DISTRICT HEALTH PLAN 2015/2016
ILEMBE
KWAZULU-NATAL
ILEMBE DISTRICT HEALTH PLAN 2014/15
1. ACKNOWLEDGEMENTS
Initials and Rank Component Institution Surname
Mrs. R. Sahadeo Deputy District Manager Planning, Monitoring and iLembe District Office Evaluation.
Mrs. N. N. Khumalo Specialist PHC District Clinical Specialist Team iLembe District Office
Dr. N. Phakathi Medical Manager Medical Untunjambili Hospital
Miss. S. Dube District Facility Information Officer Planning, Monitoring and iLembe District Office Evaluation
Mr. R. Phahla Deputy Manager Human Resource Planning, Monitoring and iLembe District Office Management Evaluation
Mrs. N. E. Hlophe District Service Delivery Planning Planning, Monitoring and iLembe District Office Evaluation
MS. B. Ndlela Public Relations Officer Transversal and Clinical Support iLembe District Office
Mrs. S. Moodley Operational Manager – Quality Planning, Monitoring and iLembe District Office Evaluation
Mr. M. Mbali Operational Manager – TB Integrated Public Health iLembe District Office
Miss. M. Banda Operational Manager – HAST, Integrated Public Health iLembe District Office MMC, HCT and ARV
Mrs. N. Mkhize Operational Manager – Nutrition Integrated Public Health iLembe District Office
Mr. K. Mthunzi Operational Manager- Chronic Integrated Public Health iLembe District Office
Dr. D. Pansegrouw Specialist Paediatrics District Clinical Specialist Team iLembe District Office
Miss. S. Dube Planning, Monitoring and iLembe District Office District FIO Evaluation
Mrs. M. Rambally Operational Manager –Infection, Planning, Monitoring and iLembe District Office Prevention and Control Evaluation
Mrs. T. Radebe Specialist Paediatrics District Clinical Specialist Team iLembe District Office
Mrs. Z. Ngcamu District Manager iLembe District Kheth’Impilo
Dr. Bon Egubjie HSS Manager Clinical Kheth’Impilo
Dr. O. Oydayi National Program Manager Clinical Kheth’Impilo
Dr. M. Khayinda MNCWH Clinical Kheth’Impilo
Ms. L. Moncaith National Pharmacist Clinical Kheth’Impilo
Dr. S. Allie Health Improvement Officer Clinical Kheth’Impilo
Mr. K. Ramaseer Designated Specialist Team Clinical Kheth’Impilo Pharmacist
Mrs. K. Moodley Designated Specialist Team Clinical Kheth’Impilo Pharmacist
Dr. E. Mothibi Chief Operations Manager National Manager Kheth’Impilo
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2. OFFICIAL SIGN OFF
It is hereby certified that this District Health Plan:
Was developed by the District Management Team of iLembe District with the technical support from the provincial district development directorate and the strategic planning unit. Was prepared in line with the current Strategic Plan and Annual Performance Plan of the Department of Health of KZN
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3. TABLE OF CONTENTS
1. ACKNOWLEDGEMENTS ...... 2 2. OFFICIAL SIGN OFF ...... 3 3. TABLE OF CONTENTS ...... 5 4. LIST OF ACRONYMS ...... 7 5. EXECUTIVE SUMMARY BY DISTRICT MANAGER ...... 10 6.2 SOCIAL DETERMINANTS OF HEALTH ...... 13 7. DISTRICT SERVICE DELIVERY ENVIRONMENT ...... 18 7.1 DISTRICT HEALTH FACILITIES ...... 18 8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S ...... 24 9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA) ...... 26 10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS ...... 28 10.1 INTRA- DISTRICT EQUITY IN THE PROVISION OF SERVICES ...... 28 11. ORGANISATIONAL ENVIRONMENT ...... 34 11.1 Organisational Structure of the District Management Team ...... 34 11.2 Human Resources ...... 34 12. DISTRICT HEALTH EXPENDITURE ...... 37 PART B - COMPONENT PLANS ...... 40 13. SERVICE DELIVERY PLANS for district health services ...... 40 13.1 SUB-PROGRAMME: District Health Services ...... 40 STRATEGIC CHALLENGES ...... 40 a. Sub-Program: District Hospitals ...... 49 14. HIV & AIDS & TB CONTROL (HAST) ...... 58 14.1 PROGRAMME Overview ...... 58 CHALLENGES ...... 58 14.2 HIV & AIDS, STI & TB CONTROL (HAST): Strategies/ Activities to be implemented 2015/16 . 66 15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION ...... 67 15.1 PROGRAMME Overview ...... 67 5.2 STRATEGIC CHALLENGES ...... 68 15.2 STRATEGIES/ Activities to be implemented 2015/16 ...... 81 16. DISEASE PREVENTION AND CONTROL (Environmental Health Indicators) ...... 82 16.1 PROGRAMME Overview ...... 82 16. 2 Strategies/ Activities to be implemented 2015/16 ...... 86 17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES ...... 87 18. SUPPORT SERVICES ...... 89 18.1 PHARMACEUTICAL SERVICES ...... 89 STRATEGIC CHALLENGES: ...... 92 STRATEGIES AND ACTIVITES: ...... 92 18.2 EQUIPMENT AND MAINTENANCE ...... 92 18.3 EMERGENCY MEDICAL SERVICES (EMS) ...... 94 STRATEGIC CHALLENGES ...... 94 STRATEGIES AND ACTIVITIES ...... 96 19. HUMAN RESOURCES ...... 98 20. DISTRICT FINANCE PLAN ...... 101 PART C: LINKS TO OTHER PLANS ...... 103 21. CONDITIONAL GRANTS (Where applicable) ...... 103
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22. PUBLIC-PRIVATE PARTNERSHIPS (PPPs) and PUBLIC PRIVATE MIX (PPM)...... 104 PART E: INDICATOR DEFINITIONS ...... 105
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4. LIST OF ACRONYMS
A
AIDS Acquired Immune Deficiency Syndrome
ANC Ante Natal Care
APP Annual Performance Plan
ART Anti-Retroviral Therapy
ARV Anti-Retroviral
B
BAS Basic Accounting System
BLS Basic Life Support
BUR Bed Utilisation Rate
C
CARMMA Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa
CCG’s Community Care Givers
CEO(s) Chief Executive Officer(s)
CHC(s) Community Health Centre(s)
COE Compensation of Employees
D
DCST(s) District Clinical Specialist Team(s)
DHER(s) District Health Expenditure Review(s)
DHIS District Health Information System
DHP(s) District Health Plan(s)
DHS District Health System
DOH Department of Health
DQPR District Quarterly Progress Report
E
EMS Emergency Medical Services
ETB.R Electronic Tuberculosis Register
ETR.net Electronic Register for TB
F
FHT Family Health Teams
G
G&S Goods and Services
H
HAST HIV, AIDS, STI and TB
HCT HIV Counselling and Testing
HIV Human Immuno Virus
HOD Head of Department
HPS Health Promoting Schools
HPV Human papillo virus
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HR Human Resources
HTA High Transmission Area
I
IDP(s) Integrated Development Plan(s)
IPT Ionized Preventive Therapy
J
K
KZN KwaZulu-Natal
L
LG Local Government
M
M&E Monitoring and Evaluation
MDG Millennium Development Goals
MDR-TB Multi Drug Resistant Tuberculosis
MEC Member of the Executive Council
MNC&WH Maternal, Neonatal, Child & Women’s Health
MO Medical Officers
MOU Maternity Obstetric Unit
MTEF Medium Term Expenditure Framework
MTSF Medium Term Strategic Framework
MUAC Mid-Upper Arm Circumference
N
NDOH National Department of Health
NCS National Core Standards
NGO(s) Non-Governmental Organisation(s)
NHI National Health Insurance
NIMART Nurse Initiated and Managed Antiretroviral Therapy
O
OSD Occupation Specific Dispensation
OSS Operation Sukuma Sakhe
P
P1 Calls Priority 1 calls
PCR Polymerase Chain Reaction
PCV Pneumococcal Vaccine
PDE Patient Day Equivalent
Persal Personnel and Salaries System
PHC Primary Health Care
PN Professional Nurse
R
RV Rota Virus Vaccine
S
SCM Supply Chain Management
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SHS School Health Services
SHT School Health Teams
SLA Service Level Agreement
Stats SA Statistics South Africa
STI(s) Sexually Transmitted Infection(s)
T
TB Tuberculosis
U
V
VCT Voluntary Counselling and Testing
W
WBOT Ward Based Outreach Teams
X
XDR-TB Extreme Drug Resistant Tuberculosis
Y and Z
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5. EXECUTIVE SUMMARY BY DISTRICT MANAGER
The ILembe district department of health has put forward this DHP as a strategic document that will provide direction and guide for the continued and improved delivery of quality health care services to the district’s population during the 2015/16 fiscal year. The plan have been put together based on the existing as well as relevant National and Provincial health priorities, policies, and also following careful considerations of the district’s local context through adequate situational analysis.
The iLembe DHP 2015/16 is underpinned by the strategic importance to align the district’s performances in terms of critical indicators across all health programmes such as HIV/AIDS, TB, Maternal, New-born, Child and Women Health (MNCWH), Non-communicable diseases (NCD) and others, to the expected National and Provincial targets. Hence the provision of quality healthcare based on equitable distribution of resources and improved access to services has been given high priority.
Looking at annual health report and other performances indicators, the district has been able to move in the positive direction in provision of service and maintenance of health in some programme areas such as reducing mother to child transmission of HIV (Infant 1st PCR test positive around 6 weeks rate has consistently reduced from 2.9% in 2012 to about 1.8% in 2014), improving TB treatment cure rate (TB client treatment success rate has improved from 83.5% in 2012 to 89.8% in 2014) as well as many others improvements recorded in the past year.
However a lot still remains to be done as despite these noted improvements, many of the performances fall well below target expectations. Infant mortality rate is still unacceptably high at more than 60/1000 live births in 2014, mortality from TB is still high while the emergence of NCD as major causes of morbidity and mortality in the district threatens the health gains made so far. With these in mind, the district management team in putting together the DHP sought explanations through performance review as well as situational analysis to better understand why certain conditions remains and what changes need to be made to improve health status of the population in the district.
Several challenges were identified as consisting reasonable barrier to the attainment of expected health experience for the population in the district and include; inadequate and non-availability of appropriately skilled man power for health service delivery in the district (including misdistribution of available ones), non-participation of communities in programmes design and implementation, Inadequate use of data for decision making across all programmes, inadequate infrastructural availability, as well as challenges posed by transport logistics for patients wishing to utilise our healthcare infrastructure, among many others. Some of these identified challenges are within the domain of the district health team and have been adequately addressed in this DHP while efforts and plans have been put in place to motivate for support in solving some others which are not entirely within the district department of health.
The plans to address these identified challenges and ensure improved performances are contained in the various sections of the DHP viz; Service Delivery, Support Services, Infrastructure, Human Resources and Finances
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In terms of service delivery, the district will pursue improved equity in distribution of human resources for health and access to healthcare services utilising existing resources where possible. This is particularly necessary in some of the sub-districts such as Mandeni and KwaDukuza which bear the highest burden of patients load within the district. Outreach teams formation and deployment to uncovered communities is considered our focus for the year, we attempt to improve service access especially in Northern and Western Ndwedwe sub-districts which have not been well covered due to challenges with facility location. The department of health will seek inter-sectorial collaboration with transport and other departments to improve service utilisation for the population. The team has worked with the District support partner Kheth’Impilo to ensure the implementation of regular performance review and data use meeting that will support use of evidence for programme improvement at all times. The plans include the conduct of quarterly district level data review and performance improvement meeting and with the partners support strengthen facility information committee meetings which have been identified as the bedrock for good evidence based planning in the district. To create efficiency and improve quality of care, the National core standards and Ideal clinic models have been identified as critical performance area. The district intends to achieve set provincial target of facility NCS and Ideal clinic compliance and accreditation. The district will seek to reduce child and maternal mortality through strengthening the implementation of community prevention intervention and increased management capacity in health facilities.
Support services plays crucial role in sustaining district health care delivery. The district will be strengthening the Pharmaceutical services for improved performance essentially to reduce stock- out of medicines and to ensure pharmacies comply with relevant Pharmaceutical legislation. Proper documentation and reporting of pharmacy-related activities through implementation of Rx solutions have been targeted. The district health referral system will be reviewed for improved performance and better service for the population, while the EMS and ambulance services will be improved through staff training and other governance practice.
Indeed the district is under no illusion that the above plans will be easy to implement, however we are committed to achieving the goals we set for our district to improve healthcare of the population. Implementing the DHP will require commitment as well as improved capacity among the DMT as well as facility staff. We are very optimistic and hopeful that the plan we have put together sets the tone for genuine and sustainable improvement in healthcare service delivery within the district in the next year.
6.1 MAJOR DEMOGRAPHIC CHARACTERISTICS Table 1: District Population 2013/14
population % Uninsured Sub-District Total Population uninsured Population
Mandeni Local Municipality 143 586 133 104 92.70
KwaDukuza Local Municipality 242 502 224 799 92.70
Ndwedwe Local Municipality 145 163 134 566 92.70
Maphumulo Local Municipality 99 213 91 970 92.70
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population % Uninsured Sub-District Total Population uninsured Population
DISTRICT TOTAL 630 464 584 439 92.70 Source: DHER 2013/14
Demographic factors are significant indicators in health service planning and delivery, more especially within the current severe budgetary constraints. The district comprises of 4 sub- districts which are Ndwedwe, Maphumulo, Mandeni and KwaDukuza. KwaDukuza sub district is semi urban whereas Mandeni sub district has a semi urban hub with surrounding rural areas. This affects health service delivery and planning as clients prefer to utilize services in the more urban areas due to the flow of transport routes and additional services such as social services, business and education which results in the non-adherence to the referral guidelines affecting utilization rates at the rural clinics. The estimated district population of 630 464, from the previous population of 606 809 (DHP District Population 2102/13), indicates an increase of 3.9% in the total population. This could be significant in terms of an increase in total headcounts in the health facilities. Furthermore, the mountainous and deep rural location of some clinics makes it difficult to access especially during adverse weather conditions. This affects the PHC efficiency indicators such as PHC headcounts, PHC utilization rates and increasing costs. Rapid infrastructural developments in the semi-urban areas such as KwaDukuza and the industrial hub around Mandeni have resulted in rural-urban migration within the district. The facilities in the semi urban areas then experience an increase in pressure however this situation cannot be addressed exclusively by the Department of Health as it necessitates the collaborative efforts of other departments to provide the required social services in rural areas.
Figure 1: District Population Pyramid (DHER 2013/14)
The district population distribution demonstrates 53% (333 253) are females and 47% (297 214)
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are males. The population pyramid of the district indicates that there is an increase in female population in comparison to the male population therefore female health should be prioritised which means that programmes like MNCWH and PMTCT will need to be given more attention within the district. 62% (392 904) of the population are below the ages of 29 years and 38% (237 560) of the population are 30years and above. The adolescent population represents 42% (266 478) of the population and despite this, the district has only one youth friendly clinic that is functional. The district will need to fast-track youth friendly clinics in all sub districts. The below 5 population group is the second largest in the pyramid. The under 5 population group for iLembe has increased by 9.1% from 63 334 in 2012 to 69 341 in 2013 which indicates that child care services needs improvement. Primary health care projections should prioritise family and school health teams.
Graph 1: Population distribution per Municipality
16% 23%
23%
38%
Mandeni KwaDukuza
Ndwedwe Maphumulo
Source: DHIS
The district experiences increased migration of people to the semi urban areas in search of comprehensive governmental and business services (KwaDukuza) and employment opportunities in Mandeni. The dense population in KwaDukuza is due to the decent road infrastructure and the efficient public transport system. This sub-district is in urgent need of a CHC or a clinic that will operate on a 24 hour service. KwaDukuza comprises 38% of the district population yet they have only 29% of health facilities. 34% of the PHC headcount is in KwaDukuza. The PHC utilisation rate is low in KwaDukuza due to an absence of a much needed 24 hour services and MOUs in the sub district.
6.2 SOCIAL DETERMINANTS OF HEALTH
Table 2 (A1): Social Determinants of Health
Sub-Districts Data Source Total number of households Unemployment rate population living below per R283line of poverty month householdsNumber of in Informal dwelling householdsNumber of in formal dwelling Percentage of accessHouseholds with sanitation to Households with piped e water inside the dwelling Percentage of accessHouseholds with to electricity Adult literacy rate Census 2001 28 657 45% 20% 12.3% 54% 87.1% 62.6% 82.8% Mandeni Community 33% 28% 19.5% 93.8% 76.5% 99.04%
Survey 2007
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Sub-Districts Data Source Total number of households Unemployment rate below living population poverty line of R283per month Number of households in Informal dwelling Number of households in formal dwelling Percentage of Householdsaccess with to sanitation with piped e Households insidewater the dwelling Percentage of Householdsaccess with to electricity Adult literacy rate Census 2011 38 235 28.6% 36% 58.7% 91.8% 82.5% 89.9%
Census 2001 44 117 34% 18% 20.9% 64.1% 77.6% 75.6% 85.63%
Community 21% 25% 14.7% 88.9% 88% 98.77% KwaDukuza Survey 2007
Census 2011 70 284 25% 59% 80.9% 93.1% 90.2% 90.3%
Census 2001 25 467 68% 20% 4.4% 28.9% 77.6% 21.6% 75.64%
Community 34% 23% 0.2% 81.5% 24.2% 99.08% Ndwedwe Survey 2007
Census 2011 29 200 48.7% 5% 48.5% 85.7% 9.5% 37.3% 77.8%
Census 2001 22 149 76% 9% 1.5% 22.9% 68.9% 17.0% 76.06%
Community 23% 28% 2.3% 83.8% 36.9% 99.52% Maphumulo Survey 2007
Census 2011 19 973 49% 2% 40.8% 80.5% 6.3% 33.7% 68.8%
Census 2001 120390 48% 17% 11.5% 81.6% 49.3% 80%
Community 27% 26% 11.0% 87.8% 63.2% 99.07% District Total Survey 2007
Census 2011 157692 37.8% 9% 87.8% 60.9% 84.7%
People’s experiences with health are greatly influenced by the social determinants. The total number of households has increased in the district except for Maphumulo sub district which has decreased. Increased households in the district will result in an increase in the demand of the CCG programme and home based care services with the expectation to reach all households and there will also be an increase in the demand for health care services at our public health facilities. Ward based outreach teams (WBOTs) need to be strengthened. Although unemployment has decreased in the district which should expect a greater income in the household and therefore have an improved quality of life and health outcomes, there remains an increase in the population that are living below the poverty line. This means that people still cannot afford transport and food. Only 63% (census 2011) of the households in iLembe are linked to regional/local water schemes (operated by municipality or other water service provider). This continues to pose a challenge in curbing water-borne diarrhoeal diseases, and KwaDukuza sub-district is the leading sub-district that has high numbers child with diarrhoea with dehydration new 1028 in 2013/14 and child under 5years admitted with diarrhoea 428 in 2013/14. This has been due to the informal dwellings surrounding this sub- district. 57% (census 2011) of the households in the district are formal dwellings which relate to the increased households with access to sanitation and electricity. Nearly half of the district population continue to reside in informal dwellings which negatively affects TB incidence due to the poor socio-economic conditions. The percentage of households with access to electricity has decreased. Cooking with firewood and coal predisposes to acquiring chest
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infections like asthma and TB. 46% of clients of the district total are clients on TB treatment in KwaDukuza sub-district, meaning that this sub-district has the highest case load within the district.
6.3 EPIDEMIOLOGICAL (DISEASE) PROFILE OF THE DISTRICT
Source: Stats SA; statistical release P0309.3
Tuberculosis (TB) continues to remain the single main cause of mortality in the district although the data shows that deaths due to TB have decreased. This can be attributed to early detection and treatment using the Gene expert testing. It is noteworthy that the Non Communicable Diseases such as cerebrovascular diseases, diabetes mellitus, hypertension, together, are responsible for about 20% of the deaths in the District therefore the District has to commit more resources with the intention to implement the National Strategic Plan for the prevention and control of NCDs. HIV is still a priority disease to be tackled, even though it is not the cause of death. People living with HIV increase the strain on health facilities.
Table: Causes of death in children and mothers in hospitals Trend Indicator Causes 2011/12 2012/13 2013/14
Perinatal mortality Extreme multi-organ immaturity 100 108 22
Hypoxia 39 69 33
Infection 4 7 7
Haemorrhagic 3 35 37
Congenital abnormalities 15 16 11
Other 85 53 22
Neonatal mortality Septicaemia 4 8 12
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Trend Indicator Causes 2011/12 2012/13 2013/14 rate Meconium aspiration 16 11 10
Hypoxia 27 29 13
Acute renal failure 0 0 0
Other 6 8 8
Facility infant Diarrhoea 12 16 18 mortality rate Septicaemia 4 3 24
Pneumonia 10 7 3
Meningitis 0 0 2
TB 0 4 2
Other 24 9 9
Facility child Septicaemia 14 6 17 mortality rate Diarrhoea 17 17 6
Respiratory diseases 8 9 5
TB pulmonary 6 7 3
TB Meningitis 0 3 3
Cardiac diseases 2 0 1
Meningitis 0 1 0
SAM 23 22 10
Herbal intoxaemia 3 2 0
Hospital acquired infection 0 0 0
Other 37 22 33
Maternal mortality Anaesthetic death 2 1 1 rate Severe anaemia 2 1
Haemorrhage 1 1 5
Septicaemia 1 1 2
AIDS 2 5
TB 1 1 5
Eclampsia 1 1 -
Cardiac 1 -
Pulmonary embolism - 2 -
Ectopic pregnancy - 1 -
Pneumonia - - 1
TOTAL 11 10 20
Source: Facility records
The main cause of infant mortality is prematurity which is associated with the low socio- economic status of mothers who live in rural areas which is further supported by the low
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literacy rate. Another significant factor identified in the district is the influence of intra cultural beliefs in women where they do not disclose their pregnancy therefore women do not go to Ante Natal Clinic (ANC) early which impacts negatively on attending ANC clinic before 20 weeks of pregnancy. This delays identification and transfer of high risk patients to higher levels of care at clinics or hospitals which means that PHC facilities need to market MCWH services more vigorously than ever. The district has to revive the waiting mother’s lodge utilisation at the facilities. The lack of specialised equipment (CPAP machine) in the district hospitals contributes to high causes of premature deaths.
Delayed turnaround times at EMRS services in reaching health facilities timeously is also a contributory factor hence the need to improve on emergency transport services.
Interventricular haemorrhagic is the leading cause of perinatal mortality and has increased significantly (over 100%) from 3 to 37 in two years.
Although hypoxia is decreasing as the leading cause of neonatal mortality, septicaemia has increased by 50% taking the lead in causes of neonatal, infant and child death. An analysis by the DCST paediatrician revealed that most deaths occur within one week of birth and babies become highly susceptible to infections due to prematurity. The possible contributory factors to increased septicaemia in the new born are due to poor infrastructure resulting in weak infection prevention and control practices in the high risk areas. There is an urgent need to strengthen infection prevention and control practices in the high risk areas.
Child mortality due to Severe Acute Malnutrition (SAM) has decreased by 50%, associated with work in the Phila Mntwana Centres and use of MUAC as promoted by the MEC for Health for early identification of malnutrition and referral.
There has been a marked increase in maternal mortality due the leading cause of death being post- partum haemorrhage and a 100% increase in TB which is related to treatment defaulters and non- compliance. The district needs to strengthen and activate TB tracer defaulter system for ANC patients, linking patients with Patient Advocates in collaboration with supporting partners like Kheth’Impilo, CCGs and the WBOTs.
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7. DISTRICT SERVICE DELIVERY ENVIRONMENT
7.1 DISTRICT HEALTH FACILITIES
7.1.1 PRIMARY HEALTH CARE FACILITIES Table 3 (NDoH 1): PHC facilities (Provincial and LG combined) per Sub-District as at 31 March 2014 Sub-Districts Health Posts Mobiles Satellites Clinics Community Community Standalone District Day Centre1 Health Centres MOU3 Hospitals (24 x 7)2
LG P LG P LG P LG P LG P LG P LG P Mandeni - - 0 1 - - 0 7 - - 0 1 - - 0 KwaDukuza - - 0 2 - - 0 9 - - 0 0 - - 0
Ndwedwe - - 0 4 - - 0 74 - - 0 1 - - 1
Maphumulo - - 0 3 - - 0 115 - - 0 0 - - 2 District - - 0 10 - - 0 34 - - 0 2 - - 3
Source: DHIS This District has 31 fixed clinics and 3 Gateway clinics located within each of the district hospitals. According to the vision in the PHC structure document, the DHIS catchment population estimates the number of fixed clinics within the district. Clinics should be functioning according to the following classifications: 20 small clinics, 6 medium clinics and 5 large clinics. KwaDukuza should have four large clinics at Ballito, Groutville, KwaDukuza and Shakaskraal. (A health facility providing a range of primary health care services which falls within the scope of practice of a Professional Nurse, the ratio of one professional nurse to the catchment population is approximately 20,000. The majority of people could normally access the services throughout the week including weekends and public holidays. The facility will be open for 24 hours, seven days a week and have fully fledged maternity services). KwaDukuza Clinic is functioning as a 24 hour clinic and is currently working with infrastructure to have maternity unit completed. KwaDukuza should ideally have five medium clinics which are Darnall, Glennhills, Kearsney, Mpumelelo and Nandi. Maphumulo clinic in Maphumulo sub district should be a medium clinic. (A health facility providing a range of primary health care services falling within the scope of practice of a Professional Nurse to a
1 There are no Community Day Centres in KwaZulu-Natal 2 All Community Health Centres (CHC’s) in KwaZulu-Natal do not have MOU’s according to the definitions used in the DHER 2011/12. All KZN CHC’s operate on a 24 hour, 7 day a week basis. 3 Accordingly to the DHER 2011/12 definitions for Stand Alone MOU’s, there are no Stand Alone MOU’s operational within KwaZulu-Natal 4 There is one additional gateway clinic in Ndwedwe sub districts with six standalone clinics. 5 There are 2 gateway clinics in Maphumulo which makes the total number of clinics 11. However there are only nine standalone clinics in the sub district.
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catchment population of approximately 15,000. The majority of persons can normally access the service outside normal working hours. The facility will be open for 12 hours, seven days a week). These clinics are not functioning as categorized due to poor infrastructure and poor manpower. The district plans on prioritizing these clinics to function as per category. The district has 20 small, 6 medium and 5 large clinics therefore infrastructure poses a challenge to 4 identified large clinics (KwaDukuza, Isithebe, Groutville and Shakaskraal). There is still a need to increase outreach services within the four sub-districts, especially in the rural clinics where accessibility is a problem.
Table 4: Provincial Clinic Facility to Population – 2013/14 Sub-Districts/ District PHC facility per pop ratio - Health PHC facilities per pop - Mob PHC facilities per pop ratio - Clinic PHC facilities per pop ratio - CHC Post provincial provincial provincial
Mandeni - 20 512.30 143 586.00 143 586.00 KwaDukuza - 121 251.00 26 944.70
Ndwedwe - 36 290.80 20 737.60 145 163.00
Maphumulo - 33 071.00 9 019.40 Source: DHER 2012/13 Customised District Report
The table above depicts the average population ratio per category of service. This table reveals that Mandeni, Ndwedwe and KwaDukuza sub-districts clinics have bigger catchment populations above 20 000, therefore, during the prioritisation of new fixed clinics, this should be taken into consideration. Maphumulo sub-district according to the table above shows there is no need for new fixed facilities. The PHC facilities have been tasked to identify, within their staff establishment, posts for outreach services. Mandeni has one mobile clinic and Ndwedwe has four mobile clinics. It is not feasible for Mandeni sub district to reach the pockets of population that are less than 5000 with one mobile clinic. There is a gap in mobile clinics and the district needs to improve mobile health services. The demarcation of the health facilities and the flow of transport to and from the clinics influence the utilisation of the clinics especially in sub districts that are rural.
Table 5 (NDoH 2): District Hospital Catchment Populations 2013/14 Name of District Hospital 2012/13 2013/14
Montobello District Umphumulo District Untunjambili District Montobello District Umphumulo District Untunjambili District Hospital Hospital Hospital Hospital Hospital Hospital
Catchment Population of District Hospital 23 760 101 388 20 724 23760 101388 20724 Source: DHER 2013/14 (GIS)
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Note: District Hospital Catchment Populations are calculated according to the catchment population of referring clinics.
Stanger hospital takes care of the remaining 484 592 (77%) of the district population. In addition to this are referrals from the district hospitals and CHCs, therefore affecting the quality of service delivery and creating increased pressure at Stanger hospital. There is an urgent need for additional resources or another district hospital in Mandeni sub district. Stanger hospital, although has the status as a regional functions also as a district hospital. Table 6 (NDoH 3): PHC Headcount Trend Sub-District 2012/13 2013/14 Variation
Facility Count PHC Total PHC Total Facility Count PHC Total PHC Total Facility Count PHC Total PHC Total Headcount Utilisation Rate Headcount Utilisation Rate Headcount Utilisation Rate
Mandeni 9 567 987 3.9. 9 547 789 3.8 0 -20 198 -0.1
KwaDukuza 11 760 573 4.1. 11 715 911 3.0 0 -44 662 -1.1
Ndwedwe 12 273 525 2.1. 13 398 853 2.7 1 125 328 0.6
Maphumulo 14 388 349 2.3. 16 353 860 3.6 2 -34 489 1.3
District 1 990 434 3.1. 49 2 016 413 3.3 3 25 979 0.7
Source: DHIS downloads
District PHC facility headcounts has decreased by 19% (438 455) from 1 990 434 in 2012/13 to 1 551 979 in 2013/14 (Mandeni 4%, KwaDukuza 6%, Maphumulo 9%). This is attributed by various factors as follows: The renovations and repairs have affected one community health centre. Sundumbili CHC headcounts decreased by 2% (4509) from 268 514 in 2012/13 to 264 005 in 2013/14 financial years. The process of data collections especially for headcounts was reviewed and now data is collected from one central point which is the reception area. This has affected KwaDukuza sub-district as it has decreased by 6% (44 662) from 760 573 in 2012/13 to 715 911 in 2013/14 financial years. The monitoring of data collection in the facilities has to be continuous and to be known by all the staff. The training of Clinic Operational Managers on data use is still on the pipeline by the supporting partner Kheth’Impilo (NGO).
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Graph 2: PHC Utilisation (Provincial Clinics) vs. Population to PHC facility (Provincial clinics) – 2013/14
4 30000 3.5 25000 3 2.5 20000 2 15000 1.5 10000 1 facilty facilty 0.5 5000 0 0 Population to to to prrovincial Population ProvincialUtilisation PHC Rate
PHC Utilisation Rate Avg catchment Population per clinic
Source: DHIS & DHER 2012/13 Customised District Report
Overlapping of catchment populations favour the KwaDukuza and Mandeni sub-districts due to the flow of transport into the semi urban areas. KwaDukuza has a low PHC utilisation rate although it has a high population to PHC facility. This may be attributed to the low number of uninsured population compared to the other sub districts that may be utilising private general practitioners and hospital services rather than public health services. Mandeni has a high PHC utilisation rate for the population contributing to the increased waiting times. Maphumulo clinic has contributed to the high PHC utilisation rate in Maphumulo sub-district due to its ideal location within the sub district. KwaDukuza low utilisation rate compared to the highest catchment population is attributed to the data clean up in respect of headcounts and the increasing headcounts in Maphumulo clinic.
Graph 3: PHC Utilisation rate in relation to PN Workload Provincial Clinics
4 60 3.5 50 3 2.5 40 2 30 1.5 20 1 0.5 10 0 0 Workload Rate PHC Utilisation Rate
PHC Utilisation rate PN Workload
Source: DHIS, DHER
Mandeni sub-district has got high PN workload because of Isithebe clinic and Sundumbili CHC rendering 24hour service, is accessible and ideally located in the semi-urban area. Mandeni has got 27% of the PHC headcount and has 32% of PNs allocated. Maphumulo sub district has got 20% of the PHC headcount and is allocated 23% of the PNs. Maphumulo sub district utilisation rate is high, whilst the PN workload is low, hence there is no need for more staff. Ndwedwe PHC headcount is 20% and they have a PN allocation of 18%. They have adequate number of PNs in relation to the utilisation rate and headcount. KwaDukuza has 35% of PHC headcount and 27% of PNs. The utilisation is not absolute, it is proportional. There is a need for more PNs in KwaDukuza sub
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district based on the headcounts and the proposed opening of the MOU services at KwaDukuza clinic.
Table 7 (NDoH 4): District Hospital activities District Hospitals Year Montebello Umphumulo Untunjambili District Totals District Hospital District District Hospital Hospital
1. Inpatient Days – 2012/13 27 342 35 156 26 651 89 149 total 2013/14 24 165 31 069 24 931 80 169
Variation -3 177 -4 087 -1 720 -8 980
2. Day patient – total 2012/13 31 4 679 714
2013/14 2 100 958 1 060
Variation -29 96 279 346
3. OPD Headcount not 2012/13 11 455 7 658 10 684 29 797 referred new 2013/14 8 734 8 382 13 284 30 400
Variation -2721 724 2 600 603
4. Inpatient 2012/13 3 432 4 593 5 215 13 240 Separations 2013/14 3 430 4 889 5 547 13 866
Variation -2 296 312 626
5. Inpatient Deaths 2012/13 239 281 306 826
2013/14 278 291 251 820
Variation 39 10 -55 -6
6. OPD Headcount – 2012/13 44 012 53 210 52 075 149 297 total 2013/14 50 507 30 123 24 788 105 418
Variation 6 495 -23 087 -27 287 -43 879
7. Emergency 2012/13 202 2 908 1 348 4 458 headcount total 2013/14 104 3 373 1 308 4 785
Variation -198 465 -40 327
8. Patient Day 2012/13 41 948 53 677 44 620 140 245 Equivalent 2013/14 41 036 42 284 34 109 117 429
Variation -912 -11 393 -10 511 -22 816
9. Cost per PDE 2012/13
2013/14 R1 909.5 R1 951.9 R2 144.5 R2 002
Variation
10. Delivery by 2012/13 36.1 23.2 21.1 26.8 caesarean section 2013/14 34.5 22.5 27.9 28.3 rate Variation -1.6 -0.7 6.8 1.5
11. Average length of 2012/13 8.0 7.7 5.2 6.6 stay - total 2013/14 7.0 6.5 5.5 6.3
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District Hospitals Year Montebello Umphumulo Untunjambili District Totals District Hospital District District Hospital Hospital
Variation -1 -1.2 0.3 -0.3
12. Inpatient bed 2012/13 67.5 72.8 54.7 65 utilization rate – 2013/14 59.6 63.2 53.6 58.8 total Variation -7.9 -9.6 -1.1 -6.2
Source: DHIS Downloads 2012/13 & 2013/14 The decrease in OPD headcounts and IPD is attributable to improved PHC support by doctors, also the review of admission and discharge criteria in the district hospitals. The increase in the day patients is mostly due to increase of male medical circumcision conducted within the hospitals. The large number of un-referred OPD headcount may be attributed to the services at gateway clinics are not offered after 4pm, weekends and public holidays. Maphumulo sub-district has fully operational Gateway clinics in the two hospitals resulting in a drop in the total OPD headcounts. The huge drop in the total OPD headcount in Maphumulo sub-district has led to the subsequent decrease in the PDE raising the cost per PDE. Expenditure is high at Montebello and Umphumulo hospital, financial data needs to be reviewed and institutional MTEC needs to be revived to locate expenditure. Montebello hospital has a low number of deliveries thus skewing the percentage of delivery by caesarean section. The decreasing average length of stay is an indication of improving patient management within the hospitals. Bed utilisation rate has decreased due to the support services by doctors for early referral, diagnosis and treatment.
Graph 4: District Hospitals Cost per PDE vs. IPD and OPD 80% R 2 500
60% R 2 000 40% R 1 500 20%
0% R 1 000 Montobello Umphumulo Untunjambili
Total IPD as % of PDE Total OPD as % of PDE Total Emergency as % of PDE Cost per PDE
Source: DHER 2012/13 Customised District Report
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8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S
Table 8 (NDoH 5): Review of Progress towards the Health-Related Millennium Development Goals (MDG’s) and required progress by 2015
MDG Target Indicator Provincial progress Source of District progress District targeted progress 2013/14 data 2013/14 2015/16
Goal 1: Halve, between 1990 Prevalence of underweight Not recorded DHIS 1% 0.5% Eradicate Extreme and 2015, the children under 5 years of age (1438/262 480) (1537/298651) Poverty And Hunger proportion of people who suffer from hunger Severe malnutrition under 5 11% DHIS 10/1 000 4.1/1000 years incidence ) (382/3462) (613/61861)
Goal 4: Reduce by two-thirds, Under-five mortality rate – use 5% DHIS 9.2% 3.7% Reduce Child between 1990 and proxy “Inpatient death under 5 (3902/72726) (404/4383) (171/4587) Mortality 2015, the under-five years rate” mortality rate Infant mortality rate – use proxy 6.6% DHIS 15.7/1k 8.4/1k “Child under 1 year mortality in (3104/48078) (241/15387) (136/16103) facility rate”
Goal 4: Reduce by two-thirds, Measles 2nd Dose coverage Not recorded DHIS 71.2% 93.8% Reduce Child between 1990 and (10692/15012) (15287/16294) Mortality 2015, the under-five mortality rate Immunisation coverage under 1 95.8% DHIS 77% 87.6% year (203528/212497) (11687/15012) (14048/16041)
Goal 5: Reduce by three- Maternal mortality ratio (only 136.6/100k DHIS 185/100 000 94/100k Improve Maternal quarters, between facility mortality ratio) (266/196146) (20/10812) (11.3/11931) Health 1990 and 2015, the maternal mortality rate Proportion of births attended by Not recorded DHIS 94% 96% skilled health personnel (Use (2511/2664) delivery in facility as proxy indicator)
Goal 6: Have halted by 2015, HIV prevalence among 15- 19- Not recorded National HIV Results not yet
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MDG Target Indicator Provincial progress Source of District progress District targeted progress 2013/14 data 2013/14 2015/16
Combat HIV and and begin to reverse year-old pregnant women Syphilis received from national. AIDS, malaria and the spread of HIV and Prevalence other diseases AIDS Survey of SA
HIV prevalence among 20- 24- National HIV Results not yet year-old pregnant women Syphilis received from national. Prevalence Survey of SA
Contraceptive prevalence rate 50.7% DHIS 33% 63% (use Couple year protection rate (1 225832/2 418784) (107272/169879) as proxy)
TB Cure Rate ETR.Net 88% 89.9% (3142/3499)
Goal 1 There is a decrease in severe malnutrition due to the work done by OSS, Phila Mtwana, CCGs and MUAC strategies but the district still needs to continue improving due to the rising unemployment, high prevalence of HIV and TB correlation. Goal 4 The norm is 20/1000, the district is at 62/1000, this goal is unlikely to be met and district needs to improve strategies to curb child mortality.
Goal 5 The district is far from meeting this goal. The maternal mortality has doubled. The MCWH and PMTCT strategies and ambulance services need to be strengthened.
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9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA)
The National Development Plan 2030 was adopted by government as its vision for the health sector. It will be implemented over three electoral cycles of government. The MTSF 2014-2019 therefore finds its mandate from National Development Plan 2030.
Table 9: (NDoH): Alignment between NDP Goals 2030, Priority interventions proposed by NDP 2030 and Sub-outcomes of MTSF 2014-2019 NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)
Average male and female life expectancy at birth a. Address the social determinants that affect HIV & AIDS and Tuberculosis prevented and successfully increased to 70 years health and diseases Managed Tuberculosis (TB) prevention and cure progressively improved; d. Prevent and reduce the disease burden and promote health Maternal, infant and child mortality reduced
Prevalence of Non-Communicable Diseases reduced by 28% Maternal, infant and child mortality reduced
Injury, accidents and violence reduced by 50% from 2010 levels
Health systems reforms completed b. Strengthen the health system Improved health facility planning and infrastructure delivery
Health care costs reduced
c. Improve health information systems Efficient Health Management Information System for improved decision making
h. Improve quality by using evidence Improved quality of health care
Primary health care teams deployed to provide care to Re-engineering of Primary Health Care families and communities
Universal health coverage achieved e. Financing universal healthcare coverage Universal Health coverage achieved through implementation of National Health Insurance
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NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)
Posts filled with skilled, committed and competent individuals f. Improve human resources in the health sector Improved human resources for health
Improved health management and leadership g. Review management positions and appointments and strengthen accountability mechanisms
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10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS
10.1 INTRA‐ DISTRICT EQUITY IN THE PROVISION OF SERVICES
Challenges Explanation of the challenge Resolution
CCGs availability Not all areas are covered by CCGs Collaboration with Department of Social development regarding CCG integration
Absence of comprehensive PHC facilities not offering full One large clinic to commence full maternal services in one sub- complement of MNCWH package package of MNCWH. district
Not meeting set target 2 sub-district not meeting the set 1. Identify posts within the targets each clinic staff Low PHC utilisation establishment, to be used for Family Health Teams Low MMC coverage 2. Market services by conduct Low TROA community dialogues
Poor management skills Data collection, Onsite training and interpretation, analysis and mentoring feedback remains a Performance review session challenge quarterly Not reaching set targets in Strategies to address MMC, child mortality and MNCWH and MMC maternal mortality
Long and delaying SCM processes Low expenditure on Timeous implementation of maintenance remains maintenance plans challenge Improve communication Long turnaround time in with HTS regarding receiving ordered equipment equipment
Table 10 (NDoH 6): PHC Expenditure Sub-District PHC Expenditure / PHC Utilisation Rate PN to Patient Cost per % Share of District Capita (Uninsured) number Headcount Population 2013/14
Mandeni 681.5 3.8 5941.7 165.6 22.8%
KwaDukuza 245 3.0 9041.5 76.9 38.5%
Ndwedwe 479.1 2.7 4156.6 161.6 23.0%
Maphumulo 366.7 3.6 6002.7 95.3 15.7%
District 443.07 3.3 6285.6 124.85 100%
Source: DHER 2013/14 Customised District Report, DHIS
Note: The CHC’s have been included in the analysis and will affect the balance of equity. The table above presents the lowest and the highest expenditure per capita between sub- districts. Mandeni and Ndwedwe sub-districts are the highest because of the community
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health centres within the two sub-districts. Isithebe Clinic which offers 24 hours services within Mandeni sub-district contributes to the high expenditure per capita. This expenditure per uninsured for Mandeni sub-district decreased from R700 in 2012/13 to R681.5 in 2013/14 financial years, which is still below the National average of R780. KwaDukuza sub-district expenditure per capita is lowest of the sub-districts due to backlog on journals out of the 4 sub districts. Expenditure for un-referred PHC patients that are seen at Stanger hospital is not reflected under PHC. Maphumulo sub-district increased from R248 in 2012/13 to R367 in 2013/14 financial years due to increase in expenditure by 36% (10 014 464) in 2013/14. This has been due to employment of clinic staff in trying to equalize the distribution of resources fairly within the district.
Graph 5: Equity of resources vs population and headcount – 2013/14 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0%
% Share of PN's % Share of Population % Share of Expenditure % Share of Headcount
Source: DHER 2013/14 Customised District Report
There is an inequitable distribution of resources. Sub districts that have less, needs to be allocated more resources, those that have excess do not fill posts.
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Table 11 (NDoH 7 (a)): Number of patients to staff type (Sub-District) – PDoH PHC Clinics Sub-Districts Spec. Counsellors DC GW/C MO NA PA Basic PA PostBasic Pharm PN SN Admin Clinical other
Mandeni 24307.0 19098.4 133688.5 11140.7 24307.0 5941.7 8912.6
KwaDukuza 57262.7 28631.3 171788.0 40420.7 20210.4 687152.0 9041.5 11646.6
Ndwedwe 23548.2 8830.6 141289.0 20184.1 35322.3 4155.6 5887.0
Maphumulo 78034.8 18361.1 62427.8 20809.3 6002.7 10763.4
District
Source: DHER 2013/14 Customised District Report, DHIS
KwaDukuza sub-district has the highest number of patients to PN type of 9 042 compared to the 3 sub-districts. This seems to be high when looking to raw numbers as such, but when drilling further this is saying that each professional nurse has seen 34 clients per day, which is in almost in-line with the Provincial norm of 1:35 clients per PN. The calculation is based on extended hours of service, as most clinics in this sub-district provide services on public holidays and during the day only. Maphumulo sub-district has the second highest number of PN type 6 003 compared to the other 2 sub-districts and this is backed by the increase of headcounts mentioned in section 7.1.1. The calculation is based on the fact that clinics in this sub-district provide services on public holidays, Saturday and stand-by Sunday, therefore each PN on average sees 20 clients per day. The PN to client ratio still has to be reviewed because of the increased time spent with one patient due to the integrated comprehensive provision of service.
There is still a need of Administrative staff in Maphumulo sub-district, since the table above has shown a highest number of patients to this category compared to other sub-districts.
Table 12 (NDoH 7 (b)): Number of patients to staff type (Sub-District) – CHC’s CHC Name PA Basic PA Post Basic Pharm PN SN Spec. Admin Admin Clinical other Counse llors DC GW/C MO NA
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CHC Name Spec. Spec. Admin Admin Clinical other Counse llors DC GW/C MO NA PA Basic PA Post Basic Pharm PN SN
Mandeni 8250.2 20308.1 88001.7 22000.4 44000.8 26400.5 264005.0 33000.6 33000.6 5617.1 10154.0
Ndwedwe 9110.4 28632.7 100214.5 40085.8 33404.8 28632.7 50107.3 200429.0 50107.3 6073.6 13361.9
Source: DHER 2013/14 Customised District Report, DHIS Note: There are no CDC’s operational in KwaZulu-Natal. Note: There are no Stand-Alone MOU’s in KwaZulu-Natal.
The two community health centres are operating 24hour services, 7days per week. The calculation is generally based on that Community Health Centres are operating for 24 hours daily and did not consider those that were off, sick, at meetings and those on study leave. Ndwedwe CHC has a high (6 074) number of patients per PN per annum compared to Sundumbili CHC (5 617) at Mandeni sub-district. When drilling further this is saying that each professional nurse, at Ndwedwe CHC, has seen 17 clients on average per day. Sundumbili CHC at Mandeni has seen 16 clients on average per PN per day.
Sundumbili CHC has the highest number of patients to MO type of 44 001 compared to Ndwedwe CHC that has 33 405.Therefore this means that Medical Officers at Mandeni sub-district have seen 175 clients on average per day per MO whereas Ndwedwe sub-district have seen 127 clients on average per day per MO. It is not all the clients are seen by Medical Officers as they see complicated, referred and emergency clients. This requires more attention for the categories mentioned above for strengthening of primary health care. The availability of medical officers in the community health centres will assist in giving support to clinics. Partner support for medical officers can assist in coverage.
Table 13 (NDoH 8): Population to Staff per sub-district – 2013/146 Sub-District Population to Medical Officers Population to Professional Nurses
Total Population Uninsured Population Total Population Uninsured Population
Mandeni Local Municipality 23931.0 22184.0 1560.7 1446.8
6 District hospital plus PHC
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Sub-District Population to Medical Officers Population to Professional Nurses
Total Population Uninsured Population Total Population Uninsured Population
KwaDukuza Local Municipality - - 3190.8 2957.9
Ndwedwe Local Municipality 24193.8 22427.7 2166.6 2008.4
Maphumulo Local Municipality - - 1907.9 1768.7
District Source: DHER 2013/14 Customised District Report, DHIS
Note: The National Table A12 has been combined to incorporate both Medical Officers and Professional Nurses.
The Medical staff is only available in community health centres only and supports clinics on weekly basis. Ndwedwe sub-district has high population to Medical Officer of 24 194 compared to Mandeni sub-district that has 23 931. The two sub-districts have the same number of 5 doctors which includes the Medical Manager and a Community Service Doctor. General calculation and considering that each client is
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expected to visit the facility thrice a year, therefore each doctor sees 32 clients on average per day. It is then envisaged that there is a need for more doctors in the sub-district to support and strengthen primary health care.
KwaDukuza sub-district has the highest uninsured population to Professional Nurse of 2 958 compared to the 3 sub-districts. Ndwedwe sub-district is the second highest uninsured population to professional nurse of 2008. According to the table above it shows disparities in the sense that in this indicator both PHC and CHC facilities are combined at Mandeni and Ndwedwe sub-districts, yet the other two sub-districts do not have. The outreach teams for school, TB and Family health teams are still required within the district and all these teams will be of importance in primary health care engineering.
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11. ORGANISATIONAL ENVIRONMENT
11.1 Organisational Structure of the District Management Team
District Manager (Vacant)
District Health Stanger Regional Community Health District Clinical Transverse Services Services hospital Centre Services Specialist Team
Deputy District District Ndwedwe CHC Family Health Co‐orperate Services PHC Specialist Managers Hospital Services (Vacant)
Umphumulo P,M & E Sundumbili CHC Paediatrics Nurse Forensic Pathology Hospital
Pharmaceutical Public Health Ntunjambili Hospital Family Physician Services
PHC Manager Montobello Hospital Advanced Midwife Emergency Rescue (vacant) Services
Paedatrician Communication Services
Obstetrician
anaesthetist (vacant)
11.2 Human Resources
Current deployment of human resources in relation to service delivery requirements;
There is a gap with regard to the current deployment of human resources in relation to service delivery in iLembe Health. However there has been some progress especially in the nursing field. Through the support provided by the Manager: Budget control where he approved the advertising and the filling of various categories of posts in nursing i.e. professional nurses, clinical nurse practitioners, staff nurses in various clinics within the district. All those posts have been filled and this has gone a long way towards addressing the gaps in service delivery but still is not enough because the gaps are still there in other fields such as pharmacy, paramedical and administration.
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Another challenge is lengthy process of getting the approval to fill a post especially the newly created posts on the organogram and the newly approved organograms which have not been funded i.e. Regional Hospital, District Hospitals and the Community Health Centres. Creating a structure that is not funded does not assist the department in any way because the posts that have been created cannot be filled and institutions suffer with these posts on their organograms.
Accuracy of staff establishment at all levels of the system compared to service requirements (link with PERSAL report);
There is a minimal challenge in this area caused by staff members held out of adjustment, incorrect linkage of staff although there is a steady improvement but this still needs to be monitored closely by Institutional teams i.e. Finance Manager, HR Manager and Nursing Manager. The linkage must be checked every month and corrected. Staffing levels and staff mix: could current staff absorb additional visits;
The staff mix is not balanced but rather happens randomly due to the staff shortage; therefore staff cannot absorb additional visits.
Staff recruitment and retention system and challenges;
The existing recruitment system has the following gaps:
Process takes long especially when filling the post of staff nurses because of rigid restrictions (to recruit from the existing database) and the challenge is that the staff on the data base do not meet the minimum requirements. The practical example is that of the staff nurse that the District need to fill who will work in TB &HIV Outreach team, iLembe has not filled the 6 staff nurse posts because there is no staff nurse on the database that has a driver’s licence which is a minimum requirement for this post. As a result the 6 staff nurse posts for TB/HIV in iLembe have not been filled. The existing retention policy is not effective and the attrition rate is not improving, Doctors, specialists’ pharmacists and speciality nurses are leaving in high numbers.
Absenteeism and staff turn-over rates. There is high absenteeism rate in iLembe which is caused by the abuse of sick leave by the staff and poor monitoring of leave by supervisors although there are policies in place. This area needs to be strengthened by the HR Managers in the institutions.
There is also high turnover rate caused by: Disparities in the rural allowances i.e. 8% and 12% pay within the Department, leading to professional nurse applying in higher paying hospitals into the presidential nodal points (rural allowance)
Clinicians leaving for green pastures overseas.
Unhappiness with poor working conditions and unavailability of medical equipment.
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Table 14: Staff type to Patient Ratio in Facilities [per 10 000] – Provincial Clinics Sub-Districts MO to Patient PN to Patient EN to Patient ENA to Data General Provincial Provincial Provincial Patient Capturer to Worker to Clinics Clinics Clinics Provincial Patient Patient Clinics Provincial Provincial Clinics Clinics
Mandeni 5941.7 8912.6 24307.0 133688.5 11140.7
KwaDukuza 9041.5 11646.6 20210.4 171788.0 40420.7
Ndwedwe 4155.6 5887.0 24307.0 141289.0 20184.1
Maphumulo 6002.7 10763.4 62427.8 20809.3
Source: DHER 2013/14 Customised District Report
Refer to table 11 the analysis is the same.
Table 15: Staff type to Patient Ratio in Facilities [per 10 000] – Provincial CHC
Sub-Districts MO to Patient PN to Patient EN to Patient ENA to Data General Provincial Provincial Provincial Patient Capturer to Worker to Clinics Clinics Clinics Provincial Patient Patient Clinics Provincial Provincial Clinics Clinics
Mandeni 44000.8 5617.1 10154.0 26400.5 88001.7 22000.4
Ndwedwe 33404.8 6073.6 13361.9 28632.7 100214.5 40085.8
Table 16: Cost per Headcount in relation to Workload Sub-Districts and District Total Staff Cost per PHC PN Workload Staff to Patient ratio at Headcount Provincial Clinics - PN
Mandeni R149.91 42.6 5941.7
KwaDukuza R81.38 48.5 9041.5
Ndwedwe R147.28 36.9 4155.6
Maphumulo R86.99 35.3 6002.7
Source: DHER 2012/13 Customised District Report, DHIS
KwaDukuza and Maphumulo sub-districts have the low staff cost per headcount which is caused by journaling challenges that are not occurring in time. It is also envisaged that some items are taken from the supporting institutions, without recording expenditure to relevant PHC facilities. Another fact is that expenditure from the conditional grant has been excluded from this exercise whereas headcount from ARV and PMTCT has been included.
Table 17: District Hospital Staff to PDE Ratio Total Pharmacy Total Medical Total Clinical Total Support Total Nursing District Hospital Staff Staff Staff Other Staff Staff
Montebello Hospital 4103.6 8207.3 3419.7 621.8 295.2
Umphumulo Hospital 3844.0 5285.5 4698.3 741.8 280.0
Untunjambili Hospital 6821.7 4872.7 3789.9 509.1 270.7 Source: DHER 2012/13 Customised District Report
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12. DISTRICT HEALTH EXPENDITURE
Table 18 (NDoH 9): Summary of District Expenditure
(Budget, Transfer to (Expenditure, (Expenditure, Transfer Data element (Budget, Province) (Budget, LG Own) (Expenditure, LG Own) LG) Province) to LG)
DF - 2.1: District Management 16 277 000.00 - - 16 478 428.00 - -
DF - 2.2: Clinics 155 726 000.00 658 000.00 - 155 883 127.00 657 417.00 -
DF - 2.3: Community Health 90 915 000.00 - - 90 826 167.00 - - Centres
DF - 2.4: Community Services 0.00 - - 0.00 - -
DF - 2.5: Other Community Services 54 657 000.00 - - 54 642 279.00 - -
DF - 2.6: HIV/AIDS 170 757 000.00 - - 169 787 675.00 - -
DF - 2.7: Nutrition 2 714 000.00 - - 2 714 177.00 - -
DF – 2.9: District Hospitals 247 242 000.00 - - 248 913 703.00 - -
DF – 2.12: Donor Funding 0.0 - - 0.0 - -
Source: DHER 13/14 District Customised Template
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Table 19 (NDoH 10): Capita PHC expenditure per sub-district – 2013/14 Total Population District Service Delivery Expenditure PHC PHC % % Cost per Cot per Expenditure / Expenditure Uninsured Expenditu Uninsured Uninsured Sub-Districts Capita (Total / Uninsured populatio re Capita Capita and District Population) Capita n compare 2011/12 2012/13 compare d to d to District District
Mandeni R 131 752 458 R917.59 R989.85 23% 36% R700.2
KwaDukuza R 101 954 102 R420.43 R453.53 38% 28% R294.7
Ndwedwe R 81 812 974 R563.59 R607.98 23% 23% R455.1
Maphumulo R 47 205 388 R457.80 R513.27 16% 13% R248.3
District R 362 724 922 R575.33 R620.64 100% 100% R424.58 Source: DHER 2013/14 Customised District Report, DHER 2011/12 and 2012/13
Note: The PHC expenditure is inclusive of sub-programmes 2.2 to 2.7 Note: The above expenditure excludes HIV/AIDS grant and other community services allocated to district hospitals.
Table 20 (NDoH 11): PHC Budget and Expenditure (%) excluding “Other Donor Funding” – 2013/14
Budget Amount Budget Expenditure Amount Expenditure
District Management (2.1) 16 277 000.00 2.2% 16 478 428.00 2.2%
PHC (2.2 – 2.7) 474 769 000 65.2% 473 853 425 64.1%
District Hospitals (2.9) 247 242 000.00 33.9% 248 913 703.00 33.7%
Source: DHER 2013/14 Customised District Report
Note: The National Table for District Finance Proportional Expenditure [%] is included in Table A15 above.
Table 21 (NDoH 12): PHC Cost per Headcount– 2013/14
LG PHC Facilities Provincial PHC Facilities Total Staff Cost per PHC Headcount
District N/A R179.89 R95.62
Source: DHER 2013/14 Customised District Report
Table 22: District Hospital Expenditure District Hospital Expenditure per PDE ALOS BUR Proportion (%) of expenditure spent on staff (CoE)
Montobello R1 909.5 7.0 59.6 80.1%
Umphumulo R1 951.9 6.5 63.2 81.2%
Untunjambili R2144.5 5.5 53.6 76.9%
District R 2001.97 6.3 58.8 79.5% Source: DHER 2013/14 Customised District Report
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The average length of stay for Untunjambili Hospital was 5.5, the lowest in the district. Montobello Hospital burden of disease of TB clients raised the ALOS to 7.0.
Graph 6: District Hospital Expenditure in relation to Service Delivery – 2013/14 R 2 500
R 2 000
R 1 500 R1 650 R1 529 R1 585 R 1 000
R 500 R 358 R 352 R 468 R - Montobello Umphumulo Untunjambili
CoE / PDE GS/PDE
Source: DHER 2012/13 Customised District Report
Table 23: Non-Negotiable Expenditure per PDE Non-Negotiable [Rands per PDE] Montobello Umphumulo Untunjambili Hospital Hospital Hospital
Infrastructure Maintenance 19.7 0.1 0.0 Food Services -0.0 -0.0 -0.0
Medicine Expenditure 0.0 -0.0 0.0
Medical Sundries (Supplies) Expenditure 0.0 0.3 -0.3
Essential Equipment -878.7 -0.0 10.2 Laundry Expenditure 0.0 0.0 0.0
Vaccination Expenditure -0.1 0.3 -0.0
Blood Support Expenditure 0.1 -0.0 0.0
Infection Control Expenditure -0.1 1.1 -0.1
Medical Waste Expenditure -0.3 0.0 0.2
Laboratory Services Expenditure 0.0 0.0 0.0
Security Services 0.0 0.0 0.0
Source: DHER 2013/14 Customised District Report
39 | Page ILEMBE DISTRICT HEALTH PLAN 2014/15
PART B - COMPONENT PLANS
13. SERVICE DELIVERY PLANS FOR DISTRICT HEALTH SERVICES
13.1 SUB-PROGRAMME: DISTRICT HEALTH SERVICES
13.1.1 PHC SUB-PROGRAMME OVERVIEW
PHC The District has 31 fixed clinics; 2 provide 24 hour service. One clinic provides 24 hour services except maternity services hence this is being negotiated with the relevant managers at local level. 18 clinics provide on call services while the rest provides extended hour of services. There are 7 PHC supervisors at the sub-districts. The district has 12 operational school health teams due to the difficulty in filling professional nurses’ post. There are only 5 functional Family Health Teams (2 in KwaDukuza sub- district and 3 in Mandeni sub- district). 3 Family Health Teams at Maphumulo sub-district to start in April 2015. The Family Health Teams also have a challenge of shortage of vehicles so they travel with School Health Teams. KwaDukuza sub-district still reports at the District Office while the one sub-district PHC Supervisors is now delinked and reports to the district hospitals. The other two PHC Supervisors fall under the two Community Health Centres.
STRATEGIC CHALLENGES
Recruitment and retention of professional nurses especially at Maphumulo sub- district remains a challenge. Low doctor coverage at Maphumulo sub- district Transport and office space in the clinics for FHT and School Health Teams remains a challenge. Absence of the PHC Managers in three out four sub-districts remains a challenge in managing PHC at sub-district level.
Hospital Gateway Clinics not offering a comprehensive package of service
PHC deliveries are still offered by district hospitals
Gateway clinics are not offering services after 4pm, weekends and public holidays
Absence of comprehensive MNCWH package offering in KwaDukuza sub-district PHC facilities leading to Regional Hospital offering PHC services. Infrastructure challenges leading to PHC facilities to offer limited services
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Table 24 (NDoH 13): Situation Analysis: Indicators for District Health Services 2013/14 Financial Year Type Mandeni Sub- KwaDukuza Ndwedwe Sub- Maphumulo District Indicators district Sub-district district Sub-district Average
1. Percentage of fixed PHC facilities compliant with Quarterly % 0 0 0 0 0 all extreme measures of the National Core Standards
Fixed PHC facilities compliant with all the extreme No 0 0 0 0 0 measures of the National Core Standards for health facilities
Fixed PHC clinics plus fixed CHCs / CDCs No 7 9 6 9 31
2. Patient satisfaction survey rate (PHC Facilities) Quarterly % 100% 100% 100% 100% 100%
Fixed PHC facilities that have conducted Patient No 7 9 6 9 31 Satisfaction Surveys
Fixed PHC clinics plus fixed CHCs / CDCs No 7 9 6 9 31
3. PHC patient satisfaction rate at PHC facilities Annual % 91% 80% 94% 78% 85.8%
Patient satisfied with health services No - - - - -
Patients participating in PSS No - - - - -
4. OHH registration visit coverage Annual % Not reported Not reported Not reported Not reported Not reported
OHH registration visit No - - - - -
OHH in Population No - - - - -
5. Number of District Clinical Specialist Teams Quarterly No 0 0 0 0 5 (DCST’s)
6. PHC utilisation rate Annual 3.7 3.7 2.7 2.7 3.1 %
PHC headcount total No 541 780 715 911 441 534 323 782 2023 007
Population Total No 143 586 242 502 145163 99212 630 463
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Type Mandeni Sub- KwaDukuza Ndwedwe Sub- Maphumulo District Indicators district Sub-district district Sub-district Average
7. Complaints Resolution Rate Quarterly % 73.8% 93.3% 45.1% 80% 71.2%
Complaints resolved No 62 28 23 28 141
Complaints received No 84 30 51 35 198
8. Complaint resolution within 25 working days rate % 51.6% 93.3% 21.6% 59% 70.9% Quarterly
Complaint resolved within 25 working days No. 32 28 11 27 100
Complaint resolved No. 62 30 51 35 141
Table 25 (NDoH 14): District Performance Indicators – District Health Services Audited/ Actual Performance Estimated Medium Term Targets Provinci Data Frequency Indicator Performance al Target Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Proportion of fixed PHC QA % 0 0 0 0 0 0 2 facilities compliant with all assessment Quarterly the extreme measures of the records National Core Standards
Fixed PHC facilities compliant QA No 0 0 0 0 2 3 4 with all the extreme measures of assessment the National Core Standards for records health facilities
Fixed PHC clinics plus fixed CHCs DHIS No 0 0 33 33 33 33 33 / CDCs calculates
2. Patient experience of Care QA % Not Not 100% 100% 100% 100% 100% 100% survey rate (PHC Facilities) calculates Quarterly reported reported
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Audited/ Actual Performance Estimated Medium Term Targets Provinci Data Frequency Indicator Performance al Target Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Fixed PHC facilities that have OSS No - - 33 33 33 33 33 conducted Patient Satisfaction records Surveys
Fixed PHC clinics plus fixed CHCs DHIS No - - 33 33 33 33 33 / CDCs calculates
3. PHC patient experience of DHIS % Not Not 80.2% 85% 87% 90% 95% 75% Care rate calculates Annual reported reported
Patient satisfied with health PSS results No - - 529 562 580 600 630 services
Patients participating in PSS PSS records No - - 660 660 660 660 660
4. OHH registration visit DHIS % Not Not Not DHIS not fully Baseline Review Review - coverage calculates Annual reported reported reported activated to be establishe d
OHH registration visit DHIS/Tick No - - register WBOT
OHH in Population District No - - Records
5. Number of District Clinical Persal/ Quarterly 4/7 5/7 6/7 6/7 7/7 7/7 11 Specialist Teams (DCST’s) District No Records
6. PHC utilisation rate DHIS Annual 3.1 3.1 3.1 3.2 3.5 3.8 4.1 3.1 calculates %
PHC headcount total DHIS/PHC No 1,946,224 1,990,434 2,023,007 1,026,924 2,225,308 2,447,838 2,692,622 tick register
Population Total DHIS/Stats No 629,625 632,458 630,463 320,394 638,660 646,963 655,373 SA
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Audited/ Actual Performance Estimated Medium Term Targets Provinci Data Frequency Indicator Performance al Target Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
7. Complaints Resolution Rate DHIS Quarterly % 70.1% 71.2% 71.9% 72.6% 73.3% 82% calculates
Complaints resolved DHIS / No 277 248 141 147 153 159 185 Complaint records
Complaints received DHIS / No - 354 198 204 210 216 223 Complaint records
8. Complaint resolution within DHIS Quarterly % 87.7% 106% 70. % 78% 86% 95% 97% 75% 25 working days rate calculates
Complaint resolved within 25 DHIS / No. 243 264 100 115 132 152 180 working days Complaint records
Complaint resolved DHIS / No. 277 248 141 147 153 159 185 Complaints record
Table 26 (Table 15): District Specific Objectives and Performance Indicators – District Health Services Estimated Strategic Performance Frequenc Audited/ Actual Performance Medium Term Targets Data Source Performance Objective Indicators y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. Increase 1.1 PHC utilisation DHIS Quarterly 4.7 5.0 5.0 5.1 5.2 5.3 5.4 PHC under rate under 5 years calculates % 5yrs to 5.4 (annualised) visits per PHC headcount DHIS/PHC No 311, 609 341,289 344,959 353,629 363 ,745 372,594 381,521 child by 2017 under 5 tick register
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Estimated Strategic Performance Frequenc Audited/ Actual Performance Medium Term Targets Data Source Performance Objective Indicators y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Population under DHIS/Stats SA No 5 years 66,129 68,117 69,339 69,603 69,951 70,301 70,652
2. Increase 2.1 Expenditure per DHIS/BAS Quarterly R165 R115 R122 R124 R126 R128 R131 PHC PHC headcount R expenditure per client Total expenditure BAS (R’000) R’000 320,683,160 228,243,656 246,709,294 276,314,409 309,472,138 346,608,795 388,201,850 PHC
PHC headcount DHIS No 1,946,224 1,990,434 2,023,007 2,225,308 2,447,838 2,692,622 2,961,885 total calculates
3. Improve 3.1 Number of School District Quarterly 5 5 12 12 14 16 18 School Health Teams Records/ No Health (cumulative) Persal Teams 3.2 Number of Health Quarterly 12 14 17 19 21 23 25 services accredited Health Promotion No Promoting Schools database (cumulative)
3.3 School ISHP DHIS % Not Not reported Not Not reported Establish Review coverage reported reported baseline baseline (annualised)
Schools with any DHIS / Tick No learner screened register SHS
Schools – total DHIS / DoE database
4. Improve 4.1 Dental extraction DHIS Quarterly 6:1 12:1 3:1 3.1 3:1 3:1 3:1 efficiencies to restoration ratio calculates Ratio in dental health by Tooth extraction DHIS/Tick No 2 225 24 753 36 636 36,270 35,907 35,548 35,192 reducing the register dental Tooth restoration DHIS/Tick No 387 2 003 11 793 12,147 12,511 12,887 13,273 extraction register
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Estimated Strategic Performance Frequenc Audited/ Actual Performance Medium Term Targets Data Source Performance Objective Indicators y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
5. Increase % 5.1 Percentage of QA Annual Not Not reported 0 0 9.1% 15.2% 21.2% PHC facilities PHC facilities assessment % reported to be conditionally records conditionally compliant to the compliant to National Core NCS to 21% Standards by 2017 Clinics QA No 0 0 3 5 7 conditionally assessment compliant (50%- records 75%)to National Core Standards
CHC’s and clinics DHIS No 33 33 33 33 33 total calculates
6. Increase 6.1 District PHC BAS / Stats SA R R520 R394 R422 R432 R442 R452 R463 expenditure expenditure per per uninsured person
uninsured person to R463 by 2017 Total expenditure on BAS R’000 320 683 160 228 243 656 246,709,294 256,577,666 266,840,772 277,514,403 288,614,979 PHC services
Number of uninsured DHIS / Stats No 579 255 534 425 584 439 594 010 603 891 614 057 623 887 people in the SA District(Stats SA)
7. Improve PHC 7.1 PHC supervisor visit DHIS % 69% 80% 87% 88% 92% 96% 99 supervision rate (fixed clinic/ % visit at PHC CHC/ CDC) facilities to PHC supervisor visit Supervisor No 260 299 327 330 344 360 370 87.7% by (fixed clinic/ CHC/ checklists 2017 CDC)
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Estimated Strategic Performance Frequenc Audited/ Actual Performance Medium Term Targets Data Source Performance Objective Indicators y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Fixed clinics plus fixed DHIS No 372 372 372 372 372 372 372 CHCs/CDCs Calculates
8. Scale up the 8.1 Number of District No Not Not reported 5 8 11 15 18 implementat functional Ward Based Managemen reported ion of WBOT Outreach Teams t / to 18 by 2017 (Family Health Teams) Appointment (cumulative) letters
9. Review PHC 9.1 Number of Primary No Not Not reported Not Baseline to To review To review To review facilities Health Care Clinics reported reported be baseline qualifying as that qualify as Ideal established Ideal Clinics Clinics
10. Improve 10.1 Number of No 31 31 27 31 31 31 31 PHC facilities Primary Health Care governance Clinics with functional Clinic Committees
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13.1.2 District Health Services: Strategies /Activities to be implemented 2015/16
Strategies Activities
1. Improve Community participation Advertise clinic committee posts. Market PHC operational hours and services provided.
2. Expansion of outreach teams within the Identify more Family Health Teams and School Health Teams, within the existing resources. Order vehicles for outreach teams. existing resources
3. Strengthen the functioning of hospital Create and link staff to the new gateway clinic component. Create unit cost for goods and services for gateway clinics. gateway clinics Extend hours of services to weekends, public holidays and after hours. Revitalize physical infrastructure at gateway clinics. Negotiate PHC labour ward services with district hospitals.
4. Improve communication in management fora Conduct performance reviews on Medical Officer visits to clinics
5. Improve access to PHC services Facilitate 24hour services of comprehensive MNCWH package in PHC facilities
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A. SUB-PROGRAM: DISTRICT HOSPITALS
13.2.1 Sub-Programme Overview The district has 3 district hospitals, one at Ndwedwe and two at Maphumulo sub-districts whereas Mandeni sub-district is without a district hospital. This requires intense review as Stanger Regional Hospital still remain as a referral institution for Mandeni sub-district for district hospital services and this has an impact on Stanger Regional Hospital to function at fully at Regional level. The three district hospitals were classified as small district hospitals, and this is in-line with systems strengthening and optimisation of resources. The process of Hospital Gateway clinics, which were created to curb non-referred PHC clients, is progressing as funding was made available.
Challenges Scarce skilled Staff high attrition rate
SCM turnaround time remains a challenge
Insufficient budget to cover National Core Standards requirements
Data management remains a challenge
Limited space
Medical records
Seclusion rooms
MDR unit to be built too small for the district due to the large waiting list.
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Table 27 (NDoH 16): Situational Analysis Indicators for District Hospitals – 2013/14 Financial Year Indicators Type Montobello District Umphumulo District Untunjambili District District Average Hospital Hospital Hospital
1. National Core Standards self-assessment rate Quarterly 100% 100% 100% 100% %
National Core Standards self-assessment No 1 1 1 3
District Hospitals total No 1 1 1 3
2. Quality Improvement plan after self-assessment Quarterly 100% 100% 100% 100% rate %
Quality Improvement plan after self-assessment No 1 1 1 3
District Hospitals total No 1 1 1 3
3. Percentage of District Hospitals compliant to all Quarterly 0 0 0 0 extreme and vital measures of the National Core % Standards
District Hospitals fully compliant (75%-100%) to all No 0 0 0 0 extreme and vital measures of National Core Standards
District Hospitals total No 1 1 1 3
4. Patient satisfaction survey rate Quarterly 100% 100% 100% 100% %
Number of district hospitals that have conducted No 1 1 1 3 patient satisfaction surveys
District Hospitals total No 1 1 1 3
5. Patient satisfaction rate Annual 100% 75% 90% 97% %
Number satisfied customers No 80 15 72 175
Number users participated in survey No 80 20 80 180
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Indicators Type Montobello District Umphumulo District Untunjambili District District Average Hospital Hospital Hospital
6. Average length of stay Quarterly 7.0 6.5 5.5 6.3 Days
In-patient days No 24165 31069 24931 80165
Day patients No 2 100 958 1060
Inpatient separations No 3430 4889 5547 13866
7. Inpatient bed utilisation rate Quarterly 59% 60% 55% 58% %
In-patient days No 24165 31069 24931 80165
Day patients No 2 100 958 1060
Inpatient bed days available No 40519 51470 47455 139 444
8. Mental health admission rate Quarterly 1% 4% 2% 3% %
Mental health admissions total No 42 217 125 384
Inpatient Separations - total No 3430 4889 5547 13866
9. Expenditure per PDE Quarterly R1909 R1951 R2144 R2002 R
Expenditure total R’000
Patient day equivalent No 41036 42284 34109 117429
10. Complaint resolution rate Quarterly 83% 33% 62% 56% %
Complaint resolved No 10 9 32 51
Complaint received No 12 27 52 91
11. Complaint resolution within 25 working days rate Quarterly 90% 88% 100% 96% %
Complaint resolved within 25 days No 9 8 32 49
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Indicators Type Montobello District Umphumulo District Untunjambili District District Average Hospital Hospital Hospital
Complaint resolved No 10 195 32 51
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Table 28 (NDoH 17): Performance Indicators for District Hospitals Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performanc Target Indicator Source y Type e 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1 National Core Standards QA/DHIS Quarterly 100% 100% 100% 100% 100% 100% 100% 100% self-assessment rate calculates %
National Core Standards self- QA No 3 3 3 3 3 3 3 assessment assessment records
District Hospitals total DHIS No 3 3 3 3 3 3 3 calculates
2 Quality Improvement plan QA/DHIS Quarterly 100% 100% 100% 100% 100% 100% 100% 100% after self-assessment rate calculates %
Quality Improvement plan QA No 3 3 3 3 3 3 3 after self-assessment assessment records
District Hospitals total QA No 3 3 3 3 3 3 3 assessment records
3 Percentage of District QA/DHIS Quarterly 0 0 0 0 0 33% 66% 30% Hospitals compliant to all calculates % extreme and vital measures of the National Core Standards
District Hospitals fully compliant QA No 0 0 0 0 0 1 2 11 (75%-100%) to all extreme and assessment vital measures of National records Core Standards
District Hospitals total DHIS No 3 3 3 3 3 3 3 37 calculates
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performanc Target Indicator Source y Type e 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
4 Patient satisfaction survey QA / DHIS Quarterly 100% 100% 100% 100% 100% 100% 100% - rate calculates %
Number of district hospitals QA No 3 3 3 3 3 3 3 that have conducted patient assessment satisfaction surveys records
District Hospitals total DHIS No 3 3 3 3 3 3 3 calculates
5 Patient satisfaction survey DHIS Annual 90% 78% 97% 80% rate calculates %
Number satisfied customers PSS No - 62 175 2 100
Number users participated in PSS No - 80 180 240 2 800 survey
6 Average length of stay DHIS Quarterly 6.5 7.0 6.3 5.6 5.4 5.1 4.9 5.5 calculates Days
In-patient days Midnight No 80,912 89,149 80,615 84,646 88,878 93,322 97,988 2 043 291 census
Day patients Midnight No 8 714 1,060 1,113 1,169 1,227 1,288 8 208 census
Inpatient separations DHIS No 12,022 12,526 13,866 15,253 16,778 18,456 20,301 367 467 calculates
7 Inpatient bed utilisation DHIS Quarterly 58.8% 65.3% 58% 62.4% 57% 68.8% 72.2% 64.5% rate calculates %
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performanc Target Indicator Source y Type e 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
In-patient days Midnight No 80912 89149 80165 84646 80165 93322 97988 2 043 291 census
Day patients Midnight No 8 714 1060 1,113 1060 1,227 1,288 8 208 census
Inpatient bed days available Manageme No 139 444 3173 310 137,520 137,520` 137,520 137,520 137,520 137,520 nt
8 Mental health admission DHIS Annual % 6% 7% 3% 2.9% 2.9% 2.8% 2.7% rate calculates
Mental health admissions total DHIS No 384 689 811 380 376 373 369 calculates
Inpatient Separations - total DHIS No 13866 12,022 11,626 12,972 13,141 13,312 13,485 calculates
9 Expenditure per PDE BAS/DHIS Quarterly R1,464 R1619 R2002 R2446 R2822 R3256 R3757 R2 146 R
Expenditure total BAS R’000 186,366,552 227,338, 609 248,913,703 1,260,125,62 5 891 136 373,370,555 560,055,832 840,083,748 1
Patient day equivalent DHIS No 127,698 140,425 117,429 2 744 964 152,658 198,455 257,992 335,389 calculates
10 Complaint resolution rate DHIS Quarterly 88% 70% 56% 71% 77% 80% 81% - %
Complaint resolved PSS No 243 248 51 305 350 400 450
Complaint received PSS No 277 354 91 427 450 500 550
11 Complaint resolution within DHIS Quarterly 78% 68% 87% 65% 73% 79% 80% 75% 25 working days rate %
Complaint resolved within 25 PSS No 190 169 80 198 258 315 360 2 130 days
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performanc Target Indicator Source y Type e 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Complaint resolved PSS No 277 248 91 305 350 400 450 2 841
Table 29 (NDoH 18): District Strategic Objectives and Annual Targets for District Hospitals
Strategic Estimated Frequency Audited/ Actual Performance Medium Term Targets Objective Performance Indicator Data Source Performance Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Improve 1. Delivery by caesarean DHIS Quarterly 22% 27% 28% 26.2% 24.5% 22.9% 21.3% hospital section rate calculates % efficiencies by Delivery by caesarean section Delivery No 552 673 735 720 706 692 678 implementing register the long term Delivery in facility total Delivery No 2566 2537 2511 2745 2882 3026 3177 plan for register revitalisation of hospitals 2. OPD headcount- total DHIS/OPD Quarterly 154,952 145,347 105,418 107,526 109,677 111,870 114,108 2015-2019 tick register No
3. OPD headcount not DHIS/OPD Quarterly 42 867 60 053 30400 28880 27436 26064 24761 referred new tick register No
4. Number of District Hospitals with functional 3 3 3 3 3 3 3 boards
5. Proportion of District QA / DHIS Quarterly 0 0 0 0 0 33% 66% Hospitals conditionally calculates
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Strategic Estimated Frequency Audited/ Actual Performance Medium Term Targets Objective Performance Indicator Data Source Performance Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 compliant to National % Core Standards
District Hospitals conditionally QA No 3 3 3 3 0 1 2 compliant assessment records
District Hospitals Total DHIS No 3 3 3 3 3 3 3 calculates
13.2.2 District Hospitals: Strategies /Activities to be implemented 2015/16
Strategies Activities
1. Improve infrastructure Review multi-year to include new development according to National Core Standards
2. Improve human resources Capacitation of new management
3. Improve quality of data Strengthen information management. Performance reviews to be conducted in line with the plans.
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14. HIV & AIDS & TB CONTROL (HAST)
14.1 PROGRAMME OVERVIEW
All facilities within the district are providing HIV and AIDS, TB and STI services. The male medical circumcision performance remains low due to mobilisation in the facilities with non-functionality of MMC Co-ordinators. HTAs staff establishment remains a challenge due to the fact that structure in the HTAs consists of CPN, EN and Peer educator. The absence of CPNs creates a challenge in the sense that some services are not happening therefore the staff nurse presence remains dormant.
Condom distribution rate is at 30 condoms per person instead of 50 condoms per male.
The lack of appointment and tracing system creates a challenge in knowing the clients remain in care. Management and monitoring of clients in care remains a huge challenge because clients are not monitored as per guidelines. The district performance has improved tremendously with cure rate TB outcome consistently above the national target of 85% and defaulter rate maintained below 5%.
CHALLENGES
Red tape on long processes on employment of enrolled which led to tracing teams not fully functionally.
Replacement of exited tracing team staff remains a challenge
Non-existence of the MDR site within the district remains a challenge and processes of acquiring one at Montobello Hospital are very slow.
Non-replacement of SMS printers in the clinics remains a challenge thereby delay in sputum turnaround time
Low condom distribution rate
Increased numbers of loss to follow-up clients
Lack of monitoring of clients in care (ART) e.g. Viral load
Low MMC coverage
Inadequate staff establishment at the HTAs
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Table 30 (NDoH 19): Situational Analysis Indicators for HIV & AIDS, STI’s and TB Control - 2013/14 Financial Year Indicator Type Mandeni Sub-District KwaDukuza Sub-District Ndwedwe Sub- Maphumulo Sub-District District Average District
1. Total clients remaining Quarterly No 14114 20037 8151 6958 49890 on ART month
2. Clients tested for HIV Quarterly No 39,046 56,806 41,922 46,654 184,428 (incl ANC)
3. TB symptom 5 years and Quarterly % 4.3% 0.3% 2% 2.4% 2.9% older screened rate
Client 5 years and older No. 20,033 16,050 6,578 6,627 49,288 screened for TB symptoms
PHC headcount 5 years and No. 470,242 602,544 330,171 281,509 1,684,466 older
4. Male condom distribution Quarterly 33.0 8.6 12.9 19.8 16.4 Rate Rate per male
Male condoms distributed No 1,489,960 750,130 543,389 484,505 3,267,984
Population 15 years and Population 45,197 86,936 42,257 24,498 198,888 older male
5. Female condom Quarterly 2.0 0.31 0.45 0.37 0.74 distribution Rate Rate per female
Female condoms distributed No 108 909 28 321 23 899 13 611 174,740
Population 15 years and Population 54,147 91,555 52,814 36,978 235,494 older female
6. Medical male Quarterly 1654 1870 3984 2289 9797 circumcision performed No – Total
7. TB client treatment Quarterly % 88.3% 87.7% 88.5% 88.4% 88.2% success rate
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Indicator Type Mandeni Sub-District KwaDukuza Sub-District Ndwedwe Sub- Maphumulo Sub-District District Average District
TB client successfully No 334 646 303 253 1,536 completed treatment
TB client start on No 378 736 342 286 1742 treatment
8. TB client lost to follow up Quarterly % 9.8% 1.5% 16.1% 7.3% 15.2% rate
TB client lost to follow up No 37 151 55 21 264
TB client start on No 378 736 342 286 1,742 treatment
9. TB client death Rate Annual 2.6% 4.0% 4.0% 6.2% 4.2% %
TB client died during No 10 31 14 18 73 treatment
TB client start on No 378 736 342 286 1742 treatment
10. TB MDR confirmed Annual Not reported Not reported Not reported Not reported Not reported treatment start rate %
TB MDR confirmed client start No on treatment
TB MDR confirmed client No
11. TB MDR treatment Annual % Not reported Not reported Not reported Not reported Not reported success rate
TB MDR client successfully No. treated
TB MDR confirmed client No. start on treatment
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Table 31 (NDoH 20): Performance Indicators for HIV & AIDS and TB Control Indicator Data Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial Source cy Type Performanc Target e
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Total clients remaining on DHIS Quarterl 35 665 42411 49890 68 349 93 639 128 285 175 750 1 192 247 ART month calculates y No
2. Clients tested for HIV (incl. DHIS Quarterl 126,460 162,172 184,428 202,871 223,158 245,474 270,021 - ANC) calculates y No
3. TB symptom 5 years and DHIS Quarterl 2.8% 2.3% 2.9% 3.1% 3.2% 3.3% 3.5% - older screened rate y %
Client 5 years and older TB Register No. 44,496 38,123 49,288 56,681 65,183 74,961 86,205 screened for TB symptoms
PHC headcount 5 years and DHIS No. 1,601,372 1,635,216 1,684,466 1,852,913 2,038,204 2,242,024 2,466,227 older calculates
4. Male condom distribution DHIS Quarterl 9.7 16.0 16.4 20.0 24.4 30.5 37.2 63 Rate calculates y Rate per male
Male condoms distributed DHIS/Stock No 1,826,788 3,104, 539 3,267,984 4,084,980 5,106,225 6,382,781 7,978,477 212 000 cards 000
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Indicator Data Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial Source cy Type Performanc Target e
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Population 15 years and older DHIS/Stats Populati 188,766 193,764 198,888 204,114 209,114 209,313 214,499 3 370 510 male SA on
5. Female condom distribution DHIS Quarterl 0.38 0.78 0.74 0.81 0.89 0.98 1.07 - Rate calculates y Rate per female
Female condoms distributed DHIS/Stock No 84,633 180 234 174,740 195,709 219,194 245,497 274,957 cards
Population 15 years and older DHIS/Stats Populati 225,396 230,368 235,494 240,755 246,013 251,247 256,117 female SA on
6. Medical male circumcision DHIS / MMC Quarterl 3489 6460 9797 11,756 14,108 16,929 20,315 - performed – Total register y No
7. TB client treatment success ETR.Net % 83.5% 83.5% 88.2% 89.0% 89.8% 90.6% 91.4% 85% rate calculates
TB client successfully TB Register No 1333 1 770 1,536 1705 1893 2101 2332 32 257 completed treatment
TB client start on treatment TB Register No 1,597 2,119 1,742 1916 2108 2319 2550 37 949
8. TB client lost to follow-up ETR.Net Quarterl 18.6% 13% 15.2% 13.6% 12.3% 11.0% 9.9% - rate calculates y%
TB client lost to follow up TB Register No 291 275 264 261 259 256 254
TB client start on treatment TB Register No 1597 2 119 1,742 1916 2108 2319 2550
9. TB client death Rate ETR.Net Annual 1.0% 1.0% 4.2% 2.9% 2.1% 1.5% 1.0% 4% calculates %
TB client died during TB Register No 67 21 73 73 72 72 72 1 140 treatment
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Indicator Data Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial Source cy Type Performanc Target e
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
TB client start on treatment TB register No 1597 2 119 1742 6,416 6,608 6,807 7,011 28 500
10. TB MDR confirmed treatment ETR.Net Annual Not Not Not Not MDR Baseline to Review start rate calculates % reported reported reported reported section to established be established
TB MDR confirmed client start on TB Register No treatment
TB MDR confirmed client TB Register No
11. TB MDR treatment success EDR Annual Not Not Not Not MDR Baseline to Review rate calculates % reported reported reported reported section to established be established
TB MDR client successfully EDR No treated Register
TB MDR confirmed client start EDR No on treatment Register
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Table 32 (NDoH 21): District Strategic Objectives and Annual Targets for HIV & AIDS Estimated Data Frequenc Audited/ Actual Performance Medium Term Targets Strategic Objective Performance Indicator Performance Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. 1. Number of patients EDR.Net Annual Not Not Not Not Not Not Not applicable applicabl applicable applicable applicable applicable that started regimen calculates applicabl No e iv treatment (MDR-TB) e
2. MDR-TB Six month EDR.Net Annual Not Not Not Not Not Not Not applicabl applicable applicabl applicable applicable applicable applicable interim outcome calculates % e e 3. Number of patients ETR.Net Annual Not Not Not Not Not Not Not applicabl applicable applicabl applicable applicable applicable applicable that started XDR-TB calculates No e e treatment
4. XDR-TB Six month EDR.Net Annual Not Not Not Not Not Not Not applicabl applicable applicabl applicable applicable applicable applicable interim outcome calculates % e e 2. Reduce TB 5. TB incidence (per ETR.Net Annual 289.8/100 251.1/100k 201.3/100 205.5/100k 200.9/100k 196.3/100k 191.9/100k incidence to 191.9/ 100 000 population) No per k k 100k by 2017 100,000
New TB infections ETR.Net No 1 770 1 558 1 326 1313 1300 1287 1274
Total population DHIS/Stats Populatio 610820 620474 630464 638660 646963 655373 663893 SA n
3. Scale up 6. STI treated new DHIS Quarterly 74.4/1k 70.2/1k 63.4/1k 59.0/1k 55.0/1k 51.1/1k 47.6/1k prevention services episode incidence calculates No per to less than 47.6/1k (annualised) 1000 by 2017 STI treated new DHIS/Tick No 30798 29766 27560 25906 24352 22891 21517 episode register PHC/ casualty
Population 15 years DHIS/Stats Populatio 414162 424132 434387 438731 443118 447549 452025 and older SA n
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Estimated Data Frequenc Audited/ Actual Performance Medium Term Targets Strategic Objective Performance Indicator Performance Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
4. Reduce TB 7. TB (new pulmonary) ETR.Net % 6.9% 6.4% 4.4% 4.2% 4.1% 3.9% 3.8% defaulter rate to defaulter rate calculates 3.8% by 2017
TB(new TB Register No 110 135 275 272 270 267 264 pulmonary)treatment defaulter
TB(new TB Register No 1597 2 119 6 229 6 416 6 608 6 807 7011 pulmonary)client initiated on treatment
5. Improve the 8. TB AFB sputum result ETR.Net % 64.7% 75.7% 87.9% 89.5% 91.1% 92.8% 94.4% sputum turnaround turn-around time calculates time under 48hours under 48 hours rate to 94% by 2017 TB AFB sputum result TB Register No 14 976 57 248 50 741 56 830 63 650 71 287 79 842 received within 48 hours
TB AFB sputum TB Register No 23 156 75 579 57 743 63 517 69 869 75 856 84 542 sample sent
6. Increase TB cure 9. TB (new pulmonary) ETR.Net % 76.7% 83.5% 87.3% 88.5% 89.8% 91.1% 92.4% rate to 92% by 2017 cure rate calculates
TB (new pulmonary) TB Register No 1225 1 770 1 558 2212 3142 4461 6335 client cured
TB (new pulmonary) TB Register No 1597 2 119 1 785 2499 3499 4898 6857 client initiated on treatment
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14.2 HIV & AIDS, STI & TB CONTROL (HAST): STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16
Strategies Activities
1. Improve TB outcomes Facilitate employment of tracer teams. Negotiate the use of vehicles in order to improve TB outcomes.
2. Scale up integration of services in TB and HIV TB and HIV/AIDS services to be conducted comprehensively. Ideal clinic approach and PC101 to be commenced. Increase programmes at PHC MMC coverage and condom distribution.
3. Reduce the incidence of HIV Enforce the tracing and tracking of ART clients. Closely monitor the implementation of tier.net. Support facilities on record and documentation of clinical charts. Condom Distribution Plan to be implemented by facilities.
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15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION
15.1 PROGRAMME OVERVIEW
MNCWH programme contributes towards the achievement of the Health related Millennium Development Goals4 & 5 which aims at the reduction of child mortality rate (by two thirds) of children under 5years, improving maternal health and reducing maternal mortality rate by three quarters. The services under MNCWH include the implementation of CARMMA ( Campaign for Accelerated Reduction of Maternal Mortality in Africa), cervical cancer screening, Child Health(EPI, Vitamin A, etc.), Sexual Reproductive Health through implementation of National Contraception and Fertility Planning guidelines, Essential Steps in Management of Obstetric Emergencies (ESMOE), Child Problem Identification Programme and ( Child PIP) and Perinatal Problem Identification Programme(PPIP) in all facilities.
Capacitation of Heath Workers on Sexual Reproductive Health ( training on National Contraception and Fertility Planning) which improved the accessibility and provision of all contraceptives methods including intra-uterine device (IUD). The implementation of KZN Initiation of New-born Care (KINC) has improved neonatal care.
Prevention of mother to child transmission programme aims at ensuring optimum care by reaching MDG 4, 5 & 6 BY 2015, which aims at reduction of child mortality rate by two thirds of children under 5 and improving maternal health through combating TB and HIV. EMTCT/PMTCT aims at ensuring that all pregnant women access health services as early as possible and they are issued with treatment of Fixed Drug Combination (FDC) to eliminate transmission during pregnancy, delivery and during the whole duration of breastfeeding. EMTCT/PMTCT also aims at ensuring that all pregnant women during ANC & PNC visits are tested for HIV every 12 weeks (3 months), for early detection of sero-conversion and proper management and they are all screened for TB at least times 6 visits and IPT is initiated for those who qualify. Children under 1 year who are diagnosed as HIV positive and eligible, are initiated on HAART irrespective of their CD4 count and WHO clinical staging.
The Integrated Nutrition Programme (INP) aims at ensuring optimum nutrition for all citizens by preventing and managing malnutrition. Nutrition component therefore plays a key role in developing and ensuring that nutrition programmes and or services are implemented at facility and community level. Main target group for INP programme is children under 5 years, pregnant and lactating women, HIV/AIDS, TB and chronic patients.
Health education on Infant and Young Child feeding (IYCF) is primary intervention offered at all levels. This includes vigorous promotion, support and protection of breastfeeding. National IYCF policy is the supporting document to this effect. Other Child Health interventions including Vitamin A, deworming, Immunisation etc. are key to improve child health. Growth monitoring & Promotion (GMP) is also intensified especially at community level in order to detect growth early and correct malnutrition early. The integrated Management of Malnutrition (IMAM) guidelines give direction towards prevention and treatment of malnutrition for children and adults. Adult patients, whether pregnant, lactating, HIV/AIDS, TB or chronics nutritional status is assessed and offered necessary nutritional support needed.
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5.2 STRATEGIC CHALLENGES
MCWH Low Vitamin A 12-59 month’s coverage due to non-inclusion of vitamin A given by CCGs in the DHIS. Low deworming 12-59 months coverage Low ANC booking 20weeks rate High early neonatal mortality Poor Couple Year Protection rate Low Cervical Cancer screening rate Maternal mortality due to non- obstetric complications is still a challenge Infrastructure for implementation of CARMMA (waiting mother’s lodge and Kangaroo Mother Care) is still a challenge.
Table 33 (NDoH 22): Situational Analysis Indicators for MCNWH & N – 2013/14 Financial Year Indicator Type Mandeni Sub-District KwaDukuza Sub- Ndwedwe Sub- Maphumulo Sub- District Average District District District
1. Antenatal 1st visit before 20 weeks rate Quarterly 53.4% 51.1% 49.7% 54.7% 52.1% % Antenatal 1st visit before 20 weeks No 1912 3096 1081 1356 7445
Antenatal 1st visit total No 3580 6062 2175 2481 14298
2. Proportion of mothers visited within 6 days of Quarterly 135.2% 55.9% 98.2 91.8% 77.1% delivering their babies % Mother postnatal visit within 6 days after delivery No 1939 3600 1163 1644 8346 Delivery in facility total No 1434 6443 1184 1767 10828
3. Antenatal client initiated on ART rate Annual 100% 94.1% 99.8% 106.7% 97.9% % ANC client started on ART ART 969 1780 558 476 3783 Register ANC client eligible for ART initiation ART 969 1892 559 446 3866 Register
4. Infant 1st PCR test positive around 6 weeks rate Quarterly 1% 3.6% 1.7% 3.6% 2.1% % Infant 1st PCR test positive around 6 weeks No 13 81 12 27 133
Infant 1st PCR test around 6 weeks No 1246 2264 12 746 6206
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Indicator Type Mandeni Sub-District KwaDukuza Sub- Ndwedwe Sub- Maphumulo Sub- District Average District District District
5. Immunisation coverage under 1 year (annualised) Quarterly 66.6% 80.7% 77.5% 87.1% 77.9% % Immunised fully under 1 year new No 2291 4226 2793 2377 11687 Population under 1 year No 3440 5240 3603 2729 15012
6. Measles 2nd dose coverage Quarterly 64.2% 72.5% 69.1% 80.5% 71.2% % Measles 2nd dose No 2207 3797 2490 2198 10692 Population 1 year No 3440 5240 3603 2729 15012
7. DTaP-IPV-HepB-Hib 3 - Measles 1st dose drop-out Quarterly 7.0% 7.6% 5.4% 1.3% 5.8% rate % DTaP-IPV-HepB-Hib 3 to Measles1st dose drop-out No 239 399 194 38 870 DTaP-IPV-HepB-Hib 3rd dose No 3440 5240 3603 2729 15012
8. Child under 5 years diarrhoea case fatality rate Quarterly 13.3% 1.6% 6.4% 2.0% 2.5% % Child under 5 years with diarrhoea death No 2 10 3 6 21
Child under 5 years with diarrhoea admitted No 15 464 47 304 830
9. Child under 5 years pneumonia case fatality rate Quarterly 0 1.1% 6.1% 0.6% 1.1% % Child under 5 years pneumonia death No 0 4 2 2 8
Child under 5 years pneumonia admitted No 13 324 33 349 709
10. Child under 5 years severe acute malnutrition Quarterly 33% 2.8% 12.5% 4.3% 3.4% case fatality rate % Child under 5 years severe acute malnutrition death No 1 I2 1 4 18
Child under 5 years severe acute malnutrition No 3 422 8 93 526 admitted
11. School Grade R screening coverage Quarterly Not reported Not reported Not reported Not reported Not reported %
School Grade R learners screened No.
School Grade R learners - total No.
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Indicator Type Mandeni Sub-District KwaDukuza Sub- Ndwedwe Sub- Maphumulo Sub- District Average District District District
12. School Grade 1 screening coverage Quarterly Not reported Not reported Not reported Not reported Not reported %
School Grade 1 learners screened No.
School Grade 1 learners - total No.
13. School Grade 8 screening coverage Quarterly Not reported Not reported Not reported Not reported Not reported %
School Grade 8 learners screened No.
School Grade 8 learners - total No. 14. Couple year protection rate Quarterly 35.2% 34% 26.4% 33.9% 35.7% % Contraceptive years dispensed No 15289 24876 9945 8749 58859
Population 15-49 years female No 39843 67293 34261 23496 164893
15. Cervical cancer screening coverage (amongst Quarterly 47.1% 59.4% 55.7% 95.5% 61.6% women) % Cervical cancer screening in women 30 years and No 1238 2732 1519 1825 7305 older Population 30 years and older female/10 No 2628 4597 2729 1912 11866
16. Human Papilloma Virus Vaccine 1st Dose Annual Not reported Not reported Not reported Not reported Not reported coverage % Numerator No
Denominator No
17. Vitamin A dose12 – 59 months coverage Quarterly 55.2% 63.3% 65.6% 70.6% 63.3% % Vitamin A dose 12 - 59 months No 13604 23364 17413 13696 68077 Population 12-59 months (multiplied by 2) No 24654 36942 26534 19408 107538
18. Maternal mortality in facility ratio Annual 0 248.6/100k I70.6/100k 55.5/100k 184.8/100k No per 100K Maternal death in facility No 0 16 2 2 20
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Indicator Type Mandeni Sub-District KwaDukuza Sub- Ndwedwe Sub- Maphumulo Sub- District Average District District District
Live birth in facility No 1413 6436 1172 1801 10822
19. Early neonatal death in facility rate Annual 0.2% 1.6% 0.7% 0.6% 1.1% Per 1 000 Death in facility 0-7 days No 3 102 8 10 123 Live birth in facility No 1,413 6,436 1,172 1,799 10,820
Table 34 (NDoH 23): Performance Indicators for MCWH&N Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Antenatal 1st visits before 20 DHIS Quarterly % 37.9% 45.3% 52.1% 59.5% 68.0% 77.7% 88.8% 60% weeks rate
Antenatal 1st visit before 20 weeks DHIS / Tick No 4,821 5,686 7,445 8,934 10,721 12,865 15,438 139 012 register PHC
Antenatal 1st visit total DHIS No 12,715 12,561 14,298 15,013 15,764 16,552 17,379 231 686 calculates
2. Proportion of mothers visited DHIS Quarterly % 68.6% 72.9% 77.1% 79.1% 81.3% 83.4% 85.7% 74.4% within 6 days of delivering their babies
Mother postnatal visit within 6 DHIS / Tick No 7051 7644 8346 9598 11038 12693 14597 151 711 days after delivery Register PHC
Delivery in facility total DHIS / No 10286 10486 10828 12126 13581 15211 17036 203 910 Delivery register
3. Antenatal client initiated on DHIS Annual 75.4% 78.2% 97.9% 98.8% 99.8% 100.7% 101.7% - ART rate calculates %
ANC client started on ART ART Register No 1115 873 3783 3915 4052 4194 4341
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
ANC client eligible for ART ART Register No 1478 1117 3866 3963 4062 4163 4267 initiation
4. Infant 1st PCR test positive DHIS Quarterly % 2.9% 2.8% 2.1% 1.8% 1.2% 0.8% 0.5% <1% around 6 weeks rate
Infant 1st PCR test positive around DHIS / Tick No 140 142 133 106 85 68 54 905 6 weeks register PHC
Infant 1st PCR test around 6 weeks DHS / Tick No 4810 5062 6206 5952 7142 8571 10285 90 535 Register PHC
5. Immunisation coverage DHIS Quarterly % 94.5% 75.5% 77.9% 80.8% 87.6% 94.9% 102.9% 96% under 1 year
Immunised fully under 1 year DHIS / Tick No 11433 11687 11687 12771 14048 15453 16998 207 619 new register PHC
Population under 1 year DHIS / Stats No 12093 15472 15012 15804 16041 16281 16525 215 481 SA
6. Measles 2nd dose coverage DHIS Quarterly % 91.4% 70.0% 71.2% 80.0% 93.8% 110.0% 129.1% -
Measles 2nd dose DHIS / Tick No 11057 10832 10692 12739 15287 18344 22013 register PHC
Population 1 year DHIS / Stats No 12093 15472 15012 15928 16294 16669 17053 SA
7. DTaP-IPV-HepB-Hib 3 - DHIS Quarterly 9.1% 10.7% 5.8% 5.1% 4.6% 4.0% 3.6% - st Measles 1 Dose drop-out % rate
DTaP-IPV-HepB-Hib 3 to DHIS / Tick No 1109 1302 870 783 705 634 571 Measles1st dose drop-out register PHC
DTaP-IPV-HepB-Hib 3rd dose DHIS / Tick No 12166 12134 15012 15237 15466 15698 15933 register PHC
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
8. Child under 5 years DHIS Quarterly % 6.9% 5.5% 2.5% 2.4% 2.3% 2.2% 2.1% 3.6% diarrhoea case fatality rate
Child under 5 years with DHIS / Tick No 19 37 21 20 19 18 17 339 diarrhoea death register
Child under 5 years with Admission No 276 670 830 822 813 805 797 10 224 diarrhoea admitted Records
9. Child under 5 years DHIS Quarterly % 3.2% 2.0% 1.1% 1.1% 1% 0.9% 0.7% 2.4% pneumonia case fatality rate
Child under 5 years pneumonia DHIS / Tick No 14 11 8 8 7 6 5 227 death register
Child under 5 years pneumonia Admission No 435 537 709 712 705 698 691 9 199 admitted records
10. Child under 5 years severe DHIS Quarterly % 11.1% 8.3% 3.4% 3.3% 3.2% 3.1% 3.0% 8.7% acute malnutrition case fatality rate
Child under 5 years severe acute DHIS / Tick No 28 36 18 17.1 16 15 14 310 malnutrition death register
Child under 5 years severe acute Admission No 252 432 526 515.5 505 495 485 3 553 malnutrition admitted records
11. School Grade R screening DHIS Quarterly % Not Not Not Not Baseline to To review To review coverage reported reported reported reported be established
School Grade R learners DHIS / Tick No. ------screened register SHS
School Grade R learners - DHIS / DoE No. ------total database
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
12. School Grade 1 screening DHIS Quarterly % Not Not Not 9.8% 10.7% 11.6% 12.7% - coverage reported reported reported
School Grade 1 learners DHIS / Tick No. - - - 1 651 1 816 1 998 2 198 screened register SHS
School Grade 1 learners - DHIS / DoE No. - - - 16 857 17 025 17 196 17 368 total database
13. School Grade 8 screening DHIS Quarterly % Not Not Not 2.9% 3.2% 3.4% 3.7% - coverage reported reported reported
School Grade 8 learners DHIS / Tick No. - - - 431 474 522 574 screened register SHS
School Grade 8 learners - DHIS / DoE No. - - - 14 857 15 006 15 156 15 307 total database
14. Couple year protection rate DHIS Quarterly % 25.8% 29.4% 35.7% 47.5% 63.1% 84.0% 111.7% 50%
Contraceptive years dispensed DHIS No 40,766 47,410 58,859 79,461 107,272 144,818 195,504 1 464 872 calculates
Population 15-49 years female DHIS/Stats SA No 158,088 161,435 164,893 167,368 169,879 172,427 175,014 2 929 745
15. Cervical cancer screening DHIS Quarterly % 83.2% 62.7% 61.6% 69.8% 79.0% 89.5% 101.4% 80.4% coverage (amongst women)
Cervical cancer screening in DHIS / Tick No 10,662 8,285 7,305 8,401 9,661 11,110 12,776 193 688 women 30 years and older register PHC / Hospital
Population 30 years and older DHIS / Stats No 12822 13210 11866 12044 12225 12408 12594 239 122 female/10 SA
16. Human Papilloma Virus DHIS Annual Not Not Not Baseline to To review Dependent Review - st vaccine 1 Dose coverage % reported reported reported be baseline on the established baseline
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Numerator DHIS / Tick No ------register SHS
Denominator DHIS / DoE No ------enrolment
17. Vitamin A dose12 – 59 DHIS Quarterly % 39.2% 34.7% 63.3% 74.6% 88.2% 104.3% 123.3% 60% months coverage
Vitamin A dose 12 - 59 months DHIS / Tick No 40214 36488 68077 81476 97772 117326 140791 1 072 060 register PHC
Population 12-59 months DHIS / Stats No 102578 105290 107538 109159 110797 112459 114145 1 786 768 (multiplied by 2) SA
18. Maternal mortality in facility DHIS Annual No 112.2/100k 95.6/100k 184.8/10 132.0/100k 94.3/100k 67.4/100k 48.1/100k 126/100k ratio per 100K 0k
Maternal death in facility DHIS / No 12 10 20 15.0 11 8 6 255 Midnight census
Live birth in facility DHIS / No 10692 10465 10822 11363.1 11931 12527 13154 202 473 Delivery register
19. Early neonatal death in DHIS Annual % 1.2% 0.9% 1.1% 1.1% 1.0% 0.9% 0.9% - facility rate
Death in facility 0-7 days No 127 97 123 121 118 116 113
Live birth in facility No 10,666 10,470 10,820 11361 11929 12526 13152
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Table 35 (NDoH 24): District Objectives and Annual Targets for MCWH & N
Strategic Audited/actual Performance Estimated Performance Data Frequency Medium Term Targets Objective Performance Indicators Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. Reduce the 1.1 Neonatal DHIS Quarterly 5.5/1k 0.4/1k 0.7/1k 0.07/1k 0.06/1k 0.05/1k 0.04/1k neonatal mortality in facility calculates Rate per mortality in rate (annualised) 1000 facility rate to 0.04/1k by Inpatient death DHIS/Midni No 84 6 12 12 10 8 7 2017 early neonatal ght census Population DHIS/ No 15282 15936 16037 16406 16783 17169 17 564 estimated live Delivery births register
2. Reduce 3.1 Child under 1 DHIS Annual 12.0/1k 15.1/1k 15.7/1k 11.5/1k 8.4/1k 6.2/1k 4.5/1k under 1year year mortality in Per 1 K mortality rate facility rate in facility to (annualized) 4.5/1k by Inpatient death DHIS No 183 239 241 181 136 102 76 2017 under 1 year calculates
Population DHS No 15 207 15 858 15 387 15 741 16 103 16 473 16 852 estimated live calculates births
3. Reduce 5.1 Inpatient DHIS Annual 10.1% 6.5% 9.2% 5.9% 3.7% 2.4% 1.5% inpatient death under 5 Per 1 K death under years rate 5yrs to 1.5% Inpatient death DHIS No 183 239 404 263 171 111 72 by 2017 under 5 years calculates
Inpatient DHS No 1812 3699 4383 4484 4587 4692 4800 separations under calculates 5 years
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Strategic Audited/actual Performance Estimated Performance Data Frequency Medium Term Targets Objective Performance Indicators Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
4. Decrease 6.1 Child under 5 DHIS Annual 20.6/1k 20.5/1k 23.7/1k 17.5/1k 12.9/1k 9.6/1k 7.1/1k diarrhoea years diarrhoea calculates No per incidence to with dehydration 1000 7.1/1k by incidence 2017 (annualised)
Child under 5 PHC Tick No 1364 1395 1643 1232 924 693 520 years diarrhoea Register with dehydration new
Population under 5 DHIS/Stats No 66 129 68 117 69 339 70 379 71 435 72 506 73 594 years SA
5. Decrease 7.1 Child under 5 DHIS Annual 284/1k 116/1k 107/1k 78/1k 12.9/1k 9.6/1k 7.1/1k under 5 years years pneumonia calculates No per incidence to incidence 1000 7.1/k/1k by (annualised) 2017 Child under 5 PHC Tick No 18 796 7 917 7 454 5 522 4 845 3 149 1 331 years with Register pneumonia new
Population under 5 DHIS/Stats No 66 129 68 117 69 339 70 379 71 435 72 506 73 594 years SA
6. Decrease 8.1 Child under 5 DHIS Annual 4.8/1k 7.4/1k 8.7/1k 8.6/1k 8.4/1k 8.2/1k 8.0/1k severe acute years severe acute calculates No per malnutrition malnutrition 1000 incidence to incidence 8.0/1k by (annualised) 2017 Child under 5 DHIS/Tick No 320 507 613 607 601 595 589 years with severe register acute malnutrition PHC new
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Strategic Audited/actual Performance Estimated Performance Data Frequency Medium Term Targets Objective Performance Indicators Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Population under 5 DHIS/Stats No 66 129 68 117 69 339 69 603 71 435 72 506 73 594 years SA
7. Reduce the Child under 2 DHIS No per Not reported Not reported 3.6% 3.4% 3.3% 3.1% 3.0% child under years underweight 1000 2years for age incidence Annual underweight (annualised) for age to 3% Child under 2 DHIS / Tick No - - 1 067 1 046 1 025 1 004 984 by 2017 years underweight register - new (weight PHC between - 2SD and - 3SD new)
Population under 2 DHIS / Stats No - - 30 024 30 715 31 421 32 144 32 883 years SA
8. Increase the 11.1 Deworming DHIS Quarterly Not reported Not reported 70.9% 60.8% 80.8% 107.5% 143.0% number of dose 12-59 months % children coverage receiving (annualised) deworming Numerator Tick No. - - 49 132 66 328 89 543 120 883 163 192 regime 143% Register by 2017 PHC
Population 12-59 DHIS / Stats No - - 107 538 109 159 110 797 112 459 114 145 months (multiplied SA by 2)
9. Increase 12.1 Measles 1st DHIS Quarterly 100.6% 78.4% 77.0% 80.7% 88.4% 96.8% 105.9% immunization dose under 1 year % coverage to coverage more 90% by (annualized) 2017 Measles 1st dose DHIS / Tick No 12 166 12 134 11 562 12 860 14 403 16 131 18 067 under 1 year register PHC
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Strategic Audited/actual Performance Estimated Performance Data Frequency Medium Term Targets Objective Performance Indicators Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Population under 1 DHIS / Stats No 12 093 15 472 15 012 15 928 16 294 16 669 17 053 year SA
12.2 PCV 3rd dose DHIS Quarterly 26.3% 78.1% 77.1% 80.1% 86.9% 92.3% 99.4% coverage % (annualized)
PCV 3rd dose DHIS / Tick No 3 175 12 081 11 573 12 757 14 161 15 718 16 947 Register PHC
Population under 1 DHIS / Stats No 12 093 15 472 15 012 15 928 16 294 16 669 17 053 year SA
12.3 RV 2nd dose DHIS Quarterly 103.6% 84.7% 83.9% 86.3% 92.8% 95.6% 96.1% coverage % (annualised)
RV 2nd dose DHIS / Tick No 12 529 13 102 12 600 13 741 15 115 15 927 16 390 Register PHC
Population under 1 DHIS / Stats No 12 093 15 472 15 012 15 928 16 294 16 669 17 053 year SA
10. Reduce 13.1 Infant given DHIS Quarterly 100.4% 101.1% 99.5% 99.8% 100.2% 100.6% 101.0% mother to NVP within 72 % child hours after birth transmission uptake rate 7 to less than Infant given NVP DHIS / Tick No 4 177 4 060 3 914 5 108 6 666 8 699 11 352 0.5% by 2017 within 72 hours register after birth OPD/ PHC, delivery register
7 Baby Nevirapine uptake rate
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Strategic Audited/actual Performance Estimated Performance Data Frequency Medium Term Targets Objective Performance Indicators Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Live birth to HIV DHIS / No 4 162 4 016 3 935 5 116 6 650 8 645 11 239 positive woman delivery register
11. Reduce 14.1 Delivery in DHIS Annual 1.1% 9.3 10.8 9.7% 7.6% 6.0% 4.7% delivery in facility under 18 % facility under years rate 18years to Delivery in facility DHIS / No 119 972 1 165 10 25 902 794 699 4.7% by 2017 to woman under Delivery 18 years register
Delivery in facility DHIS / No 10 868 10 486 9 424 10 555 11 821 13 240 14 829 total Delivery register
12. Improve 15.1 Infants DHIS Quarterly Not reported Not reported 52.6% 61.2% 71.3% 83.1% 96.8% exclusive exclusively % breastfeeding breastfed at to 96% by Hepatitis B 3rd dose 2017 Infant exclusively Tick register No - - 6 538 7 768 9 166 10 816 12 763 breastfed at PHC HepB3rd dose
Hep B 3rd Dose Tick register No - - 12 524 12 687 12 852 13 019 13 188 PHC
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15.2 STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16
Strategies Activities
1. Reduce neonatal, infant and child mortality Identify more outreach teams for early detection of diseases at households level
2. Upscale immunisation coverage Implement RED strategy. Monitor catch drives
3. Improve couple year protection To include data on condom distributed by non-health facilities in the DHIS collection tool. Strengthen family planning and condom distribution
4. Improve cervical cancer screening coverage Implement guidelines on cervical cancer screening
5. Reduce maternal mortality Increase support to facilities by District Clinical Specialist Team.
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16. DISEASE PREVENTION AND CONTROL (ENVIRONMENTAL HEALTH INDICATORS)
16.1 PROGRAMME OVERVIEW
The report on the causes of death from Statistics South Africa release P03909.3 revealed that non communicable diseases are on the rise collectively. The NCDs has claimed over 20.2% lives, cerebrovascular diseases 7.6%, diabetes mellitus 4.8%, hypertension 3% and ischaemic heart diseases 2.3%. This is clearly showing a rise in this category. The Provincial Strategy for Non-Communicable Diseases 2014—2019 is being finalised to provide the framework for intensified strategies and interventions.
Challenges Failure to sustain support groups
Distribution of chronic medication to community remains a challenge due to transport and non-availability of CCGs in some areas
Cheap and poor quality equipment which break easily and long turnaround for repairs
Not reaching set targets for cataract surgery
Shortage of eye nurses within the district.
Table 36 (NDoH 25): Situational Analysis for Disease Prevention and Control - 2013/14 Financial Year Indicator Type Mandeni Sub-District KwaDukuza Sub-District Ndwedwe Sub-District Maphumulo Sub-District District Average
1. Clients screened for hypertension Quarterly Not reported Not reported Not reported Not reported Not reported No
2. Clients screened for diabetes Quarterly Not reported Not reported Not reported Not reported Not reported No
3. Percentage of people screened for mental Quarterly % Not reported Not reported Not reported Not reported Not reported disorders
PHC Client screened for mental disorders No - - - - -
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Indicator Type Mandeni Sub-District KwaDukuza Sub-District Ndwedwe Sub-District Maphumulo Sub-District District Average
PHC headcount total No - - - - -
4. Percentage of people treated for mental Quarterly Not reported Not reported Not reported Not reported Not reported disorders %
Client treated for mental disorders at PHC level No - - - - -
Clients screened for mental disorders at PHC level No - - - - -
5. Cataract surgery rate No per 0 0.08% 0 0.2% 0.06% million uninsured population
Cataract surgery total No 0 172 0 163 335
Population uninsured total No 133 104 224 799 134 566 91 970 584 439
6. Malaria case fatality rate % 0 0 0 0 0
Malaria death reported No 0 0 0 0 0
Number of malaria cases (new) No 0 0 0 0 0
Table 37 (NDoH 26): Performance Indicators for Environmental Health Services Estimated Provincial Frequency Audited/ Actual Performance Medium Term Targets Data Source Performance Targets Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Clients screened for DHIS / Tick Quarterly Not reported Not reported Not reported Not reported Baseline to To review To review established hypertension register No
2. Clients screened for DHIS / Tick Quarterly Not reported Not reported Not reported Not reported Baseline to To review To review established diabetes register No
3. Percentage of people DHIS Quarterly % Not reported Not reported Not reported Not reported Baseline to To review To review established screened for mental calculates disorders
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Estimated Provincial Frequency Audited/ Actual Performance Medium Term Targets Data Source Performance Targets Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
PHC Client screened for DHIS / Tick No To review To review mental disorders register
PHC headcount total DHIS / Tick No To review To review Register
4. Percentage of people DHIS Quarterly % Not reported Not reported Not reported Not reported Baseline to To review To review established treated for mental Calculates disorders
Client treated for mental DHIS / Tick No disorders at PHC level register
Clients screened for mental DHIS / Tick No disorders at PHC level register
5. Cataract surgery rate DHIS Quarterly Not reported 0.08% 0.06% 0.02% 0.12% 0.12% 0.12% No per 1 mil uninsured population
Cataract surgery total DHIS / No 443 335 139 764 766 770 Theatre register
Population uninsured total DHIS / Stats No 538 846 584 439 594 010 603 891 614 057 623 887 SA
6. Malaria case fatality rate Malaria Annual 0 0 0 0 0 0 0 Register %
Malaria death reported Malaria No 0 0 0 0 0 0 0 register / Tick register PHC
Number of malaria cases (new) Malaria No 0 0 0 0 0 0 0 register / Tick register PHC
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Table 38 (NDoH 27): District Objectives and Annual Targets for Environmental Health Services
Strategic Estimated Frequency Audited/ Actual Performance Medium Term Targets Objective Performance Indicator Data Source Performance Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. Malaria incidence per Malaria Annual 0 0 0 0 0 0 0 1000 population at risk register Per 1000 population at risk
Number of malaria Malaria No ------cases (new) register/Tick register PHC
Population DHIS/Stats SA Population ------
2. Hypertension incidence DHIS Quarterly 26.2/1000 16.2/1000 18.1/1000 17.9/1000 17.6/1000 17.3/1000 17.2/1000 (annualised) No per 1k
Hypertension client DHIS / PHC No 3 573 2 277 2 621 2 674 2 727 2 781 2 837 treatment new tick registers
Population 40 years DHIS / Stats No 136 259 140 382 144 957 149 846 154 945 160 182 165 190 and older SA
3. Diabetes incidence DHIS Quarterly 1.8/1000 1.4/1000 1.0/1000 1.0/1000 1.0/1000 1.0/1000 0.9/1000 (annualised) No per 100k
Diabetes client DHIS / PHC No 1 116 872 625 650 650 663 671 treatment new tick registers
Population total DHIS / Stats No 610 280 620 472 630 464 640 790 651 445 662 413 673 017 SA
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16. 2 STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16
Strategies Activities
1. Prevent NCDs and promote Involvement of Municipal Health Services in ensuring clean water and proper sanitation. Healthy lifestyle at community level. health and wellness
2. Improve control of NCDs Early diagnosis and treatment. Medicine supply, pre-dispensing and distribution at community level. Strengthen Mpilonde/support groups. through health systems strengthening
3. Monitor NCDs and their main Quarterly review meetings. Monthly support visits to facilities. Integrated ward based services through Operation Sukuma Sakhe risks factors
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17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES
Table 39 (NDoH 38): Performance Indicators for Health Facilities Management Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Expenditure on facility maintenance as % of total district % 4% 4% 4% 3% 3% 3% 3% health expenditure
Numerator
Denominator
2. Number of facilities that have undergone major and minor Not Not Not Not To To review To review refurbishment collected collected collected collected establish baseline
3. Fixed PHC facilities with access to continuous supply of % 100% 100% 100% 100% 100% 100% 100% clean portable water
Numerator 31 32 33 33 33 33 33
Denominator 31 32 33 33 33 33 33
4. Fixed PHC facilities with access to continuous supply of % 100% 100% 100% 100% 100% 100% 100% electricity
Numerator 31 32 33 33 33 33 33
Denominator 31 32 33 33 33 33 33
5. Fixed PHC facilities with access to sanitation 100% 100% 100% 100% 100% 100% 100%
Numerator 31 32 33 33 33 33 33
Denominator 31 32 33 33 33 33 33
6. Fixed PHC facilities with access to fixed telephone line % 100% 100% 100% 100% 100% 100% 100%
Numerator 31 32 33 33 33 33 33
Denominator 31 32 33 33 33 33 33
7. Percentage of PHC facilities with network access 6.5% 6.5% 6.5% 6.5% 6.5% 30% 45.5%
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Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Numerator 2 2 2 2 2 10 15
Denominator 31 32 33 33 33 33 33
8. Number of additional clinics and community health centres 1 1 0 0 0 0 0 constructed
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18. SUPPORT SERVICES
There are 6 institutional Pharmacies in the district that are registered with South African Pharmacy Council. Stanger Hospital, Umphumulo Hospital, Untunjambili Hospital and Sundumbili CHC have achieved A grading and are approved for training of Pharmacy assistants and interns until end of December 2016. Ndwedwe CHC is due for inspection currently but also holds an A grading. Montebello Hospital achieved a B grading and is approved for training until December 2015.
There are stipend learners at Stanger Hospital, Umphumulo Hospital, Sundumbili CHC and Ndwedwe CHC who are funded by Kheth’Impilo (KI) or KZNPPHC (KZN Progressive Primary Health Care). Post Basic Pharmacy Assistants provide pharmaceutical support to all PHC clinics, mobiles and Gateway clinics and are supervised indirectly by a pharmacist. There is also a KI designated supervisory pharmacist in each sub-district as well as a KI District Pharmacy Manager that provides active supportive supervision, mentoring and training to both PHC staff and pharmacy assistants.
Leadership and Management skills are being developed in Pharmacy Managers to improve their competency in addressing work challenges and improving pharmaceutical service delivery. Improving Medicine Supply Management is a priority at all levels to ensure adequate medicine availability for priority programmes; optimal input into budget and expenditure reviews and to reduce fruitless and wasteful expenditure.
18.1 PHARMACEUTICAL SERVICES
Table 40 (NDoH 39): Pharmaceutical Services Performance Indicators Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Percentage of institutions % - - Not recorded 100% 100 100 100 (District Hospitals and CHC’s) with functional of Pharmaceutical and Therapeutics Committees
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Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16 (PTC’s)
Number of CHC’s and District - - Not recorded 5 5 5 5 Hospitals with functional Pharmaceutical and Therapeutic Committees
Number of District Hospitals and 3 5 5 5 5 5 5 CHC’s
2. Any ARV Drug Stock Out % 0 0 0 0 0 0 0 Rate
Number of ARV drug’s out of stock
Number of ARV’s drugs
3. Any TB Stock Out Rate % 0 0 0 0 0 0
Number of TB drugs out of stock
Number of TB drugs
4. Percentage of Hospitals % 100% 100% 100% 100% 100% 100% 100% with Pharmacists
Number of District Hospitals with 3 3 3 3 3 3 3 Pharmacists
Number of District Hospitals 3 3 3 3 3 3 3
5. Percentage of CHC’s with % N/A 100% 100% 100% 100% 100% 100% Pharmacists
Number of CHC’s with 0 2 2 2 2 2 2 pharmacists
Number of CHC’s 0 2 2 2 2 2 2
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Table 41 (NDoH 30): Pharmaceutical Services Estimated Audited/ Actual Performance Medium Term Targets Strategic Objective Performance Indicator Data source Type Performance 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. 1. Percentage of Pharmacy Annual 83% 100% 100% 100% 100% 100% 100% Pharmacies that records % obtained A and B grading on inspection
Pharmacies with A or B Pharmacy No 5 6 6 6 6 6 6 Grading records
Number of pharmacies Pharmacy No 6 6 6 6 6 6 6 records
2. Tracer medicine Pharmacy Quarterly stock-out rate records % 2.1% 1.85% 7.42% 4.2% 4.0% 3.8% 3.5% (Institutions)
Number of tracer Pharmacy No 74 65 156 150 141 135 121 medicines stock out in records bulk store
Number of tracer Pharmacy No 3501 3501 3501 3501 3501 3501 3501 medicines expected to records be stocked in the bulk store
2. 3. Number of Management Annual 0 0 0 0 0 0 0 mortuaries No rationalised
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STRATEGIC CHALLENGES:
Retention of Pharmacy Managers at Untunjambili and Umphumulo Hospitals is difficult. Pharmacist turnover is also high as they are attracted to urban areas and to private sector There are no full time Pharmacy assistant posts at PHC clinics despite several attempts to motivate for creation of posts There is in adequate storage space at most facilities to meet the increasing demands for medicine as more programmes are added on and patient numbers increase Expired stock is still high at both hospitals and PHC clinics
STRATEGIES AND ACTIVITES:
The District Pharmacy & Therapeutics Committee has been formed and is providing support to institutional PTC to address rational medicine usage Weekly stock out reports are monitored for all facilities Pharmacy Managers have embarked on a project to reduce expired stock ; improve relocation of excess stock and improve medicine supply management A new computerised stock programme ( Rx Solutions) is to be rolled out to improve stock management at all facilities. Training of pharmacy Assistants is progressing with supporting partners.
18.2 EQUIPMENT AND MAINTENANCE
District asset acquisition plan attached
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Table 42: District Equipment and Maintenance Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Percentage of maintenance budget spent Annual Not reported Not reported 95% 81.5% 90% 94% 98% 100% %
Expenditure on maintenance (preventive and No - - 13 083 929 10 600 000 26 000 000 29 120 000 36 018 087 scheduled)
Maintenance budget No - - 13 777 000 13 000 000 29 000 000 30 885 000 36 753 150
2. Proportion of Programme 8 ( infrastructure Annual Not reported Not reported 16% 12% 27% 29% 32% 12% budget) spent on all maintenance % (preventative and scheduled)
Expenditure on maintenance (preventive and No - - 13 083 929 10 600 000 26 000 000 29 120 000 34 361 600 159 000 scheduled)
Infrastructure budget No - - 81 225 000 86 910 750 92 994 502 99 504 117 106 469 405 1 312 088
3. Number of health facilities that have Annual 3 2 2 1 1 2 3 undergone major and minor refurbishments No.
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18.3 EMERGENCY MEDICAL SERVICES (EMS)
Emergency Medical Rescue Services (EMRS) is one of the three core functions within the Department of Health, which aims to provide a quality, efficient, professional and caring emergency medical and rescue service
STRATEGIC CHALLENGES
Proper implementation of Disaster Management. Need support from Provincial Level/ District Health Office
Shortage of administrative personnel, (i.e HR, Finance and General Support). Rely on District Health and EMS Province which delays some outputs.
SCM:
o Separation of functions concerning SCM processes due to shortage of staff
o Slow SCM processes due to being a partially centralized and decentralised function. PPT: To implement 100% clinic to hospital coverage. Amandlalathi and Mphise Clinics are not yet serviced by EMRS iLembe due to border issues.
The current budget constraints will impact on service delivery.
There are many vacant posts that need to be filled and additional posts required to effectively manage obstetric unit which is a new service to the department
No training budget to address HRD needs
High incidence of inter-district transfers that result in long turnaround times
Fleet:
o Aging vehicles need to be replaced.
o Vehicle monitoring system implemented at a high cost to the department but not effective as a Monitoring tool
o Fleet Maintenance and service provider Transit Solutions cannot cope with the demands made by EMS
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Table 43 (NDoH 31 (a)): Operational Ambulances per 10,000 Population Coverage (inclusive of LG) District Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Mandeni 0.17 (3) 0.17(3) 0.14 (2) 0.14 (2) 0.21(3) 0.35(5) 0.50(7) Not set
KwaDukuza 0.22 (4) 0.27(5) 0.27(5) 0.20(5) 0.25(6) 0.33(8) 0.41(10) Not set
Ndwedwe 0.14(2) 0.17 (3) 0.17 (3) 0.20(3) 0.26 (4) 0.40(6) 0.53(8) Not set
Maphumulo 0.23(3) 0.23(3) 0.23(3) 0.30(3) 0.40(4) 0.60(6) 0.80(8) Not set
Tongaat (EThekwini) 0.20(3) 0.20(3) n/a n/a n/a n/a n/a n/a
District Average 0.23(15) 0.26(17) 0.20(13) 0.20(13) 0.26(17) 0.39(25) 0.52(33)
Table 44 (NDoH 31 (b)): Ambulance Response Time Rural under 40 minutes (Inclusive of LG) Type Audited/ Actual performance Estimate MTEF Projection Provincial Target 2015/16 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Mandeni % 8% 6% 5% 10% 15% 15% 15%
KwaDukuza % 9% 10% 10% 15% 20% 20% 20%
Ndwedwe % 6% 4% 5% 10% 15% 15% 15%
Maphumulo % N/A N/A N/A N/A N/A N/A N/A
District Average % 7% 6% 9% 24% 39% 39% 39%
Table 45 (NDoH 31(c)): Ambulance Response Times Urban under 15 minutes (Inclusive of LG) Ambulance Response Time: Urban Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Mandeni % 37% 28% 37% 40% 42% 42% 42%
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Ambulance Response Time: Urban Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
KwaDukuza % 43% 34% 47% 50% 55% 55% 55%
Ndwedwe % 27% 24% 30% 35% 40% 40% 40%
Maphumulo % 21% 16% 29% 35% 40% 40% 40%
District Average % 36% 28% 43% 60% 77% 77% 77%
Table 46 (NDoH 31 (d)): EMS Inter-facility Transfer Rate District Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Mandeni % 8.9 6.73 7.88 7.78 7.46 7.66 7.86 No set
KwaDukuza % 5.57 4.46 5.51 5.13 6.58 6.81 7.03 Not set
Ndwedwe % 2.27 2.33 3.07 2.53 3.29 4.26 5.17 Not set
Maphumulo % 4.53 4.07 5.76 4.72 6.58 7.45 8.27 Not set
Other % 8.76 8.57 5.87 n/a n/aa n/a n/a n/a
District % 30 26 28 20 24 26 28
STRATEGIES AND ACTIVITIES
Full implementation of obstetric units hence the envisaged improvement in service delivery regarding maternal health. increased the scheduled rostered ambulances from 15 to at least 20, includes Obstetric and Inter-facility transfer units To conduct more awareness campaigns with DOT and District Health Improve clinical governance and quality assurance to reduce deaths in transit
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Improve vehicle monitoring systems to improve response times Increase the frequency of in-service training to improve clinical skills Conduct client satisfaction surveys and staff satisfaction surveys To revisit incentive framework to increase productivity To increase staff morale Aeromedical coverage has been improved and is available on a 24 hour basis. Landing zones have been established. 5 Supervisory posts have been filled this year as well as EMS District Manager Post for strategic leadership GEMC communication system has been upgraded from 4.4.1 to 4.4.2 version. New vehicle monitoring system NETSTAR has been fitted in all vehicles to improve monitoring. Communication with key stakeholders has been strengthened for enhanced teamwork.
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19. HUMAN RESOURCES
Table 47 (NDoH 32): Performance for Human Resources TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Health sub-districts Personnel category1
Mandeni PHC facilities
Medical officers 4 5 6 7 7 10 10
Professional nurses 70 92 109 127 127 135 150
Pharmacists 5 5 6 6 6 10 12
KwaDukuza PHC facilities
Medical officers 0 0 0 0 0 0 0
Professional nurses 68 73 77 95 115 130 140
Pharmacists 0 1 1 1 1 1 1
Ndwedwe PHC facilities
Medical officers 4 4 4 5 6 7 7
Professional nurses 41 41 44 50 60 70 80
Pharmacists 3 3 3 4 5 6 6
District hospitals
Medical officers 6 7 8 9 9 10 10
Professional nurses 81 81 79 82 85 90 90
Pharmacists 2 2 2 3 3 4 4
Radiographers 2 2 2 3 3 3 3
Maphumulo PHC facilities
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TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Medical officers 0 0 0 0 0 0 0
Professional nurses 29 29 38 42 44 55 60
Pharmacists 0 0 0 0 0 0 0
Umphumulo District hospitals
Medical officers 10 3 3 4 5 6 7
Professional nurses 69 45 43 45 48 50 55
Pharmacists 6 2 1 2 2 3 3
Radiographers 3 1 1 1 1 2 2
Untunjambili District hospitals
Medical officers 3 10 7 10 13 15 15
Professional nurses 45 69 76 85 95 100 105
Pharmacists 2 6 4 5 5 6 6
Radiographers 1 3 3 3 3 3 3
District PHC facilities
Medical officers 8 9 10 12 13 17 17
Professional nurses 208 251 268 314 346 390 430
Pharmacists 8 9 10 11 12 17 18
District hospitals
Medical officers 19 20 18 23 27 31 32
Professional nurses 195 195 198 212 228 240 250
Pharmacists 10 10 7 10 10 12 13
Radiographers 6 6 5 7 7 8 8
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Table 48 (NDoH 33): Plans for Health Science and Training
CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 8 performance
2014/15 2015/16 2016/17 2017/18
Problem solving and decision making Good problem solving skills 30 40 40 40 Practical Labour Law Improved production levels 30 40 40 40 Health and Safety Management Improved health and safety 10 15 15 15 management Further Education Training Improved performance and better 20 20 20 20 prospects for promotion to higher posts Financial Management Improved financial management skills 60 60 60 60 Supervisory skills Improved supervisory skills 30 40 40 40 Strategic management Strategic management skills 30 40 40 40
8 This would include formal and informal (short courses, refreshers, etc.) courses.
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20. DISTRICT FINANCE PLAN
Table 49 (NDoH 34): District Health MTEF Projections Sub-programme Audited outcome Main Adjusted Revised Medium term expenditure estimates appropriation appropriation estimate
R’ thousand 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
District 12,026,904 16,374,000 16 478 428.00 17 926 000 - 17 802 572 19 226 778 20 476 519 21 807 493 Management
9 Clinics 255,554,360 161,387,000 155 883 127.00 171 173 000 - 176 879 863 192 799 051 210 150 967 229 064 554 Community Health 86,740,000 104 095 000 - 103 825 302 112 131 326 121 101 832 130 789 978 155,119,204 90 826 167.00 Centers
Community Services - - 0.00 0 - 0 0 0 0
Other Community 53,600,046 52,331,000 54 642 279.00 63 374 000 - 68 500 605 72 953 144 77 695 098 82 745 279 Coroner Services - 5,721,000 5 896 000 - 5 899 811 6 283 299 6 691 713 7 126 674
HIV and AIDS 102,847,992 122, 141,000 169 787 675.00 197 429 000 - 200 801 128 213 853 201 227 753 659 242 557 647
Nutrition 3,741,508 2,095,000 2 714 177.00 1 308 021 - 2 616 042 2 786 085 2 953 250 3 130 445
District Hospitals 372,733,104 3,256,000 248 913 703.00 258 800 000 - 251 447 555 267 791 646 285 198 103 303 735 980 Environmental ------Health Services
TOTAL 955,623,118 1,115,487,000 739 245 556.00 827 772 878 887 824 530 952 021 141 1 020 958 050
9 Clinics budget have been increased by 9% to accommodate FHT and SHT resources
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Table 50 (NDoH 35): District Health MTEF Projections per Economic Classification R’ Thousands Adjusted Medium-term estimate Main appropriat Revised Audited Outcomes appropriation ion estimate
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Current payments 945 702 178 1081 947 949 1 062 590 967 1 126 346 425 - - 1 199 558 942 1 277 530 273 1 360 569 740
Compensation of 690 805 196 791 777 404 422 535 896 583 265 000 - 571 647 306 611 662 617 654 479 000 700 292 530 employees
Goods and services 251 907 361 290 170 545 139 984 510 232 406 000 - 247 634 567 264 968 986 283 516 815 303 362 992
Transfers and subsidies to 2 989 621 13 596 877 4 859 878 1 255 000 - 1 172 788 1 231 427 1 292 998 1 357 647
Payments for capital assets 12 659 358 13 938 568 1 906 931 2 519 000 - 2 541 296 2 693 773 2 855 399 3 026 722
Total economic 958,361,536 1,109,483,394 1 631 878 182 1 945 791 425 - 2 080 115 745 2 219 674 485 2 368 609 631 classification
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PART C: LINKS TO OTHER PLANS
21. CONDITIONAL GRANTS (WHERE APPLICABLE)
Table 51 (NDoH 36): Outputs of a result of Conditional Grants
Name of conditional Purpose of the grant Performance indicators Indicator targets grant (extracted from the Business Case prepared for each Conditional Grant for 2015/16
COMPREHENSIVE 1. To enable the health sector to develop an effective 1. Total Number of fixed public health facilities offering ART Services 37 HIV AIDS response to HIV and AIDS including universal access to CONDITIONAL HIV Counselling and Testing 2. Number of new patients that started on ART 25 290 GRANT 2. To subsidize in-part funding for the antiretroviral treatment plan 3. Total number of patients on ART remaining in care. 93 639 3. To support the implements of the National operational 4. Number of beneficiaries served by home-based categories 278 937 plan for comprehensive HIV and AIDS treatment and care 5. Number of active home-based carers receiving stipends 562
6. Number of male and female condoms distributed 5 325 419
7. Number of High Transmission Areas (HTA) intervention sites 4
8. Number of Antenatal Care (ANC) clients initiated on lifelong ART 7 155
9. Number of babies Polymerase Chain Reaction (PCR) tested at 6 weeks 9 927
10. Number of HIV positive clients screened for TB 36 298
11. Number of HIV positive patients that started on IPT 13 641
12. Number of active lay counselors on stipends 91
13. Number of clients pre-test counselled on HIV testing (including Antenatal) 223 158
14. Number of HIV tests done 269 180
15. Number of health facilities offering MMC services 5
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Name of conditional Purpose of the grant Performance indicators Indicator targets grant (extracted from the Business Case prepared for each Conditional Grant for 2015/16
16. Number of Medical Male Circumcisions performed 14 108
17. Sexual assault cases offered ARV prophylaxis 650
18. Step down care (SDC) facilities/units 3
19. Doctors and professional nurses training on HIV/AIDS, STIs, TB and chronic diseases
22. PUBLIC-PRIVATE PARTNERSHIPS (PPPS) AND PUBLIC PRIVATE MIX (PPM)
Table 52 (NDoH 38): Outputs as a result of PPP and PPM Name of PPP or PPM Purpose Outputs Current Annual Budget (R’Thousand) Date of Termination Measures to ensure smooth transfer of responsibilities
1. Khethimpilo HIV and AIDS (CCMT) Improving PMTCT outcomes Not known 2017.09.30 collaboration
iLembe Health District commenced working together with Khethimpilo at district level, hence planned activities will be documented.
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PART E: INDICATOR DEFINITIONS
Indicator Name Definition Numerator Denominator Source
A
Antenatal visits before 20 Women who have a booking visit (first visit) before Antenatal 1st visit Antenatal 1st visit before 20 DHIS weeks rate they are 20 weeks (about half way) into their before 20 weeks weeks + Antenatal 1st visit 20 pregnancy as a proportion of all antenatal 1st visits weeks or later
Mother postnatal visit within 6 Mothers who received postnatal care within 6 days Mother postnatal Delivery in facility total DHIS days rate after delivery as proportion of deliveries in health visit within 6 days facilities after delivery
Antenatal client HIV 1st test rate Antenatal clients HIV tested for the first time during Antenatal client HIV Antenatal 1st visit - Antenatal DHIS current pregnancy as the proportion of antenatal 1st test client on HAART at 1st visit - clients eligible for first HIV tests Antenatal client known HIV positive but NOT on HAART at 1st visit
Antenatal client HIV 1st test Antenatal clients tested HIV positive as the proportion Antenatal client HIV Antenatal client HIV 1st test DHIS positive rate of antenatal clients HIV tested for the first time during 1st test positive current pregnancy
Antenatal client initiated on HIV positive antenatal clients initiated on ART as the Antenatal client Antenatal client eligible for ART DHIS ART rate proportion of HIV positive antenatal clients with CD4 initiated on ART counts under the specified threshold and/or WHO staging of 4
Antenatal client CD4 1st test HIV positive antenatal clients (NOT on HAART) CD4 Antenatal client CD4 Antenatal client known HIV DHIS rate tested for the first time during current pregnancy as 1st test positive but NOT on HAART at the proportion of antenatal clients eligible for first CD4 1st visit + Antenatal client HIV 1st tests. Antenatal clients with positive HIV status (NOT test positive + Antenatal client on HAART) are eligible for first CD4 tests. This is all HIV re-test positive at 32 weeks antenatal clients who tested positive for first HIV tests or later PLUS clients re-tested positive at 32 weeks or later
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Indicator Name Definition Numerator Denominator Source
PLUS first visits clients known HIV positive but NOT on HAART.
B
Infant 1st PCR test around 6 Infants PCR tested for the first time around 6 weeks Infant 1st PCR test Live birth to HIV positive women DHIS weeks uptake rate after birth as proportion of live births to HIV positive around 6 weeks women
Immunisation coverage under Proportion children under 1 year who completed their Immunised fully Population under 1 year DHIS 1 year (annualised) primary course of immunisation under 1 year new
Measles 2nd dose coverage Proportion of children 1 year (12-23 months) who Measles 2nd dose Population 1 year DHIS (annualised) received measles 2nd dose, normally at 18 months
DTaP-IPV/Hib 3 - Measles 1st Proportion children who dropped out of the DTaP-IPV/ Hib3 to DTaP-IPV/ Hib 3rd dose DHIS dose drop-out rate immunisation schedule between DTaP-IPV/IPV Hib 3rd Measles1st dose dose, normally at 14 weeks and measles 1st dose, drop-out normally at 9 months
Child under 5 years diarrhoea Proportion of children under 5 years admitted with Child under 5 years Child under 5 years with DHIS case fatality rate diarrhoea who died with diarrhoea death diarrhoea admitted
Child under 5 years pneumonia Proportion of children under 5 years admitted with Child under 5 years Child under 5 years pneumonia DHIS case fatality rate pneumonia who died pneumonia death admitted
Bed utilization rate A measure of the average number of beds that are Inpatient days +half Useable bed days DHIS occupied – expressed as the proportion of all day patient available bed days, which is calculated as the number of actual beds multiplied by the average number of days in a month (30;42)
C
Caesarean section rate Caesarean section deliveries, expressed as the Caesarean section Delivery in facility DHIS proportion of total deliveries in facility in facility
Couple year protection rate Women protected against pregnancy by using Contraceptive years Population 15-44 years female (annualised) modern contraceptive methods, including dispensed sterilisations, as proportion of female population 15-44 year. Contraceptive years are the total of (Oral pill
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Indicator Name Definition Numerator Denominator Source
cycles / 13) + (Medroxyprogesterone injection / 4) + (Norethisterone enanthate injection / 6) + (IUCD x 4) + )Male condoms distributed / 200) + (Male sterilisation x 20) + (Female sterilisation x 10)
Cervical cancer screening Women 30 years and older with a cervical (pap) Cervical smear in Female 45 years and older + DHIS coverage smear done for screening purposes according to the woman 30 years and Female 30-34 years + Female national policy of screening all women in this age older 35-39 years + Female 40-44 category every 10 years, as the proportion of all years/ 10 women 30 years and older in the target population
Vitamin A dose 12-59 months Proportion of children 12-59 months who received Vitamin A dose 12-59 Population 12-59 months DHIS coverage (annualised) vitamin A 200,000 units, preferably every six month month (multiplied by 2)
Deworming dose 12-59 months Proportion of children 12-59 months who received Deworming dose 12- Population 12-59 months DHIS coverage (annualised) deworming medication, preferably every six month 59 months (multiplied by 2)
Child under 2 years Children under 2 years newly diagnosed as Child under 2 years Population under 2 years underweight for age incidence underweight (weight between -2 and -3 Standard underweight - new (annualised) Deviations) per 1,000 children under 2 years in the (weight between -2 population SD and -3 SD new)
Child mortality rate(facility The proportion of inpatients under 5years that died Inpatient death Inpatient separations under 5 DHIS child mortality under 5years during their stay in the facility. under 5 years years rate)
Maternal mortality in facility Women who died in hospital as a result of Maternal death in Live birth in facility DHIS ratio (annualised) childbearing, during pregnancy or within 42 days of facility delivery or termination of pregnancy, per 100,000 live births in facility
Neonatal mortality in facility Inpatient deaths within the first 28 days of life per Inpatient death early Population estimated live births DHIS rate (annualised) 1,000 estimated live births. Estimated live births in neonatal population is calculated by multiplying estimated population under 1 year by 1.03 to compensate for infant mortality
Inpatient death under 5 year Proportion of children under 5 years Inpatient death Inpatient separations under 5 rate admitted/separated who died during their stay in the under 5 years years facility. Inpatient separations under 5 years is the total
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Indicator Name Definition Numerator Denominator Source
of inpatient discharges, inpatient deaths and inpatient transfer outs
D
Delivery rate in facility under 18 The proportion of pregnant women under 18 years at Delivery in facility Delivery in facility DHIS years delivery under 18 years
Dental extractions to The ratio between the number of teeth extracted Tooth extractions Tooth restorations DHIS restorations rate and the number of teeth restored
Diarrhoea with dehydration The proportion of all admissions under 5years due to Diarrhoea with Diarrhoea with dehydration DHIS case fatality rate under 5 years diarrhoea with dehydration that died dehydration under 5 under 5years -admitted years -death
Diarrhoea incidence under Children with diarrhoea per 1000 children in the Diarrhoea under 5 Catchment population under DHIS 5years catchment population. Diarrhoea is formally defined years-new 5years. as 3 or more watery stools in 24hours, but any episode ambulatory diagnosed/or treated as diarrhoea after an interview with the adult accompanying the child should be counted.
Diabetes Mellitus detection Newly diagnosed diabetic patients put on treatment Diabetes mellitus PHC headcount 5 years and DHIS rate as proportion of HPC headcount 5 years and older cases put on older treatment-new
Doctor clinical work load – PHC The number of patients seen per doctor per clinical PHC case seen by Doctor clinical work days DHIS work day doctor
E
Expenditure per CHC The average cost per patient - total headcount Expenditure - Total PHC headcount - total headcount
Expenditure per PHC The average cost per patient - total headcount Expenditure - Total PHC headcount - total headcount
Expenditure per PDE The average cost per patient day equivalent, with Expenditure - Total Patients day equivalent – Total patient day equivalent calculated as inpatient days SUM(Inpatient discharges - + 0.5*day patients + 0.33*OPD/Emergency total Total)+SUM(Inpatient deaths- headcount Total)+SUM (Inpatient transfers
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Indicator Name Definition Numerator Denominator Source
out - Total)+SUM(Day patients - Total)*0.5)+SUM(OPD total headcount)+SUM (Emergency total headcount) * 0.33)
F
Facility infant mortality (under 1 The proportion of inpatients under 1years that died Inpatient death Inpatient separations under DHIS year) rate during their stay in the facility under 1 year total 1year separations
Facility child mortality (under 5 The proportion of inpatients under 5 years that died Inpatient death Inpatient death under 5 years + DHIS years) rate during their stay in the facility under 5 years Inpatient discharge under 5 years + Inpatient transfer out under 5 years
Facility mortality under 1 year The proportion of inpatients under 1 year that died Inpatient death Inpatient discharge under 1 DHIS rate during their stay in the facility under 1 year year + Inpatient death under 1 year + Inpatient transfer out under 1 year
Fixed PHC facilities with a Proportion of fixed PHC facilities visited by a Fixed PHC facilities Total number of fixed PHC DHIS monthly supervisory visits rate dedicated clinic supervisor, who performs a visit that were visited by facilities that have reported according to the clinic supervision manual. supervisor. data.
H
HCT testing rate The proportion of clients, excluding antenatal clients, HIV client tested HIV pre-test counselled DHIS receiving pre-test counselling who accepted testing (excluding (excluding antenatal) and were tested for HIV antenatal)
HIV incidence New HIV cases per 100,000 people in the catchment Total new HIV clients Total population DHIS population
HIV prevalence among 15- to The proportion of 15 to 24 years old pregnant women, HIV test positive – HIV antenatal clients tested DHIS 24 years old pregnant women tested for HIV who were found to be positive new 15 to 24 years antenatal clients
HIV testing rate (excluding The proportion of clients, excluding antenatal clients, HIV client tested SUM([HIV pre-test counselled DHIS antenatal) receiving pre-test counselling who accepted testing (excluding (excluding antenatal)]) and were tested for HIV antenatal)])
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Indicator Name Definition Numerator Denominator Source
Hypertension incidence Newly diagnosed hypertension clients initiated on Hypertension client Population 40 years and older DHIS (annualised) treatment per 1,000 population 40 years and older treatment new
Diabetes incidence Newly diagnosed diabetes clients initiated on Diabetes client Population total DHIS (annualised) treatment per 1,000 population treatment new
I
Immunisation coverage under The proportion of all children in the target area under Immunised fully Female under 1 year and male DHIS 1 year one year who complete their primary course of under 1 year – new under 1 year immunisation. A Primary Course includes BCG, OPV 1,2 & 3, DTP-Hib 1,2 & 3, HepB 1,2 & 3, and 1st measles (usually at 9 months).
Incidence of severe Children who weigh below the minus 3 line on the Severe malnutrition Catchment population under DHIS malnutrition in children (under road to health chart (new cases that month) per 1 under 5 years new 5years 5 years of age) 000 children in the target population.
M
Malaria case fatality rate Number of deaths due to malaria expressed as a Number of deaths Total number of malaria cases NIDS EHS percentage of total malaria cases. due to malaria
Malaria incidence New cases of malaria reported for every 100 000 Malaria reported to Total population NIDS EHS people of the total population. EHS- new case
Male condom distribution rate The number of male condoms distributed- to patients Male condoms Male target population 15 DHIS at the facility or through other channels- per male 15 distributed. years and older. years and older in the catchment population.
Maternal mortality rate in Women who die as a result of childbearing, during Maternal death in Live birth in facility DHIS facility pregnancy or within 42 days of delivery or termination facility of pregnancy, per 100,000 live births
Measles 1st dose under 1 year The proportion of children who received their first Measles first dose Target population under 1 year. DHIS coverage measles dose (normally at 9 months) – annualised. under 1 year.
N
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Indicator Name Definition Numerator Denominator Source
Neonatal mortality rate in Inpatient deaths within the first 28 days of life per Inpatient death – Live birth in facility DHIS facility 1,000 live births early neonatal + Inpatient death – late neonatal
New smear positive TB New smear positive PTB cases where the patients New smear positive New smear positive TB cases – DHIS and ETR defaulter rate defaulted as the proportion of all new smear positive TB cases-defaulted total (outcome) PTB cases (including those moved in) from treatment
Not gaining weight rate under The proportion of children weighed who had an Not gaining weight Child under 5 years weighed DHIS 5 years episode of growth faltering/failure during the period under 5 years
O
OPD headcount – Total A headcount of all outpatients attending outpatient clinics in the facility. Data element
P
Patient Day Equivalent – Total Patient day equilvalent is a weighted combination of inpatient days, day patients and OPD/ emergency total DHIS headcount, with inpatient days multiplied by a factor of 1, day patient multiplied by a factor of 0.5 and OPD or emergency total headcount multiplied by a factor of 0,33.
Percentage of qualifying HIV- Patients initiated on ART as the proportion of all Adult patient HIV positive patients eligible for DHIS positive patients on ART patients eligible for ART. Eligible to start ART are initiated on ART ART (HIV positive adult [15 years patients with: and older] patients eligible for CD4 count less 200 cells per mm3 starting ART rate) irrespective of clinic stage or CD4 count = 35cells in patients with TB or HIV or pregnant women. Or WHO stage iv irrespective of CD4 count Or MDR/XDR –TB irrespective of CD4 count.
Percentage of pregnant The proportion of women coming for their first Antenatal clients Antenatal first (booking) visit. DHIS women tested for HIV antenatal visit that are tested for HIV – the assumption tested for HIV (proportion antenatal clients is that ALL antenatal clients receive pre-test tested for HIV) counselling as part of the antenatal protocol {i.e. the PMTCT Programme}
Percentage of pregnant The proportion HIV positive pregnant women not on Antenatal HIV Antenatal HIV clients eligible for DHIS
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Indicator Name Definition Numerator Denominator Source women who are eligible HAART who received AZT prophylaxis from 28 weeks positive client AZT prophylaxis placed on ARV prophylaxis onward during the current pregnancy initiating AZT prophylaxis
Percentage of eligible HIV positive antenatal clients initiated on HAART as Antenatal client Antenatal clients eligible for DHIS pregnant women placed on the proportion of HIV positive antenatal clients with initiated on HAART. HAART. HAART CD4 count under the specified threshold and / or (antenatal client initiated on WHO staging of 4. HAART rate)
Mortality rate in facility Peri-natal deaths per 1,000 births. Peri-natal deaths Still birth in facility + Live birth in facility + Still birth in DHIS are still births and early neonatal deaths Inpatient death – facility early neonatal
(PCV) 3rd coverage The proportion of children who received their 3rd PCV7 3rd doses to Target population under 1 year DHIS PCV7 dose {around 9 months} – annualised children under 1year.
RV 2nd dose coverage Proportion children under 1 year who received RV RV 2nd dose Population under 1 year DHIS (annualised) 2nd dose, normally at 14 weeks but NOT later than 24 weeks
Infant given NVP within 72 Infants given Nevirapine (NVP) within 72 hours of birth Infant given NVP Live birth to HIV positive woman DHIS hours after birth uptake rate as proportion of live births to HIV positive women within 72 hours after birth
The proportion of PHC headcount under 5 years that Child under 5 years PHC headcount under 5 years Weighing rate under 5 years were weighed and the weight plotted onto the Road weighed to Health Card/Booklet, the patients folder or a relevant register for the first time this month
Prevalence of underweight in The proportion of all children weighed who were Underweight for age Children under 5 years DHIS children (under 5years of age) found to be below the minus two line but above the under 5years – new weighed. (underweight for age rate minus 3 line on the weight for age chart in the road to cases. children under 5 years) health card/ booklet.
Proportion antenatal clients The proportion of women coming for their first SUM([Antenatal SUM([Antenatal 1st visit]) DHIS antenatal visit that are tested for HIV – the assumption
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Indicator Name Definition Numerator Denominator Source tested for HIV is that ALL antenatal clients receive pre-test client HIV 1st test]) counselling as part of the antenatal protocol (i.e. the PMTCT Programme).
Proportion of HIV exposed The proportion of infants born to known HIV positive HIV PCR test positive HIV PCR test of infant born to DHIS babies testing PCR positive mothers who were PCR tested for HIV and found to of infant born to HIV HIV positive mother around 6 (proportion of HIV exposed be positive around six 6 weeks after birth. positive mother weeks infants PCR tested positive for around 6 weeks. HIV around 6 weeks)
R
S
Smear positivity rate Smear positive Pulmonary TB as the proportion of all Smear positive All pulmonary TB cases DHIS pulmonary TB cases pulmonary TB cases
Staff as % of cost Expenditure on staff divided by total expenditure Expenditure on staff Expenditure - total DHIS (Expenditure on staff as percentage of total expenditure)
STI partner treatment rate Partners treated as a proportion of all new STI STI partner treated - STI treated - new episode DHIS episodes new
T
TB case finding index The proportion of PHC clients 5 years and older Suspected TB case PHC headcount 5 years and DHIS suspected of TB with sputum samples sent to the with sputum sent older laboratory
U
Underweight for age under 5 The incidence of children whose weight-for-age is Underweight for age Female under 5 years + DHIS years incidence below the -2 line but above the -3 line on the weight- under 5 years - new SUM([Male under 5 years for-age chart in the Road-to-Health Card/Booklet case
Average length of stay - total The average number of client days an admitted Inpatient days + 1/2 Inpatient separations DHIS client spends in hospital before separation. Inpatient Day clients
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Indicator Name Definition Numerator Denominator Source
separation is the total of day clients, Inpatient discharges, Inpatient deaths and Inpatient transfer outs
Usable bed utilization rate - A measure of the average number of beds that are Inpatient days - Total Usable beds - Total * 30.42 DHIS total occupied - expressed as the proportion of all + Day patients - Total available bed days, which is calculated as the / 2 number of actual beds multiplied by the average number of days in a month (30.42).
PHC Utilization rate The rate at which PHC services are utilised by the PHC headcount Total population DHIS total catchment population, represented as the under 5 years + PHC average number of visits per person per year in the headcount 5 years catchment population. The denominator is usually and older Census-derived population estimates.
PHC – Utilization rate under 5 The rate at which PHC services are utilised by children PHC headcount Female under 5 years + Male DHIS years under 5 years in the catchment population, under 5 years under 5 years represented as the average number of PHC visits per child under 5 per year in the target population.
Utilisation rate – PHC The rate at which PHC services are utilised by the PHC total Total catchment population DHIS total catchment population, represented as the headcount average number of visits per person per year in the catchment population. The denominator is usually Census-derived population estimates.
Utilisation rate under 5 years - The rate at which PHC services are utilised by children PHC headcount Catchment population under 5 DHIS PHC under 5 years in the catchment population, under 5 years years represented as the average number of PHC visits per child under 5 per year in the target population. The denominator is usually Census-derived population estimates.
Complaint resolution within 25 Proportion of complaints resolved within 25 working Complaint resolved Complaint resolved working days rate days out of all complaints resolved within 25 working days
Professional Nurse clinical work The average number of patients seen per Professional PHC case seen by SUM([Professional Nurse clinical DHIS
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Indicator Name Definition Numerator Denominator Source load – PHC Nurse per Professional Nurse clinical work day Professional Nurse work days])
V
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