10 (Section B) Gauteng Province DHP20172018

Home , Boipatong, Bophelong, Evaton, Ratanda, Sebokeng, Sharpeville

Section B: DistrictProfile GautengHealth Profiles Province

10 Gauteng Province

Sedibeng District Municipality (DC42)

Overview of the district The Sedibeng District Municipalitya is a Category C municipality situated on the southern tip of the Gauteng Province and strategically located on the border of three other provinces, namely Free State, North West and Mpumalanga. The municipality is the only area in the province that is situated on the banks of the Vaal River and Vaal Dam, covering the area formerly known as the Vaal Triangle. The municipality is a stone’s throw from Johannesburg along the scenic Vaal, Klip and Suikerbos Rivers. It is comprised of the Emfuleni, Lesedi and Midvaal Local Municipalities and includes the historic townships of Evaton, Sebokeng, Boipatong, Bophelong, Sharpeville and Ratanda, which have a rich political history and heritage. It has a variety of attractions offering a vast cultural heritage and historical experience. The Sedibeng region boasts several heritage sites related to the South African War of 1899–1902 and the two World Wars that followed. The Sharpeville Memorial Precinct stands as a reminder of the Sharpeville Massacre of 21 March 1960 when 69 people lost their lives while protesting the pass laws of the then apartheid South Africa. Sedibeng is the fourth-largest contributor to the Gauteng economy. The predominant economic sector in the district is the manufacturing of fabricated metal and chemicals. In the metal sector, the Arcelor-Mittal Steel plant, the Cape Gate Davsteel Wire and Steel plant, and the Ferromanganese plant of Samancor are the three main large baseline plants in the district, while DCDDorbyl Heavy Engineering is the biggest manufacturer of engineered products in Southern Africa. Area: 4 173km² Population (2016)b: 961 306 Population density (2016): 230.4 persons per km2 Estimated medical scheme coverage: 21.2% Cities/Towns: De Deur/Walkerville, Devon, Eikenhof, Evaton, Heidelberg, Meyerton, Nigel, Sebokeng, Vaal Marina, Vaal Oewer, Vanderbijlpark, Vereeniging, Vischkuil. Main Economic Sectors: Manufacturing (30.8%), government (17.8%), business services (17.8%), trade (13.7%).

Population distribution, local municipality boundaries and health facility locations

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

254 SectionSection B: ProfileB: District Gauteng Health Province Profiles

DistrictSedibeng population DM (DC42) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 15 618 21 199 24 885 32 990 60-64 years 12 426 13 198 16 599 18 257 55-59 years 17 174 16 944 20 538 21 915 50-54 years 21 838 22 102 23 459 24 298 45-49 years 25 770 25 925 27 230 27 137 40-44 years 28 644 28 407 32 556 31 395 35-39 years 32 797 31 807 37 596 36 781 30-34 years 37 978 36 159 39 730 39 390 25-29 years 40 815 40 333 46 547 44 880 20-24 years 38 665 39 858 43 284 41 991 15-19 years 40 221 40 636 37 180 36 601 10-14 years 37 526 37 026 39 824 39 525 05-09 years 36 349 35 657 42 943 43 003 00-04 years 41 212 40 745 45 788 44 984

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

2006 2016

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

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.8% 2.5% 2.6% 3.4% 60-64 years 1.4% 1.5% 1.7% 1.9% 55-59 years 2.0% 2.0% 2.1% 2.3% 50-54 years 2.5% 2.6% 2.4% 2.5% 45-49 years 3.0% 3.0% 2.8% 2.8% 40-44 years 3.3% 3.3% 3.4% 3.3% 35-39 years 3.8% 3.7% 3.9% 3.8% 30-34 years 4.4% 4.2% 4.1% 4.1% 25-29 years 4.8% 4.7% 4.8% 4.7% 20-24 years 4.5% 4.7% 4.5% 4.4% 15-19 years 4.7% 4.7% 3.9% 3.8% 10-14 years 4.4% 4.3% 4.1% 4.1% 05-09 years 4.2% 4.2% 4.5% 4.5% 00-04 years 4.8% 4.8% 4.8% 4.7%

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

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

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa Sedibeng DM (DC42) Show history

255 Section B: DistrictProfile GautengHealth Profiles Province

Social determinants of health

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

256 SectionSection B: ProfileB: District Gauteng Health Province Profiles

GP, Sedibeng: DC42 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history GP, Sedibeng: DC42 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 82% 7%7%4% 77% 5%11% 7% HIV and TB 5-14 36% 20% 14% 29% 28% 17% 18% 37% Comm_mat_peri_nut 15-24 30% 18% 16% 36% 22% 21% 17% 40% 25-64 32% 24% 34% 10% 22% 26% 39% 12% 65+ 16% 3% 79% 2% 15% 4% 78% 3% Total 34% 17% 41% 9% 24% 18% 48% 10%

Rank_.. 2006-2010 2011-2015 1 Diarrhoeal diseases (25.1%) Lower respiratory infections (20.2%) Percentages are shown 2 Lower respiratory infections (25.0%) Preterm birth complications (16.5%) according to all the 3 Preterm birth complications (15.1%) Diarrhoeal diseases (15.4%) deaths within the 4 HIV/AIDS (6.1%) Sepsis/other newborn infectious (8.3%) age/period category of 5 Birth asphyxia (5.9%) Birth asphyxia (6.7%) each box, although only 6 Protein-energy malnutrition (4.4%) HIV/AIDS (4.1%) the leading 10 causes are <5 years <5 Sepsis/other newborn infectious (2.1%) Protein-energy malnutrition (3.7%) 7 displayed. 8 Other perinatal conditions (1.7%) Other perinatal conditions (2.6%) 9 Meningitis/encephalitis (1.4%) Septicaemia (2.2%) 10 Accidental threats to breathing (1.3%) Fires, hot substances (2.2%) 1 Lower respiratory infections (18.0%) Lower respiratory infections (11.9%) 2 Tuberculosis (10.8%) Drowning (11.9%) 3 Diarrhoeal diseases (10.5%) Accidental threats to breathing (10.8%) 4 HIV/AIDS (10.3%) HIV/AIDS (9.2%) 5 Road injuries (9.2%) Tuberculosis (8.9%)

5-14 6 Drowning (5.9%) Other unintentional injuries (7.1%) 7 Meningitis/encephalitis (5.0%) Diarrhoeal diseases (6.5%) 8 Accidental threats to breathing (4.7%) Fires, hot substances (4.6%) 9 Fires, hot substances (4.5%) Epilepsy (4.0%) 10 Mechanical forces (3.2%) Meningitis/encephalitis (3.4%) 1 Lower respiratory infections (16.5%) Interpersonal violence (13.9%) 2 Interpersonal violence (12.2%) Lower respiratory infections (11.5%) 3 Tuberculosis (11.5%) Tuberculosis (11.5%) 4 Road injuries (7.0%) HIV/AIDS (10.3%) 5 HIV/AIDS (6.9%) Accidental threats to breathing (9.8%) 6 Diarrhoeal diseases (6.2%) Mechanical forces (7.7%) 15-24 7 Mechanical forces (6.0%) Diarrhoeal diseases (3.6%) 8 Accidental threats to breathing (5.9%) Fires, hot substances (3.5%) 9 Meningitis/encephalitis (5.0%) Meningitis/encephalitis (3.1%) 10 Endocrine nutritional,blood, immune (1.8%) Epilepsy (2.2%) 1 Lower respiratory infections (19.5%) Tuberculosis (14.8%) 2 Tuberculosis (15.5%) Lower respiratory infections (13.4%) 3 HIV/AIDS (8.1%) HIV/AIDS (11.4%) 4 Diarrhoeal diseases (6.8%) Cerebrovascular disease (5.8%) 5 Ischaemic heart disease (4.8%) Ischaemic heart disease (5.6%) 6 Cerebrovascular disease (4.7%) Diarrhoeal diseases (3.7%) 25-64 7 Meningitis/encephalitis (3.8%) Mechanical forces (3.4%) 8 Hypertensive heart disease (3.1%) Diabetes mellitus (3.2%) 9 Diabetes mellitus (3.0%) Nephritis/nephrosis (3.0%) 10 Interpersonal violence (2.4%) Meningitis/encephalitis (2.9%) 1 Cerebrovascular disease (14.3%) Cerebrovascular disease (14.8%) 2 Ischaemic heart disease (14.2%) Ischaemic heart disease (14.3%) 3 Lower respiratory infections (10.4%) Lower respiratory infections (9.7%) 4 Hypertensive heart disease (9.1%) Hypertensive heart disease (7.7%) 5 Diabetes mellitus (6.6%) Diabetes mellitus (6.1%)

65+ 6 COPD (4.4%) COPD (4.2%) 7 Nephritis/nephrosis (4.0%) Nephritis/nephrosis (4.0%) 8 Diarrhoeal diseases (3.4%) Tuberculosis (3.0%) 9 Tuberculosis (2.4%) Diarrhoeal diseases (2.6%) 10 Prostate (1.9%) Septicaemia (2.1%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (36.6%) n=13 Indirect maternal (28.3%) n=36 2 Hypertension in pregnancy (27.2%) n=10 Other maternal (21.4%) n=27 3 Other maternal (14.9%) n=5 Maternal haemorrhage (17.0%) n=22 4 Maternal sepsis (12.2%) n=4 Hypertension in pregnancy (16.4%) n=21 15-49 Female 5 Abortion (9.0%) n=3 Abortion (12.2%) n=16 6 Maternal sepsis (4.8%) n=6

257 Section B: DistrictProfile GautengHealth Profiles Province

Women and maternal health

Source: DHIS.

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

258 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Child and school health

Source: DHIS.

259 Section B: DistrictProfile GautengHealth Profiles Province

HIV

Source: DHIS.

260 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

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

261 Section B: DistrictProfile GautengHealth Profiles Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

262 SectionSection B: ProfileB: District Gauteng Health Province Profiles

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

Sedibeng Emfuleni LM Lesedi LM LM Midvaal

Resuscitation room is equipped with functional basic equipment for resuscitation 89 92 75 100

Restore the emergency trolley daily or after every time it was used 92 88 100 100

Cold chain procedure for vaccines is maintained 97 96 100 100

90% of the tracer medicines are available 97 96 100 100

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

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

263 Section B: DistrictProfile GautengHealth Profiles Province 0.8% 0.0% 74.1% (4.4%) 36.0% (10.0%) (10.8%) (12.3%) (38.7%) % Overspent (underspent) 47 111 262 Provincial Provincial Expenditure Total 2017/18 0 417 571 51 0 7 465 377 14 390 057 274 24 229 803 271 95 261 792 420 55 893 218 113 00 421 379 634 12 172 00 172 12 58 789 37 Budget 437 084 1 417 969 0 417 126 578 6 126 168 626168 2 273 909 0 Total 2017/18

61 84 001 923 27 055 561 -36 890 6 Transfer to LG to Transfer

7 74 18 20 03 34 2017/18 Provincial Expenditure 7 465 377 51 571 41 571 51 113 893 2 113 390 057 2 261 792 4 421 379 6 229 8 271 Provincial

14 729 107 475 -80 673 9 Transfer to LG to Transfer 2017/18 Budget

12 172 000 172 12 58 789 370 437 084 114 417 969 000417 126 578 655126 168 626168 224 273 909 095 Provincial 1 495 128 458 -80 673 914 107 729 475 1 475 431 143 -36 890 661 84 001 923 1 522 184 019 1 522 542 405 al Government. *LG – Loc*LG

BAS,

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

264 SectionSection B: ProfileB: District Gauteng Health Province Profiles

West Rand District Municipality (DC48)

Overview of the district The West Rand District Municipalitya is a Category C municipality located in the west of the Gauteng Province. The West Rand extends from Randfontein (the seat of the district) in the west to Roodepoort in the east, and includes the town of Krugersdorp. It is bordered by Bojanala Platinum to the north-west, City of Tshwane to the north-east, City of Johannesburg to the east, Sedibeng to the south-east, and Dr Kenneth Kaunda to the south-west. It comprises three local municipalities: Merafong, Mogale and Rand West Cities. The municipality is situated relatively closely to the hub of economic activity in Gauteng and is transversed by major national roads, namely, the N12 and N14. Its main contribution lies primarily within the mining sector, however, areas such as Krugersdorp fulfil a residential function for many people working in Johannesburg. The West Rand remains the poorest region contributing to Gauteng’s Gross Domestic Product. The Cradle of Humankind falls under the jurisdiction of Mogale City and Merafong City and is a World Heritage Site. Area: 4 087km² Population (2016)b: 863 261 Population density (2016): 211.2 people per km2 Estimated medical scheme coverage: 23.3% Cities/Towns: Carletonville, Fochville, Krugersdorp, Magaliesburg, Muldersdrift, Randfontein, Wedela, Westonaria. Main Economic Sectors: Manufacturing (22%), mining (19%), community services (19%), finance (16%), trade (10%), transport (6%), construction (4%).

Population distribution, local municipality boundaries and health facility locations

265 Section B: DistrictProfile GautengHealth Profiles Province

DistrictWest populationRand DM pyramid(DC48) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 11 003 14 204 19 321 22 196 60-64 years 10 454 9 702 19 268 14 431 55-59 years 16 987 12 995 26 887 19 478 50-54 years 25 750 18 092 29 994 23 681 45-49 years 34 953 23 858 30 237 27 198 40-44 years 38 394 28 542 30 428 29 211 35-39 years 38 794 33 070 31 091 31 636 30-34 years 38 599 35 018 32 872 32 310 25-29 years 35 804 35 765 39 889 37 145 20-24 years 30 563 31 603 36 055 35 591 15-19 years 31 420 32 054 33 647 35 138 10-14 years 30 829 32 174 35 983 35 821 05-09 years 34 357 36 123 36 880 36 935 00-04 years 38 422 37 355 40 467 39 471

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

2006 2016

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

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.8% 2.2% 2.6% 60-64 years 2.2% 1.7% 55-59 years 2.1% 1.6% 3.1% 2.3% 50-54 years 3.2% 2.3% 3.5% 2.7% 45-49 years 4.4% 3.0% 3.5% 3.2% 40-44 years 4.8% 3.6% 3.5% 3.4% 35-39 years 4.9% 4.1% 3.6% 3.7% 30-34 years 4.8% 4.4% 3.8% 3.7% 25-29 years 4.5% 4.5% 4.6% 4.3% 20-24 years 3.8% 4.0% 4.2% 4.1% 15-19 years 3.9% 4.0% 3.9% 4.1% 10-14 years 3.9% 4.0% 4.2% 4.1% 05-09 years 4.3% 4.5% 4.3% 4.3% 00-04 years 4.8% 4.7% 4.7% 4.6%

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

Gender male female

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

Graph 1: District population pyramid 2006 and 2016 Graph 2: District % population by age-gender group in 2006 and 2016 compared to South Africa West Rand DM (DC48) Show history

266 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Social determinants of health

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

267 Section B: DistrictProfile GautengHealth Profiles Province

GP, West Rand: DC48 Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history GP, West Rand: DC48 Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 78% 12% 6%4% 67% 9% 16% 8% HIV and TB 5-14 37% 21% 13% 29% 24% 16% 25% 35% Comm_mat_peri_nut 15-24 25% 26% 13% 37% 17% 21% 17% 46% 25-64 26% 35% 28% 12% 17% 29% 38% 15% 65+ 15% 4% 78% 3% 12%3% 81% 4% Total 30% 25% 34% 10% 20% 19% 48% 12%

Rank_.. 2006-2010 2011-2015 1 Lower respiratory infections (24.9%) Lower respiratory infections (16.6%) Percentages are shown 2 Diarrhoeal diseases (24.6%) Diarrhoeal diseases (14.2%) according to all the 3 Preterm birth complications (11.6%) Preterm birth complications (11.9%) deaths within the 4 HIV/AIDS (10.2%) Birth asphyxia (8.2%) age/period category of 5 Birth asphyxia (5.4%) HIV/AIDS (7.6%) each box, although only 6 Protein-energy malnutrition (3.2%) Sepsis/other newborn infectious (4.8%) the leading 10 causes are <5 years <5 Sepsis/other newborn infectious (2.8%) Other perinatal conditions (4.0%) 7 displayed. 8 Other perinatal conditions (1.9%) Protein-energy malnutrition (3.7%) 9 Tuberculosis (1.9%) Congenital heart anomalies (2.6%) 10 Meningitis/encephalitis (1.6%) Poisonings (including herbal) (2.1%) 1 Lower respiratory infections (16.3%) Lower respiratory infections (11.2%) 2 Tuberculosis (12.1%) HIV/AIDS (9.8%) 3 Diarrhoeal diseases (11.3%) Accidental threats to breathing (9.1%) 4 HIV/AIDS (10.4%) Drowning (7.6%) 5 Road injuries (7.8%) Tuberculosis (7.5%)

5-14 6 Drowning (7.4%) Fires, hot substances (6.2%) 7 Meningitis/encephalitis (7.0%) Road injuries (5.7%) 8 Accidental threats to breathing (4.0%) Diarrhoeal diseases (5.2%) 9 Fires, hot substances (3.6%) Other unintentional injuries (4.3%) 10 Other unintentional injuries (2.3%) Leukaemia (3.8%) 1 Tuberculosis (15.8%) Interpersonal violence (15.0%) 2 Interpersonal violence (12.6%) Accidental threats to breathing (11.7%) 3 HIV/AIDS (10.3%) HIV/AIDS (10.8%) 4 Lower respiratory infections (10.2%) Tuberculosis (10.7%) 5 Accidental threats to breathing (7.3%) Lower respiratory infections (8.6%) 6 Road injuries (6.6%) Mechanical forces (7.2%) 15-24 7 Mechanical forces (6.5%) Road injuries (4.9%) 8 Diarrhoeal diseases (5.3%) Fires, hot substances (3.8%) 9 Meningitis/encephalitis (4.9%) Meningitis/encephalitis (3.3%) 10 Epilepsy (1.8%) Diarrhoeal diseases (2.2%) 1 Tuberculosis (20.6%) HIV/AIDS (15.6%) 2 HIV/AIDS (14.0%) Tuberculosis (13.9%) 3 Lower respiratory infections (13.8%) Lower respiratory infections (10.1%) 4 Diarrhoeal diseases (6.8%) Ischaemic heart disease (5.4%) 5 Cerebrovascular disease (4.0%) Cerebrovascular disease (4.6%) 6 Ischaemic heart disease (3.5%) Mechanical forces (3.5%) 25-64 7 Meningitis/encephalitis (3.0%) Accidental threats to breathing (3.1%) 8 Mechanical forces (2.7%) Interpersonal violence (2.9%) 9 Road injuries (2.6%) Diarrhoeal diseases (2.8%) 10 Interpersonal violence (2.5%) Diabetes mellitus (2.6%) 1 Ischaemic heart disease (15.3%) Ischaemic heart disease (16.6%) 2 Cerebrovascular disease (11.9%) Cerebrovascular disease (10.4%) 3 Lower respiratory infections (9.3%) Lower respiratory infections (7.6%) 4 Hypertensive heart disease (6.6%) Hypertensive heart disease (6.6%) 5 COPD (5.6%) COPD (5.7%)

65+ 6 Diabetes mellitus (4.9%) Diabetes mellitus (4.6%) 7 Diarrhoeal diseases (3.8%) Nephritis/nephrosis (3.8%) 8 Tuberculosis (3.5%) Alzheimer’s and other dementias (2.4%) 9 Nephritis/nephrosis (3.1%) Trachea/bronchi/lung (2.3%) 10 Cardiomyopathy (2.1%) Prostate (2.2%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (49.5%) n=18 Indirect maternal (36.3%) n=41 2 Hypertension in pregnancy (27.3%) n=10 Other maternal (23.6%) n=27 3 Maternal haemorrhage (13.3%) n=5 Hypertension in pregnancy (17.6%) n=20 4 Other maternal (9.9%) n=4 Maternal haemorrhage (13.8%) n=16 15-49 Female 5 Abortion (8.6%) n=10 6

268 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Women and maternal health

Source: DHIS.

269 Section B: DistrictProfile GautengHealth Profiles Province

Child and school health

Source: DHIS.

270 SectionSection B: ProfileB: District Gauteng Health Province Profiles

HIV

Source: DHIS.

271 Section B: DistrictProfile GautengHealth Profiles Province

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

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

272 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

273 Section B: DistrictProfile GautengHealth Profiles Province

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

West Rand Rand West Merafong City LM Mogale City LM Rand West City LM

Restore the emergency trolley daily or after every time it was used 63 64 44 81

Resuscitation room is equipped with functional basic equipment for resuscitation 88 93 72 100

The temperature of the medicine room/dispensary is maintained within the safety range 96 100 89 100

Cold chain procedure for vaccines is maintained 98 100 94 100

90% of the tracer medicines are available 100 100 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

274 SectionSection B: ProfileB: District Gauteng Health Province Profiles 3.1% 9.4% 5.0% 10.9% (8.6%) (3.0%) (11.0%) (16.2%) (140.1%) % Overspent (underspent) 3 666 764 Provincial Provincial 1 535 285 461 285 535 1 Expenditure Total 2017/18 0 93 796 228 8 106 391 703 11 230 282 708 70 263 354 006 68 980 371 194 00 463 967 350 4 012 0004 012 85 762 61 95 902 32 Budget 219 220219 0 417 857 1 417 314 367 9 314 450 174 0 450 174 Total 2017/18

69 33 575 279 -4 602 970 1 846 510 -31 728 7 Transfer to LG to Transfer 8 94 50 03 08 06 2017/18 Provincial Expenditure 3 666 764 93 796 22 371 980371 1 106 391 7 230 282 7 463 967 3 263 354 0 Provincial

49 48 494 379 -53 097 3 Transfer to LG to Transfer 2017/18 Budget

4 012 0004 012 85 762 610 95 902 328 219 220219 011 417 857 168 417 314 367 970 314 450 174 000450 174 Provincial 1 587 296 087 -53 097 349 48 494 379 1 533 438 951 -31 728 769 33 575 279 1 582 693 117 al Government. *LG – Loc*LG

BAS,

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

275 Section B: DistrictProfile GautengHealth Profiles Province

Ekurhuleni Metropolitan Municipality (EKU)

Overview of the district The City of Ekurhuleni Metropolitan Municipalitya is a Category A municipality and covers an extensive area from Germiston in the west to Springs and Nigel in the east. The former administrations of the nine towns in the former East Rand were amalgamated into the metropolitan municipality, along with the Khayalami Metropolitan Council and the Eastern Gauteng Services Council. It is one of the most densely populated areas in the province, and the country. The economy in the region is larger and more diverse than that of many small countries in Africa. It accounts for nearly a quarter of Gauteng’s economy, which in turn contributes over a third of the national Gross Domestic Product. Many of the factories for the production of goods and commodities are located in Ekurhuleni, often referred to as ‘Africa’s Workshop’. The network of roads, airports, rail lines, telephones, electricity grids and telecommunications found in Ekurhuleni rivals that of Europe and America. It can be regarded as the transportation hub of the country. It is home to OR Tambo International Airport; South Africa’s largest railway hub; a number of South Africa’s modern freeways and expressways; the Maputo Corridor Development; direct rail, road and air links connecting Ekurhuleni to Durban; the Blue IQ projects, with linkages to the City Deep Container terminal; the Gautrain rapid rail link to Johannesburg and Pretoria; and the OR Tambo International Airport Industrial Development Zone (IDZ). The City of Ekurhuleni Metropolitan Municipality comprises six health sub-districts, namely Ekurhuleni East 1 and East 2, Ekurhuleni North 1 and North 2, and Ekurhuleni South 1 and South 2. Area: 1 975km² Population (2016)b: 3 461 050 Population density (2016): 1 752.4 persons per km2 Estimated medical scheme coverage: 24.8% Cities/Towns: Alberton, Bedfordview, Benoni, Birchleigh, Boksburg, Brakpan, Clayville, Daveyton, Dunnottar, Edenvale, Geduld, Germiston, Katlehong, Kempton Park, Kwa-Thema, Machenzieville, Nigel, Olifantsfontein, Springs, Tembisa, Tokoza, Vosloorus, Vorsterkroon. Main Economic Sectors: Manufacturing (23%), finance and business services (22%), community services (19%), trade (15%), transport (11%), construction (5%), electricity (3%), mining (2%).

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

276 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Population distribution, sub-district boundaries and health facility locations

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

277 Section B: DistrictProfile GautengHealth Profiles Province

DistrictEkurhuleni population MM pyramid(EKU) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 47 591 61 776 91 316 104 178 60-64 years 40 471 40 783 61 171 58 563 55-59 years 57 329 53 271 79 846 74 553 50-54 years 76 147 69 883 98 205 88 019 45-49 years 95 748 86 964 119 345 104 282 40-44 years 115 541 101 388 139 298 122 385 35-39 years 140 170 120 592 145 784 133 963 30-34 years 160 399 140 436 147 455 139 479 25-29 years 153 974 143 838 171 462 156 582 20-24 years 128 314 127 255 152 054 144 649 15-19 years 123 431 121 631 132 562 128 460 10-14 years 121 319 120 637 140 632 137 989 05-09 years 132 261 127 722 145 262 143 078 00-04 years 146 800 143 483 151 854 148 624

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

2006 2016

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

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.6% 2.1% 2.6% 3.0% 60-64 years 1.8% 1.7% 55-59 years 1.9% 1.8% 2.3% 2.2% 50-54 years 2.5% 2.3% 2.8% 2.5% 45-49 years 3.2% 2.9% 3.4% 3.0% 40-44 years 3.9% 3.4% 4.0% 3.5% 35-39 years 4.7% 4.0% 4.2% 3.9% 30-34 years 5.3% 4.7% 4.3% 4.0% 25-29 years 5.1% 4.8% 5.0% 4.5% 20-24 years 4.3% 4.2% 4.4% 4.2% 15-19 years 4.1% 4.1% 3.8% 3.7% 10-14 years 4.0% 4.0% 4.1% 4.0% 05-09 years 4.4% 4.3% 4.2% 4.1% 00-04 years 4.9% 4.8% 4.4% 4.3%

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

Gender male female

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

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

278 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Social determinants of health

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

279 Section B: DistrictProfile GautengHealth Profiles Province

GP, Ekurhuleni: EKU Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history GP, Ekurhuleni: EKU Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 77% 10% 8%5% 70% 7% 17% 6% HIV and TB 5-14 36% 24% 16% 24% 29% 22% 22% 27% Comm_mat_peri_nut 15-24 24% 26% 14% 37% 18% 26% 17% 39% 25-64 26% 33% 30% 10% 17% 34% 37% 12% 65+ 14% 4% 79% 3% 13% 4% 81% 3% Total 30% 24% 36% 10% 21% 23% 46% 10%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (22.1%) Preterm birth complications (17.5%) 2 Lower respiratory infections (20.0%) Lower respiratory infections (14.8%) according to all the 3 Preterm birth complications (13.4%) Diarrhoeal diseases (11.3%) deaths within the 4 HIV/AIDS (8.2%) Birth asphyxia (8.4%) age/period category of 5 Birth asphyxia (6.1%) Sepsis/other newborn infectious (5.9%) each box, although only 6 Sepsis/other newborn infectious (4.6%) HIV/AIDS (5.2%) the leading 10 causes are <5 years <5 Protein-energy malnutrition (4.1%) 7 Other respiratory (4.8%) displayed. 8 Septicaemia (2.4%) Septicaemia (3.4%) 9 Tuberculosis (2.1%) Protein-energy malnutrition (3.1%) 10 Meningitis/encephalitis (2.0%) Other perinatal conditions (2.5%) 1 Lower respiratory infections (15.4%) HIV/AIDS (12.1%) 2 HIV/AIDS (12.9%) Lower respiratory infections (10.5%) 3 Tuberculosis (11.3%) Tuberculosis (10.2%) 4 Diarrhoeal diseases (10.0%) Drowning (7.4%) 5 Drowning (5.6%) Diarrhoeal diseases (6.9%)

5-14 6 Meningitis/encephalitis (5.4%) Fires, hot substances (5.8%) 7 Accidental threats to breathing (4.8%) Accidental threats to breathing (5.0%) 8 Road injuries (4.0%) Meningitis/encephalitis (4.2%) 9 Fires, hot substances (3.5%) Other respiratory (3.1%) 10 Epilepsy (2.2%) Other unintentional injuries (2.9%) 1 Tuberculosis (15.7%) HIV/AIDS (14.2%) 2 Lower respiratory infections (12.1%) Tuberculosis (12.3%) 3 Mechanical forces (10.7%) Mechanical forces (11.1%) 4 Interpersonal violence (10.6%) Accidental threats to breathing (11.0%) 5 HIV/AIDS (10.1%) Interpersonal violence (9.5%) 6 Accidental threats to breathing (6.0%) Lower respiratory infections (8.2%) 15-24 7 Road injuries (4.6%) Fires, hot substances (3.7%) 8 Meningitis/encephalitis (4.4%) Meningitis/encephalitis (3.7%) 9 Diarrhoeal diseases (4.0%) Diarrhoeal diseases (2.4%) 10 Fires, hot substances (2.8%) Epilepsy (1.4%) 1 Tuberculosis (20.1%) HIV/AIDS (18.3%) 2 Lower respiratory infections (14.3%) Tuberculosis (15.3%) 3 HIV/AIDS (13.2%) Lower respiratory infections (9.4%) 4 Diarrhoeal diseases (5.2%) Cerebrovascular disease (4.9%) 5 Cerebrovascular disease (3.9%) Ischaemic heart disease (4.4%) 6 Meningitis/encephalitis (3.9%) Mechanical forces (4.3%) 25-64 7 Ischaemic heart disease (3.8%) Diabetes mellitus (3.0%) 8 Mechanical forces (3.4%) Diarrhoeal diseases (2.8%) 9 Diabetes mellitus (2.3%) Meningitis/encephalitis (2.6%) 10 Interpersonal violence (2.0%) Nephritis/nephrosis (2.5%) 1 Cerebrovascular disease (13.7%) Ischaemic heart disease (12.7%) 2 Ischaemic heart disease (13.2%) Cerebrovascular disease (12.3%) 3 Lower respiratory infections (9.0%) Lower respiratory infections (7.6%) 4 Hypertensive heart disease (6.0%) Hypertensive heart disease (6.5%) 5 Diabetes mellitus (5.6%) COPD (6.3%)

65+ 6 COPD (5.2%) Diabetes mellitus (6.0%) 7 Nephritis/nephrosis (3.3%) Nephritis/nephrosis (4.0%) 8 Tuberculosis (3.0%) Tuberculosis (2.5%) 9 Diarrhoeal diseases (2.6%) Colo-rectal (2.4%) 10 Cardiomyopathy (2.4%) Prostate (2.3%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (52.0%) n=69 Indirect maternal (30.7%) n=144 2 Hypertension in pregnancy (14.1%) n=19 Other maternal (25.8%) n=121 3 Other maternal (14.0%) n=19 Hypertension in pregnancy (13.7%) n=64 4 Maternal haemorrhage (12.1%) n=16 Maternal haemorrhage (12.4%) n=58 15-49 Female 5 Abortion (4.4%) n=6 Abortion (12.1%) n=57 6 Maternal sepsis (3.4%) n=5 Maternal sepsis (5.2%) n=25

280 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Women and maternal health

Source: DHIS.

281 Section B: DistrictProfile GautengHealth Profiles Province

Child and school health

Source: DHIS.

282 SectionSection B: ProfileB: District Gauteng Health Province Profiles

HIV

Source: DHIS.

283 Section B: DistrictProfile GautengHealth Profiles Province

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

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

284 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

285 Section B: DistrictProfile GautengHealth Profiles Province

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

Ekurhuleni Ekurhuleni East 1 SD Ekurhuleni East 2 SD Ekurhuleni North1 SD Ekurhuleni North 2 SD Ekurhuleni South 1 SD Ekurhuleni South 2 SD

Resuscitation room is equipped with functional basic equipment for resuscitation 99 100 94 100 100 100 100

Restore the emergency trolley daily or after every time it was used 99 93 100 100 100 100 100

There is at least one functional wall mounted room thermometer in the medicine room/dispensary 100 100 100 100 100 100 100 The temperature of the medicine room/dispensary is recorded daily 100 100 100 100 100 100 100 The temperature of the medicine room/dispensary is maintained within the safety range 100 100 100 100 100 100 100 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

286 SectionSection B: ProfileB: District Gauteng Health Province Profiles 1.9% 4.2% 3.7% 2.2% 2.2% 13.2% (4.0%) 25.2% (3.8%) % Overspent (underspent) Provincial Provincial Expenditure Total 2017/18 0 688 835 11 9 96 553 478 92 526 786 288 66 596 596 132 38 288 991 341 34 1 064 628 212 00 385 776 312 77 065 51 12 154 00 154 12 Budget 526 0 761 282 231 0 306 0 479 548 494 4 1 021 552 7 Total 2017/18

0 952 1 386 862 803 1 207 806 848 1 233 851 841 -153 02 -153 Transfer to LG to Transfer

5 3 12 91 76 96 88 2017/18 Provincial Expenditure 11 688 8311 96 55 478 312 385 7 312 288 9 341 596 5 132 526 786 2 Provincial 1 064 628 2

6 217 1 362 893 065 -155 08 -155 Transfer to LG to Transfer 2017/18 Budget

77 065 519 12 154 000 154 12 526 066 761 282 231 038 306 000 479 548 494 492 Provincial 1 021 552 734 2 774 7372 774 849 086 -155 217 1 362 893 065 2 896 442 250 020 -153 952 1 386 862 803 3 982 544 697 4 130 284 101 al Government. *LG – Loc*LG

BAS,

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

287 Section B: DistrictProfile GautengHealth Profiles Province

Johannesburg Metropolitan Municipality (JHB)

Overview of the district The City of Johannesburg Metropolitan Municipalitya is located in the Gauteng Province. Johannesburg is the most advanced commercial city in Africa and the engine room of the South African and regional economy. It is a city with a unique, African character, world-class infrastructure in the fields of telecommunications, transportation, water and power, and with globally-competitive health care and educational facilities. However, the city is also one of contrasts – home to both wealthy and poor, residents and refugees, global corporations and emerging enterprises. The demographics of Johannesburg indicate a large and ethnically diverse metropolitan area. As the largest city in South Africa, its population is defined by a long history of local and international migration. Johannesburg is home to almost five million people, accounting for about 36% of Gauteng’s population and 8% of the national population. The city has been growing over the past decade and a key contributor to this is that the city continues to attract people from other provinces, and internationally, who are looking for better economic opportunities and quality of life. The population pyramid indicates that the city’s population is predominantly young. This can be attributed to migration from other parts of the country as young people look for jobs. Johannesburg is considered the economic hub of South Africa and is often the first choice of destination by job-seekers across the country. The City of Johannesburg Metropolitan Municipality is divided into seven health sub-districts, named Johannesburg Sub-district A to Johannesburg Sub-district G. Area: 1 645km² Population (2016)b: 3 461 050 Population density (2016): 3 018.4 people per km2 Estimated medical scheme coverage: 25.0% Cities/Towns: Alexandra, Diepkloof, Diepsloot, Ennerdale, Johannesburg, Johannesburg South, Lawley, Lenasia, Lenasia South, Meadowlands East, Meadowlands West, Midrand, Orange Farm, Pimville, Randburg, Roodepoort, Sandton, Soweto. Main Economic Sectors: Finance and business services, community services, manufacturing, trade (collectively 82%).

Population distribution, sub-district boundaries and health facility locations

288 SectionSection B: ProfileB: District Gauteng Health Province Profiles

DistrictJohannesburg population MM pyramid (JHB) and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 61 882 87 234 115 215 149 365 60-64 years 48 879 55 211 74 292 82 548 55-59 years 69 135 72 743 99 679 102 327 50-54 years 88 611 93 828 128 875 121 397 45-49 years 114 259 113 162 170 814 154 483 40-44 years 143 419 131 015 212 993 195 315 35-39 years 186 255 164 493 227 918 226 488 30-34 years 222 988 201 328 216 632 226 126 25-29 years 214 290 211 862 236 834 234 706 20-24 years 161 562 168 964 200 500 198 612 15-19 years 144 856 143 408 174 858 171 752 10-14 years 141 429 138 606 191 923 187 753 05-09 years 162 636 157 108 210 418 206 117 00-04 years 186 251 181 718 226 308 220 954

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

2006 2016

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

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.6% 2.3% 2.3% 3.0% 60-64 years 1.4% 1.5% 1.7% 55-59 years 1.8% 1.9% 2.0% 2.1% 50-54 years 2.3% 2.4% 2.6% 2.4% 45-49 years 3.0% 2.9% 3.4% 3.1% 40-44 years 3.7% 3.4% 4.3% 3.9% 35-39 years 4.8% 4.3% 4.6% 4.6% 30-34 years 5.8% 5.2% 4.4% 4.6% 25-29 years 5.5% 5.5% 4.8% 4.7% 20-24 years 4.2% 4.4% 4.0% 4.0% 15-19 years 3.7% 3.7% 3.5% 3.5% 10-14 years 3.7% 3.6% 3.9% 3.8% 05-09 years 4.2% 4.1% 4.2% 4.2% 00-04 years 4.8% 4.7% 4.6% 4.5%

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

Gender male female

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

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

289 Section B: DistrictProfile GautengHealth Profiles Province

Social determinants of health

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

290 SectionSection B: ProfileB: District Gauteng Health Province Profiles

GP, Johannesburg: JHB Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history GP, Johannesburg: JHB Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 70% 10% 14% 5% 65% 5% 24% 7% HIV and TB 5-14 23% 20% 28% 29% 21% 12% 34% 32% Comm_mat_peri_nut 15-24 18% 23% 19% 41% 13% 20% 22% 44% 25-64 20% 33% 36% 12% 15% 29% 43% 13% 65+ 12%3% 83% 3% 12%3% 82% 4% Total 22% 22% 45% 10% 18% 18% 53% 11%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (19.4%) Preterm birth complications (17.4%) 2 Lower respiratory infections (16.3%) Lower respiratory infections (12.1%) according to all the 3 Preterm birth complications (13.2%) Diarrhoeal diseases (9.6%) deaths within the 4 HIV/AIDS (8.5%) Birth asphyxia (7.0%) age/period category of 5 Birth asphyxia (5.3%) Sepsis/other newborn infectious (6.2%) each box, although only 6 Sepsis/other newborn infectious (5.1%) Congenital heart anomalies (5.5%) the leading 10 causes are <5 years <5 Congenital heart anomalies (3.3%) 7 HIV/AIDS (3.9%) displayed. 8 Septicaemia (3.0%) Septicaemia (3.7%) 9 Protein-energy malnutrition (2.9%) Other perinatal conditions (3.1%) 10 Meningitis/encephalitis (2.3%) Other congenital abnormalities (2.9%) 1 HIV/AIDS (11.3%) Fires, hot substances (8.1%) 2 Tuberculosis (8.6%) Lower respiratory infections (7.7%) 3 Lower respiratory infections (8.4%) HIV/AIDS (7.7%) 4 Drowning (7.3%) Drowning (7.0%) 5 Road injuries (7.0%) Accidental threats to breathing (5.7%)

5-14 6 Fires, hot substances (4.9%) Leukaemia (4.7%) 7 Meningitis/encephalitis (4.7%) Tuberculosis (4.6%) 8 Diarrhoeal diseases (4.5%) Meningitis/encephalitis (3.8%) 9 Accidental threats to breathing (3.9%) Diarrhoeal diseases (3.1%) 10 Leukaemia (3.5%) Other unintentional injuries (3.0%) 1 Mechanical forces (15.3%) Mechanical forces (14.2%) 2 Tuberculosis (11.7%) Accidental threats to breathing (11.3%) 3 HIV/AIDS (11.0%) HIV/AIDS (11.2%) 4 Lower respiratory infections (8.0%) Tuberculosis (9.3%) 5 Interpersonal violence (7.7%) Interpersonal violence (8.5%) 6 Accidental threats to breathing (7.0%) Lower respiratory infections (5.1%) 15-24 7 Road injuries (5.4%) Fires, hot substances (3.2%) 8 Diarrhoeal diseases (2.9%) Road injuries (2.3%) 9 Meningitis/encephalitis (2.8%) Nephritis/nephrosis (1.9%) 10 Fires, hot substances (2.3%) Meningitis/encephalitis (1.9%) 1 HIV/AIDS (16.7%) HIV/AIDS (16.9%) 2 Tuberculosis (16.4%) Tuberculosis (12.4%) 3 Lower respiratory infections (10.2%) Lower respiratory infections (7.2%) 4 Mechanical forces (4.4%) Mechanical forces (4.9%) 5 Diarrhoeal diseases (3.9%) Cerebrovascular disease (4.4%) 6 Cerebrovascular disease (3.7%) Ischaemic heart disease (4.0%) 25-64 7 Ischaemic heart disease (3.6%) Nephritis/nephrosis (3.6%) 8 Nephritis/nephrosis (2.7%) Accidental threats to breathing (2.5%) 9 Meningitis/encephalitis (2.3%) Diabetes mellitus (2.3%) 10 Diabetes mellitus (2.1%) Septicaemia (2.3%) 1 Ischaemic heart disease (12.4%) Ischaemic heart disease (11.8%) 2 Cerebrovascular disease (10.6%) Cerebrovascular disease (10.1%) 3 Lower respiratory infections (7.0%) Lower respiratory infections (6.3%) 4 COPD (5.1%) COPD (5.9%) 5 Diabetes mellitus (5.1%) Nephritis/nephrosis (4.9%)

65+ 6 Hypertensive heart disease (5.0%) Diabetes mellitus (4.6%) 7 Nephritis/nephrosis (4.5%) Hypertensive heart disease (4.3%) 8 Trachea/bronchi/lung (3.0%) Trachea/bronchi/lung (3.2%) 9 Colo-rectal (2.7%) Septicaemia (3.0%) 10 Alzheimer’s and other dementias (2.5%) Colo-rectal (2.8%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Other maternal (34.5%) n=44 Indirect maternal (29.2%) n=142 2 Indirect maternal (34.4%) n=43 Other maternal (28.5%) n=139 3 Hypertension in pregnancy (11.1%) n=14 Hypertension in pregnancy (17.8%) n=86 4 Abortion (10.8%) n=14 Abortion (10.8%) n=53 15-49 Female 5 Maternal haemorrhage (6.0%) n=8 Maternal haemorrhage (10.7%) n=52 6 Maternal sepsis (3.2%) n=4 Maternal sepsis (2.9%) n=14

291 Section B: DistrictProfile GautengHealth Profiles Province

Women and maternal health

Source: DHIS.

292 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Child and school health

Source: DHIS.

293 Section B: DistrictProfile GautengHealth Profiles Province

HIV

Source: DHIS.

294 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

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

295 Section B: DistrictProfile GautengHealth Profiles Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

296 SectionSection B: ProfileB: District Gauteng Health Province Profiles

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

Johannesburg Johannesburg SD A Johannesburg SD B Johannesburg SD C Johannesburg SD D Johannesburg SD E Johannesburg SD F Johannesburg SD G Johannesburg

Restore the emergency trolley daily or after every time it was used 74 92 88 62 61 57 73 85

Resuscitation room is equipped with functional basic equipment for resuscitation 76 85 100 62 75 71 60 81

90% of the tracer medicines are available 98 100 100 100 96 100 100 96

The temperature of the medicine room/dispensary is recorded daily 99 100 100 100 100 100 100 96

The temperature of the medicine room/dispensary is maintained within the safety range 99 100 100 100 100 100 100 96 Source: Ideal Clinic database.

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

297 Section B: DistrictProfile GautengHealth Profiles Province 3.5% 0.8% 17.7% (1.1%) 17.2% (4.0%) (8.7%) (10.4%) (25.3%) % Overspent (underspent) Provincial Provincial Expenditure Total 2017/18 0 732 851 12 16 787 292 774 57 907 1 196 111 65 380 728 126 65 958 210 142 83 772 800 448 00 627 031 914 13 38613 00 Budget 861 948 5 158 779158 8 659 625 2 509 493 7 605 704 0 1 209 656 5 Total 2017/18

7 344 1 061 039 155 772 881 000 909 321 811 -151 71 -151 Transfer to LG to Transfer

2 11 74 14 26 58 48 2017/18 Provincial Expenditure 12 851 73 851 12 142 210 9 210 142 627 031 9 787 292 7 380 728 1 772 800 4 Provincial 1 196 9071 196 1

7 000 929 408 000 -156 52 -156 Transfer to LG to Transfer 2017/18 Budget

13 38613 000 861 948 516 158 779158 865 659 625 283 509 493 765 605 704 000 Provincial 4 018 5934 018 987 527 -156 000 929 408 000 823 3 919 064 344 717 -151 1 061 039 155 987 4 791 474 4 829 144 875 1 209 656 557 al Government. *LG – Loc*LG

BAS,

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

298 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Tshwane Metropolitan Municipality (TSH)

Overview of the district The City of Tshwane Metropolitan Municipalitya is a Category A municipality situated in the Gauteng Province. It merged with the Metsweding District, which was a consequence of the Gauteng Global City Region Strategy to reduce the number of municipalities in Gauteng to at least four by 2016. The City of Tshwane is the single-largest metropolitan municipality in the country, comprising seven regions, 105 wards and 210 councillors. Pretoria is the capital of South Africa. It has the second-largest number of embassies in the world after Washington DC. Many embassies thus call this city their home. The Union Buildings house the administrative hub of the country and has also been the setting for the presidential inaugurations of Nelson Mandela, Thabo Mbeki and the incumbent South African president, Cyril Ramaphosa. These sandstone buildings offer beautiful views over the city. Its rich and colourful heritage is reflected in the city’s myriad of museums, monuments and historical buildings, and is punctuated by contemporary arts and crafts markets, bringing it alive with a unique blend of old and new. The Science and Technology Museum offers a tactile experience of science at work. The South African mint has a minting press dating back to 1892 that is still in operation. The City also offers township sleepovers with a five-star stay. Church Square and the State Theatre often host international and national performances. There are also two nature reserves where visitors can view wildlife such as buffalo, antelope, cheetah, jackal, giraffe and sable. The City of Tshwane Metropolitan Municipality is divided into seven health sub-districts, namely, Tshwane health sub-district 1 to Tshwane health sub-district 7. Area: 6 298km² Population (2016)b: 3 316 198 Population density (2016): 526.5 persons per km2 Estimated medical scheme coverage: 30.5% Cities/Towns: Akasia, Atteridgeville, Bronkhorstspruit, Centurion, Cullinan, Ekangala, Ga-Rankuwa, Garsfontein, Hammanskraal, Irene, Kudube, Mabopane, Mamelodi, Pretoria, Pretoria North, Rayton, Refilwe, Roodeplaat, Soshanguve, Temba, Winterveldt. Main Economic Sectors: General government (28.1%), finance, insurance, real estate and business services (24.7%), manufacturing (13.0%), wholesale and retail trade, catering and accommodation (11.9%), transport, storage and communication (10.3%), community, social and personal services (5.2%), construction (3.5%), electricity, gas and water (1.9%), mining and quarrying (0.7%), agriculture, forestry and fishing (0.5%).

299 Section B: DistrictProfile GautengHealth Profiles Province

Population distribution, sub-district boundaries and health facility locations

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

300 SectionSection B: ProfileB: District Gauteng Health Province Profiles

DistrictTshwane population MM (TSH) pyramid and comparison with the national pyramid

Year AgeGrp 2006 2016 65+ 44 496 60 772 76 428 100 238 60-64 years 34 580 37 939 50 751 53 153 55-59 years 45 496 47 163 66 985 68 061 50-54 years 60 988 60 059 82 270 80 645 45-49 years 76 550 74 546 103 102 100 082 40-44 years 90 949 85 940 121 346 117 997 35-39 years 111 630 105 237 140 644 141 117 30-34 years 124 987 120 082 147 083 154 875 25-29 years 132 121 132 743 166 317 166 767 20-24 years 118 106 125 966 144 546 145 812 15-19 years 113 296 112 603 115 923 114 742 10-14 years 106 040 103 938 132 014 129 411 05-09 years 104 847 101 705 144 173 141 345 00-04 years 127 888 124 473 156 995 153 376

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

2006 2016

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

AgeGrp 8% 6% 4% 2% 0% 2% 4% 6% 8% 8% 6% 4% 2% 0% 2% 4% 6% 8% 65+ 1.7% 2.4% 2.3% 3.0% 60-64 years 1.5% 1.5% 1.6% 55-59 years 1.8% 1.8% 2.0% 2.1% 50-54 years 2.4% 2.3% 2.5% 2.4% 45-49 years 3.0% 2.9% 3.1% 3.0% 40-44 years 3.5% 3.3% 3.7% 3.6% 35-39 years 4.3% 4.1% 4.2% 4.3% 30-34 years 4.8% 4.6% 4.4% 4.7% 25-29 years 5.1% 5.1% 5.0% 5.0% 20-24 years 4.6% 4.9% 4.4% 4.4% 15-19 years 4.4% 4.4% 3.5% 3.5% 10-14 years 4.1% 4.0% 4.0% 3.9% 05-09 years 4.1% 3.9% 4.3% 4.3% 00-04 years 4.9% 4.8% 4.7% 4.6%

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

Gender male female

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

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

301 Section B: DistrictProfile GautengHealth Profiles Province

Social determinants of health

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

302 SectionSection B: ProfileB: District Gauteng Health Province Profiles

GP, Tshwane: TSH Burden of disease – leading causes of death in district Percentage of deaths by broad causes and single leading causes Show history GP, Tshwane: TSH Broadcause Injury AgeGroup.. 2006-2010 2011-2015 NCD <5 years 73% 10% 11%5% 66% 7% 19% 7% HIV and TB 5-14 29% 18% 30% 22% 23% 19% 33% 25% Comm_mat_peri_nut 15-24 20% 20% 19% 41% 16% 22% 25% 37% 25-64 19% 28% 41% 12% 14% 29% 46% 11% 65+ 10%3% 84% 3% 10%3% 84% 3% Total 22% 18% 49% 10% 16% 18% 57% 9%

Rank_.. 2006-2010 2011-2015 Percentages are shown 1 Diarrhoeal diseases (23.4%) Diarrhoeal diseases (16.0%) 2 Lower respiratory infections (19.6%) Lower respiratory infections (15.8%) according to all the 3 Preterm birth complications (10.4%) Preterm birth complications (11.8%) deaths within the 4 HIV/AIDS (8.0%) Birth asphyxia (6.6%) age/period category of 5 Birth asphyxia (4.8%) HIV/AIDS (5.6%) each box, although only 6 Protein-energy malnutrition (3.9%) Sepsis/other newborn infectious (4.8%) the leading 10 causes are <5 years <5 7 Protein-energy malnutrition (3.6%) Sepsis/other newborn infectious (3.9%) displayed. 8 Septicaemia (2.4%) Congenital heart anomalies (3.6%) 9 Tuberculosis (2.3%) Other perinatal conditions (3.0%) 10 Congenital heart anomalies (2.2%) Septicaemia (2.7%) 1 Lower respiratory infections (11.1%) HIV/AIDS (10.5%) 2 Road injuries (10.6%) Road injuries (9.6%) 3 Tuberculosis (9.7%) Tuberculosis (8.7%) 4 HIV/AIDS (8.8%) Lower respiratory infections (8.5%) 5 Diarrhoeal diseases (8.6%) Diarrhoeal diseases (7.0%)

5-14 6 Meningitis/encephalitis (4.6%) Accidental threats to breathing (5.0%) 7 Drowning (3.9%) Drowning (3.4%) 8 Leukaemia (3.7%) Leukaemia (3.2%) 9 Congenital heart anomalies (2.3%) Meningitis/encephalitis (2.9%) 10 Endocrine nutritional,blood, immune (1.8%) Fires, hot substances (2.8%) 1 Road injuries (13.2%) HIV/AIDS (11.9%) 2 Tuberculosis (10.6%) Tuberculosis (10.3%) 3 HIV/AIDS (9.4%) Accidental threats to breathing (10.0%) 4 Lower respiratory infections (9.1%) Mechanical forces (9.0%) 5 Interpersonal violence (8.0%) Road injuries (7.2%) 6 Mechanical forces (7.7%) Lower respiratory infections (6.9%) 15-24 7 Accidental threats to breathing (5.0%) Interpersonal violence (4.5%) 8 Diarrhoeal diseases (3.5%) Diarrhoeal diseases (2.4%) 9 Meningitis/encephalitis (2.9%) Meningitis/encephalitis (2.2%) 10 Cardiomyopathy (2.2%) Leukaemia (2.2%) 1 Tuberculosis (14.9%) HIV/AIDS (16.4%) 2 HIV/AIDS (12.8%) Tuberculosis (12.7%) 3 Lower respiratory infections (9.8%) Lower respiratory infections (7.3%) 4 Ischaemic heart disease (5.5%) Ischaemic heart disease (5.5%) 5 Road injuries (4.6%) Cerebrovascular disease (4.8%) 6 Diarrhoeal diseases (4.5%) Diabetes mellitus (3.4%) 25-64 7 Cerebrovascular disease (4.1%) Nephritis/nephrosis (3.1%) 8 Diabetes mellitus (2.6%) Hypertensive heart disease (2.8%) 9 Hypertensive heart disease (2.5%) Road injuries (2.6%) 10 Mechanical forces (2.4%) Mechanical forces (2.6%) 1 Ischaemic heart disease (15.7%) Ischaemic heart disease (12.9%) 2 Cerebrovascular disease (11.7%) Cerebrovascular disease (11.7%) 3 Hypertensive heart disease (8.6%) Hypertensive heart disease (9.6%) 4 Lower respiratory infections (6.0%) Diabetes mellitus (6.4%) 5 Diabetes mellitus (5.8%) Lower respiratory infections (6.0%)

65+ 6 Nephritis/nephrosis (4.3%) Nephritis/nephrosis (5.1%) 7 COPD (4.2%) COPD (4.2%) 8 Trachea/bronchi/lung (2.3%) Trachea/bronchi/lung (2.4%) 9 Cardiomyopathy (2.3%) Prostate (2.4%) 10 Tuberculosis (2.1%) Tuberculosis (2.3%)

Maternal conditions Rank.. 2006-2010 2011-2015 1 Indirect maternal (44.9%) n=30 Indirect maternal (32.0%) n=92 2 Hypertension in pregnancy (24.9%) n=17 Other maternal (28.3%) n=81 3 Other maternal (11.7%) n=8 Hypertension in pregnancy (17.1%) n=49 4 Abortion (9.9%) n=7 Abortion (12.1%) n=35 15-49 Female 5 Maternal haemorrhage (8.6%) n=6 Maternal haemorrhage (6.2%) n=18 6 Maternal sepsis (4.3%) n=12

303 Section B: DistrictProfile GautengHealth Profiles Province

Women and maternal health

Source: DHIS.

304 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Child and school health

Source: DHIS.

305 Section B: DistrictProfile GautengHealth Profiles Province

HIV

Source: DHIS.

306 SectionSection B: ProfileB: District Gauteng Health Province Profiles

Tuberculosis

Source: DHIS, ETR.Net, EDRWeb.

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

307 Section B: DistrictProfile GautengHealth Profiles Province

Non-communicable diseases

Source: DHIS.

Numbers of deaths in facilities

Source: DHIS.

Percentage ideal clinics

Source: Ideal Clinic database.

308 SectionSection B: ProfileB: District Gauteng Health Province Profiles

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

Tshwane Tshwane 1 SD Tshwane 2 SD Tshwane 3 SD Tshwane 4 SD Tshwane 5 SD Tshwane 6 SD Tshwane 7 SD

Restore the emergency trolley daily or after every time it was used 81 90 92 83 100 50 89 29

Resuscitation room is equipped with functional basic equipment for resuscitation 89 81 100 92 100 100 100 57

Cold chain procedure for vaccines is maintained 99 95 100 100 100 100 100 100

90% of the tracer medicines are available 99 100 100 100 100 83 100 100

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

Number of facilities by level, 2017/18

Source: DHIS.

Human resources – filled posts

Source: Persal, Ward-based outreach team database.

309 Section B: DistrictProfile GautengHealth Profiles Province 0.2% 3.2% 3.2% (1.1%) 15.5% (0.5%) (6.0%) (0.7%) (11.3%) % Overspent (underspent) 380 967 111 140 495140 179 Provincial Provincial Expenditure Total 2017/18 0 883 13 933 27 866 857 878 94 36 03 459 620 381 60 193 591 515 00 166 717 1 190 13 85913 00 Budget 629 1 103 136 138 6 871 052871 4 369 331 8 398 026 5 1 203 590 0 Total 2017/18

6 388 560 978 082 450 026 072 694 399 241 -161 73 -161 Transfer to LG to Transfer

3 81 78 79 93 66 7 111 2017/18 Provincial Expenditure 13 88313 93 591 515 1 591 515 380 96 140 495140 1 459 620 3 866 857 8 Provincial 1 190 717 1 717 1 190

LG 616 490616 020 3 644 056 840 736 -161 388 560 978 082 4 071 127 692 4 043 298 534

3 948 490 616 020 -166 46 -166 -166 463 948 463 -166 Transfer to LG to Transfer 2017/18 Budget

13 85913 000 629 160 103 136 138 636 871 052871 427 369 331 894 398 026 503 Provincial 3 621 620 101 1 203 590 000 al Government. *LG – Loc*LG

BAS,

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

310