140 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------59.6 55.0 58.6 68 322 114 722 2016/17 on ART rate (%) Clients remaining - 72 27 42 29 30 65 85 66 34 34 276 459 238 539 77.6 81.0 77.8 90.0 90.3 85.3 85.2 86.2 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------879 908 74.3 73.1 77.2 70.7 75.9 75.9 80.0 72.8 2 196 2 227 1 067 6 990 14 267 2015 months (%) on ART after 12 Adult percentageAdult - 8 17 12 15 21 21 27 49 34 38 120 166 222 306 57.1 81.0 77.6 68.1 79.4 72.5 72.3 53.3 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------487 546 450 87.7 89.7 89.8 89.8 89.5 89.8 90.5 86.2 1 075 7 980 4 056 1 366 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 15 61 21 21 26 27 32 62 49 34 217 166 425 306 77.8 59.7 55.7 79.0 72.0 76.5 80.8 46.9 (%) 2015 Child with viral load completion completion load rate at months 12 ------745 675 649 77.9 65.7 68.7 65.4 86.4 80.6 69.3 80.9 1 581 1 564 5 033 10 247 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Denominator Numerator Numerator Indicator Numerator Indicator Denominator Numerator Denominator Indicator Denominator Denominator Indicator Numerator Indicator Indicator Indicator Numerator Denominator Denominator Indicator Numerator

Setsoto SD Phumelela SD Phumelela Thabo Mofutsanyana Mofutsanyana Thabo Free State South Africa South Nketoana SD Nketoana Mantsopa SD Mantsopa Dihlabeng SD Dihlabeng Maluti a Phofung SD Source: HIS.

352 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

TB 51.6 52.7 43.7 46.7 95.7 53.0 36.4 45.5 48.9 41 246 94 278 79 448 38 829 96 969 96 38 962 203 141 212 164 213 268 107 038 363 351 782 498 782 777 538 777 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------83.7 88.7 72.8 2 134 2 550 1 483 734 2016 Output rate (%) on treatment treatment on TB client initiated 63 63 98 747 101 162 150 328 328 278 783 288 97.0 89.7 95.4 92.6 96.5 88.3 96.5 1 725 100.0 100.0 1 664 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------111 144 77.1 74.4 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------5.6 5.2 6.2 144 2 550 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------92 50 54.3 50.5 45.8 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------14 92 17.9 15.2 23.5 2014 (EDRWeb) (%) to follow up rate TB DR client loss 218 143 129 201 823 238 683 260 465 600 81.0 80.1 84.1 77.5 83.0 83.0 84.5 83.8 90.2 1 310 3 621 1 557 3 006 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 1 11 18 31 32 33 0.7 6.4 5.6 4.6 3.9 3.5 2.0 6.9 5.5 126 143 823 238 260 600 3 621 1 557 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------18 92 19.6 23.0 25.3 2014 death rate TB DR client (EDRWeb) (%) mpact 11 I 20 99 22 86 7.7 6.6 8.4 8.5 143 428 190 823 238 260 600 11.8 12.0 10.5 14.3 12.2 3 621 1 557 2015 TB death rate (ETR.net) (%) Indicator Indicator Denominator Indicator Numerator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator

Thabo Mofutsanyana Mofutsanyana Thabo Free State South Africa South Setsoto SD Phumelela SD Phumelela Nketoana SD Nketoana Mantsopa SD Mantsopa Maluti a Phofung SD Dihlabeng SD Dihlabeng Source: HIS.

353 Section B: NationalProfile Free and State District Province Profiles

TB Annual trends FS, DC19, Thabo Mofutsanyana District Municipality, SEQ 3

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

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

0 15

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

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

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

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

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

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

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

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

Measure Names IndValue P rov_av ZA_av

354 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Dihlabeng SD Indicator 4.3 20.9 Numerator 539 707 Denominator 1 502 079 406 155 Maluti a Phofung SD Indicator 3.4 29.1 Numerator 1 082 2 297 Denominator 3 859 305 946 617 Mantsopa SD Indicator 3.2 60.6 Numerator 157 771 Denominator 591 123 152 637 Nketoana SD Indicator 2.7 18.4 Numerator 155 277 Denominator 695 625 180 831 Phumelela SD Indicator 1.6 15.4 Numerator 75 192 Denominator 553 206 149 475 Setsoto SD Indicator 5.0 40.8 Numerator 538 1 130 Denominator 1 300 875 332 571 Thabo Mofutsanyana Indicator 3.6 29.7 Numerator 2 546 5 374 Denominator 8 502 213 2 168 286 Free State Indicator 2.4 26.4 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualFS, trends DC19, Thabo Mofutsanyana District Municipality, SEQ 3

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

355 Section B: NationalProfile Free and State District Province Profiles

Fezile Dabi District Municipality (DC20)

Fezile Dabi District is located in the northern Free State Province and is divided into four health sub-districts, namely Moqhaka, Metsimaholo, Ngwathe and Mafube. The district has a population of 527 525, with a population density of 25.5 people per km2 and falls in socio-economic Quintile 4. Estimated medical scheme coverage is 13.3%.

Social determinants of healtha Population per selected category

Unemployment ratea 33.9% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 44.4% under 1 year 8 424 8 385 8 511 8 652 No schooling 6.7% under 5 years 46 307 45 681 45 170 44 755 Matric 31.4% 05-09 years 47 827 47 902 47 640 47 269 Higher education 7.8% 10-14 years 42 953 44 112 45 503 46 694 Households 172 370 15-19 years 43 886 42 789 41 860 41 541 Female-headed households 39.5% 20-24 years 44 486 44 207 43 897 43 343 Formal dwellings 85.6% 25-29 years 48 348 47 453 46 428 45 416 Flush toilet connected to sewerage 80.9% 30-34 years 42 793 44 562 46 369 48 048 Weekly refuse removal 82.6% 35-39 years 36 951 37 629 38 106 38 396 Piped water inside dwellings 48.3% 40-44 years 30 805 31 476 32 195 32 943 Electricity for lighting 92.3% 45-49 years 26 381 26 696 27 034 27 438 Blue Drop water score 57.2% 50-54 years 22 254 22 619 22 998 23 345 55-59 years 19 324 19 313 19 340 19 438 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 16 753 16 799 16 808 16 803 65-69 years 12 932 13 158 13 365 13 524 70-74 years 9 159 9 298 9 429 9 568 75-79 years 5 502 5 769 5 997 6 167 80 years and older 4 503 4 603 4 712 4 827 Total 501 170 504 058 506 856 509 520 Estimated pregnant women* 9 014 8 972 9 107 9 258 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

356 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Mafube SD 12 8 0 1 0 0 0 Metsimaholo SD 19 9 1 1 0 0 2 Moqhaka SD 12 9 2 0 1 0 2 Ngwathe SD 5 12 2 2 0 0 0 Fezile Dabi 48 38 5 4 1 0 4 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Fezile Dabi 323 251 128 252 71 50 4 5 1 0 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Mafube SD Indicator 2.8 - - - - - Numerator 172 551 - - - - - Denominator 748 512 - - - - - Metsimaholo SD Indicator 1.6 - - - - - Numerator 261 653 - - - - - Denominator 1 952 016 - - - - - Moqhaka SD Indicator 1.8 - - - - - Numerator 310 252 - - - - - Denominator 2 083 365 - - - - - Ngwathe SD Indicator 2.1 - - - - - Numerator 270 490 - - - - - Denominator 1 557 810 - - - - - Fezile Dabi Indicator 1.9 22.0 51.3 1 509 937 422 Numerator 1 014 946 9 20 690 169 079 428 612 681 428 612 681 Denominator 6 341 703 41 39 457 248 457 248 1 014 946 Free State Indicator 2.2 34.8 78.5 1 665 1 046 403 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

357 Section B: NationalProfile Free and State District Province Profiles ------Annual trends 20.3 28.3 FS, DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

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

referred rate rate referred Inpatient crude 6 Prov_av death rate ZA_av ------

1_Impact 4 5.4 3.6

1_Management 2 8 rate (%) Inpatient Inpatient

crude death 6 Average length of stay (district ------4 hospitals) 84.3 2

(%) 4K utilisation rate - total

2_Outcome Expenditure per Inpatient bed patient day 3K ------equivalent 2K

Tertiary/Central Hospital (district 5 122 4 227 hospitals) 1K day (Rand) equivalent equivalent per patient Expenditure Inpatient bed 100 ------utilisation rate 6.9 6.2 (district hospitals) 50 (Days) Average length of of length 100 stay - total 3_Output OPD new client ------not referred rate 50 29.1 37.2 (district 7 058 7 058 hospitals) 26 039 26 039 (%) 0 OPD new client not not client 100 referred rate rate referred 5 ------7.3 27.1 7.3 27.1

6.3 Percentage 996 996 50 Ideal clinics 13 559 13 559 rate (%)

Inpatient Inpatient 0 crude death Provincial and 3K 0

------LG District Health Services 78.3 2K expenditure per 59 821 59 821

(%) capita ospital (uninsured)

H 1K utilisation rate - total Inpatient bed Regional Hospital Regional ------Provinc ial and 1500

4_Process_input LG PHC 2 951 2 938 2 938 2 894 expenditure per 77 344 77 77 344 77 1000 capita day

(Rand) (uninsured) equivalent equivalent per patient 227 207 016 227 207 016 500 Expenditure ------5.1 4.4 4.4 5.3 Provincial and 400 LG PHC 13 559 13 559 59 821 59 821 expenditure per

(Days) PHC headcount Average length of of length 200 stay - total - - - 2008 2010 2012 2014 2016 2018 71.2

63.7 Year 70.5 59.3 73.2 68.5 7 730 13 792 18 520 58 476 10 556 21 654 26 266 26 40 042 Measure Names (%) IndValue OPD new client not not client

referred rate rate referred P rov_av ZA_av - - - 7.1 5.1 6.1 6.6 6.3 167 523 456 2 717 6 451 1 146 8 891 18 059 rate (%) Inpatient Inpatient crude death - - - 0 - - - 67.4 83.7 85.5 5.9 68.3 60.7 21 127 68 555 68 (%) utilisation rate - total Inpatient bed District Hospital District - - - 2 870 75.5 2 248 2 925 2 550 2 568 2 538 34 917 52 179 12 404 99 500 day (Rand) equivalent equivalent 100 791 198 per patient 253 764 521 Expenditure - - - 4.4 2.7 3.8 4.5 3.3 3.3 2 717 6 451 8 891 7 386 36 278 354 7 386 21 127 18 059 40 042 287 376 117 40 042 68 555 68 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Numerator Indicator Numerator Indicator Denominator

Fezile Dabi Ngwathe SD Moqhaka SD Moqhaka Metsimaholo SD Metsimaholo South Africa South Free State Mafube SD Source: HIS and BAS.

358 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 11 74 17 17 19 38 166 2 142 6 553 6 176 844 Total District District ------tertiary Central/ hospital 7 - 15 16 26 55 77 2016/17 996 2 189 77 344 77 Hospital Regional Regional 12 19 10 84 1 146 4 260 District District Hospital - 2 - - 4 7 - - - 3 - - 99 500 5 104 / MOU PHC / CHC 19 19 13 13 35 187 106 7 217 182 668 182 Total District District ------1 340 ------2 267 - tertiary Central/ Hospital 11 14 19 87 28 90 268 1 111 82 145 2015/16 Hospital Regional Regional 16 94 348 1 156 4 638 2 403 - 100 523 District District Hospital - 7 -- - - 5 - 4 2 - 6 1 1 6 - 8 - 2 1 - 3 - 1 1 - 2 - 5 8 - - 2 - 6 176 724 / MOU PHC / CHC 17 14 12 18 16 49 85 33 174 7 686 7 1 444 1 181 846 Total District District ------2 348 - tertiary Central/ Hospital 6 - 13 18 10 83 60 34 304 1 123 2 201 85 656 85 2014/15 Hospital Regional Regional 15 15 12 25 84 324 4 967 96 190 District District Hospital - - 1 - 7 5 - - - - 6 - - - 1 225 2 7 8 - 7 518 816 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

359 Section B: NationalProfile Free and State District Province Profiles

PercentageFS, Fezile Dabi:of deaths DC20, by broad 2010 cause- 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 79% 7% 9% 5% 81% 4%8% 7% causes and 5-14 40% 20% 15% 24% 21% 17% 19% 42% single leading 15-24 26% 37% 18% 18% 11% 15% 15% 59% causes 25-64 23% 31% 40% 5% 20% 31% 35% 15% 65+ 14% 3% 81% 2% 15% 6% 76% 3% Broadcause 25% 19% 51% 5% 24% 21% 42% 13% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (25.5%) Lower respiratory infections (22.4%) HIV and TB 2 Diarrhoeal diseases (20.1%) Diarrhoeal diseases (21.5%) Comm_mat_peri_nut 3 Preterm birth complications (15.7%) Preterm birth complications (17.2%) 4 Birth asphyxia (7.0%) Birth asphyxia (8.4%) Prov, District 5 Protein-energy malnutrition (6.4%) Protein-energy malnutrition (5.7%) FS, Fezile Dabi: DC20 6 HIV/AIDS (4.9%) HIV/AIDS (3.6%) Show history

<5 years <5 7 Sepsis/other newborn infectious (2.2%) Sepsis/other newborn infectious (2.9%) 8 Tuberculosis (1.9%) Road injuries (2.3%) Percentages are shown 9 Road injuries (1.8%) Other perinatal conditions (2.0%) according to all the deaths 10 Endocrine nutritional,blood, immune (1.4%) Accidental threats to breathing (1.3%) within the age/gender 1 Lower respiratory infections (25.3%) Road injuries (18.9%) category of each box, 2 Diarrhoeal diseases (17.6%) Drowning (18.3%) although only the leading 3 Tuberculosis (16.4%) Lower respiratory infections (12.2%) 10 causes are displayed. 4 Road injuries (12.5%) Tuberculosis (11.7%) 5 HIV/AIDS (10.6%) HIV/AIDS (9.1%)

5-14 6 Drowning (8.2%) Accidental threats to breathing (6.5%) 7 Endocrine nutritional,blood, immune (3.2%) Diarrhoeal diseases (4.6%) 8 Fires, hot substances (3.1%) Fires, hot substances (4.2%) 9 Meningitis/encephalitis (3.1%) Epilepsy (3.3%) 10 Intestinal obstruction, strangulated he (2.7%) 1 HIV/AIDS (19.9%) Road injuries (20.5%) 2 Tuberculosis (19.3%) Interp ersonal violence (16.2%) 3 Lower respiratory infections (14.7%) Accidental threats to breathing (10.7%) 4 Road injuries (10.3%) Tuberculosis (10.2%) 5 Diarrhoeal diseases (5.1%) Lower respiratory infections (6.2%)

15-24 6 Interpersonal vio lence (4.3%) HIV/AIDS (5.7%) 7 Endocrine nutritional,blood, immune (3.1%) Drowning (5.1%) 8 Meningitis/encephalitis (2.7%) Mechanical forces (3.8%) 9 Cardiomyopathy (2.6%) Fires, hot substances (2.9%) 10 Indirect maternal (2.4%) Epilepsy (2.3%) 1 HIV/AIDS (16.6%) Tuberculosis (18.2%) 2 Tuberculosis (14.7%) Lower respiratory infections (14.0%) 3 Lower respiratory infections (13.7%) HIV/AIDS (12.5%) 4 Cerebrovascular disease (5.9%) Road injuries (6.6%) 5 Diarrhoeal diseases (4.9%) Ischaemic heart disease (5.6%)

25-64 6 Hypertensive heart disease (4.7%) Cerebrovascular disease (4.4%) 7 Diabetes mellitus (4.2%) Diarrhoeal diseases (3.3%) 8 Ischaemic heart disease (3.3%) Nephritis/nephrosis (2.6%) 9 Endocrine nutritional,blood, immune (3.1%) Hypertensive heart disease (2.5%) 10 Road injuries (3.0%) Accidental threats to breathing (2.4%) 1 Cerebrovascular disease (17.0%) Ischaemic heart disease (14.5%) 2 Ischaemic heart disease (12.9%) Cerebrovascular disease (11.9%) 3 Hypertensive heart disease (12.4%) Lower respiratory infections (10.0%) 4 Diabetes mellitus (8.1%) Hypertensive heart disease (6.6%) 5 Lower respiratory infections (8.0%) Prostate (5.1%)

65+ 6 Nephritis/nephrosis (4.1%) COPD (5.1%) 7 Diarrhoeal diseases (3.7%) Tuberculosis (5.0%) 8 Endocrine nutritional,blood, immune (2.3%) Diabetes mellitus (5.0%) 9 Tuberculosis (2.2%) Nephritis/nephrosis (4.1%) 10 COPD (2.0%) Diarrhoeal diseases (2.8%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (36.3%) n=27 HIV/AIDS (21.6%) n=1 122 2 Other maternal (26.6%) n=19 Tuberculosis (18.5%) n=964 3 Hypertension in pregnancy (16.1%) n=12 Lower respiratory infections (16.1%) n=838 4 Maternal haemorrhage (8.8%) n=6 Diarrhoeal diseases (5.4%) n=278 5 Maternal sepsis (6.1%) n=4 Road injuries (4.5%) n=232

15-49 6 Abortion (6.1%) n=4 Endocrine nutritional,blood, immune (3.4%) n=175 Female 7 Cerebrovascular disease (2.7%) n=143 8 Meningitis/encephalitis (2.7%) n=143 9 Nephritis/nephrosis (2.2%) n=114 10 Cervix (2.0%) n=102

360 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Mafube SD Indicator - 92.5 6.8 64.4 82.4 56.5 99.2 Numerator - 160 51 656 1 205 10 076 740 Denominator 749 173 746 1 019 17 541 213 924 746 Metsimaholo SD Indicator - 96.6 5.7 64.3 43.9 39.3 . Numerator - 368 114 1 388 1 620 18 821 1 245 Denominator 1 988 381 2 013 2 157 44 270 574 776 2 013 Moqhaka SD Indicator 261.7 90.5 5.8 65.1 35.6 177.0 58.2 Numerator 6 351 129 1 421 1 563 86 884 1 301 Denominator 2 293 388 2 237 2 182 52 668 588 939 2 237 Ngwathe SD Indicator 131.3 88.4 6.8 68.0 50.4 59.4 92.7 Numerator 2 313 104 1 235 1 662 21 952 1 418 Denominator 1 523 354 1 529 1 816 39 589 443 250 1 529 Fezile Dabi Indicator 122.1 92.0 6.1 65.5 47.1 90.8 72.1 Numerator 8 1 192 398 4 700 6 050 137 732 4 704 Denominator 6 553 1 296 6 525 7 174 154 068 1 820 889 6 525 Free State Indicator 152.8 94.2 5.9 65.8 54.2 66.8 71.2 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual FS,trends DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

361 Section B: NationalProfile Free and State District Province Profiles

Child and School Health Annual trends FS, DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

Measure Names 100 IndValue 57.1 51.5 61.5 55.4 59.5 58.0 52.5

5 378 Child under 5 Prov_av 11 598 11 083 11 646 39 705 years diarrhoea 108 462 271 566 253 422253 859 908 50 case fatality rate ZA_av months Vitamin A dose 12-59

coverage (%) coverage 0

7.1 30 166 570 289 299 12.1 27.8 19.8 15.5 Child under 5 20.9 30.3 2 341 2 724 1 324 1 077 3_Child and school health school and 3_Child years 20

102 444 102 pneumonia case fatality rate 10 8 screening coverage (%) coverage

School Grade 0 60 1_Impact

20 Child under 5 0.6 9.8 742 321 429 13.1 21.3 33.1 26.5 33.0 years severe 40 1 512 3 146 1 621 3 287 2 395 226 458 3 485 3 acute

138 468 malnutrition 20 case fatality rate

1 screening 0 coverage (%) coverage School Grade

Output Inpatient early 20 97.8 89.1 73.6 88.9 96.2 2 214 7 768 105.8 108.3 1 960 1 neonatal death 27 159 12 504 31 935 rate

dose 10 nd Measles Measles 2 0 coverage (%) coverage 150

rd Immunisation 810 551 1 128 829 47.1 47.0 47.8 41.6 60.5 46.2 43.2

1 874 coverage under 1 765 100 1 year Infant Infant

DTaP-IPV- 50 exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) Infant 80 exclusively

899 breastfed at 60 93.4 59.3 69.8 69.9 72.8 82.3 84.2 1 576 5 943 3 254 DTaP-IPV-Hib- 11 556 911 32 016 25 971 32 442 2 260 33 228 40 101 985 6 810 104 826 HBV 3rd dose (%) rate 20 coverage under 1 year Immunisation Immunisation

3_Output 150 2 1 886 1 064 2 466 5 7 1 582 1 15 1.4 1.4 1.3 1.3 0.6 0.8 2.5 Measles 2nd 351 166 259 277 dose coverage 100 1 053 (%) 50 Outcome around 10 Infant PCR weeks rate test positive positive test 100 2 8 School Grade 1 11 91 70 1.3 5.5 screening 10.7 14.3 12.4 13.9

30.5 50 cover age

0 (per1K) neonatal neonatal Inpatient Inpatient death rate 2009 2010 2011 2012 2013 2014 2015 2016 Year 8 - - 11 74 55 Measure Names 9.9 5.5 749 749 11.4 11.3 10.7 24.0 1 523 1 523 1 988 1 988 6 5536 553 6 IndValue P rov_av (per1K)

Inpatient Inpatient ZA_av death rate early neonatal neonatal early 5 13 19 7.4 6.1 1.5 4.4 5.5 2.5 175 140 103 770 339 10.0 1 025 2 293 2 293 2 309 Inpatient Inpatient year rate (%) death under 5 4 19 10 67 96 6.6 6.3 8.3 3.2 125 129 286 636 11.6 15.1 14.9 1 114 mpact I Inpatient Inpatient year rate (%) death under 1 7 3 4 3 17 18 27 53 69 9.6 4.3 8.0 167 16.7 14.8 13.2 10.2 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 1 1 1 16 19 37 29 54 7.3 1.9 2.7 3.4 2.0 3.2 142 262 11.3 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 1 2 - - - - 81 50 33 1.2 0.6 2.0 2.0 2.8 172 336 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Indicator Denominator Denominator Denominator Numerator Denominator Numerator Numerator Numerator Indicator Indicator Indicator Indicator Numerator Denominator

Fezile Dabi Moqhaka SD Moqhaka Ngwathe SD Indicator Metsimaholo SD Metsimaholo Mafube SD Free State South Africa South Source: HIS.

362 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

HIV Annual trends FS, DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

60 Measure Names 593 300 IndValue 27.4 37.9 19.0 15.8 12.3 12.8 22.0 4_HIV 1 111 4 659 2 655 HIV testing 40 Prov_av 841 137 841 551 280 887 580 845 580 coverage (including ANC) ZA_av 20 (per1K) 2016/17 Medical male male Medical

circumcision rate rate circumcision 200

Male condom 47.5

18.5 distribution 40.6 42.5 66.9 30.5 100 145.6 coverage 616 800 242 322 764 280 753 555 753 509 964 509 9 146 0009 146 4_Process_input 1 725 600

2016/17 80 distribution distribution Male condom condom Male

coverage (No) 60 Medical male circumcision 40 rate 20 27.7 27.7 26.8 35.9 29.2 22.5 26.2 9 944 27 477 19 436 79 663 664 12 400 22 806 000 1 176 0

3 654 993 2 270 121 2 544 420 2009 2010 2011 2012 2013 2014 2015 2016 (%) 90-90-90

2016/17 Year coverage st HIV testing 1 Measure Names Process & input (including ANC) IndValue - 374 1 189 - - - 842 037 - - - - - 703 1 214 - - 408 879 - P rov_av 8.1 9.5 8.2 ZA_av 7 027 86 682 86 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 58.6 65.5 35 007 53 436 2016/17 on ART rate (%) Clients remaining - 81 61 76 50 86 66 35 45 212 288 77.8 77.8 76.7 75.3 73.6 65.8 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------71.6 77.2 70.7 72.3 72.8 70.2 2 115 2 145 7 207 1 853 1 094 2015 months (%) on ART after 12 Adult percentageAdult - 12 13 19 16 24 25 29 22 60 100 68.1 66.7 52.0 60.0 54.5 65.5 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------783 640 845 644 87.5 91.6 90.0 90.0 89.5 90.2 2 912 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 24 25 29 58 22 64 33 45 100 200 41.4 59.7 75.8 50.0 45.3 48.9 (%) 2015 Child with viral load completion completion load rate at months 12 ------814 61.1 79.1 49.7 65.7 53.4 58.8 4 951 1 288 1 466 1 383 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Denominator Denominator Indicator Numerator Numerator Numerator Indicator Denominator Indicator Denominator Denominator Indicator Numerator Indicator Numerator Indicator

Ngwathe SD Fezile Dabi South Africa South Moqhaka SD Moqhaka Free State Metsimaholo SD Metsimaholo Mafube SD Source: HIS.

363 Section B: NationalProfile Free and State District Province Profiles

TB Annual trends FS, DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

Measure Names 15 IndValue 5_TB 37.7 47.8 51.6 51.5 45.1 53.0 43.3

71 492 Prov_av 98 772 86 695 TB death rate 149 451 264 674 228 164 136 369 136 871 968

393 328 10 (ETR.net) ZA_av

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact - 229 679 ------TB DR client 40 91.2 88.7 72.8 death rate 1 612 1 767 (EDRWeb) 20

2016 0 Output rate (%) 15 on treatment treatment on TB client initiated TB client lost to 10 follow up rate 110 476 351 122 279 509 466 443 (ETR.Net) 95.1 89.7 79.5 90.3 93.5 88.3 90.2 5 1 448 1 308 0 2016

Net) (%) Net) 80 TB/HIV co- TB client ART rate (ETR. treatment infected client on success rate 60 ------(ETR.net) 73 108 67.6 74.4

68.0 40

2016 TB DR client treatment treatment loss to follow up 20 TB Rifampicin Rifampicin TB

resistant clients clients resistant rate (EDRWeb) initiation rate (%) rate initiation ------0 6.1 5.2 6.2 108

1 767 60 2_Outcome TB DR treatment 40 2016

rate (%) success rate

resistance resistance (EDRWeb) 20 TB Rifampicin Rifampicin TB confirmed client confirmed client 0 ------97 50 51.5 50.5 45.8 TB Rifampicin 20 resistance confirmed client 10 2014 rate Outcome

success rate rate success 0 (EDRWeb) (%)

TB DR treatment treatment DR TB 100 ------TB/HIV 97 22 17.9

22.7 co-infected 23.5 client on ART 50 rate (ETR.Net)

2014 0 100 (EDRWeb) (%) to follow up rate TB DR client loss TB symptom 5 years and older screened in 50 415 743 576 242 190 577 552 680 77.4 81.0 74.3 80.1 72.0 84.9 78.5

2 241 facility rate 1 734

4_Process_input 0

2015 2009 2010 2011 2012 2013 2014 2015 2016 TB client client TB treatment treatment Year success rate rate success (ETR.net) (%) Measure Names IndValue 4 57 26 22 1.7 4.9 9.9 6.4 5.6 3.5 3.2 743 576 242 109 680 P rov_av 2 241 ZA_av 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------97 22 22.7 23.0 25.3 2014 death rate TB DR client (EDRWeb) (%) mpact I 47 91 64 9.4 6.6 743 142 576 242 680 344 19.1 15.4 19.4 15.8 10.5 2 241 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Indicator Denominator Denominator Indicator Numerator Numerator Indicator Numerator Denominator Indicator Indicator Numerator Indicator Denominator

Fezile Dabi Ngwathe SD Moqhaka SD Moqhaka Metsimaholo SD Metsimaholo South Africa South Free State Mafube SD Source: HIS.

364 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Mafube SD Indicator 0.8 17.3 Numerator 49 288 Denominator 748 512 200 247 Metsimaholo SD Indicator 1.3 22.4 Numerator 210 968 Denominator 1 952 016 518 514 Moqhaka SD Indicator 1.3 18.4 Numerator 227 987 Denominator 2 083 365 644 325 Ngwathe SD Indicator 4.7 55.5 Numerator 613 2 125 Denominator 1 557 810 459 522 Fezile Dabi Indicator 2.1 28.8 Numerator 1 099 4 368 Denominator 6 341 703 1 822 608 Free State Indicator 2.4 26.4 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual trends FS, DC20, Fezile Dabi District Municipality, SEQ 4 (well off)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

365 Section B: NationalProfile Free and State District Province Profiles

Mangaung Metropolitan Municipality (MAN)

Mangaung Metro is located in the central interior of Free State Province and comprises three health sub-districts, namely Bloemfontein, Botshabelo and Thaba N’chu. The district has the largest population in the province at 807 160, with a population density of 128.4 people per km2. It falls in socio-economic Quintile 5, among the wealthiest districts. Estimated medical scheme coverage is 20.7%.

Social determinants of healtha Population per selected category

Unemployment ratea 22.7% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 37.2% under 1 year 14 050 14 278 14 565 14 776 No schooling 5.2% under 5 years 72 826 72 788 72 870 73 010 Matric 32.8% 05-09 years 73 687 73 482 73 131 72 905 Higher education 13.3% 10-14 years 70 126 71 345 72 461 73 205 Households 265 561 15-19 years 68 659 68 519 68 635 69 069 Female-headed households 41.4% 20-24 years 75 033 73 236 71 744 70 770 Formal dwellings 87.1% 25-29 years 75 921 75 836 75 426 74 519 Flush toilet connected to sewerage 66.7% 30-34 years 65 589 67 933 70 452 73 054 Weekly refuse removal 78.9% 35-39 years 58 039 58 677 58 949 58 920 Piped water inside dwellings 38.2% 40-44 years 50 024 50 793 51 695 52 624 Electricity for lighting 95.5% 45-49 years 44 955 45 143 45 214 45 365 Blue Drop water score 60.2% 50-54 years 37 324 38 420 39 496 40 364 55-59 years 31 268 31 569 31 941 32 459 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 26 251 26 627 26 934 27 204 65-69 years 19 947 20 537 21 116 21 621 70-74 years 14 347 14 667 15 008 15 398 75-79 years 7 041 7 109 7 171 7 224 80 years and older 6 263 6 241 6 225 6 211 Total 786 925 791 490 795 927 800 201 Estimated pregnant women* 16 074 15 985 16 112 16 228 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

366 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Bloemfontein SD 9 30 2 1 0 2 16 Botshabelo SD 5 13 0 1 0 0 0 Thaba N'chu SD 8 12 0 1 0 0 1 Mangaung 22 55 2 3 0 2 17 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Mangaung 323 1 045 313 958 273 78 11 28 24 6 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bloemfontein SD Indicator 1.6 - - - - - Numerator 853 136 - - - - - Denominator 6 537 768 - - - - - Botshabelo SD Indicator 2.7 - - - - - Numerator 451 198 - - - - - Denominator 1 976 466 - - - - - Thaba N'chu SD Indicator 2.2 - - - - - Numerator 218 212 - - - - - Denominator 1 183 116 - - - - - Mangaung Indicator 1.9 23.4 72.3 1 801 1080 454 Numerator 1 522 546 11 34 1 152 794 625 691 096 216 691 096 216 Denominator 9 697 350 47 47 639 930 639 930 1 522 546 Free State Indicator 2.2 34.8 78.5 1 665 1 046 403 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

367 Section B: NationalProfile Free and State District Province Profiles ------Annual trends 20.3 28.3 28.3 28.3 FS, MAN, Mangaung Metropolitan Municipality, SEQ 5 (least deprived) 24 367 24 367 85 988 85 988

(%) 8 Measure Names OPD new client not not client IndValue referred rate rate referred Inpatient crude 6 Prov_av ------death rate ZA_av 5.4 3.6 3.6 3.6 1_Impact 4 1 852 1 852 51 037 1_Management 51 037 2

rate (%) 8 Inpatient Inpatient crude death 6

- Average length 0 0 ------of stay (district 4 84.3 hospitals) 315 267 315 267

(%) 2 utilisation rate - total

Inpatient bed 4K

2_Outcome Expenditure per ------patient day 3K Tertiary/Central Hospital 5 122 5 122 5 122

4 227 equivalent (district 2K 424 595 424 595 day hospitals) (Rand) 1K equivalent equivalent per patient Expenditure 2 174 850 382 2 174 2 174 850 382 2 174 ------6.9 6.2 6.2 6.2 Inpatient bed 100 utilisation rate 51 037 51 037 315 267 315 267 (district (Days)

Average hospitals) length of of length

stay - total 50 ------100 3_Output 29.1 37.2 OPD new client

(%) not referred rate 50 (district OPD new client not not client

referred rate rate referred hospitals) 5 ------0 6.3 100

rate (%) Percentage Inpatient Inpatient 50 crude death Ideal clinics ------

78.3 0 3K (%) Provincial and ospital

H LG District utilisation rate - total

Inpatient bed Health Services 2K

Regional Hospital Regional expenditure per ------capita (uninsured) 2 951

2 894 1K day (Rand) equivalent equivalent per patient Provinc ial and 1500 Expenditure

4_Process_input LG PHC ------expenditure per 1000 5.1 5.3 capita (uninsured) 500 (Days) Average length of of length stay - total

Provincial and 400 LG PHC 64.1 71.2 65.4 20.8 59.3 86.9 expenditure per 3 173 15 281 79 154 24 083 23 502 23 27 044 36 829 PHC headcount

(%) 200 OPD new client not not client referred rate rate referred 2008 2010 2012 2014 2016 2018 Year 7.6 7.5 5.1 6.6 5.5 6.9 488 448 8 214 1 154 6 401 Measure Names 2 090 50 758 30 101 15 486 15 IndValue rate (%)

Inpatient Inpatient P rov_av crude death ZA_av - - - - 67.4 78.7 65.4 60.7 64.2 104.5 35 811 32 315 113 574 (%) utilisation rate - total Inpatient bed District Hospital District 2 369 2 940 2 556 2 568 2 538 2 604 72 625 46 887 52 068 171 580 day (Rand) equivalent equivalent per patient 137 853137 198 123 339123 647 446 848 862 Expenditure 4.4 5.6 3.8 3.9 2.9 3.3 8 214 6 401 35 811 32 315 30 101 15 486 15 45 449 656 185 017 45 449 113 574 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Numerator Denominator Indicator Indicator

Mangaung Mangaung Thaba N'chu SD Botshabelo SD Botshabelo Bloemfontein SD Bloemfontein Free State South Africa South Source: HIS and BAS.

368 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 17 12 31 21 21 27 54 398 12 763 596 175 Total District District 14 19 16 27 26 53 311 124 128 424 595 tertiary Central/ hospital - - 2016/17 Hospital Regional Regional 1 - 74 171 580 District District Hospital - 4 - - 1 - - 4 - - 2 - - 3 - - 3 - 9 ------5 - - 2 090 - 1 852 3 942 13 2 623 5 443 - 4 697 / MOU PHC / CHC 17 15 61 29 43 30 168 381 3 921 1 248 13 557 582 119 Total District District 11 14 12 20 20 23 60 36 154 293 5 116 405 490 tertiary Central/ Hospital ------1 08 2015/16 Hospital Regional Regional 14 15 78 360 5 110 176 629 District District Hospital --- - - 1 - - 7 - - 7 - - - 4 - - - 5 - 10 780 3 331 / MOU PHC / CHC 17 52 42 29 29 34 34 154 364 1 419 4 334 - 2 096 - 1 825 14 740 712 084 Total District District 19 16 23 42 23 32 144 123 258 2 074 530 712 tertiary Central/ Hospital - - 5 577 ------2014/15 Hospital Regional Regional 11 10 13 10 23 92 294 5 137 181 371 District District Hospital - 2 - - - - - 6 - - - 9 - 8 - - 2 260 - 1 14 4 026 1 002 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

369 Section B: NationalProfile Free and State District Province Profiles

PercentageFS, Mangaung: of deaths MAN, by 2010 broad - 2015cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 71% 7% 18% 4% 70% 7% 17% 6% causes and 5-14 21% 21% 32% 26% 26% 22% 22% 29% single leading 15-24 21% 43% 20% 16% 10% 19% 12% 59% causes 25-64 18% 34% 43% 4% 16% 34% 36% 14% 65+ 15% 3% 80% 3% 14% 5% 77% 3% Broadcause 21% 21% 53% 5% 19% 24% 44% 13% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (16.0%) Lower respiratory infections (14.3%) HIV and TB 2 Preterm birth complications (12.6%) Preterm birth complications (14.1%) Comm_mat_peri_nut 3 Diarrhoeal diseases (12.5%) Diarrhoeal diseases (12.8%) 4 Protein-energy malnutrition (8.0%) Protein-energy malnutrition (9.8%) Prov, District 5 Birth asphyxia (6.6%) Birth asphyxia (6.8%) FS, Mangaung: MAN 6 Sepsis/other newborn infectious (6.2%) Sepsis/other newborn infectious (5.2%) Show history

<5 years <5 7 HIV/AIDS (5.5%) HIV/AIDS (4.8%) 8 Septicaemia (4.7%) Septicaemia (3.9%) Percentages are shown 9 Congenital heart anomalies (3.9%) Congenital heart anomalies (3.8%) according to all the deaths 10 Other congenital abnormalities (2.4%) Other perinatal conditions (2.3%) within the age/gender 1 Tuberculosis (12.3%) HIV/AIDS (14.5%) category of each box, 2 HIV/AIDS (11.0%) Drowning (11.7%) although only the leading 3 Lower respiratory infections (8.0%) Tuberculosis (9.9%) 10 causes are displayed. 4 Fires, hot substances (7.2%) Lower respiratory infections (8.1%) 5 Diarrhoeal diseases (4.7%) Diarrhoeal diseases (6.3%)

5-14 6 Accidental threats to breathing (4.6%) Fires, hot substances (5.3%) 7 Drowning (3.9%) Accidental threats to breathing (5.1%) 8 Road injuries (3.4%) Meningitis/encephalitis (4.5%) 9 Other neurological conditions (3.4%) Road injuries (3.9%) 10 Endocrine nutritional,blood, immune (3.1%) Epilepsy (3.2%) 1 HIV/AIDS (23.3%) Interpersonal violence (26.8%) 2 Tuberculosis (20.8%) Tuberculosis (10.9%) 3 Lower respiratory infections (8.8%) Accidental threats to breathing (10.4%) 4 Accidental threats to breathing (4.2%) Mechanical forces (9.7%) 5 Interpersonal violence (2.6%) HIV/AIDS (8.5%)

15-24 6 Mechanical forces (2.6%) Road injuries (5.5%) 7 Diarrhoeal diseases (2.6%) Fires, hot substances (5.1%) 8 Fires, hot substances (2.6%) Lower respiratory infections (4.2%) 9 Indirect maternal (2.2%) Drowning (2.3%) 10 Adverse effects medical/surgical (2.1%) Diarrhoeal diseases (2.2%) 1 HIV/AIDS (18.6%) Tuberculosis (18.4%) 2 Tuberculosis (15.8%) HIV/AIDS (15.9%) 3 Lower respiratory infections (9.2%) Lower respiratory infections (9.3%) 4 Cerebrovascular disease (6.6%) Cerebrovascular disease (5.2%) 5 Diarrhoeal diseases (3.8%) Interpersonal violence (3.9%)

25-64 6 Cervix (3.0%) Ischaemic heart disease (3.4%) 7 Diabetes mellitus (2.9 %) Nephritis/nephrosis (3.0%) 8 Nephritis/nephrosis (2.9%) Diarrhoeal diseases (2.9%) 9 Breast (2.7%) Mechanical forces (2.6%) 10 Hypertensive heart disease (2.4%) Accidental threats to breathing (2.3%) 1 Cerebrovascular disease (18.2%) Ischaemic heart disease (12.0%) 2 Hypertensive heart disease (9.2%) Cerebrovascular disease (11.9%) 3 Lower respiratory infections (8.6%) Lower respiratory infections (8.7%) 4 Ischaemic heart disease (8.3%) COPD (5.9%) 5 Diabetes mellitus (5.8%) Nephritis/nephrosis (4.8%)

65+ 6 Nephritis/nephrosis (5.1%) Hypertensive heart disease (4.6%) 7 COPD (3.0%) Prostate (4.6%) 8 Diarrhoeal diseases (3.0%) Tuberculosis (3.9%) 9 Septicaemia (2.6%) Diabetes mellitus (3.7%) 10 Breast (2.2%) Trachea/bronchi/lung (3.1%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (41.2%) n=72 HIV/AIDS (24.9%) n=2 391 2 Other maternal (26.2%) n=46 Tuberculosis (20.8%) n=1 997 3 Hypertension in pregnancy (17.9%) n=31 Lower respiratory infections (10.5%) n=1 011 4 Maternal sepsis (6.0%) n=11 Diarrhoeal diseases (4.3%) n=415 5 Maternal haemorrhage (4.7%) n=8 Cerebrovascular disease (3.1%) n=294

15-49 6 Abortion (4.1%) n=7 Endocrine nutritional,blood, immune (2.4%) n=228 Female 7 Nephritis/nephrosis (2.3%) n=220 8 Cervix (2.2%) n=213 9 Meningitis/encephalitis (2.1%) n=202 10 Breast (1.8%) n=173

370 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bloemfontein SD Indicator 305.5 94.4 4.9 61.8 40.0 41.8 45.3 Numerator 27 1 324 443 4 184 5 464 68 761 4 063 Denominator 8 838 1 402 8 971 6 766 164 048 1 972 101 8 971 Botshabelo SD Indicator - 96.2 3.9 66.8 70.8 50.2 92.1 Numerator - 501 106 2 077 2 782 23 375 2 491 Denominator 2 682 521 2 704 3 107 47 149 558 816 2 704 Thaba N'chu SD Indicator - 93.5 3.5 66.0 36.2 43.8 60.3 Numerator - 186 43 788 909 11 942 740 Denominator 1 243 199 1 227 1 194 30 094 327 408 1 227 Mangaung Indicator 211.5 94.8 4.6 63.7 45.5 43.7 56.5 Numerator 27 2 011 592 7 049 9 155 104 078 7 294 Denominator 12 763 2 122 12 902 11 067 241 290 2 858 325 12 902 Free State Indicator 152.8 94.2 5.9 65.8 54.2 66.8 71.2 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualFS, MAN, trends Mangaung Metropolitan Municipality, SEQ 5 (least deprived)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

371 Section B: NationalProfile Free and State District Province Profiles

Child and School Health Annual trends FS, MAN, Mangaung Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names 57.1 51.4 32.6

58.0 100 32.5 36.9 IndValue 5 185 14 567 44 451 24 699 24 191 124 913 272 Child under 5 Prov_av

1 444 656 years diarrhoea months 50 ZA_av Vitamin A

dose 12-59 case fatality rate coverage (%) coverage

0 150 661 594 11.1 17.7 19.8 12.5 10.2 30.3 6 503 6 3 363 340 260 30 134 628 Child under 5

3_Child and school health school and 3_Child years 20 8 screening

coverage (%) coverage pneumonia School Grade case fatality rate 10

24.1 0 24.7 33.1 16.9 33.0 55.2 1 121 4 547 1 246 2 259 1 353 4 064 1 405

10 024 60 201 960 201 1_Impact Child under 5 years severe 40 1 screening coverage (%) coverage School Grade acute malnutrition 20

Output case fatality rate 85.7 93.0 90.2 96.2 101.5 8 027 1 697 1 693 105.8 3 365 0 13 085 39 771 21 840 112 386 173 997 dose nd Measles Measles 2 20 coverage (%) coverage Inpatient early neonatal death

rd rate 10 892 41.6 67.6 45.0 45.9 46.2 48.2 1 412 3 136 3 193 1 320 6 954 11 410 0 Infant Infant

DTaP-IPV- 150 exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) Immunisation coverage under 100 67.0 75.0 69.5 82.3 63.9 84.2 1 year 1 150 5 953 9 440 5 497 19 857 37 392 111 798 169 047 (%) 50 coverage under 1 year Immunisation Immunisation Infant 80

5 2 337 exclusively - - 15 20 1.1 1.1 1.3 1.3 1.3

130 breastfed at 437 60 1 178 1 745 DTaP-IPV-Hib- HBV 3rd dose 40 (%) rate Outcome around 10 Infant PCR weeks rate 20 test positive positive test 3_Output

3 150 - - 1.1 179 182 14.3 14.3 12.4 20.3 Measles 2nd dose coverage 100 (per1K) neonatal neonatal Inpatient Inpatient death rate 50 3 - -

1.1 100 9.9 128 125 11.4 14.1 10.0 1 243 1 243

12 763 12 763 School Grade 1 screening 50 (per1K)

Inpatient Inpatient cover age death rate early neonatal neonatal early 0 3 4 4.7 0.7 4.4 0.3 6.9 5.5 403 227 234 2009 2010 2011 2012 2013 2014 2015 2016 3 300 8 838 8 838 Year Measure Names Inpatient Inpatient IndValue year rate (%) death under 5 P rov_av 3 3 ZA_av 9.7 6.4 0.3 2.3 6.3 8.3 213 130 207 2 127 1 049 1 322 2 682 2 682 3 306 5 025 mpact I Inpatient Inpatient year rate (%) death under 1 2 2 17 21 89 33 7.0 6.1 5.7 9.6 8.0 2.2 244 366 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 3 9 - - 12 78 1.6 1.6 1.9 2.0 3.2 748 184 486 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 1 17 15 59 1.7 0.9 2.8 2.0 2.8 3.5 110 602 433 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Denominator Indicator Numerator Denominator Numerator Indicator Denominator Indicator Numerator Numerator Indicator Denominator Indicator

Mangaung Mangaung Thaba N'chu SD Botshabelo SD Botshabelo Free State South Africa South Bloemfontein SD Bloemfontein Source: HIS.

372 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

HIV Annual trends FS, MAN, Mangaung Metropolitan Municipality, SEQ 5 (least deprived)

60 Measure Names 27.4 19.0 19.3 32.0 29.2 22.6 IndValue 1 106 3 973 6 702 1 623 4_HIV HIV testing

415 350 Prov_av 666 843 666 coverage 40 (including ANC) ZA_av (per1K) 2016/17 20 Medical male male Medical circumcision rate rate circumcision 200 47.5 27.8 26.1 28.0 30.3 42.5 Male condom 350 121 762 000 762 distribution 100 5 026 800 coverage 2016/17 4_Process_input distribution distribution Male condom condom Male coverage (No) 80 60

18.4 Medical male 26.6 26.8 22.0 35.9 22.5

9 236 40

69 156 circumcision 22 366 1 392 000 603 618 100 758 800 7 180 rate 5 377 209 3 072 282 3 558 825 20 (%) 90-90-90 2016/17 coverage st

HIV testing 0 1 Process & input (including ANC) 2009 2010 2011 2012 2013 2014 2015 2016 Year - - 1 008 186 550 773 - - - - - 3 765 405 388 2 171 632 2 476 - - 9.5 8.2

11.3 Measure Names

13 072 IndValue 115 557 P rov_av (%)

2016/17 ZA_av and older rate client years 15 (including ANC) HIV test positive ------57.8 55.0 58.6 80 226 46 342 2016/17 on ART rate (%) Clients remaining - 91 56 43 118 187 123 252 366 74.0 77.8 63.1 76.8 68.9 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage - - - - - 71.0 70.7 69.8 60.5 64.2 1 240 2 979 6 739 10 958 10 2015 months (%) on ART after 12 Adult percentageAdult - 12 19 50 46 30 35 77 115 67.0 68.1 70.0 65.2 63.2 (%) 2015 rate months 12 Child with viral load suppressed suppressed load - - - - - 423 91.6 92.1 92.7 89.9 89.5 2 196 3 624 1 005 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 19 28 46 50 90 115 107 225 51.1 51.1 67.9 59.7 46.7 (%) 2015 Child with viral load completion completion load rate at months 12 - - - - - 675 62.7 50.4 65.7 56.8 59.2 3 712 6 381 1 994 1 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Denominator Numerator Indicator Numerator Denominator Indicator Denominator Numerator Indicator Denominator Indicator Indicator Numerator

Mangaung Mangaung Thaba N'chu SD Botshabelo SD Botshabelo South Africa South Free State Bloemfontein SD Bloemfontein Source: HIS.

373 Section B: NationalProfile Free and State District Province Profiles

TB Annual trends FS, MAN, Mangaung Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names 15 51.6 49.1 63.1 52.9 58.0 53.0 IndValue 5_TB

92 504 Prov_av 199 461 199 719 902 745 945 745 188 334 376 902 TB death rate 10 (ETR.net) ZA_av

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact ------453 980 -

87.2 40 88.7 72.8 TB DR client 3 314 3 800 1 285 138 death rate (EDRWeb) 20 2016 Output rate (%) 0 on treatment treatment on

TB client initiated 15

TB client lost to 10 211 523 263 650 87.4 89.7 80.5 90.8 80.2 88.3 follow up rate 2 781 2 431 1 697 1 868 1 (ETR.Net) 5

2016 0 Net) (%) Net) TB/HIV co- ART rate (ETR.

infected client on 80 TB client treatment ------success rate 60 129 184 70.1 74.4 68.0 (ETR.net) 40

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

initiation rate (%) rate initiation TB DR client loss to follow up 20 ------rate (EDRWeb) 4.8 5.2 6.2 184 3 800 0

2016 60 2_Outcome rate (%)

resistance resistance TB DR

TB Rifampicin Rifampicin TB treatment 40 confirmed client confirmed client success rate (EDRWeb) 20 ------52 143 36.4 50.5 45.8 0

2014 TB Rifampicin 20 Outcome resistance success rate rate success (EDRWeb) (%) confirmed client TB DR treatment treatment DR TB 10 rate ------

32 0 143 17.9 22.4 23.5 100

TB/HIV

2014 co-infected client on ART 50 (EDRWeb) (%)

to follow up rate rate (ETR.Net) TB DR client loss 0 391 499 946 100 81.9 81.0 81.5 80.1 78.4 84.4 1 121 3 010 3 791 2 454 2 4 630 TB symptom 5 years and older 2015 screened in 50 TB client client TB treatment treatment facility rate success rate rate success (ETR.net) (%)

4_Process_input 0

13 2009 2010 2011 2012 2013 2014 2015 2016 24 7.0 2.1 6.4 2.6 5.6 9.5 499 285 322

3010 Year 1 121 4 630 Measure Names IndValue 2015 P rov_av TB client loss (ETR.Net) (%) (ETR.Net)

to follow up rate ZA_av ------50 143 35.0 23.0 25.3 2014 death rate TB DR client (EDRWeb) (%) mpact I 77 7.7 9.3 6.6 122 231 499 430 15.4 10.9 10.5 1 121 3 010 4 630 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Numerator Denominator Indicator Indicator Indicator

Mangaung Mangaung Thaba N'chu SD Botshabelo SD Botshabelo Bloemfontein SD Bloemfontein South Africa South Free State Source: HIS.

374 SectionSection B: NationalB: Profile andFree DistrictState Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Bloemfontein SD Indicator 2.3 34.1 Numerator 1 278 5 122 Denominator 6 537 768 1 802 334 Botshabelo SD Indicator 4.7 46.9 Numerator 782 1 962 Denominator 1 976 466 502 068 Thaba N'chu SD Indicator 1.0 21.8 Numerator 101 617 Denominator 1 183 116 340 401 Mangaung Indicator 2.7 34.9 Numerator 2 161 7 701 Denominator 9 697 350 2 644 803 Free State Indicator 2.4 26.4 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualFS, MAN, trends Mangaung Metropolitan Municipality, SEQ 5 (least deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

375