District Performance Assessment 2008-2010

[Part 1: (DC10), Amatole (DC12) and Chris Hani (DC13) Districts]

Sizulu Moyo, Thokozani Mbatha, Catherine Ogunmefun, Peter Bock, Rene English

District Hospital Performance Assessment Eastern Cape 2008-2010 [Part 1: Cacadu (DC10), Amatole (DC12) and Chris Hani (DC13) Districts]

Sizulu Moyo, Thokozani Mbatha, Catherine Ogunmefun, Peter Bock, Rene English

Published by Health Systems Trust

34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] http://www.hst.org.za

Published: November 2011

Suggested citation:

Moyo S, Mbatha T, Ogunmefun C, Bock P, English R. District Hospital Performance Assessment: Eastern Cape Province 2008-1010 Part 1. Health Systems Trust; Durban, 2012

The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes.

Acknowledgements

We would like to thank the National Department of Health for providing the data for the report. We are also grateful to Candy Day for assistance with the data. We thank Dr Peter Barron for input and guidance in writing the final report.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] i

Contents

INTRODUCTION ...... 1 BACKGROUND ...... 3 A CACADU DISTRICT – DC10 ...... 6 1. Aberdeen Hospital ...... 6 i: Description ...... 6 ii: Input and process indicators ...... 6 iii: Outcomes indicators ...... 8 iv: Impact Indicators ...... 8 v: Conclusions ...... 10 2. ...... 11 i: Description ...... 11 ii: Input and process indicators ...... 11 iii: Outcomes indicators ...... 12 iv: Impact Indicators ...... 13 v: Conclusions ...... 14 3. Midland Hospital ...... 15 i: Description ...... 15 ii: Input and process indicators ...... 15 iii: Outcomes indicators ...... 16 iv: Impact Indicators ...... 17 v: Conclusions ...... 18 4. Willowmore Hospital ...... 19 i: Description ...... 19 ii: Input and process indicators ...... 19 iii: Outcomes indicators ...... 20 iv: Impact Indicators ...... 21 v: Conclusions ...... 22 5. SAWAS Memorial (Jansenville) Hospital ...... 23 i: Description ...... 23 ii: Input and process indicators ...... 23 iii: Outcomes indicators ...... 24 iv: Impact Indicators ...... 25 v: Conclusions ...... 26 6. BJ Vorster (Kareedouw) Hospital ...... 27 i: Description ...... 27 ii: Input and process indicators ...... 27 iii: Outcomes indicators ...... 28 iv: Impact Indicators ...... 29 v: Conclusions ...... 30 7. Humansdorp Hospital ...... 31 i: Description ...... 31 ii: Input and process indicators ...... 31 iii: Outcomes indicators ...... 32 iv: Impact Indicators ...... 33

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] ii

v: Conclusions ...... 34 8. Sundays Valley (Kirkwood) Hospital ...... 35 i: Description ...... 35 ii: Input and process indicators ...... 35 iii: Outcomes indicators ...... 36 iv: Impact Indicators ...... 37 v: Conclusions ...... 38 9. Port Alfred Hospital ...... 39 i: Description ...... 39 ii: Input and process indicators ...... 39 iii: Outcomes indicators ...... 40 iv: Impact Indicators ...... 41 v: Conclusions ...... 42 10. ...... 43 i: Description ...... 43 ii: Input and process indicators ...... 43 iii: Outcomes indicators ...... 44 iv: Impact Indicators ...... 45 v: Conclusions ...... 46 B AMATHOLE DISTRICT – DC 12 ...... 47 1. Adelaide Hospital ...... 47 i: Description ...... 47 ii: Input and process indicators ...... 47 iii: Outcomes indicators ...... 49 iv: Impact Indicators ...... 49 v: Conclusions ...... 51 2. Bedford Hospital ...... 52 i: Description ...... 52 ii: Input and process indicators ...... 52 iii: Outcomes indicators ...... 53 iv: Impact Indicators ...... 54 v: Conclusions ...... 55 3. Victoria Hospital ...... 56 i: Description ...... 56 ii: Input and process indicators ...... 56 iii: Outcomes indicators ...... 57 iv: Impact Indicators ...... 58 v: Conclusions ...... 59 4. ...... 60 i: Description ...... 60 ii: Input and process indicators ...... 60 iii: Outcomes indicators ...... 61 iv: Impact Indicators ...... 62 v: Conclusions ...... 63 5. Bhisho Hospital ...... 64 i: A: Description ...... 64 ii: Input and process indicators ...... 64

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] iii

iii: Outcomes indicators ...... 65 iv: Impact Indicators ...... 66 v: Conclusions ...... 67 6. ...... 68 i: Description ...... 68 ii: Input and process indicators ...... 68 iii: Outcomes indicators ...... 69 iv: Impact Indicators ...... 70 v: Conclusions ...... 71 7. ...... 72 i: A: Description ...... 72 ii: Input and process indicators ...... 72 iii: Outcomes indicators ...... 73 iv: Impact Indicators ...... 74 v: Conclusions ...... 75 8. Butterworth Hospital ...... 76 i: Description ...... 76 ii: Input and process indicators ...... 76 iii: Outcomes indicators ...... 77 iv: Impact Indicators ...... 78 v: Conclusions ...... 79 9. ...... 80 i: Description ...... 80 ii: Input and process indicators ...... 80 iii: Outcomes indicators ...... 81 iv: Impact Indicators ...... 82 v: Conclusions ...... 83 10. Cathcart Hospital ...... 84 i: A: Description ...... 84 ii: Input and process indicators ...... 84 iii: Outcomes indicators ...... 85 iv: Impact Indicators ...... 86 v: Conclusions ...... 87 11. SS Gida Hospital ...... 88 i: A: Description ...... 88 ii: Input and process indicators ...... 88 iii: Outcomes indicators ...... 89 iv: Impact Indicators ...... 90 v: Conclusions ...... 91 12. Stutterheim Hospital ...... 92 i: A: Description ...... 92 ii: Input and process indicators ...... 92 iii: Outcomes indicators ...... 93 iv: Impact Indicators ...... 94 v: Conclusions ...... 95 13. ...... 96 i: Description ...... 96 ii: Input and process indicators ...... 96

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] iv

iii: Outcomes indicators ...... 97 iv: Impact Indicators ...... 98 v: Conclusions ...... 99 14. Newhaven Hospital ...... 100 i: A: Description ...... 100 ii: Input and process indicators ...... 100 iii: Outcomes indicators ...... 101 iv: Impact Indicators ...... 102 v: Conclusions ...... 103 C CHRIS HANI DISTRICT - DC13 ...... 104 1. All Saints Hospital ...... 104 i: Description ...... 104 ii: Input and process indicators ...... 104 iii: Outcomes indicators ...... 106 iv: Impact Indicators ...... 106 v: Conclusions ...... 107 2. ...... 108 i: Description ...... 108 ii: Input and process indicators ...... 108 iii: Outcomes indicators ...... 109 iv: Impact Indicators ...... 110 v: Conclusions ...... 111 3. Cala Hospital ...... 112 i: Description ...... 112 ii: Input and process indicators ...... 112 iii: Outcomes indicators ...... 113 iv: Impact Indicators ...... 114 v: Conclusions ...... 115 4. Elliot Hospital ...... 116 i: Description ...... 116 ii: Input and process indicators ...... 116 iii: Outcomes indicators ...... 117 iv: Impact Indicators ...... 118 v: Conclusions ...... 119 5. Hospital ...... 120 i: Description ...... 120 ii: Input and process indicators ...... 120 iii: Outcomes indicators ...... 121 iv: Impact Indicators ...... 122 v: Conclusions ...... 123 6. Cradock Hospital ...... 124 i: Description ...... 124 ii: Input and process indicators ...... 124 iii: Outcomes indicators ...... 125 iv: Impact Indicators ...... 126 v: Conclusions ...... 127 7. ...... 128

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i: Description ...... 128 ii: Input and process indicators ...... 128 iii: Outcomes indicators ...... 129 iv: Impact Indicators ...... 130 v: Conclusions ...... 131 8. Glen Grey Hospital ...... 132 i: Description ...... 132 ii: Input and process indicators ...... 132 iii: Outcomes indicators ...... 133 iv: Impact Indicators ...... 134 v: Conclusions ...... 135 9. Hospital ...... 136 i: Description ...... 136 ii: Input and process indicators ...... 136 iii: Outcomes indicators ...... 137 iv: Impact Indicators ...... 138 v: Conclusions ...... 139 10. ...... 140 i: Description ...... 140 ii: Input and process indicators ...... 140 iii: Outcomes indicators ...... 141 iv: Impact Indicators ...... 142 v: Conclusions ...... 143 11. ...... 144 i: Description ...... 144 ii: Input and process indicators ...... 144 iii: Outcomes indicators ...... 145 iv: Impact Indicators ...... 146 v: Conclusions ...... 147 12. Hospital ...... 148 i: Description ...... 148 ii: Input and process indicators ...... 148 iii: Outcomes indicators ...... 149 iv: Impact Indicators ...... 150 v: Conclusions ...... 151 13. Martje Venter Hospital ...... 152 i: Description ...... 152 ii: Input and process indicators ...... 152 iii: Outcomes indicators ...... 153 iv: Impact Indicators ...... 154 v: Conclusions ...... 155 14. Wilhem Stahl Hospital ...... 156 i: Description ...... 156 ii: Input and process indicators ...... 156 iii: Outcomes indicators ...... 157 iv: Impact Indicators ...... 158 v: Conclusions ...... 159

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] vi

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] vii

Introduction

Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.

This report aims to provide health managers at all levels within the health services, with a useful screening tool for assessing District Hospital management performance. It provides managers with a snap shot of how a facility is performing in key areas of hospital management. It focuses on individual facilities and assesses seven key hospital performance indicators listed in Table 1. Data on these seven indicators is retrieved primarily from the DHIS. Individual facility data is compared to the national and provincial indicator average values. The are assessed over a period of three financial years: 2008/2009; 2009/2010 and 2010/2011. These are depicted as 2008, 2009 and 2010 respectively in the graphs and text in the report. The data presented should be viewed with an awareness of problems common to routine data, namely incorrect and missing data, as well as specific contextual factors.

The report should be considered in conjunction with a number of other published documents including; Key District Health Indicators in Primary Health Care- Volume 1,-2007, The Guidebook for District Hospital Managers- Health Systems Trust-2006, A District Hospital Service Package for South Africa – The South African National Department of Health – 2002, and the Negotiated Service Delivery Agreement.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 1

Table 1: Selected Hospital performance indicators: definitions and description Indicator Definition Description Numerator Denominator Unit of reporting

Average length of How long on The average Inpatients Separations: - Day stay average each length of time days + 1/2 Discharges + (ALOS) patient spends in inpatients spend in Day patients Deaths + hospital hospital Transfers out + Day patients

Cost per patient The average cost The average cost Total Total patient day Rand day equivalent per patient day per patient per day expenditure equivalent (CpPDE) seen in a hospital seen in a hospital on health per hospital

Usable bed The proportion of The number of Total patient Total usable bed Percent utilisation rate beds in hospital patient days during days - days (%) (BUR) that were utilised the reporting (Inpatient or occupied period, expressed days + 1/2 as a percentage of Day patients) the sum of the x 100 daily number of useable beds.

Caesarean The proportion The number of Caesarean All deliveries in Percent section rate deliveries in which caesarean section section the facility (%) (CS rate) a caesarean deliveries, deliveries section is expressed as a performed percentage of all deliveries

Facility crude The proportion of The number of all Total inpatient Total inpatient Percent death rate all inpatient inpatient deaths deaths separations- (%) (FCDR): separations that expressed as a Includes - are deaths percentage of all inpatient inpatient transfers out, day separations patients, inpatient deaths and inpatient discharges.

Perinatal The number of The sum of still Still births and Total births in Perinatal mortality rate perinatal deaths births + those inpatient early facility deaths/ (PNMR) per 1000 births. babies dying within neonatal 1000 The perinatal 7 days of life per deaths in births period starts at the 1000 births facility beginning of foetal viability (28 weeks gestation or 1000g) and ends at the end of the 7th day after delivery

Still birth rate The number of still The number of The number The total number Still births/ (SBR): births per 1000 babies who are of still births of births 1000 births “born dead” per births 1000 births

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 2

Background

The Eastern Cape Province is divided into seven District Municipalities (including a Metro District), demarcated as shown in Figure 1. In 2010, the province had 65 District Hospitals serving an estimated population of 6, 654,844 people. Table 2 gives a list of District Hospitals in the province by District and sub-district location. The number of useable beds per facility is also listed in Table 2.

Figure 1: Map of the Eastern Cape Province depicting district boundaries (2011)

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Table 2: District hospitals in Mpumalanga Province: Location by District and local municipality District name Local municipality Hospital Useable beds 2010 Aberdeen 18 Andries Vosloo 74 Camdeboo Midland 69

Willowmore 25 Cacadu- DC10 SAWAS Memorial (Jansenville) 20 BJ Vorster (Kareedouw) 37 Kouga Sundays Valley (Kirkwood) 37

Humansdorp 80 Makana Port Alfred 60 Settlers 196 Adelaide 80

Nkonkobe Bedford 22

Fort Beaufort Victoria 110 Victoria Fort Beaufort 70 Bhisho 205 Buffalo City Nompumelelo (Peddie) 175

Amathole- DC12 Komga 15

Mnquma Butterworth 260 Tafalofefe 161 Cathcart 33 Amahlathi SS Gida 122

Stutterheim 70 Mbhashe Madwaleni 180 Newhaven Hospital 45 Engcobo All Saints 174 Mjanyana 100 Cala 92 Sakhisizwe Elliot 52 Intsika Yethu Cofimvaba 140 Cradock 83 Emalahleni Dordrecht 35 Chris Hani – DC13 Glen Grey 151

Indwe 28 Hewu 229 Lukhanji Molteno 25 Sterkstroom 8 Martje Venter () 21

Inxuba Yethemba Wilhelm Stahl (Middelburg) 30

Ukhahlamba Maletswai Aliwal North 45 – DC14 Burgersdorp 24

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District name Local municipality Hospital Useable beds 2010 Jamestown 10 Steynsburg 16 St Francis 28

Cloete Joubert (Barkly East) 25 Senqu Empilisweni 94

Lady Grey 30 Umlamli 74 Elundini 41 Taylor Bequest (Elundini) 146 Bambisana 120 Canzibe 122 Nyandeni Isilimela 100

St Barnabas 169 Dr Malizo Mpehle Memorial 155 OR Tambo- DC15 Greenville 71 Qaukeni Holy Cross 111

St Patrick's 197 Mhlontlo Nessie Knight 150 St Lucy's 110 Umzimvubu Sipetu 100 King Dalindyebo Zitulele 146 Madzikane kaZulu Memorial 223 Alfred Nzo- DC44 Maluti Mount Ayliff 134

Tayler Bequest (Matatiele) 204 NMM NMM Uitenhage 225

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 5

A Cacadu District – DC10

Cacadu district had a population of approximately 438 025 people in 2010. It has 56 clinics, 3 CHCs, 28 mobile services, 10 District Hospitals, and 5 specialised hospitals. There are no regional, provincial, tertiary or central hospitals in the District. 1. Aberdeen Hospital i: Description

Aberdeen District Hospital has 18 beds and lies in the Camdeboo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated, decreasing between 2008 and 2009 before increasing in 2010. It was lower than the national and provincial averages throughput the reporting period

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2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased steadily over the reporting period, and was significantly higher than the national and provincial averages in 2010.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was relatively constant in 2008 and 2009 and increased in 2010. It was higher than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 7 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

iv: Impact Indicators

Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased between 2008 and 2010, and was below the national and provincial averages throughout the reporting period.

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2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, increasing dramatically in 2009, before decreasing back to the 2008 level in 2010. These data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rate in 2009.

3. Still birth rate (SBR): number of babies born dead/1000 births

There were no SBR data in 2008. The rate decreased significantly between 2009 and 2010. It was lower than national and provincial averages in 2010. These data should be reviewed to ascertain the reasons for the absence of data in 2008 and to confirm the rates observed in 2009 and 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 9

v: Conclusions

The CpPDE which is well above the national and provincial averages should be investigated. The absence of CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The PNMR should be reviewed to ascertain the reasons for the fluctuation observed. The SBR data should also be reviewed to ascertain the reasons for the absence of data in 2008 and to confirm the trend observed in 2009 and 2010.

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2. Andries Vosloo Hospital i: Description

Andries Vosloo District Hospital has 74 beds and lies in the Camdeboo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was constant in 2008 and 2009 and decreased marginally in 2010. It was in line with the national and provincial averages in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

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3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the increasing CS rate should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 12 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased by nearly 40% between 2008 and 2010. It was lower than the national and provincial averages in 2009 and 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased significantly between 2008 and 2009, before increasing slightly in 2010. The 2010 rate was higher than the national and provincial averages.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated significantly. It decreased by almost 50% between 2008 and 2009 before increasing slightly in 2010. It was higher than the national and provincial averages in 2010. These data should be reviewed to ascertain the reasons for the fluctuation and to confirm the rates observed.

v: Conclusions

The reasons for the increasing CS rate should be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 14

3. Midland Hospital i: Description

Midland District Hospital has 69 beds and lies in the Camdeboo Sub-District. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased to 3.5 days in 2009 and remained unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased sharply between 2009 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high PDE should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 15

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased significantly between 2008 and 2009 and then decreased marginally constant in 2010. It was in line with the provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 16 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was constant in 2008 and 2009 and increased in 2010. It was in line with the national average, but lower than the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated slightly, increasing to 22/1000 births in 2009 before decreasing back to the previous (2008) level in 2010. It was well below the national and provincial averages throughout the reporting period.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated peaking at 20/1000 births in 2009 before declining to a low rate of 9.5/1000 births in 2010. It was significantly lower than the national and provincial averages throughout the reporting period.

v: Conclusions

The reasons for the high CpPDE should be ascertained. The reasons for the low PNMR and SBR should be investigated for best practices. The reasons for the fluctuations observed should also be ascertained.

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4. Willowmore Hospital i: Description

Willowmore District Hospital has 25 beds and lies in the Camdeboo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated slightly. It was well below the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated over the reporting period. It decreased to a very low value of R998 in 2009 before increasing sharply in 2010 to R2291. The data should be reviewed to ascertain the reasons for the fluctuation and the high value observed in 2010

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3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing to 76% in 2009 before decreasing in 2010. It was in line with the national average but lower than the provincial average in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 20 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was very high in 2008, and decreased dramatically (a 70% decrease) in 2009 before increasing slightly in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuation and the high rates observed.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated, decreasing significantly between 2008 and 2009 before increasing again in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuation and the high rates observed.

v: Conclusions

The CPDE data should be reviewed to ascertain the reasons for the fluctuation and the high value observed in 2010. The absence of CS rate data requires investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The PNMR and SBR data should be reviewed to confirm the rates and to ascertain the reasons for the fluctuations and the high rates observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 22

5. SAWAS Memorial (Jansenville) Hospital i: Description

SAWAS Memorial District Hospital has 20 beds and lies in the Camdeboo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased marginally between 2008 and 2010. It was higher than the h the national and provincial averages throughout the reporting period. The reasons for the high ALOS should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was relatively constant between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 23

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated slightly over the reporting period. It was higher than the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 24 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased over the reporting period. It was lower than the national and provincial averages throughout this period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, increasing dramatically between 2008 and 2009 (an approximately 8–fold increase), before decreasing in 2010. It was well below the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations and to confirm the rates observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 25

3. Still birth rate (SBR): number of babies born dead/1000 births

There were no SBR data for 2008. The SBR decreased significantly between 2009 and 2010. It was lower than the national and provincial averages in 2010.

v: Conclusions

The reasons for the high ALOs should be ascertained. The absence of CS rate requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 26

6. BJ Vorster (Kareedouw) Hospital i: Description

BJ Vorster District Hospital has 37 beds and lies in the Kouga sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was very low. It increased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout this period and the reasons for this should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 27

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased steadily over the reporting pertiod. It was higher than the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased marginally between 2008 and 2009 and then decreased significantly in 2010 to a level well below the national and provincial averages.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 28 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated marginally between 2008 and 2010. It was well below the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated. It decreased between 2008 and 2009 before increasing (by more than 50%) in 2010. It was lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 29

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased marginally between 2008 and 2009, followed by a significant increase in 2010. The 2010 rate was in line with the provincial average.

v: Conclusions

The low CpPDE needs investigation. The reasons for the increasing PNMR and SBR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 30

7. Humansdorp Hospital i: Description

Humansdorp District Hospital has 80 beds and lies in the Kouga sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was relatively constant in 2008 and 2009 and decreased in 2010. The reasons for this require explanation. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 31

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased significantly between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was constant in 2008 and 2009 and increased significantly in 2010. It was higher than the provincial averages in 2010 the reasons for the increase in CS rate should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 32 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated marginally. It was well below the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 33

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased over the reporting period. The 2010 rate was in line with the national average.

v: Conclusions

The reasons for the falling CpPDE and the high CS section rate should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 34

8. Sundays Valley (Kirkwood) Hospital i: Description

Sundays Valley District Hospital has 37 beds and lies in the Kouga sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was constant in 2008 and 2009 and increased marginally in 2010. It was well below the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CPDE increased steadily over the reporting period. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 35

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated slightly. It increased between 2008 and 2009 before decreasing to a rate of 50% in 2010.It was well below the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008 to 2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 36 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR increased over the reporting period. It was well below the national and provincial averages in 2008 and 2009. The 2010 rate was close to the national average for the same year.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing significantly in 2009 before increasing back to the 2008 level in 2010. It was well below the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 37

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated, decreasing significantly between 2008 and 2009 before increasing in 2010. It was well below the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuations observed.

v: Conclusions

The reasons for the low BUR requires should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 38

9. Port Alfred Hospital i: Description

Port Alfred District Hospital has 60 beds and lies in the Makana sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was stable at about 4 days throughout the reporting period. It was generally in line with the national and provincial averages throughout this period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated, increasing to a high value of R2374 in 2009 before decreasing in 2010. It was lower the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 39

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased between 2008 and 2009 and was unchanged in 2010. It was higher than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

There were no CS rate data for 2008. The CS rate decreased between 2009 and 2010. The reasons for the absence of data in 2008 should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 40 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated marginally. It was lower than the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased significantly (an almost three-fold increase) between 2008 and 2010. It was however lower than the provincial and national averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 41

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also increased significantly between 2008 and 2009. The 2010 rate was in line with the national average.

v: Conclusions

The CpPDE data should be reviewed to ascertain the reasons for the fluctuations observed. The reasons for the absence of CS rate data in 2008 should also be ascertained as well as the increase in the PNMR and the SBR.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 42

10. Settlers Hospital i: Description

Settlers District Hospital has 196 beds and lies in the Makana sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant and in line with the national and provincial averages.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased sharply over the reporting period, nearly doubling in value. It was well above the national and provincial averages in 2009 and 2010. The reasons for this sharp increase should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 43

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated marginally. It was well below the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated slightly between 2008 and 2010. It was significantly higher than the national and provincial rates throughout this period. The reasons for the high CS rate should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 44 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was largely unchanged between 2008 and 2009 and decreased in 2010. It was in line with the national average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased steadily between 2008 and 2010. It was in line with the provincial average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 45

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR has increased significantly over reporting period. It was in line with the provincial average in 2010.

v: Conclusions

The reasons for the high CpPDE and the low BUR should be ascertained. The reasons for the high CS rate should also be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 46

B Amathole District – DC 12

Amatole District had a population of approximately 1 806 831 people in 2010. It has 221 clinics, 11 CHCs, 46 mobile services, 14 District Hospitals, 3 specialised hospitals and 2 provincial tertiary hospitals. There is no regional or central hospital in the district. 1. Adelaide Hospital i: Description

Adelaide District Hospital has 60 beds and lies in the Nkonkobe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated slightly, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 47

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased over the reporting period and was in line with the provincial average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 48 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated marginally between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period.

iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was unchanged between 2008 and 2009 and increased in 2010 when it then closer to the national average in the same year.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 49

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated over the reporting period, decreasing to a low rate of 16/1000 births in 2009 before increasing in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated, decreasing between 2008 and 2009 before increasing in 2010. It was significantly higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 50 v: Conclusions

The reasons for high ALOS should be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuation observed and the high rates in 2010. The CS data needs review to explain the reason for the low rates.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 51

2. Bedford Hospital i: Description

Bedford District Hospital has 22 beds and lies in the Nkonkobe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased over the reporting period. However it was lower than the national and provincial averages throughout this period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated, decreasing between 2008 and 2009 before increasing in 2010. It was higher than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 52

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased steadily over the reporting period. It was higher than the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

There were no CS rate data for 2008 and 2009, with a rate of 4% recorded in 2010. This was significantly lower than the national and provincial averages in the same year. The reasons for the absence of data in 2008 and 2009 should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 53 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR increased steadily between 2008 and 2010. It was well below the national and provincial averages throughout this period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased significantly between 2008 and 2010. It was significantly higher than the national and provincial averages in 2010. The reasons for the increasing PNMR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 54

3. Still birth rate (SBR): number of babies born dead/1000 births

SBR fluctuated, increasing sharply between 2008 and 2009and then decreasing inn2010. It was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for the high SBR should be ascertained.

v: Conclusions

The reasons for high PNMR and SBR should be ascertained. The CS rate data should be reviewed to ascertain the reasons for the absence of data in 2008 and 2009. If this hospital is unable to perform C Sections on a regular basis then by definition it is not a hospital and should be re-classified as a CHC.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 55

3. Victoria Hospital i: Description

Victoria District Hospital has 110 beds and lies in the Nkonkobe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated marginally increasing in 2009 before decreasing in 2010. It was well above the national and provincial averages throughout this period. The reasons for the high ALOS should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased slightly between 2008 and 2010. It was in line with the provincial average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 56

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data were only available for 2008, when Caesarean Section Rate the CS rate was 2.7%. The absence of 20.0 data in 2009 and 2010 requires urgent 15.0 investigation. 10.0

Percentage 5.0

0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 EC Average 14.3 15.8 18.5

Victoria 2.7

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 57 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high FCDR should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased slightly between 2008 and 2009 before increasing sharply in 2010. The 2010 rate was in line with the national average.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 58

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated slightly, decreasing between 2008 and 2009 with a slight increase in 2010. It was in line with the national average in 2010.

v: Conclusions

The reasons for the high ALOS, the high FCDR and the low BUR should be ascertained. The reasons for the absence of CS rate data in 2009 and 2010 should also be ascertained. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be reclassified.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 59

4. Fort Beaufort Hospital i: Description

Fort Beaufort District Hospital has 70 beds and lies in the Nkonkobe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased from 5 days in 2008 to 4 days in 2009 and was largely unchanged in 2010. It was in line with the national and provincial averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased over the reporting period. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 60

3. Usable bed utilisation rate (BUR): measures of beds which are available for use

The BUR fluctuated, decreasing between 2008 and 2009, followed by a slight increase in 2010. It was in line with the provincial average in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

There were no CS rate data for 2008 and Caesarean Section Rate 2009, with a rate of 7% in 2010. This 20.0 was significantly lower than the national 15.0 and provincial averages. The reasons for 10.0 the absence of data in 2008 and 2009 Percentage 5.0 should be ascertained. 0.0 2008 2009 2010 SA Average 16.2 18.5 18.8 EC Average 14.3 15.8 18.5 Fort Beaufort 3.7

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 61 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased between 2008 and 2010, with a marginal increase in 2010. It was just below the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply (by more than 50%), between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 62

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased significantly between 2008 and 2010 (almost doubled). It was in line with the provincial average in 2010.

v: Conclusions

The reasons for the absence of CS data in 2009 and 2010 should be ascertained. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp increases in the PNMR and SBR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 63

5. Bhisho Hospital i: A: Description

Bhisho District Hospital has 205 beds and lies in the Buffalo City sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased over the reporting Average Length of Stay period. It was higher than the national 8.0 and provincial averages. 6.0

4.0 Days 2.0

0.0 2008 2009 2010 SA Average 4.3 4.1 4.1 EC Average 3.7 4.1 4.1 Bhisho 6.8 5.2 5.7

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2010. It was in line with the provincial average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 64

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased significantly over the reporting period. It was in line with the provincial average in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased steadily from 11.5% in 2008 to 17.6% in 2010. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 65 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated, decreasing between 2008 and 2009 before increasing in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations and the high rate observed in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, increasing to21/1000 births in 2009 before decreasing in 2010. It was well below the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 66

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated, increasing between 2008 and 2009 before increasing in 2010. It was well below the national and provincial averages throughout this period. The data should be reviewed to ascertain the reasons for the fluctuations observed.

v: Conclusions

The reasons for the high ALOS should be ascertained. The FCDR, PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed. The reasons for the high FCDR should also be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 67

6. Nompumelelo Hospital i: Description

Nompumelelo District Hospital has 175 beds and lies in the Buffalo City sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was exceptionally high. It decreased to 11.6 days in 2010. It was well above the national and provincial averages throughout the reporting period. The data should be reviewed to exclude errors and to ascertain the reasons for these high values.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased over the reporting period. It was lower than the national and provincial averages.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 68

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

Usable Bed Utilization Rate The BUR was relatively stable over the 80.0 reporting period. It was higher than the 60.0 national and provincial averages 40.0 throughout this period.

Percentage 20.0 0.0 2008 2009 2010 SA Average 67.7 67.5 64.8 EC Average 58.6 60.9 60.6

Nompumelel 69.2 68.8 68.0 o

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was well below the national and the provincial averages throughout this period and the reasons for this need to be explained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 69 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased over the reporting period and, and was closer to the provincial average in 2010. It was higher than the national and provincial averages throughout the reporting period and this needs explanation.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing between 2008 and 2009 before increasing significantly in 2010. The 2010 rate was in line with the provincial average. The data should be reviewed to ascertain the reasons for the fluctuations and to confirm the rates for the hospital.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 70

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated. It decreased slightly between 2008 and 2009 before increasing by more than 50% in 2010. The 2010 rate was well above the national and provincial averages and should be explained.

v: Conclusions

The ALOS data should be reviewed to exclude errors and to ascertain the reasons for the high values observed. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed. The high SBR rate in 2010 should be investigated as should the high FCDR and the low CS rate.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 71

7. Komga Hospital i: A: Description

Komga hospital has 15 beds and lies in the Buffalo City sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased slightly between 2008 and 2009 and then decreased significantly in 2010. It was well below the national and provincial averages in 2010. The reasons for the precipitous decline in 2010 should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 72

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was very low. It increased steadily over the reporting reaching 40% in 2010. It was significantly lower than the national and provincial averages throughout this period. The reasons for the low BUR should be ascertained

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008 to 2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 73 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated marginally over the reporting period. It was lower than the national and provincial averages in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased significantly from 11/1000 births in 2008 to 4/1000 in 2009. There were no data for 2010. The reasons for the absence of data in 2010 should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 74

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased marginally between 2008 and 2009. There is no data for 2010. The reasons for the absence of data in 2010 should be ascertained.

v: Conclusions

The reasons for the precipitous decline in the CpDE in 2010 should be ascertained. The low BUR requires investigation. The absence of the CS rate data also requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the absence of PNMR and SBR data in 2010 should be ascertained. From these indicators and the number of beds there would need to be a strong motivation to retain this facility as a district hospital.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 75

8. Butterworth Hospital i: Description

Butterworth District Hospital has 260 beds and lies in the Mnquma sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated marginally over the reporting period. It increased between 2008 and 2009, before decreasing in 2010. It was lower than the national and provincial averages throughout this period. The drop in the CpPDE needs explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 76

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate decreased significantly between 2008 and 2010. It was significantly lower than the national and provincial averages throughout the reporting period. This requires explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 77 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated; increasing in 2009 before decreasing back to the 2008 level in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high FCDR should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased significantly by over 50% during the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the increase in the PNMR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 78

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased steadily between 2008 and 2010. It was higher than the national and provincial averages in 2010.

v: Conclusions

The reasons for the high ALOS, BUR, FCDR, PNMR and SBR values which are all above the national and provincial averages should be ascertained. The CS data should be reviewed to confirm and explain the very low rates observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 79

9. Tafalofefe Hospital i: Description

Tafalofefe District Hospital has 160 beds and lies in the Mnquma sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was very high in 2008 and 2009 and decreased to 8.8 days in 2010. It was significantly higher than the national and provincial averages throughout the reporting period. The data should be reviewed to confirm the rates and to ascertain the reasons for these high rates.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased marginally between 2008 and 2010. It was significantly lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 80

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased over the reporting period. It was higher than the provincial and national averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate of 3.4% in 2008 was Caesarean Section Rate significantly lower than the national and 20.0 provincial averages in the same year. 15.0 There were no CS rate data in 2009 and 10.0 2010. The absence of CS rate data in Percentage 5.0 2009 and 2010 requires urgent 0.0 2008 2009 2010 investigation. SA Average 16.2 18.5 18.8 EC Average 14.3 15.8 18.5 Tafalofefe 3.4

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 81 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high FCDR should be investigated.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing significantly between 2008 and 2009 before increasing in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates for the hospital.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 82

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR shows a trend similar to that of the PNMR, with a decrease between 2008 and 2009 and an increase in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates for the hospital.

v: Conclusions

The data presented here points to a dysfunctional hospital with very high ALOS and FCDR and no C Sections being performed. The reasons for the high ALOS and the high FCDR should be ascertained. The absence of CS rate data in 2009 and 2010 requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be reclassified as a CHC. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed and to confirm the rates for the hospital.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 83

10. Cathcart Hospital i: A: Description

Cathcart District Hospital has 33 beds and lies in the Amahlathi sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant between 2008 and 2009 and decreased sharply in 2010. It was well below the national and provincial average in 2010. This drop requires explanation.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE remained fairly constant over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 84

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing to a high level of 92% in 2009 before decreasing to 82% in 2010. It was significantly higher than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008 to 2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 85 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated, increasing between 2008 and 2009 before decreasing significantly in 2010 when it was then well below the national and provincial averages. The data should be reviewed to ascertain the reasons for the fluctuation observed.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated. It decreased significantly (an approximately 60% decrease) between 2008 and 2009, before increasing again in 2010. It was line with the provincial average in 2010. The data should be reviewed to ascertain the reasons for the fluctuation observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 86

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated significantly, decreasing sharply between 2008 and 2009, followed by a sharp increase in 2010. It was higher than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed.

v: Conclusions

The data presented here points to a dysfunctional hospital information system. The FCDR, PNMR and SBR, data should be reviewed to ascertain the reasons for the fluctuations observed. The high PNMR observed in 2010 requires investigation. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 87

11. SS Gida Hospital i: A: Description

SS Gida District Hospital has 122 beds and lies in the Amahlathi sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was high and decreased steadily over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high ALOS should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated decreasing between 2008 and 2009 before increasing in 2010. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 88

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated. It increased to high rate of 97% in 2009 before decreasing significantly in 2010. The 2010 rate was closer to the national average in the same year. The data should be reviewed to ascertain the reasons for the fluctuations observed.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008 to 2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 89 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was largely constant between 2008 and 2009 and decreased in 2010. It was higher than the national average throughout this period and was lower than the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased significantly between 2008 and 2010. The 2010 rate was in line with the national average in the same year.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 90

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased marginally between 2008 and 2009 and then increased sharply (a greater than almost five-fold increase) in 2010 to a level above the national and provincial averages. The reasons for the rapid increase should be ascertained.

v: Conclusions

The reasons for the high ALOS should be ascertained. The reasons for the rapid increase in the PNMR and SBR should also be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 91

12. Stutterheim Hospital i: A: Description

Stutterheim District Hospital has 70 beds and lies in the Amahlathi sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased between 2008 and 2010. It was lower than the national and provincial averages in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was largely constant throughout the reporting period. It was well below (roughly half) the national and provincial averages throughout this period. The reasons for these low values require explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 92

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was high, reaching 91% in 2010. It was significantly higher than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was very low. It increased from 2.4% in 2008 to 4.8% in 2010. It was significantly lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 93 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased over the reporting period. It was significantly lower than the national and provincial averages throughout this period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR and SBR data are identical. This suggests data error. The data should be reviewed and the correct values for each indicator ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 94

3. Still birth rate (SBR): number of babies born dead/1000 births

The PNMR and SBR data are identical. This suggests data error. The data should be reviewed and the correct values for each indicator ascertained.

v: Conclusions

The PNMR and SBR data should be reviewed to determine the accurate rates for each indicator since the data presented are identical for the two indicators, suggesting data error. The low CpPDE and C Section rates require explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 95

13. Madwaleni Hospital i: Description

Madwaleni District Hospital has 180 beds and lies in the Mbhashe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was very high. It decreased to 8.4 days in 2010. It was significantly higher than the national and provincial averages throughout the reporting period. The reasons for the high ALOS should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased significantly between 2008 and 2010. It was higher than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 96

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased from a very high rate of 99% in 2008 to 68% in 2010, which was closer to the national and provincial averages in the same year.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010. The data should be reviewed to ascertain the reasons for the fluctuation observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 97 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high FCDR should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased slightly between 2008 and 2009 before decreasing sharply in 2010. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 98

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased between 2008 and 2010. It was lower than the national and provincial averages throughout this period.

v: Conclusions

The reasons for the high ALOS, the high FCDR and the increasing CpPDE should be ascertained. The CS rate data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 99

14. Newhaven Hospital i: A: Description

Newhaven District Hospital has 45 beds and lies in the Mbashe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The data available show an ALOS of more than 100 days in 2008 and 2010 (56 days in 2009). A graph was not produced since these values suggest data error. The ALOS data should be reviewed urgently to ascertain the true values for the hospital.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was very low. It increased slightly between 2008 and 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to confirm the CpPDE levels and to ascertain the reasons for the low levels observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 100

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was very high, (almost 100% in 2008 and 2009, and decreased to 86% in 2008. It was significantly higher than the national and provincial averages throughout the reporting period. This requires urgent investigation.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 101 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated dramatically between 2008 and 2010, with exceptionally high levels in 2008 and 2010. These data should be reviewed to confirm the rates and ascertain the reasons for these high levels.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

Data on the PNMR were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 102

3. Still birth rate (SBR): number of babies born dead/1000 births

Data on the SBR were not available for the period 2008-2010. This requires urgent investigation.

v: Conclusions

This hospital requires urgent attention as the information system appears to be dysfunctional. The extremely high ALOS values that are suggestive of data error should be reviewed and the true rates for the hospital determined. The reasons for very low CpPDE and the high BUR should be ascertained. The FCDR data should also be reviewed urgently to confirm the rates and to ascertain the reasons for the high levels observed. The absence of CS rate, PNMR and SBR data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be reclassified as a CHC.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 103

C Chris Hani District - DC13

Chris Hani district had a population of approximately 780 975 people in 2010. It has 146 clinics, 7 CHCs, 30 mobile services, 14 District Hospitals, 1 specialised hospital, and 1 regional hospital. It has no provincial tertiary or central hospitals. 1. All Saints Hospital i: Description

All Saints District hospital has 174 beds and lies in Engcobo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was largely constant in 2008 and 2009 and increased slightly in 2010. It was higher than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 104

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased steadily between in 2008 and 2010. The 2010 average was in line with the national average.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased steadily between 208 and 2010. It was in line with the national and average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 105 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout this period.

iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 106

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased slightly between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout this period.

v: Conclusions

The reasons for the high ALOS and the high FCDR should be ascertained. The reasons for the low CS, PNMR and SBR should also be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 107

2. Mjanyana Hospital i: Description

Mjanyana District hospital has 100 beds and lies in the Engcobo sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was exceptionally high and remained largely unchanged throughout the reporting period. The data should be reviewed to confirm the values observed and to ascertain the reasons for the high ALOS levels observed.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased marginally over the reporting period. It was significantly lower compared to national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 108

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing between 2008 and 2009 and the decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 109

iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was very high. It increased slightly over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high FCDR should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

Data on the PNMR were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 110

3. Still birth rate (SBR): number of babies born dead/1000 births

Data on the SBR were not available for the period 2008-2010. This requires urgent investigation.

v: Conclusions

Most indicators point to a poorly functioning hospital. The ALOS data should be reviewed to confirm the values observed and to ascertain the reasons for the high levels observed. The reasons for the extremely FCDR should also be ascertained. The absence of CS rate, PNMR and SBR requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 111

3. Cala Hospital i: Description

Cala District hospital has 92 beds and lies in the Sakhisizwe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased marginally between 2008 and 2009 and remained unchanged in 2010. It was significantly higher than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased over the reporting period. It was in line with the national average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 112

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased significantly between 2008 and 2009 with a further marginal decrease in 2010. It was lower than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, decreasing between 2008 and 2009 and then increasing in2010. It was significantly lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 113 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR increased steadily between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased over the reporting period and was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for the high PNMR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 114

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased sharply over the reporting period. It was higher than the national and provincial averages throughout the reporting period. The reasons for the sharp increase in the PNMR should be ascertained.

v: Conclusions

The reasons for the high ALOS, the high FCDR, and the high PNMR and SBR should be ascertained. The reasons for the low BUR should also be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 115

4. Elliot Hospital i: Description

Elliot District hospital 52 beds and lies in the Sakhisizwe sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated. It decreased marginally between 2008 and 2009 and then increased in 2010. It was higher than national and provincial averages in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was constant in 2008 and 2009 and increased in 2010. It was higher than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 116

3. Usable bed utilisation rate (BUR): measures occupancy of beds which available for use

The BUR increased between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

There was no CS rate data in 2008. The CS rate increased from 0.2% in 2009 to 1.5% in 2010. It was significantly lower than the national and provincial averages. The data should be reviewed to confirm the rates observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 117 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated, decreasing between 2008 and 2009 and the increasing in 2010. It was higher than the national and provincial averages in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply over the reporting period. It was in line with the national average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 118

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased significantly over the reporting period and was closer to the national average in 2010.

v: Conclusions

The reasons for the high ALOS and the increasing CpPDE should be ascertained. The CS rate data should be reviewed to confirm the rates observed. The FCDR data should be reviewed to ascertain the reasons for the fluctuation and the high rate observed in 2010. The reasons for the sharply increase in the PNMR and SBR need ascertainment.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 119

5. i: Description

Cofimvaba District hospital has 140 beds and lies in the Intsika Yethu sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was constant between 2008 and 2009 and decreased marginally in 2010. It was significantly higher than the national and the provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 120

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing between 2008 and 2009 before decreasing in 2010. It was lower than the national and provincial averages in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, increasing to 5.5% in 2009 before decreasing in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 121 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was constant in 2008 and 2009 and then decreased in 2010. It was lower than the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated. It decreased between 2008 and 2009 and then increased sharply in 2010. It was lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 122

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated. It decreased between 2008 and 2009 and then increased sharply in 2010 to a level closer to the national average. It was lower than the national and provincial averages throughout the reporting period.

v: Conclusions

The reasons for the high ALOS should be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuation observed. The extremely low CS rates need explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 123

6. Cradock Hospital i: Description

Cradock District hospital has 83 beds and lies in the Emalahleni sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was constant at 3.2 days throughout the reporting period. It was lower than the national and provincial averages throughout this period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased steadily over the reporting period. It was higher than the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 124

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased over the reporting period. It was significantly lower than the national and provincial averages in 2010. This requires explanation.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was high and decreased marginally over the reporting period. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high CS rate should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 125 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was unchanged in 2008 and 2009 and decreased in 2010. It was lower than the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was largely unchanged in 2008 and 2009 and the increased in 2010. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 126

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated, decreased to very low rate in 2009 and then increasing sharply in 2010, to a level closer to the national average. It was lower than the national and provincial averages throughout the reporting period.

v: Conclusions

The reasons for the increasing CpPDE, the high CS rate and the very low BUR should be ascertained. The SBR data should be reviewed to ascertain the reasons for the fluctuations observed and the increase in rates.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 127

7. Dordrecht Hospital i: Description

Dordrecht District Hospital has 35 beds and lies in the Emalahleni sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased over the reporting Average Length of Stay period. It was lower than the national and 5.0 provincial averages in 2009 and 2010. 4.0 3.0

Days 2.0

1.0 0.0 2008 2009 2010 SA Average 4.3 4.1 4.1

EC Average 3.7 4.1 4.1 Dordrecht 3.6 3.3 2.6

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout the reporting period (roughly 50% of averages).

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 128

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased steadily over the reporting period reaching 74% in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 129 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated, decreasing between 2008 and 2009 and then increasing in2010. It was lower than the national and provincial averages throughout the reporting period. The data should be reviewed to ascertain the reasons for the fluctuation observed.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply over the reporting period. It was significantly higher than the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 130

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also increased sharply over the reporting period. It was significantly higher than the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.

v: Conclusions

The CpPDE data should be reviewed to ascertain the reasons for the very low levels observed. The reasons for the high BUR should also be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp increases in the PNMR and SBR should be ascertained.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 131

8. Glen Grey Hospital i: Description

Glen Grey District hospital has 151 beds and lies in the Emalahleni sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased sharply between 2008 and 2010 and was in line with the national and provincial averages in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2009 and then decreased slightly in 2010. It was lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 132

3. Usable bed utilisation rate (BUR): measures occupancy of beds which available for use

The BUR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased significantly between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 133 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased significantly over the reporting period. It was lower than the national and provincial averages in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was largely unchanged in 2008 and 2009, and then decreased significantly in 2010. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 134

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased steadily over the reporting period. It was well below the national and provincial averages throughout this period.

v: Conclusions

The significant drop in the FCDR, and the low PNMR and SBR need explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 135

9. i: Description

Indwe District hospital has 20 beds and lies in the Emalahleni sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant between 2008 and 2009 and decreased marginally in 2010. It was lower than the national and provincial averages and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated slightly, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the provincial average in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 136

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 137 iv: Impact Indicators

Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated, decreasing sharply between 2008 and 2009 and then increasing in 2010. It was equivalent to the provincial average in 2010. The FCDR data should be reviewed to ascertain the reasons for the fluctuation observed.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased significantly over the reporting. It was significantly lower than the national and provincial averages in 2010.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 138

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased significantly over the reporting period. It was well below the national and provincial averages in 2010.

v: Conclusions

The FCDR data should be reviewed to ascertain the reasons for the fluctuations observed. If the hospital is unable to perform C Sections then it is by definition not a hospital and should be reclassified as a CHC. The sharply falling PNMR and SBR rates require explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 139

10. Hewu Hospital i: Description

Hewu District hospital has 229 beds and lies in the Lukhanji sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased slightly between 2008 and 2009 and remained largely unchanged in 2010. It was higher than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased significantly over the reporting period. It was in line with the national in in 2010. The changes in these data require explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 140

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased sharply over the reporting period, reaching a very low rate of 31% in 2010. It was significantly lower than the national and provincial averages in 2010. The reasons for low BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate fluctuated, increasing slightly between 2008 and 2009 and then decreasing in 2010. It was well below the national and provincial averages in 2010. This requires explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 141 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR increased steadily over the reporting period. It was higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated. It decreased to a low rate of 13/1000 births in 2009 and then increased in 2010. It was lower than the national and provincial averages throughout this period. The data should be reviewed to ascertain the reasons for the fluctuation observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 142

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated over the reporting period. It decreased between 2008 and 2009 and then increased in 2010 to level closer to the national average. The data should be reviewed to ascertain the reasons for the fluctuation observed.

v: Conclusions

The reasons for the high ALOS and the high FCDR should be ascertained. The reasons for the very low BUR should also be ascertained. The CS rate, PNMR and the SBR data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 143

11. Molteno Hospital i: Description

Molteno District hospital has 25 beds and lies in the Lukhanji sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated marginally over the reporting period. It was higher than the national and provincial averages throughout this period. The reasons for the high ALOS should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased steadily over the reporting period. It was significantly lower than the national and provincial averages throughout this period. This requires explanation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 144

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing between 2008 and 2009 and the decreasing in 2010. It was higher than both the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

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1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was constant throughout the reporting period. It was significantly higher than the national and provincial averages. The reasons for this should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply between 2008 and 2009, with a marginal decrease in 2010. It was lower than the national and provincial averages throughout the reporting period.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR fluctuated. It decreased slightly between 2008 and 2009 and then increased sharply in 2010, when it was closer to the national average. It was lower than the closer to the national and provincial averages throughout the reporting period.

v: Conclusions

The reasons for the high ALOS should be ascertained. The reasons for very low CpPDE values should be confirmed. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The very high FCDR needs investigation.

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12. Sterkstroom Hospital i: Description

Sterksroom District hospital has 8 beds and lies in the Lukhanji sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased over the reporting period reaching 4.6 days in 2010, a level closer to the national and provincial averages in the same year.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2010. It was significantly lower than the national and provincial averages throughout the reporting period.

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3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was extremely high (exceeding 100%) in 2008 and 2009 and decreased to 69% in 2010, a level closer to the national and provincial averages.

iii: Outcomes indicators

1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation

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iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR was relatively unchanged in 2008 and 2009 and then decreased in 2010. It was significantly lower than the national and provincial averages in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was exceptionally high in 2008 and decreased sharply to a low rate of 9/1000 births in 2009 and 2010. It was well below the national and provincial averages in 2009 and 2010. The data should be reviewed to ascertain the reasons for the high rate in 2008 and to confirm the rates in 2009 and 2010. The 2009 and 2010 rates are identical to those of the PNMR suggesting data error.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR was also exceptionally high in 2008 and decreased sharply to a low rate of 9/1000 births in 2009 and 2010. It was well below the national and provincial averages in 2009 and 2010. The data should be reviewed to ascertain the reasons for the high rate in 2008 and to confirm the rates in 2009 and 2010. The 2009 and 2010 rates are identical to those of the PNMR suggesting data error.

v: Conclusions

The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The PNMR and SBR data should be reviewed to determine the accurate rates for the hospital since 2008 and 2009 values presented for the two indicators are identical. There are questions to be asked about the economics of running such a small hospital (8 beds) which does not do basic operations like C Sections.

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13. Martje Venter Hospital i: Description

Martje Venter District hospital has 25 beds and lies in the Inxuba Yethemba sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased marginally over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.

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3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was higher than the national and provincial averages throughout the reporting period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 153 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR fluctuated slightly. It decreased between 2008 and 2010 and then increased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high FCDR should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply over the reporting period. It was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for the high PNMR should be ascertained.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased significantly over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the high SBR should be ascertained.

v: Conclusions

The reasons for the high ALOS, the high FCDR and the high PNMR and SBR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.

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14. Wilhem Stahl Hospital i: Description

Wilhelm Stahl District hospital has 30 beds and lies in the Inxuba Yethemba sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2010 and remained constant in 2010. It was significantly lower than the national and provincial averages throughout the reporting period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated. It decreased between 2008 and 2009 and the increased in 2010. It was higher than the national and provincial averages throughout the reporting period.

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3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased between 2008 and 2010. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased between 2008 and 2010 and then decreased marginally in 2o010. It was lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Eastern Cape Province 2008-2010 [Part 1] 157 iv: Impact Indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased steadily over the reporting period. It was lower than the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing between 2008 and 2009 and the increasing in 2010. It was in line with the provincial average in 2010.

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3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated, decreasing between 2008 and 2009 and the increasing in 2010.It was higher than the in 2010. The reasons for this should be ascertained.

v: Conclusions

The reasons for the high CpPDE (higher than the national and provincial averages) should be ascertained. The PNMR and SBR data should be reviewed to ascertain the reasons for the fluctuations observed. The very low ALOS should be explained.

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