Section B: NationalProfile and District Province Profiles

20 Limpopo Province

Mopani District Municipality (DC33)

Mopani is located in the north-eastern quadrant of Limpopo Province and comprises five health sub-districts: Ba- , Greater , Greater Letaba, Greater and Maruleng. It has a population of 1 138 063, with a population density of 56.9 persons per km2 and falls in socio-economic Quintile 2. Estimated medical scheme coverage is 6.7%.

Social determinants of healtha Population per selected category

Unemployment ratea 39.4% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 51.4% under 1 year 27 962 27 875 27 195 26 012 No schooling 17.1% under 5 years 137 287 137 200 135 841 133 506 Matric 24.8% 05-09 years 128 595 130 142 131 931 133 933 Higher education 8.1% 10-14 years 119 168 121 295 123 342 125 104 Households 338 427 15-19 years 113 626 111 946 111 872 113 308 Female-headed households 49.2% 20-24 years 122 592 118 219 113 340 108 806 Formal dwellings 90.7% 25-29 years 124 009 124 059 123 035 120 664 Flush toilet connected to sewerage 14.1% 30-34 years 99 610 105 531 111 694 117 599 Weekly refuse removal 15.6% 35-39 years 81 012 83 494 85 532 87 295 Piped water inside dwellings 12.8% 40-44 years 63 687 66 218 68 904 71 636 Electricity for lighting 94.5% 45-49 years 51 503 52 907 54 444 56 182 Blue Drop water score 62.0% 50-54 years 42 753 43 816 44 867 45 919 55-59 years 35 655 36 304 37 086 37 936 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 31 102 31 481 31 693 31 910 65-69 years 22 768 23 921 25 085 26 115 70-74 years 14 742 15 277 15 930 16 729 75-79 years 10 364 10 340 10 316 10 325 80 years and older 9 736 10 054 10 383 10 725 Total 1 208 210 1 222 202 1 235 297 1247 693 Estimated pregnant women* 29 919 29 826 29 099 27 833 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

554 SectionSection B: National B: Profile and Limpopo District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Ba-Phalaborwa SD 20 10 1 1 0 0 0 Greater Giyani SD 32 27 2 1 0 0 2 Greater Letaba SD 29 20 1 1 0 0 0 Greater Tzaneen SD 34 31 4 2 1 0 2 Maruleng SD 14 11 0 1 0 0 0 Mopani 129 99 8 6 1 0 4 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Mopani 2 333 1 039 763 1 885 148 76 35 26 31 16 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Ba-Phalaborwa SD Indicator 2.4 - - - - - Numerator 392 300 - - - - - Denominator 1 922 481 - - - - - Greater Giyani SD Indicator 3.2 - - - - - Numerator 791 651 - - - - - Denominator 3 009 570 - - - - - Greater Letaba SD Indicator 2.8 - - - - - Numerator 605 191 - - - - - Denominator 2 632 677 - - - - - Greater Tzaneen SD Indicator 3.2 - - - - - Numerator 1 303 913 - - - - - Denominator 4 930 128 - - - - - Maruleng SD Indicator 3.4 - - - - - Numerator 337 306 - - - - - Denominator 1 186 938 - - - - - Mopani Indicator 3.0 1.9 35.5 2 103 900 279 Numerator 3 430 361 2 33 2 232 893 864 955 626 479 955 626 479 Denominator 13 681 794 105 93 1 061 534 1 061 534 3 430 361 Limpopo Indicator 2.7 10.6 56.9 2 082 866 301 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

555 Section B: NationalProfile Limpopo and District Province Profiles ------12.0 20.3 (%) OPD new client not not client referred rate rate referred ------6.1 5.4 rate (%) Inpatient Inpatient crude death ------75.5 84.3 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 4 611 4 227 day (Rand) equivalent equivalent per patient Expenditure ------7.3 6.9 (Days) Average length of of length stay - total ------37.2 46.7 46.7 60.4 18 456 18 456 39 546 39 546 (%) OPD new client not not client referred rate rate referred ------6.4 6.4 5.0 768 768 12 016 12 016 rate (%) Inpatient Inpatient crude death ------65.0 78.3 5.0 72.3 65.0 90 165 58 569 58 90 165 58 569 58 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------3 051 3 943 2 894 3 943 94 509 94 509 day (Rand) equivalent equivalent per patient 372 658 821 372 658 821 Expenditure ------4.9 4.9 4.9 5.3 12 016 12 016 58 569 58 58 569 58 (Days) Average length of of length stay - total 74.4 77.9 71.0 83.1 92.8 40.6 75.3 59.3 41 774 56 178 24 827 24 103 17 563 30 178 23 040 25 081 30 925 43 305 43 185 413 131 561 (%) OPD new client not not client referred rate rate referred 5.1 5.3 6.8 4.6 5.8 5.0 5.5 5.5 418 774 287 623 9 893 5 435 5 2 775 7 565 10 707 10 16 967 50 567 50 rate (%) Inpatient Inpatient crude death 67.4 72.1 59.0 76.9 79.6 58.6 69.6 89.5 74 651 48 185 48 28 431 71 523 43 737 673 49 991 37 964 37 89 800 315 577 227 668 227 (%) utilisation rate - total Inpatient bed District Hospital District 3 113 3 207 2 160 2 263 2 993 2 568 2 640 2 684 44 278 70 094 64 977 95 435 95 353 192 day (Rand) 276 741 365 276 741 equivalent equivalent 137 839137 104 158 651 706 651 158 per patient 206 899 156 932 590 433 Expenditure 4.4 4.7 4.4 5.2 4.3 4.2 4.5 4.5 9 893 86 298 5 435 5 7 565 57 086 10 707 10 28 431 16 967 71 523 43 737 49 991 50 567 50 33 988 201 153 360 33 988 227 668 227 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Indicator Numerator Denominator Numerator D

Mopani Mopani Maruleng SD Maruleng Greater Tzaneen SD Tzaneen Greater Greater Letaba SD Greater Giyani SD Giyani Greater Limpopo Africa South Ba-Phalaborwa SD Indicator Source: HIS and BAS.

556 SectionSection B: National B: Profile and Limpopo District Province Profiles

Annual trends Management and Deaths and Patient day equivalent 2014/15 – 2016/17 efficiency indicators for the service 31 59 46 64 84 34 34 225 deliveryLP, platform, DC33, Mopani 2016/17 District Municipality, SEQ 2 (deprived) 444 Total 450 695 450 District District 8 Measure Names IndValue - 23 904 ------3 559 - Inpatient crude 6 Prov_av death rate ZA_av

1_Impact 4 tertiary Central/ hospital 1_Management 2 9 - 8 - 8 8 - 17 12 10 10 75 - 43 2016/17 768

6 335 3

Average length 94 509 of stay (district Hospital 4 Regional hospitals) 2 47 24 72 23 26 50 36 181 333

4K 2 775 16 143 353 192 2_Outcome Expenditure per District Hospital patient day 3K ------equivalent - 1

2K 16 (district 36 4 426 hospitals) 994 2 1K / MOU PHC / CHC

Inpatient bed 52 80 30 30 45 44 100 34 252 utilisation rate 429

(district 24 880 449 716 Total

hospitals) District 50 ------1 725 ------100 - 3 830 3_Output OPD new client

not referred rate tertiary Central/ 50 Hospital (district hospitals) 9 - 2 - 6 - 8 - 6 - 13 12 62 64 175 0 736 3 015

100 91 533 2015/16 Hospital Regional Regional

Percentage 50 21 27 26 39 39 68 Ideal clinics 38 317 188 285 15 750 15 356 207

0 District Hospital 3K - - - - - Provincial and - 1

LG District 50

Health Services 6 115 2K expenditure per capita / MOU PHC / CHC (uninsured) 1K 70 86 33 66 35 125 159 549 Provinc ial and 1500 476 876476 1 976 Total 4_Process_input LG PHC District District expenditure per 1000 capita - - - - 26 659 - - 1 855 1 265 - - - - 275 - (uninsured) -- 3 858 1 3 093 500 tertiary Central/ Hospital Provincial and 400

LG PHC 8 - 11 14 15 16 26 64 38 44 951 expenditure per 180

PHC headcount 3 149 200 101 044 2014/15 Hospital Regional Regional

2008 2010 2012 2014 2016 2018 71 21 56 50 22 99

Year 121 125 423 Measure Names 230 IndValue 16 016 373 009373 District District P rov_av Hospital - - - - - ZA_av - 1 6 1 2 906 62 2 823 1 550 7 494 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

557 Section B: NationalProfile Limpopo and District Province Profiles

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

LP,Percentage Mopani: of DC33, deaths 2010 by broad - 2015 cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 79% 7% 9% 5% 79% 7% 9% 6% causes and 5-14 44% 23% 19% 14% 37% 21% 16% 26% single leading 15-24 35% 31% 20% 14% 21% 13% 18% 48% causes 25-64 29% 35% 33% 4% 27% 32% 30% 11% 65+ 27% 5% 66% 2% 24% 8% 64% 3% Broadcause 34% 20% 42% 4% 33% 21% 35% 10% Total Injury NCD Rank.. Female Male 1 Lower respiratory infections (22.9%) Diarrhoeal diseases (24.1%) HIV and TB 2 Diarrhoeal diseases (22.3%) Lower respiratory infections (19.5%) Comm_mat_peri_nut 3 Preterm birth complications (11.2%) Preterm birth complications (10.2%) 4 Protein-energy malnutrition (7.6%) Protein-energy malnutrition (7.1%) Prov, District 5 Birth asphyxia (5.3%) Birth asphyxia (6.6%) LP, Mopani: DC33 6 Meningitis/encephalitis (5.2%) Meningitis/encephalitis (5.6%) Show history

<5 years <5 7 HIV/AIDS (5.0%) HIV/AIDS (4.1%) 8 Poisonings (including herbal) (2.3%) Poisonings (including herbal) (2.7%) Percentages are shown 9 Tuberculosis (2.0%) Tuberculosis (2.5%) according to all the deaths 10 Other perinatal conditions (1.8%) Sepsis/other newborn infectious (2.2%) within the age/gender 1 Diarrhoeal diseases (15.6%) Diarrhoeal diseases (15.7%) category of each box, 2 Lower respiratory infections (15.0%) Lower respiratory infections (12.5%) although only the leading 3 Tuberculosis (14.1%) Tuberculosis (11.9%) 10 causes are displayed. 4 HIV/AIDS (12.0%) Drowning (11.7%) 5 Meningitis/encephalitis (10.0%) HIV/AIDS (11.0%)

5-14 6 Road injuries (6.0%) Road injuries (7.6%) 7 Accidental threats to breathing (3.9%) Meningitis/encephalitis (6.6%) 8 Nephritis/nephrosis (3.5%) Accidental threats to breathing (3.0%) 9 Protein-energy malnutrition (2.7%) Nephritis/nephrosis (2.6%) 10 Drowning (2.5%) Other unintentional injuries (2.1%) 1 Tuberculosis (17.6%) Road injuries (14.4%) 2 HIV/AIDS (14.8%) Accidental threats to breathing (11.5%) 3 Lower respiratory infections (11.7%) Interpersonal violence (11.3%) 4 Diarrhoeal diseases (9.7%) Tuberculosis (8.3%) 5 Meningitis/encephalitis (7.5%) Lower respiratory infections (6.1%)

15-24 6 Road injuries (5.0%) Diarrhoeal diseases (6.1%) 7 Accidental threats to breathing (2.6%) Meningitis/encephalitis (6.0%) 8 Nephritis/nephrosis (2.1%) HIV/AIDS (5.7%) 9 Cardiomyopathy (2.1%) Mechanical forces (4.2%) 10 Interpersonal violence (2.0%) Drowning (3.7%) 1 HIV/AIDS (18.7%) Tuberculosis (18.2%) 2 Tuberculosis (16.0%) HIV/AIDS (13.6%) 3 Lower respiratory infections (11.2%) Lower respiratory infections (11.0%) 4 Diarrhoeal diseases (9.5%) Diarrhoeal diseases (8.6%) 5 Meningitis/encephalitis (5.3%) Meningitis/encephalitis (5.4%)

25-64 6 Diabetes mellitus (4.6%) Road injuries (3.8%) 7 Cerebrovascular disease (4.2%) Cerebrovascular disease (3.5%) 8 Nephritis/nephrosis (3.5%) Nephritis/nephrosis (3.4%) 9 Cervix (2.8%) Diabetes mellitus (3.4%) 10 Endocrine nutritional,blood, immune (1.6%) Accidental threats to breathing (2.5%) 1 Cerebrovascular disease (20.3%) Cerebrovascular disease (12.8%) 2 Lower respiratory infections (11.6%) Lower respiratory infections (11.2%) 3 Diabetes mellitu s (9.1%) Diabetes mellitus (8.6%) 4 Meningitis/encephalitis (6.9%) Tuberculosis (6.2%) 5 Hypertensive heart disease (6.7%) Nephritis/nephrosis (6.0%)

65+ 6 Diarrhoeal diseases (6.7%) Diarrhoeal diseases (5.6%) 7 Nephritis/nephrosis (5.1%) Meningitis/encephalitis (5 .4%) 8 Ischaemic heart disease (3.1%) Ischaemic heart disease (5.3%) 9 Cardiomyopathy (3.1%) Hypertensive heart disease (4.6%) 10 Tuberculosis (3.1%) Prostate (3.7%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (30.5%) n=45 HIV/AIDS (22.0%) n=2 306 2 Other maternal (20.3%) n=30 Tuberculosis (18.6%) n=1 946 3 Hypertension in pregnancy (19.5%) n=29 Lower respiratory infections (12.4%) n=1 294 4 Abortion (16.5%) n=24 Diarrhoeal diseases (10.2%) n=1 069 5 Maternal haemorrhage (13.1%) n=19 Meningitis/encephalitis (6.0%) n=624

15-49 6 Nephritis/nephrosis (3.0%) n=314 Female 7 Diabetes mellitus (2.2%) n=234 8 Cervix (2.0%) n=204 9 Cerebrovascular disease (1.9%) n=197 10 Road injuries (1.7%) n=181

558 SectionSection B: National B: Profile and Limpopo District Province Profiles

Maternal and Women’s Health

Impact Outcome Output

Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Ba-Phalaborwa SD Indicator 161.0 91.9 6.9 70.4 67.0 80.2 81.9 Numerator 5 422 215 2 531 2 319 37 479 2 534 Denominator 3 106 459 3 095 3 594 41 528 560 826 3 095 Greater Giyani SD Indicator 16.9 100.0 8.5 71.0 65.1 101.7 80.7 Numerator 1 682 503 4 140 3 803 76 586 4 774 Denominator 5 901 682 5 916 5 829 70 070 903 975 5 916 Greater Letaba SD Indicator 219.6 98.0 6.3 64.8 47.6 72.2 85.3 Numerator 10 585 289 2 896 2 535 46 208 3 888 Denominator 4 553 597 4 559 4 470 63 865 767 532 4 559 Greater Tzaneen SD Indicator 134.0 93.1 6.2 70.1 57.2 77.0 69.2 Numerator 11 1 017 506 5 595 5 691 93 284 5 651 Denominator 8 211 1 092 8 169 7 976 119 411 1 453 392 8 169 Maruleng SD Indicator 187.5 97.3 5.2 76.6 95.1 174.1 88.6 Numerator 4 288 110 1 860 2 184 51 275 1 885 Denominator 2 133 296 2 127 2 428 27 567 353 391 2 127 Mopani Indicator 129.7 95.8 6.8 70.1 61.5 90.6 78.5 Numerator 31 2 994 1 623 17 022 16 532 304 832 18 732 Denominator 23 904 3 126 23 866 24 297 322 440 4 039 116 23 866 Limpopo Indicator 130.2 95.2 6.3 65.7 55.7 85.5 70.9 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trendsLP, DC33, Mopani District Municipality, SEQ 2 (deprived)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

50

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

559 Section B: NationalProfile Limpopo and District Province Profiles

Child and School Health 74.3 68.1 54.6 62.4 85.4 58.0 54.3 65.5 28 193 13 557 13 663 22 255 22 46 083 46 190 518 123 751 516 324 743 982 301 890 428 040 months Vitamin A dose 12-59 coverage (%) coverage 427 825 358 565 11.0 14.8 19.8 16.6 15.5 13.5 16.5 20.8 2 311 6 101 5 146 8 047 3 508 1 333 1 8 screening coverage (%) coverage School Grade 9.4 730 804 41.8 31.9 64.1 20.6 33.0 35.2 45.2 1 171 3 769 9 780 2 592 2 050 5 883 10 558 359 484 283 860 754 2 180 1 screening coverage (%) coverage School Grade Output 94.5 96.2 111.9 115.9 120.1 115.9 134.1 104.0 4 702 5 799 3 203 2 483 50 412 22 218 36 975 3 897 91 683 259 233259 dose nd Measles Measles 2 coverage (%) coverage rd 527 667 805 14.1 41.6 21.3 24.4 26.0 25.9 28.9 20.5 1 011 3 109 2 160 6 824 4 408 25 040 1 398 8 853 4 084 3 888 3 20 714 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 67.6 79.1 70.1 64.5 82.3 83.0 84.2 101.6 2 716 6 165 1 721 89 124 15 953 20 331 35 709 35 50 490 4 733 57 945 7 805 46 509 242 163 (%) coverage under 1 year Immunisation Immunisation 3 2 846 4 2 505 2 3 14 26 1.0 1.0 1.3 0.7 1.2 0.4 0.6 0.3 731 782 400 488 3 764 1 363 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 71 26 54 89 44 9.7 9.2 284 11.9 12.4 10.8 12.2 12.2 22.9 (per1K) neonatal neonatal Inpatient Inpatient death rate 70 23 49 39 44 7.5 9.4 9.9 8.6 8.5 225 10.6 15.8 10.8 8 211 8 211 2 133 2 133 3 106 3 106 5 901 5 901 4 5534 553 4 23 904 23 904 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 95 83 85 33 7.2 4.4 6.0 5.9 5.8 8.3 8.5 136 432 655 386 12.7 6008 1 578 1 029 Inpatient Inpatient year rate (%) death under 5 81 57 29 69 7.7 9.3 9.3 6.3 112 186 661 320 738 348 11.2 10.4 15.6 25.3 3 110 1 205 2 360 Impact Inpatient Inpatient year rate (%) death under 1 4 6 - - 15 21 26 46 32 33 8.0 8.3 116 146 353 14.4 15.4 13.0 12.9 18.8 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 4 9 9 1 11 34 68 1.5 4.0 3.4 2.0 3.0 2.9 2.9 2.3 118 225 363 399 1 173 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 2 7 1 11 13 34 2.1 1.0 1.5 2.0 2.0 3.3 3.2 112 131 101 341 354 11.6 1 039 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Indicator Numerator Indicator Numerator Denominator Denominator Numerator Denominator Indicator Numerator Numerator Numerator Denominator Denominator Indicator Indicator Indicator Denominator D

South Africa South Limpopo Greater Giyani SD Giyani Greater Ba-Phalaborwa SD Indicator Greater Letaba SD Greater Tzaneen Tzaneen Greater SD Maruleng SD Maruleng Mopani Mopani Source: HIS.

560 SectionSection B: National B: Profile and Limpopo District Province Profiles

Annual trendsLP, DC33, ChildMopani Districtand School Municipality, Health SEQ 2 (deprived)

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

0

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

50

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

3_Output 150

Measles 2nd dose coverage 100

50

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trendsLP, DC33, HIVMopani District Municipality, SEQ 2 (deprived)

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

200

Male condom distribution 100 coverage 4_Process_input

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

561 Section B: NationalProfile Limpopo and District Province Profiles

HIV 969 15.1 81.4 19.0 31.2 26.9 44.8 35.9 33.3 3 447 2 795 2 933 4 898 15 042 772 542 432 594 1 008 510 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 71.9 55.7 95.7 68.4 54.5 54.9 160.5 853 917 377 163 692 898 692 7 611 648 7 611 5 044 050 2016/17 distribution distribution Male condom condom Male coverage (No) 47.3 64.1 55.6 42.3 35.9 50.2 48.8 109.9 61 155 50 367 3 692 486 86 533 6 808 360 46 343 591 3 172 112 356 356 754 26 329 135 7 704 744 43 96 866 5 021 652 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - - 2 850 435 1 676 955 1 885 362 - - - - 667 638 - 1 427 829 795 933 922 644 - - - 226 1 619 - - - - - 616 1 139 4.7 4.0 8.2 15 668 15 389 227 389 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------70.6 55.0 68.6 80 829 114 449 2016/17 on ART rate (%) Clients remaining - 71 67 84 117 141 183 155 102 105 245 730 540 74.7 67.6 74.0 79.8 75.5 72.0 72.3 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------74.1 71.1 74.4 70.7 70.0 72.9 73.9 2 913 5 577 1 629 3 285 2 238 15 642 2015 months (%) on ART after 12 Adult percentageAdult - 47 75 26 52 59 68 98 46 38 124 230 403 57.1 61.3 53.1 64.4 54.8 56.0 55.3 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------81.3 81.9 84.4 84.0 83.5 82.8 85.5 1 027 9 397 1 282 1 794 1 956 1 3 338 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 47 61 75 59 98 94 69 114 514 176 124 403 77.0 78.4 70.5 79.8 86.0 69.8 85.5 (%) 2015 Child with viral load completion completion load rate at months 12 ------87.1 86.1 84.0 89.5 84.0 78.3 88.6 3 974 1 148 1 526 2 208 2 059 10 915 (%) 2015 Adult with viral load completion completion load rate at months 12 Denominator Indicator Numerator Denominator Indicator Numerator Indicator Denominator Numerator Indicator Indicator Denominator Numerator Denominator Indicator Numerator Numerator Denominator Indicator

D

Maruleng SD Maruleng Mopani Mopani Greater Tzaneen SD Tzaneen Greater Greater Letaba SD South Africa South Limpopo Ba-Phalaborwa SD Indicator Greater Giyani SD Giyani Greater Source: HIS.

562 SectionSection B: National B: Profile and Limpopo District Province Profiles

TB Annual trends LP, DC33, Mopani District Municipality, SEQ 2 (deprived)

Measure Names 15 IndValue 5_TB 51.6 56.1 69.7 75.6 85.4 79.3 65.9

104.9 Prov_av TB death rate 10 617 529 317 585 472 891 302 846 302 200 000 200 (ETR.net) ZA_av 5 2016/17

screened in 60 TB symptom 5 facility rate (%) rate facility years and older Process & input 1_Impact TB DR client 40 - - - - - 406 844 - - - 329 436 - - - 870 230 - 141 1 019 - - - 264 556 death rate (EDRWeb) 20 81.5 96.7 72.8 2 250 2 676 963 1 833 095 2 124 0 15 2016 Output rate (%) TB client lost to 10 on treatment treatment on follow up rate TB client initiated (ETR.Net) 5

0 819 195 195 220 226 239 282 236 264 888 97.3 98.7 93.6 94.8 90.6 92.2 88.3 100.0 1 734 1 830 80 TB client treatment 2016 success rate 60 Net) (%) Net) (ETR.net) TB/HIV co-

ART rate (ETR. 40 infected client on 40 ------71

114 TB DR client 60.4 68.0 62.3 loss to follow up 20 rate (EDRWeb)

2016 0 treatment treatment

TB Rifampicin Rifampicin TB 60 2_Outcome resistant clients clients resistant

initiation rate (%) rate initiation TB DR treatment 40 ------success rate 5.1 5.3 6.2

114 (EDRWeb) 20

2 250 0

2016 TB Rifampicin 20 rate (%)

resistance resistance resistance

TB Rifampicin Rifampicin TB confirmed client 10 confirmed client confirmed client rate ------0 92 56 100 58.4 50.5 60.9 TB/HIV co-infected client on ART 50 2014 rate (ETR.Net) Outcome success rate rate success

(EDRWeb) (%) 0 TB DR treatment treatment DR TB 100 ------TB symptom 5 11 92 years and older 17.9 17.8 12.0 screened in 50 facility rate

4_Process_input 0 2014 2009 2010 2011 2012 2013 2014 2015 2016 Year (EDRWeb) (%) to follow up rate TB DR client loss Measure Names IndValue 317 371 375 491 488 367 608 399 76.1 81.0 81.9 76.4 80.7 85.4 80.3 92.0 P rov_av 1 101 3 234 1 365 2 648 ZA_av 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 0 12 19 25 43 99 4.1 6.1 3.1 0.0 6.4 3.9 3.2 3.2 371 491 608 399 3 234 1 365 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------19 92 16.4 20.7 23.0 2014 death rate TB DR client (EDRWeb) (%) Impact 27 53 48 30 7.3 7.5 8.7 9.8 6.6 371 189 491 347 608 399 11.9 10.7 13.8 3 234 1 365 2015 TB death rate (ETR.net) (%) Numerator Denominator Indicator Numerator Denominator Indicator Numerator Denominator Numerator Denominator Indicator Indicator Numerator Denominator Indicator Indicator Numerator Indicator Denominator D

Ba-Phalaborwa SD Indicator Greater Giyani SD Giyani Greater Greater Letaba SD Greater Tzaneen SD Tzaneen Greater Maruleng SD Maruleng Limpopo Mopani Mopani South Africa South Source: HIS.

563 Section B: NationalProfile Limpopo and District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Ba-Phalaborwa SD Indicator 1.8 11.8 Numerator 283 462 Denominator 1 922 481 468 684 Greater Giyani SD Indicator 3.5 22.2 Numerator 880 1 295 Denominator 3 009 570 700 458 Greater Letaba SD Indicator 2.2 10.5 Numerator 491 585 Denominator 2 632 677 668 304 Greater Tzaneen SD Indicator 2.3 11.5 Numerator 955 1 260 Denominator 4 930 128 1 310 775 Maruleng SD Indicator 3.2 19.5 Numerator 313 479 Denominator 1 186 938 294 135 Mopani Indicator 2.56 14.23 Numerator 2 922 4 081 Denominator 13 681 794 3 442 356 Limpopo Indicator 2.0 16.5 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual LP,trends DC33, Mopani District Municipality, SEQ 2 (deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

0

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

564 SectionSection B: National B: Profile and Limpopo District Province Profiles

Vhembe District Municipality (DC34)

Vhembe District is located in the northern part of Limpopo Province. It borders with and in the north-west and in the south-east through the . It comprises four health sub-districts, namely , , Thulamela and Makhado. The district has a population of 1 387 625, with a population density of 54.2 persons per km2 and falls in socio-economic Quintile 2, among the poorer districts, and has an estimated medical scheme coverage of 6.4%. Vhembe is one of the 11 National Health Insurance (NHI) pilot districts.

Social determinants of healtha Population per selected category

Unemployment ratea 38.7% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 50.6% under 1 year 32 312 32 593 33 116 33 509 No schooling 14.4% under 5 years 170 206 169 654 169 249 168 941 Matric 25.0% 05-09 years 168 726 169 942 170 331 170 583 Higher education 9.6% 10-14 years 148 522 153 600 158 871 163 294 Households 382 357 15-19 years 137 841 135 981 136 221 138 743 Female-headed households 51.0% 20-24 years 147 894 143 108 137 417 132 069 Formal dwellings 86.3% 25-29 years 143 055 144 785 145 433 144 247 Flush toilet connected to sewerage 16.0% 30-34 years 114 729 121 301 128 189 135 115 Weekly refuse removal 16.5% 35-39 years 94 002 97 165 99 737 101 865 Piped water inside dwellings 7.4% 40-44 years 72 763 76 293 79 949 83 602 Electricity for lighting 94.6% 45-49 years 56 306 58 536 61 054 63 824 Blue Drop water score 39.3% 50-54 years 46 490 47 662 48 806 50 089 55-59 years 37 431 38 619 39 909 41 195 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 30 016 30 847 31 640 32 475 65-69 years 22 161 23 041 23 926 24 806 70-74 years 14 506 15 204 15 965 16 738 75-79 years 10 544 10 214 10 037 10 075 80 years and older 16 067 15 894 15 757 15 651 Total 1 431 258 1 451 836 1 472 489 1 493 306 Estimated pregnant women* 34 574 34 875 35 434 35 855 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

565 Section B: NationalProfile Limpopo and District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Makhado SD 20 48 4 3 0 0 3 Musina SD 3 4 0 1 0 0 0 Mutale SD 0 16 1 0 0 0 0 Thulamela SD 3 49 3 2 1 0 2 Vhembe 26 117 8 6 1 0 5 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Vhembe 2 288 1 218 1 009 2 828 204 96 33 46 37 22 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Makhado SD Indicator 3.0 - - - - - Numerator 1 682 251 - - - - - Denominator 6 649 632 - - - - - Musina SD Indicator 2.3 - - - - - Numerator 177 394 - - - - - Denominator 937 875 - - - - - Mutale SD Indicator 4.6 - - - - - Numerator 448 371 - - - - - Denominator 1 171 008 - - - - - Thulamela SD Indicator 2.7 - - - - - Numerator 1 817 788 - - - - - Denominator 7 945 587 - - - - - Vhembe Indicator 3.0 11.3 62.9 2 214 942 296 Numerator 4 125 804 14 78 2 876 218 445 1 223 253 436 1 223 253 436 Denominator 16 704 102 124 124 1 299 017 1 299 017 4 125 804 Limpopo Indicator 2.7 10.6 56.9 2 082 866 301 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389

Source: DHIS.

566 SectionSection B: National B: Profile and Limpopo District Province Profiles ------Annual trends

12.0 LP, DC34, Vhembe District Municipality, SEQ 2 (deprived) 20.3

(%) 8 Measure Names OPD new

client not not client IndValue referred rate rate referred Inpatient crude 6 Prov_av ------death rate ZA_av 6.1 5.4 1_Impact 4

1_Management 2

rate (%) 8 Inpatient Inpatient crude death 6 Average length ------of stay (district 4 75.5 84.3 hospitals)

(%) 2 utilisation rate - total

Inpatient bed 4K

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

4 611 equivalent 4 227 (district 2K day

(Rand) hospitals) 1K equivalent equivalent per patient Expenditure ------7.3 6.9 Inpatient bed 100 utilisation rate (district (Days) Average

length of of length hospitals) stay - total 50 ------100 3_Output 37.2 60.4 72.3 72.3 4 641 4 641 6 422 6 422 OPD new client (%) not referred rate 50 OPD new client not not client (district

referred rate rate referred hospitals) ------0 5.0 5.2 5.2 100 1 265 1 265 24 396 24 396 rate (%)

Inpatient Inpatient Percentage 50 crude death Ideal clinics ------75.4 75.4 78.3 5.0 72.3 0 110 121 110 121 146 016 146 016 (%) Provincial and 3K

Hospital LG District utilisation rate - total

Inpatient bed Health Services 2K Regional Hospital Regional expenditure per ------capita (uninsured) 3 051 3 085 2 894 3 085 1K 144 680 144 144 680 144 day (Rand) equivalent equivalent per patient 446 326 897 446 326 897 Provinc ial and Expenditure 1500

4_Process_input LG PHC ------expenditure per 4.9 4.5 1000 4.5 5.3 capita (uninsured) 24 396 24 396 110 121 110 121 500 (Days) Average length of of length stay - total

Provincial and 400 LG PHC 76.6 75.3 59.3 56.4 70.2 90.5 expenditure per 25 131 86 214 66 019 81 220 27 770 PHC headcount 195 204 136 956 136 (%) 200 OPD new client not not client referred rate rate referred 2008 2010 2012 2014 2016 2018 Year 5.1 4.7 4.6 4.6 5.0 3.5 4 774 2 995 1 400 1 430 45 806 Measure Names 30 403 65 482 65 30 305 30 IndValue rate (%) Inpatient Inpatient P rov_av crude death ZA_av 67.4 56.7 69.4 73.0 69.6 68.2 16 573 165 174 672 217 199 421 074 148 210 127 431 292 214 (%) utilisation rate - total Inpatient bed District Hospital District 655 2 611 3 127 3 673 2 993 2 568 2 956 2 32 797 29 203 221 480 221 432 030 day 1 277 131 1 277 131 (Rand) equivalent equivalent per patient 692 589 175 120 466120 225 464 076 255 Expenditure 4.4 4.3 4.9 4.5 4.2 3.5 4 774 16 573 30 403 754 177 65 482 65 30 305 30 148 210 127 431 292 214 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Indicator Denominator Numerator Denominator Numerator Indicator D

Vhembe Vhembe Thulamela SD Thulamela South Africa South Limpopo Musina SD Musina Makhado SD Makhado Source: HIS and BAS.

567 Section B: NationalProfile Limpopo and District Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 19 18 30 90 35 39 220 436 28 874 576 710 Total District District - -- 75 - - - tertiary Central/ hospital 4 - 3 - 2 - 11 12 75 - 23 23 2016/17 119 5 353 - 144 680 144 Hospital Regional Regional 13 18 15 24 67 52 37 145 284 District District Hospital ------2 33 5 774 17 747 / MOU PHC / CHC 51 37 79 20 38 111 118 516 290 1 104 Total 593 367 - 432 030 District District ------30 202 - - 4 658 - 2 995 1 265 - 4 260 - tertiary Central/ Hospital 9 - 6 - 8 - 4 - 12 21 21 29 136 100 5 187 1 242 155 035 2015/16 Hospital Regional Regional 17 14 28 67 89 43 90 318 216 190 3 416 17 708 438 276 District District Hospital ------62 56 884 7 307 / MOU PHC / CHC 29 50 65 30 86 116 141 237 529 940 4 718 32 124 Total 565 245 District District ------tertiary Central/ Hospital 9 - 5 - 9 - 5 - 4 - 14 19 16 65 120 5 137 1 197 129 019 2014/15 Hospital Regional Regional 51 81 97 20 20 45 172 125 136 356 3 521 18 177 436 226 District District Hospital ------1 53 800 8 810 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

568 SectionSection B: National B: Profile and Limpopo District Province Profiles

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

PercentageLP, Vhembe: of deathsDC34, by2010 broad - 2015 cause and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 74% 11% 9% 6% 75% 9% 9% 7% causes and 5-14 31% 28% 21% 20% 37% 22% 17% 24% single leading 15-24 28% 32% 21% 20% 14% 13% 19% 54% causes 25-64 26% 33% 36% 5% 20% 34% 32% 13% 65+ 19% 3% 76% 2% 18% 8% 70% 3% Broadcause 28% 18% 50% 4% 26% 22% 40% 11% Total Injury NCD Rank.. Female Male 1 Diarrhoeal diseases (23.2%) Diarrhoeal diseases (22.9%) HIV and TB 2 Lower respiratory infections (15.5%) Protein-energy malnutrition (14.3%) Comm_mat_peri_nut 3 Protein-energy malnutrition (14.5%) Lower respiratory infections (13.7%) 4 Preterm birth complications (9.3%) Preterm birth complications (9.9%) Prov, District 5 HIV/AIDS (8.2%) Birth asphyxia (7.6%) LP, Vhembe: DC34 6 Birth asphyxia (6.1%) HIV/AIDS (6.9%) Show history

<5 years <5 7 Tuberculosis (2.5%) Accidental threats to breathing (2.5%) 8 Accidental threats to breathing (1.9%) Septicaemia (2.0%) Percentages are shown 9 Poisonings (including herbal) (1.7%) Other perinatal conditions (2.0%) according to all the deaths 10 Septicaemia (1.7%) Tuberculosis (1.7%) within the age/gender 1 Tuberculosis (16.0%) HIV/AIDS (13.4%) category of each box, 2 HIV/AIDS (14.7%) Diarrhoeal diseases (12.7%) although only the leading 3 Diarrhoeal diseases (11.1%) Tuberculosis (9.6%) 10 causes are displayed. 4 Road injuries (8.7%) Road injuries (9.1%) 5 Lower respiratory infections (7.6%) Drowning (7.9%)

5-14 6 Septicaemia (4.7%) Lower respiratory infections (7.0%) 7 Accidental threats to breathing (4.1%) Meningitis/encephalitis (6.3%) 8 Fires, hot substances (3.2%) Malaria (2.5%) 9 Epilepsy (2.9%) Accidental threats to breathing (2.5%) 10 Meningitis/encephalitis (2.7%) Protein-energy malnutrition (2.3%) 1 HIV/AIDS (16.9%) Road injuries (20.5%) 2 Tuberculosis (15.5%) Accidental threats to breathing (20.3%) 3 Lower respiratory infections (9.2%) Tuberculosis (7.7%) 4 Diarrhoeal diseases (8.0%) Interpersonal violence (6.2%) 5 Road injuries (7.6%) HIV/AIDS (6.1%)

15-24 6 Accidental threats to breathing (7.0%) Meningitis/encephalitis (4.4%) 7 Diabetes mellitus (2.4%) Drowning (3.7%) 8 Endocrine nutritional,blood, immune (2.2%) Diarrhoeal diseases (3.2%) 9 Interpersonal violence (2.0%) Epilepsy (3.2%) 10 Meningitis/encephalitis (1.9%) Lower respiratory infections (3.1%) 1 HIV/AIDS (17.4%) Tuberculosis (19.5%) 2 Tuberculosis (15.9%) HIV/AIDS (14.4%) 3 Diarrhoeal diseases (9.8%) Lower respiratory infections (8.4%) 4 Lower respiratory infections (9.6%) Diarrhoeal diseases (7.4%) 5 Diabetes mellitus (6.1%) Road injuries (5.5%)

25-64 6 Cerebrovascular disease (4.8%) Diabetes mellitus (4.9%) 7 Cervix (3.7%) Cerebrovascular disease (4.1%) 8 Nephritis/nephrosis (3.7%) Nephritis/nephrosis (3.7%) 9 Meningitis/encephalitis (2.4%) Accidental threats to breathing (3.6%) 10 Breast (2.1%) Meningitis/encephalitis (2.0%) 1 Cerebrovascular disease (20.4%) Cerebrovascular disease (12.2%) 2 Diabetes mellitus (11.9%) Diabetes mellitus (10.4%) 3 Lower respiratory infections (8.5%) Lower respiratory infections (9.5%) 4 Hypertensive heart disease (7.5%) Nephritis/nephrosis (7.1%) 5 Diarrhoeal diseases (6.5%) Tuberculosis (5.9%)

65+ 6 Nephritis/nephrosis (5.7%) Hypertensive heart disease (5.9%) 7 Ischaemic heart disease (3.4%) Diarrhoeal diseases (5.0%) 8 Septicaemia (3.0%) Prostate (4.7%) 9 Cervix (2.7%) Ischaemic heart disease (3.7%) 10 Endocrine nutritional,blood, immune (2.7%) Septicaemia (2.4%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (29.0%) n=49 HIV/AIDS (21.2%) n=1 914 2 Maternal haemorrhage (20.6%) n=35 Tuberculosis (19.2%) n=1 738 3 Other maternal (19.1%) n=32 Diarrhoeal diseases (10.8%) n=977 4 Abortion (17.2%) n=29 Lower respiratory infections (10.5%) n=950 5 Hypertension in pregnancy (11.5%) n=19 Nephritis/nephrosis (3.1%) n=281

15-49 6 Maternal sepsis (2.5%) n=4 Diabetes mellitus (2.9%) n=266 Female 7 Road injuries (2.8%) n=254 8 Meningitis/encephalitis (2.7%) n=243 9 Cervix (2.6%) n=239 10 Cerebrovascular disease (2.2%) n=195

569 Section B: NationalProfile Limpopo and District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Makhado SD Indicator 57.6 94.9 6.9 65.5 51.8 76.6 82.8 Numerator 6 969 711 7 249 6 744 118 742 8 549 Denominator 10 421 1 021 10 323 11 062 156 226 1 860 690 10 323 Musina SD Indicator 117.2 99.3 8.0 66.1 114.7 125.8 83.4 Numerator 2 279 132 1 504 1 722 30 772 1 382 Denominator 1 707 281 1 658 2 276 18 016 293 541 1 658 Mutale SD Indicator - 100.0 9.1 72.4 75.8 85.3 321.0 Numerator - 151 57 1 772 1 618 23 714 2 003 Denominator 627 151 624 2 448 25 611 333 615 624 Thulamela SD Indicator 62.0 97.1 7.4 69.4 45.0 78.3 56.8 Numerator 10 1 052 1 200 8 946 6 802 152 592 9 204 Denominator 16 119 1 083 16 209 12 883 181 267 2 338 074 16 209 Vhembe Indicator 62.3 96.6 7.3 67.9 53.2 81.0 73.4 Numerator 18 2 451 2 100 19 471 16 886 325 820 21 138 Denominator 28 874 2 536 28 814 28 669 381 120 4 825 920 28 814 Limpopo Indicator 130.2 95.2 6.3 65.7 55.7 85.5 70.9 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual LP,trends DC34, Vhembe District Municipality, SEQ 2 (deprived)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

50

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

570 SectionSection B: National B: Profile and Limpopo District Province Profiles

Child and School Health Annual trends LP, DC34, Vhembe District Municipality, SEQ 2 (deprived)

Measure Names 100 IndValue 57.9 54.6 58.0 65.0 60.3 69.2 55.2

7 264 Child under 5

12 815 Prov_av 63 794 63 66 080 66 150 624 149 953 222 078 222 years diarrhoea 50 ZA_av 1 176 9601 176 1 436 694 case fatality rate months Vitamin A dose 12-59 coverage (%) coverage 0

30 637 306 11.1 57.1 19.1 19.8 16.5 16.2 48.0 Child under 5 3 125 2 424 1 783 5 790 11 478 14 995 3_Child and school health school and 3_Child years 20 362 820 2 986 356 pneumonia case fatality rate 10 8 screening coverage (%) coverage School Grade 0 60 1_Impact Child under 5 666 47.8 31.9 45.0 33.0 34.8 80.9 45.8 2 116 2 615 8 168

4 948 1 277 40 1 454 1 years severe 15 898

424 248 acute malnutrition 20 case fatality rate 1 screening coverage (%) coverage School Grade 0 Output 94.5 86.8 98.3 96.2 20 101.4 127.5 2 751 102.5 1 522 Inpatient early 14 051 12 270 21 048 25 896

171 561 17 076 neonatal death 143 679 14 209 362 184 362 dose rate nd 10 Measles Measles 2

coverage (%) coverage 0

150 rd 976 778 27.7 27.7 41.6 28.9 34.6 22.6 49.2 2 246

1 983 1 Immunisation 2 590 7 434 30 594 11 140 11 441 26 810 coverage under 100 1 year Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 50

Infant 80 72.4 75.9 75.3 73.3 64.5 82.3 exclusively 102.6 2 045 2

10 116 breastfed at 21 946 21

23 907 60 22 806 161 304 161 139 050 347 067 DTaP-IPV-Hib- (%) HBV 3rd dose 40 coverage rate under 1 year

Immunisation Immunisation 20 7 8 392 3 090 4 1 393 - - 3_Output 150 13 24 1.7 1.3 1.5 1.2 1.2 0.8 274 132 875 772

2 053 Measles 2nd dose coverage 100 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 50 3 - - 100 78 7.5 1.8 8.7 169 250 12.4 10.5 12.2 School Grade 1 screening 50 cover age (per1K) neonatal neonatal Inpatient Inpatient death rate 0 2009 2010 2011 2012 2013 2014 2015 2016 3 - - 66 7.6 1.8 9.4 9.9 6.3

151 Year 627 627 220 10.6 1 7071 707 1 16 119 16 119 28 874 28 874 10 421 10 421 Measure Names IndValue (per1K) Inpatient Inpatient death rate P rov_av early neonatal neonatal early ZA_av - - - 13 4.4 5.9 4.3 5.5 4.5 2.5 415 518 120 282 2 183 9 201 6 500 Inpatient Inpatient year rate (%) death under 5 6 - - - 97 7.0 7.9 3.4 9.3 6.3 177 325 802 222 12.1 3 151 4 130 Impact Inpatient Inpatient year rate (%) death under 1 6 3 - - - 39 49 30 7.4 6.1 4.7 8.0 8.3 8.5 128 530 353 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute - - - - - 11 24 52 35 1.8 1.8 1.8 2.0 2.9 621 1 325 1 998 1 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 3 6 - - - 19 10 2.1 1.9 1.0 2.0 2.5 0.5 121 530 1 172 1 823 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Indicator Indicator Numerator Numerator Denominator Denominator Indicator Numerator Denominator Indicator Denominator Numerator Numerator Denominator Indicator Indicator D

South Africa South Makhado SD Makhado Limpopo Musina SD Musina Mutale SD Mutale Vhembe Vhembe Thulamela SD Thulamela Source: HIS.

571 Section B: NationalProfile Limpopo and District Province Profiles

HIV Annual trends LP, DC34, Vhembe District Municipality, SEQ 2 (deprived)

60 Measure Names

6.8 IndValue 773 493 19.7 19.0 15.2 26.9 30.9 22.9 4_HIV 69 91 9 577 1 320 HIV testing Prov_av coverage 40 388 296 388 (including ANC) ZA_av 20 (per1K) 2016/17 Medical male male Medical

circumcision rate rate circumcision 200

Male condom distribution 47.5 71.0 77.8 95.6 68.4 60.8 69.2 100 coverage 375 615 404 823 4_Process_input 2 992 172 2 079 654 10 172 814 172 10 28 918 918 13 674 278 674 13

2016/17 80 distribution distribution

Male condom condom Male 60 coverage (No) Medical male circumcision 40 rate 20 51.1 70.1 50.9 35.9 50.2 44.2 68.2 36 111

35 491 0 131 057 184 292 635 466 635

9 125 2389 125 229 5 015 5 847 738 2009 2010 2011 2012 2013 2014 2015 2016 (%)

90-90-90 Year 2016/17 coverage st HIV testing 1 Measure Names Process & input (including ANC) IndValue - - 4 326 900 903 2 310 154 2 711 - - 607 497 320 706 ------3 555 375 2 008 005 2 343 465 - P rov_av 4.7 3.6 8.2 ZA_av 15 122 386 951 419 529 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------80.1 55.0 68.6 74 704 59 800 2016/17 on ART rate (%) Clients remaining - 24 37 29 20 183 276 203 254 596 430 72.1 54.1 73.6 72.0 72.0 82.8 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------887 868 62.1 70.7 70.0 73.4 73.6 68.8 5 188 5 334 12 277 2015 months (%) on ART after 12 Adult percentageAdult 7 3 - 11 13 63 83 44 117 216 109 57.8 27.3 56.0 53.0 54.2 53.8 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------326 400 81.3 79.3 82.3 86.8 82.8 78.2 4 815 1 831 2 258 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 11 13 16 20 83 216 156 146 109 338 69.9 65.0 69.8 63.9 56.8 68.8 (%) 2015 Child with viral load completion completion load rate at months 12 ------515 550 67.3 72.7 59.4 78.3 64.2 63.3 7 503 7 3 356 3 082 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Numerator Denominator Indicator Numerator Denominator Indicator Indicator Denominator Numerator Numerator Denominator Indicator Numerator Indicator Indicator Denominator

D

Vhembe Vhembe Thulamela SD Thulamela Makhado SD Makhado Mutale SD Mutale Limpopo Musina SD Musina South Africa South Source: HIS.

572 SectionSection B: National B: Profile and Limpopo District Province Profiles

TB Annual trends LP, DC34, Vhembe District Municipality, SEQ 2 (deprived)

Measure Names 15 IndValue 5_TB 51.6 56.1 62.1 60.4 62.0 60.0 85.6 TB death rate Prov_av 118 654 206 010 138 587

797 344 797 10 (ETR.net) ZA_av 3 185 3583 185

2016/17 5 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input 60 1_Impact ------1 321 120 - 343 528 - 856 330 - 1 382 123 TB DR client 40 96.7 72.8 94.5 death rate 2 214 2 092 1 978 338 (EDRWeb) 20 2016

Output 0 rate (%) 15 on treatment treatment on TB client initiated TB client lost to 10 follow up rate 47 47 187 478 731 186 622 682 70.1 85.1 90.6 99.5 80.9 88.3 (ETR.Net) 5 1 647 100.0 1 333 1

0 2016 Net) (%) Net)

TB/HIV co- 80 TB client ART rate (ETR.

infected client on treatment success rate 60 ------

74 (ETR.net) 143 51.7 60.4 68.0 40

40 2016

treatment treatment TB DR client

TB Rifampicin Rifampicin TB loss to follow up 20 resistant clients clients resistant initiation rate (%) rate initiation rate (EDRWeb) ------5.3 6.5 6.2 0 143 2 214 60 2_Outcome TB DR

2016 treatment 40 rate (%)

resistance resistance success rate

TB Rifampicin Rifampicin TB (EDRWeb) 20 confirmed client confirmed client 0 ------72 46 58.4 50.5 63.9 TB Rifampicin 20 resistance

2014 confirmed client 10

Outcome rate success rate rate success (EDRWeb) (%)

TB DR treatment treatment DR TB 0 100 ------13 72 TB/HIV 17.9 17.8 18.1 co-infected client on ART 50 rate (ETR.Net) 2014 0 (EDRWeb) (%)

to follow up rate 100 TB DR client loss TB symptom 5 years and older 157 128 342 994 363 76.1 81.0 74.3 81.5 79.7 83.0 94.2 screened in 50 1 313 1 198 1 766 2 777 2 3 484 facility rate 4_Process_input

2015 0 TB client client TB treatment treatment 2009 2010 2011 2012 2013 2014 2015 2016 success rate rate success (ETR.net) (%) Year 8 9 Measure Names 39 6.1 5.1 6.4 8.0 3.3 2.5 157 221 277 363 IndValue 12.5 1 198 1 766 3 484 P rov_av ZA_av 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------10 72 16.4 13.9 23.0 2014 death rate TB DR client (EDRWeb) (%) Impact 10 20 83 8.1 9.6 6.6 6.9 2.8 170 157 283 363 11.9 12.7 1 198 1 766 3 484 2015 TB death rate (ETR.net) (%) Indicator Indicator Numerator Denominator Indicator Numerator Indicator Denominator Numerator Numerator Denominator Indicator Denominator Indicator Numerator Denominator Indicator D

South Africa South Limpopo Makhado SD Makhado Mutale SD Mutale Musina SD Musina Thulamela SD Thulamela Vhembe Vhembe Source: HIS.

573 Section B: NationalProfile Limpopo and District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Makhado SD Indicator 2.1 15.5 Numerator 1 157 2 108 Denominator 6 649 632 1 633 044 Musina SD Indicator 0.7 4.9 Numerator 58 70 Denominator 937 875 169 779 Mutale SD Indicator 0.4 4.0 Numerator 39 84 Denominator 1 171 008 254 163 Thulamela SD Indicator 1.9 9.3 Numerator 1 252 1 393 Denominator 7 945 587 1 790 313 Vhembe Indicator 1.8 11.4 Numerator 2 506 3 655 Denominator 16 704 102 3 847 299 Limpopo Indicator 2.0 16.5 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual LP,trends DC34, Vhembe District Municipality, SEQ 2 (deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

0

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

574 SectionSection B: National B: Profile and Limpopo District Province Profiles

Capricorn District Municipality (DC35)

Capricorn District is located in Limpopo Province in northern South Africa and consists of five health sub-districts, namely Aganang, , Lepelle-Nkumpi, Molemole and . The district forms a gateway to Botswana, Zimbabwe and Mozambique. Capricorn has a population of 1 296 247, with a population density of 59.7 persons per km2 and falls in socio- economic Quintile 2, among the poorer districts. Estimated medical scheme coverage is 8.7%.

Social determinants of healtha Population per selected category

Unemployment ratea 37.2% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 47.4% under 1 year 26 010 26 502 27 544 28 620 No schooling 2.4% under 5 years 140 277 139 988 140 489 141 561 Matric 29.9% 05-09 years 141 791 141 957 141 319 140 646 Higher education 11.4% 10-14 years 127 560 130 638 134 409 137 512 Households 378 301 15-19 years 132 359 126 901 123 108 121 997 Female-headed households 49.1% 20-24 years 139 026 135 336 130 559 125 155 Formal dwellings 93.2% 25-29 years 134 581 135 208 134 700 132 691 Flush toilet connected to sewerage 30.2% 30-34 years 108 146 114 385 120 770 127007 Weekly refuse removal 30.4% 35-39 years 84 954 88 452 91 544 94 141 Piped water inside dwellings 19.5% 40-44 years 65 419 67 995 70 836 73 900 Electricity for lighting 95.2% 45-49 years 53 636 54 785 56 115 57 693 Blue Drop water score 81.7% 50-54 years 46 017 46 818 47 542 48 271 55-59 years 38 064 38 846 39 763 40 690 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 32 613 32 820 33 001 33 261 65-69 years 26 596 26 948 27 296 27 614 70-74 years 20 183 20 501 20 819 21 116 75-79 years 15 207 15 108 15 073 15 114 80 years and older 18 704 19 268 19 859 20 472 Total 1 325 135 1 335 951 1 347 201 1 358 841 Estimated pregnant women* 27 831 28 357 29 472 30 623 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

575 Section B: NationalProfile Limpopo and District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Aganang SD 23 11 0 1 0 0 0 Blouberg SD 21 22 2 1 0 0 1 Lepelle-Nkumpi SD 31 22 1 3 0 0 3 Molemole SD 19 8 0 1 0 0 0 Polokwane SD 47 33 2 2 0 2 3 Capricorn 141 96 5 8 0 2 7 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Capricorn 2 041 1 271 1 115 2 146 514 152 52 72 60 25 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Aganang SD Indicator 2.4 - - - - - Numerator 313 908 - - - - - Denominator 1 581 333 - - - - - Blouberg SD Indicator 3.7 - - - - - Numerator 614 257 - - - - - Denominator 1 979 445 - - - - - Lepelle-Nkumpi SD Indicator 2.8 - - - - - Numerator 667 160 - - - - - Denominator 2 816 043 - - - - - Molemole SD Indicator 2.9 - - - - - Numerator 319 157 - - - - - Denominator 1 325 055 - - - - - Polokwane SD Indicator 2.3 - - - - - Numerator 1 525 632 - - - - - Denominator 7 882 500 - - - - - Capricorn Indicator 2.6 22.0 66.7 1 974 852 293 Numerator 3 440 114 22 58 2 336 941 670 1 009 172 596 1 009 172 596 Denominator 15 584 376 100 87 1 184 062 1 184 062 3 440 114 Limpopo Indicator 2.7 10.6 56.9 2 082 866 301 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

576 SectionSection B: National B: Profile and Limpopo District Province Profiles ------12.0 12.0 12.0 20.3 97 151 11 661 97 151 11 661 (%) OPD new client not not client referred rate rate referred ------6.1 6.1 6.1 5.4 38 215 38 215 rate (%) Inpatient Inpatient crude death ------75.5 75.5 75.5 84.3 279 504 2 325 279 504 2 325 369 968 369 968 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 091 091 4 611 4 611 4 611 4 227 day (Rand) equivalent equivalent per patient Expenditure ------7.3 7.3 7.3 6.9 38 215 386 150 38 215 386 150 (Days) Average length of of length stay - total - - 279 504 1 780 588 ------279 504 1 780 588 - 37.2 60.4 (%) OPD new client not not client referred rate rate referred ------5.0 rate (%) Inpatient Inpatient crude death ------78.3 5.0 72.3 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------3 051 2 894 day (Rand) equivalent equivalent per patient Expenditure ------4.9 5.3 (Days) Average length of of length stay - total 57.9 52.7 75.3 98.4 59.3 50.3 99.9 68.3 12 741 13 178 27 144 51 469 51 10 682 34 183 18 464 25 333 25 33 630 142 637 (%) OPD new client not not client referred rate rate referred 7.0 5.1 5.6 5.0 6.9 5.5 4.2 917 221 766 258 495 7 152 6 136 13 188 2 657 97 375 48 711 10 938 20 530 rate (%) Inpatient Inpatient crude death 57.1 67.4 74.9 91.5 69.6 73.5 84.5 4.5 64.8 18 701 40 154 90 721 20 442 3 955 63 882 210 762 107 322 281 446 (%) utilisation rate - total Inpatient bed District Hospital District 825 3 014 3 748 2 570 3 105 2 923 3 022 2 993 2 568 71 142 40 521 38 821 48 599 49 645 141 201 340 284 day 1 025 673 (Rand) equivalent equivalent 113 460 272 113 per patient 426 337 651 Expenditure 4.7 4.4 4.4 4.0 4.3 4.3 4.3 4.2 7 152 6 136 3 955 48 711 18 701 10 938 46 973 467 810 182 46 973 90 721 26 022 854 579 151 26 022 20 530 28 346 897 150 169 28 346 210 762 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Indicator Denominator Numerator Denominator Indicator Numerator D

Capricorn Polokwane SD Molemole SD Molemole Lepelle-Nkumpi SD South Africa South Blouberg SD Blouberg Limpopo Aganang SD Aganang Source: HIS and BAS.

577 Section B: NationalProfile Limpopo and District Province Profiles

Annual trends Management and Deaths and Patient day equivalent 2014/15 – 2016/17 efficiency indicators for the service 61 20 32 56 69 117 152 732 delivery platform, 2016/17 464 Total LP, DC35, Capricorn District Municipality, SEQ 2 (deprived) 726 434 District District

8 Measure Names IndValue 10 87 37 40 55 90 413 270 Inpatient crude 6 Prov_av

death rate ZA_av 386 150 tertiary Central/ hospital 1_Impact 4 1_Management ------1 - 8 583 25 863 - 2 -

8 2016/17 6 Average length Hospital Regional Regional of stay (district 4 hospitals) 13 19 16 24 62 22 30 194 2 279

4K 14 439 District District Hospital

2_Outcome Expenditure per 3K - 340 284 ------patient day - 1

equivalent 40 2K

(district 2 841 hospitals)

1K / MOU PHC / CHC 26 26 32 77 83 742 177 158 Inpatient bed 577

100 2 550 - - - - -

utilisation rate 26 191 715 682 (district Total District District hospitals) 50 54 108 109 420 439 100 334 9 123 3_Output 384 598 384

OPD new client tertiary Central/ Hospital not referred rate 50 (district ------5 - - 2 - - - 9 hospitals)

0

100 2015/16 Hospital Regional Regional 17 21 23 50 68 Percentage 30 243 272 50 620 Ideal clinics 13 634 331 084 331 District District Hospital 0 ------8 - 75

Provincial and 3K 31

LG District 1 510 Health Services

2K / MOU expenditure per capita PHC / CHC (uninsured) 1K 47 61 37 87 35 474 138 189 785 2 670 5 284 - 2 799 - 2 570 5 369 - 2 657 - 2 325 4 982 Total Provinc ial and 696 790 -

1500 District

4_Process_input LG PHC expenditure per 1000 12 70 65 96 capita 44 427 (uninsured) 360 500 2 516 380 913 tertiary Central/ Hospital - - - 275 ------7 - 5 - - 9 422 27 837 3 434 Provincial and 400 - LG PHC expenditure per PHC headcount 2014/15 Hospital

200 Regional 17 17 73 25 93 40 2008 2010 2012 2014 2016 2018 30 310 199 550

Year 2 768 14 491 315 877 District District Measure Names Hospital ------IndValue - P rov_av 48 3 924 ZA_av 1 760 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

578 SectionSection B: National B: Profile and Limpopo District Province Profiles

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

PercentageLP, Capricorn: of deaths DC35, by 2010 broad - cause2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 76% 6% 12% 6% 75% 5% 13% 7% causes and 5-14 37% 15% 31% 17% 34% 14% 28% 24% single leading 15-24 35% 29% 22% 15% 14% 10% 20% 56% causes 25-64 25% 33% 37% 4% 19% 31% 35% 15% 65+ 20% 3% 75% 2% 18% 7% 72% 3% Broadcause 28% 19% 49% 4% 25% 20% 43% 12% Total Injury NCD Rank.. Female Male 1 Diarrhoeal diseases (23.7%) Diarrhoeal diseases (22.9%) HIV and TB 2 Lower respiratory infections (23.3%) Lower respiratory infections (21.1%) Comm_mat_peri_nut 3 Preterm birth complications (8.3%) Preterm birth complications (9.1%) 4 Birth asphyxia (5.7%) Birth asphyxia (6.2%) Prov, District 5 HIV/AIDS (4.5%) Sepsis/other newborn infectious (3.8%) LP, Capricorn: DC35 6 Protein-energy malnutrition (3.3%) Protein-energy malnutrition (3.6%) Show history

<5 years <5 7 Meningitis/encephalitis (3.1%) Other perinatal conditions (3.1%) 8 Sepsis/other newborn infectious (3.0%) HIV/AIDS (3.1%) Percentages are shown 9 Other perinatal conditions (3.0%) Meningitis/encephalitis (2.7%) according to all the deaths 10 Septicaemia (2.4%) Poisonings (including herbal) (2.2%) within the age/gender 1 Lower respiratory infections (16.8%) Lower respiratory infections (13.5%) category of each box, 2 Diarrhoeal diseases (12.5%) Diarrhoeal diseases (11.5%) although only the leading 3 Road injuries (10.7%) Road injuries (10.1%) 10 causes are displayed. 4 Tuberculosis (9.7%) HIV/AIDS (7.6%) 5 HIV/AIDS (6.0%) Tuberculosis (7.4%)

5-14 6 Meningitis/encephalitis (3.9%) Drowning (6.4%) 7 Other neoplasms (3.8%) Meningitis/encephalitis (4.5%) 8 Fires, hot substances (3.3%) Leukaemia (4.1%) 9 Septicaemia (2.9%) Accidental threats to breathing (3.0%) 10 Leukaemia (2.9%) Septicaemia (2.6%) 1 HIV/AIDS (17.2%) Road injuries (25.8%) 2 Lower respiratory infections (13.0%) Accidental threats to breathing (12.3%) 3 Tuberculosis (12.5%) Lower respiratory infections (6.4%) 4 Diarrhoeal diseases (10.2%) Interpers onal violence (6.2%) 5 Road injuries (8.3%) Tuberculosis (6.0%)

15-24 6 Meningitis/encephalitis (2.7%) Mechanical forces (4.8%) 7 Hypertension in pregnancy (2.6%) HIV/AIDS (4.1%) 8 Diabetes mellitus (2.3%) Diarrhoeal diseases (3.6%) 9 Accidental threats to breathing (2.3 %) Drowning (3.1%) 10 Other maternal (1.9%) Meningitis/encephalitis (2.5%) 1 HIV/AIDS (20.5%) Tuberculosis (15.6%) 2 Tuberculosis (12.7%) HIV/AIDS (15.5%) 3 Lower respiratory infections (12.2%) Lower respiratory infections (10.4%) 4 Diarrhoeal diseases (8.0%) Road injuries (7.7%) 5 Diabetes mellitus (5.0%) Diarrhoeal diseases (5.8%)

25-64 6 Cerebrovascular disease (4.4%) Diabetes mellitus (3.9%) 7 Hypertensive heart disease (3.7%) Cerebrovascular disease (3.9%) 8 Cervix (3.1%) Hypertensive heart disease (3.3%) 9 Road injuries (2.1%) Accidental threats to breathing (2.7%) 10 Breast (2.1%) Ischaemic heart disease (2.4%) 1 Cerebrovascular disease (17.7%) Cerebrovascular disease (12.1%) 2 Hypertensive heart disease (14.3%) Lower respiratory infections (11.6%) 3 Lower respiratory infections (11.8%) Hypertensive heart disease (11.5%) 4 Diabetes mellitus (10.8%) Diabetes mellitus (7.7%) 5 Diarrhoeal diseases (5.5%) Tuberculosis (5.4%)

65+ 6 Ischaemic heart disease (5.2%) Ischaemic heart disease (5.2%) 7 Nephritis/nephrosis (3.1%) COPD (4.7%) 8 Cardiomyopathy (2.2%) Diarrhoeal diseases (4.5%) 9 Cervix (2.2%) Prostate (3.9%) 10 Tuberculosis (1.8%) Nephritis/nephrosis (3.7%)

Rank.. Maternal conditions All other causes 1 Hypertension in pregnancy (26.7%) n=110 HIV/AIDS (25.4%) n=3 283 2 Other maternal (22.3%) n=92 Tuberculosis (15.5%) n=1 998 3 Indirect maternal (22.0%) n=91 Lower respiratory infections (14.4%) n=1 866 4 Maternal haemorrhage (13.8%) n=57 Diarrhoeal diseases (9.3%) n=1 198 5 Abortion (7.7%) n=32 Road injuries (3.0%) n=393

15-49 6 Maternal sepsis (7.5%) n=31 Diabetes mellitus (2.3%) n=291 Female 7 Cervix (2.2%) n=288 8 Cerebrovascular disease (2.2%) n=288 9 Meningitis/encephalitis (2.1%) n=276 10 Hypertensive heart disease (1.7%) n=225

579 Section B: NationalProfile Limpopo and District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother Antenatal 1st Couple year mortality in client initiated facility under cancer postnatal visit visit before 20 protection rate facility ratio on ART rate 18 years rate screening within 6 days weeks rate (%) (WHO) (%) (per100K) (%) (%) coverage (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Aganang SD Indicator - 99.6 4.9 64.1 48.0 105.5 107.5 Numerator - 262 83 1 396 1 411 32 992 1 803 Denominator 1 679 263 1 677 2 179 35 256 375 387 1 677 Blouberg SD Indicator 24.3 98.8 5.7 62.7 93.7 110.8 69.7 Numerator 1 496 234 2 408 3 161 47 125 2 877 Denominator 4 116 502 4 129 3 843 40 488 510 594 4 129 Lepelle-Nkumpi SD Indicator 76.1 94.3 4.5 60.6 73.5 93.3 64.5 Numerator 4 444 239 2 624 3 859 56 723 3 387 Denominator 5 258 471 5 254 4 328 62 973 729 519 5 254 Molemole SD Indicator 137.8 104.3 6.3 63.9 69.7 97.4 86.1 Numerator 2 244 92 1 199 1 664 28 067 1 256 Denominator 1 451 234 1 458 1 877 28 630 345 939 1 458 Polokwane SD Indicator 464.1 98.3 5.3 59.1 33.3 82.9 59.0 Numerator 62 1 662 711 8 070 4 590 157 491 7 853 Denominator 13 359 1 691 13 320 13 665 165 477 2 280 501 13 320 Capricorn Indicator 266.8 98.3 5.3 60.6 52.9 91.2 66.5 Numerator 69 3 108 1 359 15 697 14 685 322 398 17 176 Denominator 25 863 3 161 25 838 25 892 332 824 4 241 940 25 838 Limpopo Indicator 130.2 95.2 6.3 65.7 55.7 85.5 70.9 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

AnnualLP, trends DC35, Capricorn District Municipality, SEQ 2 (deprived)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

50

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

580 SectionSection B: National B: Profile and Limpopo District Province Profiles

Child and School Health 47.7 47.9 51.6 51.9 55.4 54.6 42.6 58.0 10 171 13 455 18 546 24 200 45 686 45 311 010 112 058 401 454 401 562 668 562 2 816 3462 816 1 286 292 months Vitamin A dose 12-59 coverage (%) coverage 755 632 644 18.1 18.7 19.8 16.5 26.6 22.6 20.5 22.5 4 182 5 134 6 069 2 986 11 240 321 636 8 screening coverage (%) coverage School Grade 31.9 43.1 34.7 35.7 49.8 33.0 30.9 22.9 1 198 4 621 1 461 3 582 3 380 5 222 5 2 935 2 867 254 922 10 847 12 947 374 712 1 screening coverage (%) coverage School Grade Output 74.4 81.4 80.7 92.7 94.5 82.9 82.5 96.2 1 978 3 686 3 47 736 37 272 37 10 956 10 31 908 161 544 dose nd Measles Measles 2 coverage (%) coverage

rd 859 51.1 41.6 44.0 43.4 28.9 50.3 42.2 2 371 1 707 1 9 657 23 800 1 296 2 946 2 1 986 4 673 2 023 1 052 4 488 11 978 22 887 346 080 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 788 57.7 57.5 37.5 59.9 69.3 29.8 64.9 64.5 82.3 2 610 3 192 7 676 16 189 31 725 45 189 35 562 63 900 3 885 67 620 6 540 160 308 336 684 336 (%) coverage under 1 year Immunisation Immunisation 3 1 923 1 028 2 507 1 544 9 2 6 42 22 1.1 1.7 1.7 1.0 1.3 1.2 1.2 0.3 711 294 543 355 1 772 (%) Outcome around 10 Infant PCR weeks rate test positive positive test 17 15 49 84 8.9 520 355 11.7 11.9 20.1 12.4 16.0 12.2 26.6 (per1K) neonatal neonatal Inpatient Inpatient death rate 13 16 78 46 7.7 9.9 311 464 17.9 11.0 11.2 14.8 10.6 23.3 4 116 4 116 1 451 1 451 1 679 1 679 13 359 13 359 25 863 25 863 3 675 (per1K) Inpatient Inpatient death rate early neonatal neonatal early 24 80 22 7.6 4.4 4.8 5.9 6.9 8.8 3.3 6.9 319 728 789 555 905 2 253 5 258 5 258 11 482 Inpatient Inpatient year rate (%) death under 5 19 69 22 9.3 6.3 8.9 4.2 114 100 108 672 452 596 462 10.1 19.3 6 870 4 585 7 277 Impact Inpatient Inpatient year rate (%) death under 1 3 8 5 1 17 51 1 123 15 73 32 25 4.0 9.8 9.2 9.8 8.3 8.2 183 349 17.6 11.0 11.6 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 4 4 2 - - 51 61 20 64 3.1 3.1 1.3 9.3 5.8 2.9 127 547 301 1 059 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 6 9 1 3 20 46 46 2.1 3.1 5.6 2.0 2.0 8.0 2.4 0.9 2.2 2.2 107 822 329 294 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Numerator Denominator Indicator Numerator Indicator Indicator Denominator Numerator Indicator Denominator Numerator Denominator Indicator Denominator Indicator Numerator Numerator Indicator Denominator D

Blouberg SD Blouberg Aganang SD Aganang South Africa South Limpopo Lepelle-Nkumpi SD Polokwane SD Molemole SD Molemole Capricorn Source: HIS.

581 Section B: NationalProfile Limpopo and District Province Profiles

AnnualLP, trends DC35, Capricorn Child and District School Municipality, Health SEQ 2 (deprived)

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

0

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

50

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

3_Output 150

Measles 2nd dose coverage 100

50

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trends HIV LP, DC35, Capricorn District Municipality, SEQ 2 (deprived)

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

200

Male condom distribution 100 coverage 4_Process_input

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

582 SectionSection B: National B: Profile and Limpopo District Province Profiles

HIV 796 689 31.8 19.0 15.8 20.7 26.7 60.4 26.9 34.3 4 786 1 860 6 885 15 016 461 811 650 781 521 667 950 349 950 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 61.7 91.6 77.2 79.8 68.4 72.3 98.8 524 181 425 130 425 387 765 801 888 801 3 245 720 2 577 260 14 108 924 14 29 404 778 2016/17 distribution distribution Male condom condom Male coverage (No) 51.7 47.3 71.7 53.7 62.9 48.6 35.9 50.2 30 125 26 184 56 052 458 4 316 72 356 416 5 156 187 582 372 299372 699 879 699 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - - - - - 938 349 ------1 381 419 - 4 632 897 030 2 742 3 089 001 - 664 497 - - 4.7 4.5 8.2 18 104 398 886 041 8 317 4 880 994 5 673 609 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------59.8 55.0 68.6 64 432 107 728 2016/17 on ART rate (%) Clients remaining - 81 28 58 32 43 90 181 123 109 572 423 250 74.1 87.5 74.0 74.3 72.4 72.0 73.2 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------74.2 70.0 70.9 70.3 72.5 72.5 69.8 1 012 1 136 1 823 6 790 1 985 12 746 2015 months (%) on ART after 12 Adult percentageAdult - 15 15 31 81 53 39 36 63 22 181 126 300 41.7 61.9 56.0 64.3 60.3 58.5 68.2 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------564 668 87.9 84.7 82.0 80.3 82.8 82.5 78.2 7 225 3 862 1 088 1 043 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 76 27 53 63 22 36 36 84 171 126 394 300 76.1 81.5 69.7 73.7 75.0 69.8 100.0 (%) 2015 Child with viral load completion completion load rate at months 12 ------766 677 87.4 87.2 86.1 78.3 80.5 85.3 83.3 1 245 8 467 1 296 4 483 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Indicator Numerator Denominator Indicator Denominator Numerator Denominator Indicator Indicator Numerator Numerator Indicator Denominator Indicator Numerator Denominator Indicator Numerator Denominator

D

South Africa South Blouberg SD Blouberg Limpopo Aganang SD Aganang Lepelle-Nkumpi SD Capricorn Molemole SD Molemole Polokwane SD Source: HIS.

583 Section B: NationalProfile Limpopo and District Province Profiles

TB 67.7 51.6 56.1 63.1 65.4 73.2 66.3 85.2 244 173 528 742 327 172 819 007 178 663 262 138 333 871 333 223 425 223 2 781 0882 781 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------493 708 ------1 252 327 96.7 72.8 112.1 2 681 3 005 1 882 138 2016 Output rate (%) on treatment treatment on TB client initiated 219 475 135 139 224 256 258 480 97.1 97.8 91.2 99.0 90.6 88.3 85.6 99.2 1 247 2 558 2 332 1 457 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------161 101 60.4 62.7 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------5.3 6.0 6.2 161 2 681 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------65 106 61.3 58.4 50.5 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------21 106 17.9 17.8 19.8 2014 (EDRWeb) (%) to follow up rate TB DR client loss 711 518 275 429 326 255 542 322 76.1 81.0 61.5 85.4 70.3 78.2 76.2 82.8 2 051 2 763 3 928 1 262 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 2 17 41 21 4.1 6.1 6.4 0.6 8.4 6.4 5.8 5.2 711 518 172 253 326 322 2 051 3 928 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------15 106 16.4 14.2 23.0 2014 death rate TB DR client (EDRWeb) (%) Impact 39 56 44 6.6 113 711 518 316 326 568 322 11.9 13.7 12.0 15.4 14.5 10.8 15.9 2 051 3 928 2015 TB death rate (ETR.net) (%) Indicator Indicator Numerator Denominator Indicator Numerator Denominator Indicator Numerator Denominator Indicator Numerator Indicator Denominator Numerator Denominator Indicator Numerator Denominator Indicator D

Limpopo Aganang SD Aganang South Africa South Blouberg SD Blouberg Lepelle-Nkumpi SD Molemole SD Molemole Polokwane SD Capricorn Source: HIS.

584 SectionSection B: National B: Profile and Limpopo District Province Profiles

AnnualLP, trends DC35, Capricorn TB District Municipality, SEQ 2 (deprived)

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

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

0 15

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

0

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

40

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

0

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

0

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

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

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

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

585 Section B: NationalProfile Limpopo and District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Aganang SD Indicator 1.3 8.3 Numerator 175 288 Denominator 1 581 333 414 363 Blouberg SD Indicator 0.6 10.7 Numerator 97 388 Denominator 1 979 445 433 215 Lepelle-Nkumpi SD Indicator 0.9 11.5 Numerator 203 656 Denominator 2 816 043 686 682 Molemole SD Indicator 1.9 11.0 Numerator 213 287 Denominator 1 325 055 312 906 Polokwane SD Indicator 2.1 13.8 Numerator 1 408 2 035 Denominator 7 882 500 1 770 870 Capricorn Indicator 1.6 12.1 Numerator 2 096 3 654 Denominator 15 584 376 3 618 036 Limpopo Indicator 2.0 16.5 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual trends LP, DC35, Capricorn District Municipality, SEQ 2 (deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

0

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

586 SectionSection B: National B: Profile and Limpopo District Province Profiles

Waterberg District Municipality (DC36)

Waterberg District is located in the western part of Limpopo Province. The district shares five border-control points with Botswana and comprises six health sub-districts, namely Bela-Bela, , , Mogalakwena, and . It has a population of 747 926, with a population density of 16.7 persons per km2 and falls in socio- economic Quintile 3. Estimated medical scheme coverage is 8.7%.

Social determinants of healtha Population per selected category

Unemployment ratea 28.1% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 35.5% under 1 year 13 542 13 578 13 804 14 029 No schooling 7.1% under 5 years 72 844 72 374 72 024 71 764 Matric 27.6% 05-09 years 73 066 73 546 73 594 73 544 Higher education 9.0% 10-14 years 63 847 65 919 68 271 70 363 Households 211 471 15-19 years 61 733 60 845 60 298 60 486 Female-headed households 40.9% 20-24 years 67 057 66 374 65 211 63 689 Formal dwellings 85.0% 25-29 years 72 795 72 957 73 081 72 951 Flush toilet connected to sewerage 43.8% 30-34 years 64 581 67 722 71 029 74 464 Weekly refuse removal 44.4% 35-39 years 53 618 55 561 57 216 58 506 Piped water inside dwellings 24.4% 40-44 years 42 286 43 916 45 623 47 449 Electricity for lighting 86.1% 45-49 years 32 823 34 011 35 342 36 767 Blue Drop water score 55.7% 50-54 years 26 763 27 322 27 880 28 520 55-59 years 21 547 22 024 22 566 23 128 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 17 443 17 698 17 923 18 183 65-69 years 12 613 12 961 13 337 13 705 70-74 years 8 506 8 550 8 640 8 788 75-79 years 5 879 5 771 5 647 5 517 80 years and older 5 112 5 171 5 238 5 313 Total 702 516 712 724 722 916 733 144 Estimated pregnant women* 14 490 14 528 14 770 15 011 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

587 Section B: NationalProfile Limpopo and District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Bela-Bela SD 0 4 0 1 0 0 1 Lephalale SD 2 7 1 2 0 0 1 Modimolle SD 2 4 0 1 0 0 1 Mogalakwena SD 9 33 1 2 1 0 3 Mookgophong SD 0 3 1 0 0 0 1 Thabazimbi SD 1 10 0 1 0 0 4 Waterberg 14 61 3 7 1 0 11 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Waterberg 1 453 685 626 1 157 238 90 34 34 30 14 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bela-Bela SD Indicator 1.7 - - - - - Numerator 125 913 - - - - - Denominator 884 166 - - - - - Lephalale SD Indicator 1.7 - - - - - Numerator 214 803 - - - - - Denominator 1 518 516 - - - - - Modimolle SD Indicator 2.2 - - - - - Numerator 165 156 - - - - - Denominator 911 865 - - - - - Mogalakwena SD Indicator 2.3 - - - - - Numerator 799 960 - - - - - Denominator 4 107 411 - - - - - Mookgophong SD Indicator 2.3 - - - - - Numerator 91 948 - - - - - Denominator 470 916 - - - - - Thabazimbi SD Indicator 2.1 - - - - - Numerator 192 329 - - - - - Denominator 1 120 689 - - - - - Waterberg Indicator 2.1 7.9 50.0 2 546 837 360 Numerator 1 590 109 5 25 1 738 454 697 571 748 631 571 748 631 Denominator 9 013 563 63 50 682 725 682 725 1 590 109 Limpopo Indicator 2.7 10.6 56.9 2 082 866 301 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

588 SectionSection B: National B: Profile and Limpopo District Province Profiles ------12.0 20.3 (%) OPD new client not not client referred rate rate referred ------6.1 5.4 rate (%) Inpatient Inpatient crude death ------75.5 84.3 (%) utilisation rate - total Inpatient bed ------Tertiary/Central Hospital 4 611 4 227 day (Rand) equivalent equivalent per patient Expenditure ------7.3 6.9 (Days) Average length of of length stay - total ------81.1 81.1 37.2 60.4 27 710 34 178 27 710 34 178 (%) OPD new client not not client referred rate rate referred ------4.6 4.6 5.0 521 521 11 449 11 449 rate (%) Inpatient Inpatient crude death ------78.3 5.0 72.3 62.2 62.2 97 101 97 101 (%) Hospital utilisation rate - total Inpatient bed Regional Hospital Regional ------3 916 3 916 3 051 2 894 84 594 84 594 day (Rand) equivalent equivalent per patient Expenditure ------5.3 4.9 5.3 5.3 11 449 11 449 60 367 331 309 473 60 367 60 367 331 309 473 60 367 (Days) Average length of of length stay - total 87.1 61.1 91.0 98.1 75.3 59.3 90.5 96.5 9 224 59 117 11 956 11 13 207 15 097 61 239 21 808 25 029 29 469 29 30 039 131 574 144 611 (%) OPD new client not not client referred rate rate referred 5.1 5.1 4.4 4.6 5.3 5.0 5.6 181 725 303 439 404 6 861 7 164 2 052 14 119 41 129 rate (%) Inpatient Inpatient crude death 51.1 67.4 71.9 64.1 63.7 69.6 62.6 5.0 56.8 61 412 85 419 31 125 37 137 37 12 784 20 077 3 429 22 764 44 535 48 550 165 220 263 924 (%) utilisation rate - total Inpatient bed District Hospital District 4 747 3 187 5 057 3 465 3 629 2 993 2 868 2 2 568 40 512 87 679 22 722 22 46 996 46 266 990 day (Rand) 114 905 651 114 equivalent equivalent 198 114 098 114 198 per patient 129 120 968 223 904 071 303 825 637 969 038 259 Expenditure 4.0 3.7 4.4 4.3 4.3 4.3 3.3 3.9 6 861 7 164 3 429 9 556 69 080 65 342 9 556 14 119 61 412 41 129 31 125 37 137 37 12 784 22 764 165 220 (Days) Average length of of length stay - total Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Indicator Numerator Indicator Denominator Numerator Indicator D

Waterberg Waterberg Thabazimbi SD Thabazimbi Mogalakwena SD Modimolle SD Lephalale SD Lephalale South Africa South Limpopo Bela-Bela SD Source: HIS and BAS.

589 Section B: NationalProfile Limpopo and District Province Profiles

Annual trends Management and efficiency indicators for the service delivery platform, 2016/17 LP, DC36, Waterberg District Municipality, SEQ 3

8 Measure Names IndValue Inpatient crude 6 Prov_av death rate ZA_av

1_Impact 4

1_Management 2 8 6 Average length of stay (district 4 hospitals) 2

4K

2_Outcome Expenditure per patient day 3K equivalent (district 2K hospitals) 1K

Inpatient bed 100 utilisation rate (district hospitals) 50

100 3_Output OPD new client not referred rate 50 (district hospitals)

0 100

Percentage 50 Ideal clinics

0

Provincial and 3K LG District Health Services 2K expenditure per capita (uninsured) 1K

Provinc ial and 1500

4_Process_input LG PHC expenditure per 1000 capita (uninsured) 500

Provincial and 400 LG PHC expenditure per PHC headcount 200

2008 2010 2012 2014 2016 2018 Year

590 SectionSection B: National B: Profile and Limpopo District Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 41 14 13 16 24 37 22 138 256 14 292 351 584 Total District District - - 2 573 - - - - tertiary Central/ hospital -- 2 - 9 - 2 - 5 - 12 47 73 2016/17 521 2 423 2 Hospital Regional Regional 11 11 13 24 91 29 35 166 10 218 District District Hospital - - - 8 6 - - - - 266 990 84 594 - - - 17 1 651 / MOU PHC / CHC 74 12 15 21 27 39 33 195 267 14 393 Total 345 388 345 District District - - - -- 2 358 2 634 - - 2 052 ------tertiary Central/ Hospital 1 - 1 - 7 - 6 - 15 10 75 - 26 42 69 616 2 355 - 85 701 2015/16 Hospital Regional Regional 11 17 14 14 24 27 48 181 126 888 2 018 9 707 9 District District Hospital ------11 2 331 / MOU PHC / CHC 15 27 23 20 92 58 54 220 335 2 685 2 14 996 Total 358 900 - 259 687 District District ------2 346 1 428 - - tertiary Central/ Hospital 3 - 4 - 7 - 11 10 20 85 68 36 632 2 391 87 546 2014/15 Hospital Regional Regional 15 51 19 16 72 44 774 135 231 271 354 District District Hospital - -- 8 7 - - - - - 2 053 - - 2 36 2 726 9 879 1 536 / MOU* PHC / CHC

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

natal natal

Neo-

year) (under 1 1 (under

D Infant Infant

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

591 Section B: NationalProfile Limpopo and District Province Profiles

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

PercentageLP, Waterberg: of deaths DC36, by broad2010 cause- 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 73% 10% 9% 7% 78% 8% 7% 7% causes and 5-14 36% 24% 19% 20% 29% 24% 17% 30% single leading 15-24 27% 39% 17% 17% 17% 19% 14% 51% causes 25-64 20% 40% 33% 6% 17% 36% 30% 16% 65+ 15% 4% 79% 2% 15% 7% 76% 2% Broadcause 24% 24% 46% 6% 23% 25% 40% 13% Total Injury NCD Rank.. Female Male 1 Diarrhoeal diseases (22.2%) Diarrhoeal diseases (22.5%) HIV and TB 2 Lower respiratory infections (21.5%) Lower respiratory infections (20.2%) Comm_mat_peri_nut 3 Preterm birth complications (10.0%) Preterm birth complications (12.6%) 4 HIV/AIDS (7.3%) Birth asphyxia (8.0%) Prov, District 5 Protein-energy malnutrition (6.3%) Protein-energy malnutrition (6.5%) LP, Waterberg: DC36 6 Birth asphyxia (6.0%) HIV/AIDS (5.4%) Show history

<5 years <5 7 Meningitis/encephalitis (3.6%) Meningitis/encephalitis (3.6%) 8 Poisonings (including herbal) (3.2%) Poisonings (including herbal) (3.2%) Percentages are shown 9 Tuberculosis (3.2%) Other perinatal conditions (3.0%) according to all the deaths 10 Other perinatal conditions (2.2%) Tuberculosis (2.7%) within the age/gender 1 Lower respiratory infections (18.7%) Road injuries (17.6%) category of each box, 2 Tuberculosis (17.0%) Diarrhoeal diseases (17.0%) although only the leading 3 Diarrhoeal diseases (14.9%) HIV/AIDS (16.1%) 10 causes are displayed. 4 HIV/AIDS (14.3%) Tuberculosis (12.3%) 5 Road injuries (13.5%) Lower respiratory infections (8.9%)

5-14 6 Meningitis/encephalitis (4.9%) Drowning (8.5%) 7 Poisonings (including herbal) (4.7%) Epilepsy (3.9%) 8 Endocrine nutritional,blood, immune (3.5%) Meningitis/encephalitis (3.7%) 9 Accidental threats to breathing (3.4%) Fires, hot substances (3.5%) 10 Epilepsy (2.8%) Accidental threats to breathing (3.2%) 1 HIV/AIDS (23.2%) Road injuries (20.2%) 2 Tuberculosis (17.6%) Accidental threats to breathing (12.2%) 3 Road injuries (11.4%) HIV/AIDS (11.2%) 4 Lower respiratory infections (11.3%) Lower respiratory infections (9.3%) 5 Diarrhoeal diseases (9.0%) Tuberculosis (8.8%)

15-24 6 Cardiomyopathy (2.5%) Interpersonal violence (8.7%) 7 Meningitis/encephalitis (2.3%) Diarrhoeal diseases (4.4%) 8 Poisonings (including herbal) (2.0%) Drowning (3.9%) 9 Septicaemia (1.8%) Epilepsy (2.7%) 10 Accidental threats to breathing (1.7%) Mechanical forces (2.3%) 1 HIV/AIDS (24.1%) Tuberculosis (18.8%) 2 Tuberculosis (16.3%) HIV/AIDS (17.8%) 3 Lower respiratory infections (9.8%) Lower respiratory infections (9.7%) 4 Diarrhoeal dis eases (6.1%) Road injuries (9.3%) 5 Cerebrovascular disease (4.7%) Ischaemic heart disease (5.0%)

25-64 6 Road injuries (4.0%) Diarrhoeal diseases (4.3%) 7 Diabetes mellitus (3.8%) Cerebrovascular disease (3.3%) 8 Ischaemic heart disease (3.0%) Accidental threats to breathing (2.4%) 9 Hypertensive heart disease (2.6%) Diabetes mellitus (2.4%) 10 Cervix (2.5%) Nephr itis/nephrosis (2.2%) 1 Cerebrovascular disease (19.3%) Ischaemic heart disease (13.9%) 2 Hypertensive heart disease (11.5%) Cerebrovascular disease (11.2%) 3 Ischaemic heart disease (10.5%) Lower respiratory infections (9.6%) 4 Diabetes mellitus (9.3%) Diabetes mellitus (6.7%) 5 Lower respiratory infections (7.8%) Hypertensive heart disease (6.3%)

65+ 6 Diarrhoeal diseases (5.6%) Tuberculosis (5.2%) 7 Nephritis/nephrosis (4.2%) COPD (5.0%) 8 Tuberculosis (2.4%) Nephritis/nephrosis (4.9%) 9 Cervix (2.1%) Prostate (4.7%) 10 Endocrine nutritional,blood, immune (1.9%) Diarrhoeal diseases (3.7%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (36.2%) n=33 HIV/AIDS (29.4%) n=1 660 2 Other maternal (25.4%) n=23 Tuberculosis (19.7%) n=1 114 3 Hypertension in pregnancy (17.9%) n=16 Lower respiratory infections (11.1%) n=628 4 Abortion (14.1%) n=13 Diarrhoeal diseases (6.9%) n=390 5 Maternal haemorrhage (6.4%) n=6 Road injuries (5.4%) n=304

15-49 6 Meningitis/encephalitis (2.2%) n=127 Female 7 Cerebrovascular disease (2.1%) n=120 8 Ischaemic heart disease (1.8%) n=105 9 Cervix (1.7%) n=98 10 Diabetes mellitus (1.7%) n=93

592 SectionSection B: National B: Profile and Limpopo District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 Bela-Bela SD Indicator 127.4 101.0 7.7 65.4 46.4 89.2 49.0 Numerator 2 198 122 854 788 16 905 771 Denominator 1 570 196 1 575 1 305 20 388 227 403 1 575 Lephalale SD Indicator 76.3 91.2 5.0 57.5 46.9 117.4 72.2 Numerator 2 635 131 1 830 1 160 38 069 1 897 Denominator 2 621 696 2 629 3 181 29 691 389 244 2 629 Modimolle SD Indicator - 93.7 8.3 62.8 59.4 102.8 78.9 Numerator - 268 133 1 152 980 20 155 1 264 Denominator 1 592 286 1 602 1 834 19 803 235 248 1 602 Mogalakwena SD Indicator 115.0 91.4 6.1 65.9 45.0 86.2 71.0 Numerator 8 877 431 4 383 3 543 73 440 4 979 Denominator 6 955 959 7 011 6 654 94 397 1 022 466 7 011 Mookgophong SD Indicator - 95.3 3.3 69.0 60.0 154.8 140.2 Numerator - 102 9 572 560 16 146 387 Denominator 275 107 276 829 11 194 125 133 276 Thabazimbi SD Indicator 156.4 97.6 8.0 69.3 53.3 91.4 70.5 Numerator 2 372 102 1 281 988 22 055 902 Denominator 1 279 381 1 280 1 849 22 232 289 668 1 280 Waterberg Indicator 98.0 93.4 6.5 64.3 48.7 97.9 71.0 Numerator 14 2 452 928 10 072 8 019 186 769 10 200 Denominator 14 292 2 625 14 373 15 652 197 704 2 289 162 14 373 Limpopo Indicator 130.2 95.2 6.3 65.7 55.7 85.5 70.9 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trendsLP, DC36, Waterberg District Municipality, SEQ 3

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

50

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

593 Section B: NationalProfile Limpopo and District Province Profiles

Child and School Health 37.7 37.0 27.3 34.7 54.6 28.3 58.0 28.2 43.5 4 118 3 427 5 936 4 844 51 515 80 916 30 650 174 744 253 014 167 526 150 672 844 740 1 671 612 months Vitamin A dose 12-59 coverage (%) coverage 0 2 540 0.0 9.8 472 424 201 783 252 605 21.5 36.1 19.8 16.5 23.4 54.2 22.3 1 078 1 373 1 2 044 8 screening coverage (%) coverage School Grade 0 0.0 851 676 706 230 306 11.9 27.4 27.3 31.9 59.4 34.0 33.0 48.9 2 197 1 188 1 473 2 561 1 739 1 307 8 042 6 395 188 148 146 544 1 screening coverage (%) coverage School Grade Output 850 666 79.1 71.8 71.8 69.4 94.5 55.8 78.2 96.2 6 211 1 324 1 427 2 097 11 349 12 57512 4 290 2 722 18 288 21 657 210 096 103 734 dose nd Measles Measles 2 coverage (%) coverage

rd 215 187 397 359 546 590 965 41.6 27.2 19.4 31.5 36.1 24.9 39.4 70.4 29.5 28.9 6 411 2 313 2 169 32 166 4 061 1 442 22 902 1 348 12 881 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 678 394 830 57.4 37.8 46.1 52.7 49.6 64.5 82.3 46.8 53.8 9 208 4 846 17 631 12 495 21 267 24 405 32 409 101 298 209 505 209 (%) coverage under 1 year Immunisation Immunisation 3 1 008 1 5 1 452 3 12 78 22 46 1.1 1.3 1.3 1.3 0.7 1.2 2.0 2.3 6.2 195 401 234 456 2 339 (%) Outcome around 10 Infant PCR weeks rate test positive positive test - - 11 19 16 16 98 6.1 8.6 160 11.9 11.2 12.4 10.2 12.2 (per1K) neonatal neonatal Inpatient Inpatient death rate 8 - - 14 14 18 84 9.7 9.9 6.3 5.3 8.9 138 11.3 12.1 14.1 10.6 2 621 2 621 1 570 1 570 1 279 1 279 1 592 1 592 14 292 14 292 (per1K) Inpatient Inpatient death rate early neonatal neonatal early - 275 275 - - 16 29 30 34 5.1 4.7 4.4 5.0 4.6 6.0 5.9 6.5 611 129 246 238 566 583 2 802 6 955 6 955 975 Inpatient Inpatient year rate (%) death under 5 - - - 13 24 24 24 7.9 7.6 7.2 9.3 6.9 6.3 112 112 314 197 182 346 11.6 13.2 1 551 2 505 4 808 Impact Inpatient Inpatient year rate (%) death under 1 3 7 6 1 7 - - - 24 67 50 4.1 6.0 0.9 8.0 5.5 2.8 8.3 109 106 250 582 10.4 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 3 2 3 8 - - - - - 16 72 1.9 1.8 1.5 1.5 2.0 3.0 2.9 110 195 198 270 845 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 1 6 3 3 - - - - - 13 34 77 2.1 2.1 1.2 4.5 2.0 2.9 2.3 619 132 133 243 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Denominator Denominator Indicator Numerator Numerator Indicator Indicator Denominator Indicator Denominator Indicator Numerator Numerator Denominator Denominator Denominator Numerator Numerator Numerator Indicator Indicator Indicator D

Waterberg Waterberg Thabazimbi SD Thabazimbi Mookgophong SD Mookgophong Modimolle SD Lephalale SD Lephalale Bela-Bela SD Mogalakwena SD South Africa South Limpopo Source: HIS.

594 SectionSection B: National B: Profile and Limpopo District Province Profiles

Annual trendsLP, DC36, Child Waterberg and SchoolDistrict Municipality, Health SEQ 3

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

0

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

50

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

3_Output 150

Measles 2nd dose coverage 100

50

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

Annual trendsLP, DC36, HIV Waterberg District Municipality, SEQ 3

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

200

Male condom distribution 100 coverage 4_Process_input

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

595 Section B: NationalProfile Limpopo and District Province Profiles

HIV 651 875 991 775 625 17.9 27.0 13.7 19.0 12.0 10.5 34.7 55.4 26.9 1 181 5 098 189 588 546 861 344 772 344 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 74.1 47.6 47.5 69.1 60.7 68.4 72.5 68.6 117.2 171 150 513 501 583 407 648 933 297 540 342 849 304 062 304 1 671 474 2 036 141 1 797 600 3 602 498 17 026 06217 2016/17 distribution distribution Male condom condom Male coverage (No) 25.3 54.5 38.9 35.9 45.3 44.8 44.8 50.2 54.2 9 785 1 538 933 11 650 15 367 26 724 39 876 70 899 6 379 416 174 301 715 608 258 120 464 145 473 880 877 488 877 4 667 808 2 976 984 3 420 426 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) ------1 878 567 324 1 107 1 347 423 ------4.7 8.4 8.2 15 758 15 188 381 188 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------55.0 68.6 68.2 66 508 45 346 2016/17 on ART rate (%) Clients remaining - 14 10 16 91 52 29 49 29 22 33 126 177 253 395 57.1 64.1 71.2 66.7 72.0 59.2 62.5 48.3 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------546 67.2 70.0 66.4 60.0 66.9 66.0 65.0 63.2 1 149 2 520 3 807 1 320 1 643 10 985 2015 months (%) on ART after 12 Adult percentageAdult - 6 2 8 3 9 5 4 11 15 24 39 65 69 130 25.0 40.0 56.0 50.0 80.0 56.5 45.8 33.3 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------510 374 223 662 79.7 80.6 85.6 84.8 75.2 82.8 78.2 80.2 1 121 1 594 4 484 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 8 9 8 5 15 19 12 24 28 69 48 122 130 237 41.7 42.1 50.0 56.6 69.8 53.6 54.9 112.5 (%) 2015 Child with viral load completion completion load rate at months 12 ------735 840 330 67.6 81.2 60.7 66.7 78.3 50.9 65.9 65.2 2 418 1 016 1 381 6 720 (%) 2015 Adult with viral load completion completion load rate at months 12 Numerator Indicator Indicator Numerator Numerator Denominator Indicator Denominator Indicator Indicator Numerator Denominator Numerator Indicator Denominator Denominator Numerator Indicator Denominator Indicator Numerator Denominator Indicator

D

Modimolle SD Bela-Bela SD Mogalakwena SD Limpopo Africa South Lephalale SD Lephalale Mookgophong SD Mookgophong Thabazimbi SD Thabazimbi Waterberg Waterberg Source: HIS.

596 SectionSection B: National B: Profile and Limpopo District Province Profiles

TB - - 51.6 37.8 56.1 39.1 35.4 25.6 72.3 34.8 19 324 62 631 36 725 75 343 90 954 125 841 160 291 167 263 105 587 447 592 237 958 237 1 263 203 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------628 878 ------96.7 72.8 107.4 2 191 2 354 2016 Output rate (%) on treatment treatment on TB client initiated 30 34 191 184 243 773 230 508 377 568 355 843 91.7 94.7 89.4 90.6 96.3 88.3 92.2 94.2 88.2 2 256 2 080 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------93 69 74.2 60.4 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------93 5.3 4.2 6.2 2 191 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------95 45 47.4 58.4 50.5 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------95 22 17.9 17.8 23.2 2014 (EDRWeb) (%) to follow up rate TB DR client loss 88 122 570 631 769 525 225 295 285 404 908 74.1 76.1 81.0 74.4 72.1 71.3 76.3 70.5 83.2 1 274 2 601 3 495 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 8 6 41 27 50 94 7.4 6.1 2.7 6.4 4.9 4.3 6.5 6.5 122 631 769 226 295 404 10.1 1 274 3 495 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------12 95 16.4 12.6 23.0 2014 death rate TB DR client (EDRWeb) (%) 8 Impact 37 43 34 6.6 5.4 6.6 178 120 122 769 631 420 295 404 11.9 14.0 15.6 10.6 12.5 12.0 1 274 3 495 2015 TB death rate (ETR.net) (%) Denominator Numerator Indicator Indicator Numerator Indicator Denominator Indicator Numerator Denominator Indicator Denominator Numerator Indicator Numerator Denominator Indicator Numerator Indicator Denominator Numerator Denominator Indicator D

Limpopo Bela-Bela SD South Africa South Lephalale SD Lephalale Modimolle SD Mogalakwena SD Mookgophong SD Mookgophong Thabazimbi SD Thabazimbi Waterberg Waterberg Source: HIS.

597 Section B: NationalProfile Limpopo and District Province Profiles

Annual trends LP, DC36, Waterberg District Municipality, SEQ 3

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

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

0 15

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

0

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

40

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

0

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

0

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

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

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

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

598 SectionSection B: National B: Profile and Limpopo District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 Bela-Bela SD Indicator 1.2 5.1 Numerator 92 109 Denominator 884 166 254 517 Lephalale SD Indicator 1.1 14.6 Numerator 144 448 Denominator 1 518 516 368 172 Modimolle SD Indicator 1.5 25.2 Numerator 115 490 Denominator 911 865 233 073 Mogalakwena SD Indicator 4.1 10.8 Numerator 14 07 966 Denominator 4 107 411 1 077 222 Mookgophong SD Indicator 0.1 2.3 Numerator 3 27 Denominator 470 916 138 339 Thabazimbi SD Indicator 0.6 13.5 Numerator 55 354 Denominator 1 120 689 314 598 Waterberg Indicator 2.4 12.0 Numerator 1 816 2 394 Denominator 9 013 563 2 385 921 Limpopo Indicator 2.0 16.5 South Africa Indicator 2.5 18.9 Source: DHIS.

Annual trends LP, DC36, Waterberg District Municipality, SEQ 3

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

0

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

599 Section B: NationalProfile Limpopo and District Province Profiles

Sekhukhune District Municipality (DC47)

Sekhukhune District is located in Limpopo Province, in northern South Africa. The district lies in the south-eastern part of the province and comprises five health sub-districts: Elias Motsoaledi, Ephraim Mogale, Fetakgomo, Makhuduthamaga and Greater Tubatse. It has a population of 1 154 587, with a population density of 85.3 persons per km2 and falls in socio- economic Quintile 1, among the poorest districts. Estimated medical scheme coverage is 5.9%.

Social determinants of healtha Population per selected category

Unemployment ratea 50.9% Population category 2017 2018 2019 2020 Youth unemployment rate (15-34 years)a 60.6% under 1 year 27 182 27 232 27 747 28 291 No schooling 16.0% under 5 years 146 964 146 290 145 856 145 635 Matric 24.3% 05-09 years 144 405 146 438 147 428 148 073 Higher education 6.4% 10-14 years 121 591 126 549 132 407 137 784 Households 290 527 15-19 years 121 421 117 948 115 679 115 601 Female-headed households 51.2% 20-24 years 132 823 129 667 125 846 121 745 Formal dwellings 87.6% 25-29 years 134 702 135 252 135 065 133 752 Flush toilet connected to sewerage 5.9% 30-34 years 110 043 116 835 123 386 129 717 Weekly refuse removal 9.0% 35-39 years 77 711 83 697 89 280 94 006 Piped water inside dwellings 4.6% 40-44 years 49 585 53 455 57 853 62 722 Electricity for lighting 89.6% 45-49 years 36 124 37 218 38 655 40 611 Blue Drop water score 47.7% 50-54 years 30 708 31 051 31 361 31 747 55-59 years 25 804 26 126 26 610 27 099 Source: StatsSA. 2014 Blue Drop Report. 60-64 years 23 425 23 109 22 775 22 547 65-69 years 19 617 19 679 19 696 19 654 70-74 years 14 306 14 547 14 748 14 886 75-79 years 9 885 9 806 9 777 9 810 80 years and older 11 696 11 621 11 569 11 539 Total 1 210 811 1 229 286 1 247 984 1 266 928 Estimated pregnant women* 29 085 29 138 29 689 30 271 Source: Mid-Year Population Estimates 2016 StatsSA. * Under 1 year population X 1.07.

Population distribution sub-district boundaries and health facility locations

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

600 SectionSection B: National B: Profile and Limpopo District Province Profiles

Number of facilities by level, 2016/17

Ward based Central/ outreach District Regional Tertiary Other teams Clinic CHC Hospital Hospital Hospitals Hospitals Elias Motsoaledi SD 1 15 0 1 1 0 0 Ephraim Mogale SD 1 15 0 1 0 0 0 Fetakgomo SD 1 13 1 0 0 0 0 Greater Tubatse SD 1 21 2 2 0 0 0 Makhuduthamaga SD 1 21 0 1 1 0 2 Sekhukhune 5 85 3 5 2 0 2 Source: DHIS.

Human resources – filled posts, 2016

Community Speech Health Nursing Enrolled Professional Medical Dental Occupational Therapy and Workers assistants nurse nurse practitioners Pharmacists practitioners therapy Physiotherapy Audiology Sekhukhune 2 912 900 779 1 474 188 131 37 37 30 14 Source: Persal, DHIS.

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

PHC Management Output Process & input Provincial and LG Percentage of District Health Provincial Provincial assessed PHC Services and LG PHC and LG PHC facilities with expenditure expenditure expenditure Percentage 90% of tracer per capita per capita per PHC PHC utilisation Ideal clinics medicines (uninsured) (uninsured) headcount rate (No) (%) available (%) (Rand) (Rand) (Rand) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 E Motsoaledi SD Indicator 2.0 - - - - - Numerator 542 407 - - - - - Denominator 3 197 397 - - - - - Ephraim Mogale SD Indicator 3.0 - - - - - Numerator 393 960 - - - - - Denominator 1 593 612 - - - - - Fetakgomo SD Indicator 3.0 - - - - - Numerator 299 359 - - - - - Denominator 1 200 987 - - - - - Greater Tubatse SD Indicator 2.3 - - - - - Numerator 870 421 - - - - - Denominator 4 452 402 - - - - - Makhuduthamaga SD Indicator 2.0 - - - - - Numerator 576 810 - - - - - Denominator 3 461 568 - - - - - Sekhukhune Indicator 2.3 9.2 65.9 1 730 774 313 Numerator 2 682 957 8 54 1 879 231 703 841 046 934 841 046 934 Denominator 13 905 966 87 82 1 086 480 1 086 480 2 682 957 Limpopo Indicator 2.7 10.6 56.9 2 082 866 301 South Africa Indicator 2.3 29.8 78.4 1 726 1 054 389 Source: DHIS.

601 Section B: NationalProfile Limpopo and District Province Profiles ------Annual trends 12.0 20.3 LP, DC47, Sekhukhune District Municipality, SEQ 1 (most deprived)

(%) 8 Measure Names

OPD new IndValue client not not client referred rate rate referred Inpatient crude 6 Prov_av death rate ------ZA_av 1_Impact 6.1 5.4 4

1_Management 2 8 rate (%) Inpatient Inpatient

crude death 6 Average length of stay (district ------4 hospitals) 75.5 84.3 2 (%) 4K utilisation rate - total 2_Outcome

Inpatient bed Expenditure per patient day 3K ------equivalent 2K Tertiary/Central Hospital (district hospitals) 1K day (Rand) 46 111 247 42 268 693 equivalent equivalent per patient Expenditure Inpatient bed 100 ------utilisation rate 7.3 6.9 (district hospitals) 50 (Days) Average length of of length

stay - total 100 3_Output OPD new client ------not referred rate 50 57.3 37.2 46.1 75.0 60.4 (district 21 117 21 749 74 836 28 987 42 866 42 45 849 45 hospitals) (%)

OPD new 0 client not not client

referred rate rate referred 100 ------4.7 4.4 5.0 4.2 769 768 Percentage 50 1 537 Ideal clinics 18 406 16 263 34 669 rate (%) Inpatient Inpatient 0 crude death

Provincial and 3K ------LG District 56.1 77.5 78.3 5.0 72.3 Health Services 102.2 2K expenditure per 174 330 120 463 120 104 401 106 726 224 865 224 (%) capita

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

4_Process_input LG PHC 3 051 2 401 2 023 2 894 3 009

96 024 expenditure per 154 124 250 149 1000 day capita (Rand) (uninsured) equivalent equivalent 311 773 236 311 per patient 600 900 713 Expenditure 500 ------3.7 4.9 5.0 6.6 5.3 Provincial and 400 18 406 16 263 67 605 288 940 664 67 605 34 669 LG PHC 174 330 106 726 expenditure per (Days) Average

length of of length PHC headcount stay - total 200

2008 2010 2012 2014 2016 2018 75.3 59.3 78.5 85.0 93.2 80.5 53.3

8 721 Year 42 281 36 140 15 284 33 192 12 985 16 362 88 591 33 693

(%) Measure Names

OPD new IndValue client not not client

referred rate rate referred P rov_av ZA_av 5.1 4.7 4.3 5.0 4.3 4.2 4.2 713 207 586 253 1 759 4 361 6 068 41 112 110 067 17 017 13 666 13 rate (%) Inpatient Inpatient crude death 57.7 67.4 67.6 68.1 76.0 69.6 100.7 19 117 55 472 18 982 43 805 43 112 067 247 862 168 884 168 (%) utilisation rate - total Inpatient bed District Hospital District 3 619 2 623 2 859 2 993 2 568 2 634 3 050 36 978 82 560 73 008 46 989 46 103 776 270 302 day (Rand) 216 571 016 112 774 893 774 112 equivalent equivalent per patient 772 706 499 Expenditure 4.1 4.1 4.4 4.4 4.3 4.9 3.8 4 361 6 068 41 112 19 117 17 017 55 472 13 666 13 29 633 044 170 104 29 633 64 663 485 273 316 64 663 168 884 168 (Days) Average length of of length stay - total Indicator Denominator Indicator Numerator Denominator Numerator Indicator Denominator Indicator Indicator Numerator Denominator Indicator Denominator Numerator Numerator Indicator D

Sekhukhune Sekhukhune Makhuduthamaga SD Greater Tubatse SD South Africa South Limpopo Ephraim Mogale SD Mogale Ephraim E Motsoaledi SD Source: HIS and BAS.

602 SectionSection B: National B: Profile and Limpopo District Province Profiles

Deaths and Patient day equivalent 2014/15 – 2016/17 21 61 72 37 25 20 29 198 481 24 558 520 451 Total District District ------tertiary Central/ hospital 7 - 3 - 4 - 11 13 18 23 80 2016/17 184 8 080 - 250 149 Hospital Regional Regional 17 13 18 24 21 54 38 118 283 14 993 District District Hospital ------1 759 1 537 - 3 296 - 270 302 1 14 1 485 1 / MOU PHC / CHC 74 24 31 40 33 60 34 213 540 3 211 1 960 1 24 927 Total 505 587 505 District District ------tertiary Central/ Hospital 7 - 5 - 15 19 10 24 82 22 161 305 8 135 252 276 2015/16 Hospital Regional Regional 17 41 19 16 52 23 26 131 550 353 14 928 253 311 District District Hospital ------26 1 105 1 864 / MOU PHC / CHC 91 91 39 39 40 40 36 280 595 26 131 Total 489 082 - District District ------1 835 - - tertiary Central/ Hospital 7 - 14 12 13 18 31 27 103 188 240 8 502 8 236 897 2014/15 Hospital Regional Regional 19 21 23 26 33 60 64 177 420 385 15 507 252 185 District District Hospital ------1 867 1 595 - 3 462 - 1 626 1 585 - 8 22 1 175 2 122 / MOU* PHC / CHC

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

natal natal

Neo-

year)

(under 1 1 (under Infant Infant D

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

603 Section B: NationalProfile Limpopo and District Province Profiles

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

PercentageLP, Sekhukhune: of deaths DC47, by broad 2010 cause - 2015 and leading causes 2010–2015 Percentage of AgeGroup.. Female Male deaths by broad <5 years 79% 7% 8% 6% 79% 7%7% 7% causes and 5-14 49% 14% 19% 18% 43% 14% 14% 29% single leading 15-24 39% 30% 17% 15% 24% 10% 17% 49% causes 25-64 34% 34% 29% 4% 29% 29% 27% 14% 65+ 30% 3% 65% 2% 29% 6% 62% 3% Broadcause 36% 19% 41% 4% 33% 19% 35% 12% Total Injury NCD Rank.. Female Male 1 Diarrhoeal diseases (30.2%) Diarrhoeal diseases (31.0%) HIV and TB 2 Lower respiratory infections (26.6%) Lower respiratory infections (26.4%) Comm_mat_peri_nut 3 Preterm birth complications (6.8%) Preterm birth complications (6.4%) 4 Protein-energy malnutrition (6.1%) Protein-energy malnutrition (5.7%) Prov, District 5 HIV/AIDS (5.8%) HIV/AIDS (5.3%) LP, Sekhukhune: DC47 6 Birth asphyxia (4.0%) Birth asphyxia (4.8%) Show history

<5 years <5 7 Septicaemia (2.1%) Poisonings (including herbal) (2.7%) 8 Poisonings (including herbal) (2.0%) Tuberculosis (1.9%) Percentages are shown 9 Meningitis/encephalitis (1.9%) Meningitis/encephalitis (1.8%) according to all the deaths 10 Tuberculosis (1.7%) Septicaemia (1.7%) within the age/gender 1 Diarrhoeal diseases (22.1%) Lower respiratory infections (21.6%) category of each box, 2 Lower respiratory infections (20.9%) Diarrhoeal diseases (18.3%) although only the leading 3 Road injuries (12.2%) Road injuries (15.4%) 10 causes are displayed. 4 HIV/AIDS (8.5%) Drowning (8.5%) 5 Tuberculosis (6.5%) HIV/AIDS (7.9%)

5-14 6 Septicaemia (4.0%) Tuberculosis (6.9%) 7 Epilepsy (3.9%) Epilepsy (4.2%) 8 Meningitis/encephalitis (3.5%) Accidental threats to breathing (3.4%) 9 Accidental threats to breathing (2.5%) Meningitis/encephalitis (2.1%) 10 Cerebrovascular disease (2.1%) Septicaemia (1.7%) 1 HIV/AIDS (20.9%) Road injuries (24.9%) 2 Lower respiratory infections (20.9%) Lower respiratory infections (12.2%) 3 Diarrhoeal diseases (10.7%) Accidental threats to breathing (11.4%) 4 Tuberculosis (10.3%) Diarrhoeal diseases (6.6%) 5 Road injuries (8.3%) Tuberculosis (6.4%)

15-24 6 Accidental threats to breathing (3.3%) HIV/AIDS (4.6%) 7 Septicaemia (2.4%) Epilepsy (4.3%) 8 Me ningitis/encephalitis (2.2%) Mechanical forces (4.1%) 9 Cardiomyopathy (1.9%) Interp ersonal violence (3.8%) 10 Endocrine nutritional,blood, immune (1.8%) Drowning (3.0%) 1 HIV/AIDS (21.8%) Lower respiratory infections (17.7%) 2 Lower respiratory infections (19.2%) HIV/AIDS (16.0%) 3 Tuberculosis (11.8%) Tuberculosis (13.4%) 4 Diarrhoeal diseases (9.5%) Road injuries (8.0%) 5 Cerebrovascular disease (5.0%) Diarrhoeal diseases (7.3%)

25-64 6 Diabetes mellitus (4.1%) Cerebrovascular disease (4.9%) 7 Hypertensive heart disease (2.5%) Diabetes mellitus (3.3%) 8 Septicaemia (2.1%) Hypertensive heart disease (2.4%) 9 Road injuries (2.0%) Accidental threats to breathing (2.3%) 10 Cervix (2.0%) Ischaemic heart disease (2.0%) 1 Cerebrovascular disease (26.0%) Lower respiratory infections (18.6%) 2 Lower respiratory infections (18.0%) Cerebrovascular disease (17.4%) 3 Hypertensive heart disease (10.4%) Hypertensive heart disease (9.6%) 4 Diarrhoeal diseases (7.7%) Diarrhoeal diseases (6.4%) 5 Diabetes mellitus (7.6%) Diabetes mellitus (6.2%)

65+ 6 Ischaemic heart disease (3.1%) Tuberculosis (4.7%) 7 Septicaemia (3.0%) Ischaemic heart disease (3.9%) 8 Cardiomyopathy (2.6%) Nephritis/nephrosis (3.3%) 9 Nephritis/nephrosis (2.3%) Cardiomyopathy (3.1%) 10 Tuberculosis (1.5%) COPD (2.9%)

Rank.. Maternal conditions All other causes 1 Indirect maternal (33.5%) n=48 HIV/AIDS (26.1%) n=2 846 2 Other maternal (20.1%) n=29 Lower respiratory infections (21.1%) n=2 296 3 Hypertension in pregnancy (17.9%) n=26 Tuberculosis (13.6%) n=1 484 4 Maternal haemorrhage (15.7%) n=23 Diarrhoeal diseases (10.4%) n=1 135 5 Abortion (7.5%) n=11 Road injuries (2.9%) n=315

15-49 6 Maternal sepsis (5.2%) n=7 Cerebrovascular disease (2.4%) n=263 Female 7 Meningitis/encephalitis (2.1%) n=232 8 Septicaemia (2.0%) n=216 9 Diabetes mellitus (1.8%) n=193 10 Endocrine nutritional,blood, immune (1.3%) n=145

604 SectionSection B: National B: Profile and Limpopo District Province Profiles

Maternal and Women’s Health

Impact Outcome Output Maternal Antenatal Delivery in Cervical Mother mortality in client initiated facility under Antenatal 1st cancer Couple year postnatal visit facility ratio on ART rate 18 years rate visit before 20 screening protection rate within 6 days (per100K) (%) (%) weeks rate (%) coverage (%) (WHO) (%) rate (%) 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 E Motsoaledi SD Indicator 136.6 89.6 6.1 63.3 84.2 85.2 58.8 Numerator 8 580 362 3 184 4 869 65 636 3 471 Denominator 5 856 647 5 904 5 031 69 422 924 864 5 904 Ephraim Mogale SD Indicator 58.1 95.5 5.9 54.2 62.4 47.3 131.6 Numerator 1 319 101 1 797 1 814 18 243 2 268 Denominator 1 720 334 1 724 3 313 34 874 462 363 1 724 Fetakgomo SD Indicator - 93.8 1.6 70.7 63.6 128.0 443.7 Numerator - 197 5 1 516 1 496 37 792 1 371 Denominator 312 210 309 2 144 28 241 354 348 309 Greater Tubatse SD Indicator 81.6 92.9 5.0 69.2 45.2 60.6 68.8 Numerator 6 1 052 369 6 108 3 369 68 532 5 104 Denominator 7 349 1 132 7 414 8 831 89 471 1 357 806 7 414 Makhuduthamaga SD Indicator 64.4 88.8 6.4 65.2 54.0 71.8 41.8 Numerator 6 557 597 4 105 3 701 60 908 3 906 Denominator 9 321 627 9 340 6 295 82 288 1 017 831 9 340 Sekhukhune Indicator 85.5 91.7 5.8 65.2 60.1 73.2 65.3 Numerator 21 2 705 1 434 16 710 15 249 251 111 16 120 Denominator 24 558 2 950 24 691 25 614 304 297 4 117 212 24 691 Limpopo Indicator 130.2 95.2 6.3 65.7 55.7 85.5 70.9 South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3 Source: DHIS.

Annual trends LP, DC47, Sekhukhune District Municipality, SEQ 1 (most deprived)

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

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

200 Couple year protection rate (WHO) 100

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

200 Mother postnatal visit within 6 days 100 rate

0 200

Antenatal client 150 initiated on ART rate 100

50

3_Output 150 Cervical cancer screening 100 coverage 50

2009 2010 2011 2012 2013 2014 2015 2016 Year

605 Section B: NationalProfile Limpopo and District Province Profiles

Child and School Health 55.1 54.6 58.0 54.5 58.8 55.5 84.2 45.2 28 413 13 102 13 930 20 163 32 108 618 714 107 716 535 410 198 498 198 707 592707 267 486 267 months Vitamin A dose 12-59 coverage (%) coverage 0 0 0 4.7 5.7 0.0 0.0 0.0 736 19.8 12.8 16.5 5 731 6 576 1 108 2 821 8 screening coverage (%) coverage School Grade 7.3 3.3 519 291 726 372 41.9 14.4 31.9 18.3 33.0 22.2 3 591 4 739 1 503 1 9 946 9 8 855 6 572 2 830 2 005 7 660 394 584 284 460 2 327 700 1 screening coverage (%) coverage School Grade Output 97.3 91.6 94.5 96.8 88.9 96.2 6 518 125.4 102.5 2 682 2 538 6 836 23 511 66 612 24 291 76 320 89 553 89 290 031 dose nd Measles Measles 2 coverage (%) coverage

rd 788 942 555 41.6 12.7 24.6 25.9 28.9 26.8 22.5 5 124 6 210 1 610 6 224 2 252 3 537 33 255 4 583 Infant Infant DTaP-IPV- exclusively exclusively Hib-HBV 3 breastfed at dose rate (%) 61.8 40.6 82.6 82.6 26.6 64.5 82.3 46.2 55.2 1 614 3 031 2 240 13 133 74 499 23 44223 32 532 32 89 490 65 586 65 285 549 22 806 (%) coverage under 1 year Immunisation Immunisation 6 1 8 2 869 6 4 3 379 1 229 4 937 1 700 25 1.9 1.3 1.2 0.7 1.2 2.4 0.8 0.5 197 547 706 254 432 2 136 (%) Outcome around 10 Infant PCR weeks rate test positive positive test - - 51 13 88 66 7.6 9.4 6.9 8.9 11.3 12.4 12.2 (per1K) neonatal neonatal Inpatient Inpatient death rate - - 12 48 58 80 7.0 8.1 9.9 9.9 8.6 6.5 312 312 198 218 10.6 9 321 9 321 1 720 1 720 7 349 7 349 24 558 24 558 (per1K) Inpatient Inpatient death rate early neonatal neonatal early - - - 27 89 4.1 7.2 4.4 3.7 5.6 5.9 101 134 351 722 988 10.2 6 241 1 234 5 856 5 856 Inpatient Inpatient year rate (%) death under 5 - - - 75 23 85 9.1 9.3 6.3 5.5 218 107 290 386 10.6 12.3 22.0 3 176 1 962 3 297 Impact Inpatient Inpatient year rate (%) death under 1 9 5 8 - - - 15 75 37 93 54 7.6 9.3 8.0 8.3 327 11.3 16.1 12.0 5 years rate (%) Child under case fatality fatality case malnutrition malnutrition severe acute 6 4 8 - - - 11 29 98 4.1 4.9 2.0 2.6 2.9 2.2 3.2 310 105 610 275 223 906 5 years rate (%) pneumonia pneumonia Child under case fatality fatality case 6 1 5 - - - 13 25 2.1 1.8 5.7 2.7 2.0 0.8 2.2 915 120 228 337 230 5 years 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 rate (%) diarrhoea diarrhoea Child under case fatality fatality case Indicator Indicator Indicator Denominator Denominator Numerator Numerator Indicator Indicator Denominator Numerator Indicator Indicator Denominator Denominator Numerator Denominator Numerator Numerator Indicator D

Greater Tubatse SD South Africa South Makhuduthamaga SD Limpopo Sekhukhune Sekhukhune Ephraim Mogale Mogale Ephraim SD Fetakgomo SD E Motsoaledi SD Source: HIS.

606 SectionSection B: National B: Profile and Limpopo District Province Profiles

AnnualLP, DC47, trends Sekhukhune Child District and School Municipality, Health SEQ 1 (most deprived)

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

0

30 Child under 5

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

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

Inpatient early 20 neonatal death rate 10

0 150

Immunisation coverage under 100 1 year

50

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

3_Output 150

Measles 2nd dose coverage 100

50

100 School Grade 1 screening 50 cover age

0 2009 2010 2011 2012 2013 2014 2015 2016 Year

AnnualLP, DC47, trends Sekhukhune HIV District Municipality, SEQ 1 (most deprived)

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

200

Male condom distribution 100 coverage 4_Process_input

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

607 Section B: NationalProfile Limpopo and District Province Profiles

HIV 36.1 19.0 15.8 32.7 26.0 26.9 26.8 32.8 1 615 3 106 1 275 3 782 1 530 11 308 591 411 423 744 423 (per1K) 2016/17 Medical male male Medical circumcision rate rate circumcision 47.5 59.4 75.5 26.6 68.4 42.3 63.2 123.0 516 678 955 935 191 1 138 366 804 366 6 351 6626 351 1 146 3801 146 5 469 581 3 759 392 21 757 80221 2016/17 distribution distribution Male condom condom Male coverage (No) 51.1 41.4 44.6 60.8 35.3 35.9 43.8 50.2 33 916 81 057 31 437 76 636 68 083 5 030 787 911 412 291 129 291 1 831 431 7 969 566 4 399 194 5 063 493 (%) 90-90-90 2016/17 coverage st HIV testing 1 Process & input (including ANC) - - - - 1 798 221 1 008 912 1 165 071 - - - - - 2 759 007 1 550 865 076 1 745 - - - 669 495 - - - 4.7 4.8 8.2 14 930 312 891 (%) 2016/17 and older rate client years 15 (including ANC) HIV test positive ------67.3 55.0 68.6 55 014 81 708 2016/17 on ART rate (%) Clients remaining - 67 26 62 44 34 110 152 125 109 108 483 354 71.7 71.0 76.5 72.0 86.4 73.3 60.9 2015 90-90-90 Output nd months (%) 2 on ART after 12 Child percentage ------867 67.0 71.5 70.0 68.7 68.7 69.8 66.5 2 315 2 616 3 982 1 343 11 123 2015 months (%) on ART after 12 Adult percentageAdult - 13 16 10 21 28 67 67 40 44 35 119 222 47.7 59.7 46.4 56.0 53.6 62.5 52.2 (%) 2015 rate months 12 Child with viral load suppressed suppressed load ------744 438 81.6 78.7 83.0 82.9 82.9 82.8 86.2 2 181 1 324 1 401 6 088 (%) 2015 90-90-90 Outcome rd 3 rate months 12 Adult with viral load suppressed suppressed load - 16 28 67 67 26 63 40 44 104 104 337 222 61.5 70.0 64.4 64.4 69.8 69.8 65.9 (%) 2015 Child with viral load completion completion load rate at months 12 ------573 850 87.5 84.1 76.4 83.4 78.3 83.5 83.5 2 614 1 575 1 677 7 289 (%) 2015 Adult with viral load completion completion load rate at months 12 Indicator Numerator Denominator Numerator Indicator Denominator Indicator Indicator Numerator Numerator Denominator Indicator Numerator Indicator Numerator Denominator Denominator Indicator Indicator Denominator

D

E Motsoaledi SD Ephraim Mogale SD Mogale Ephraim Fetakgomo SD Greater Tubatse SD South Africa South Makhuduthamaga SD Sekhukhune Sekhukhune Limpopo Source: HIS.

608 SectionSection B: National B: Profile and Limpopo District Province Profiles

TB - - 1.4 1.9 51.6 12.7 56.1 22.6 65.2 5 794 12 451 94 159 416 126 145 074 417 522 257 478 666 879 666 301 067 222 365 222 2016/17 screened in TB symptom 5 facility rate (%) rate facility years and older Process & input ------96.7 72.8 86.0 2 032 2 363 2 023 959 2016 Output rate (%) on treatment treatment on TB client initiated 34 34 145 381 138 358 357 323 500 464 94.0 92.8 90.6 92.9 90.5 95.2 88.3 1 417 1 317 100.0 2016 Net) (%) Net) TB/HIV co- ART rate (ETR. infected client on ------57 105 60.4 54.3 68.0 2016 treatment treatment TB Rifampicin Rifampicin TB resistant clients clients resistant initiation rate (%) rate initiation ------4.4 5.3 6.2 105 2 363 2016 rate (%) resistance resistance TB Rifampicin Rifampicin TB confirmed client confirmed client ------51 85 60.0 58.4 50.5 2014 Outcome success rate rate success (EDRWeb) (%) TB DR treatment treatment DR TB ------13 85 17.9 17.8 15.3 2014 (EDRWeb) (%) to follow up rate TB DR client loss 215 157 447 671 782 267 956 686 205 487 76.1 81.8 81.0 75.0 76.6 72.6 80.5 65.2 2 785 2 088 2015 TB client client TB treatment treatment success rate rate success (ETR.net) (%) 0 18 29 36 93 6.1 6.7 0.0 6.3 6.4 4.2 3.8 176 671 267 956 686 205 13.9 2 785 2015 TB client loss (ETR.Net) (%) (ETR.Net) to follow up rate ------18 85 21.2 16.4 23.0 2014 death rate TB DR client (EDRWeb) (%) 17 Impact 28 63 9.4 6.6 8.3 117 178 671 267 956 686 205 403 11.9 14.5 10.5 12.2 25.9 2 785 2015 TB death rate (ETR.net) (%) Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Denominator Numerator Indicator Indicator Indicator Numerator Denominator D

Sekhukhune Sekhukhune Makhuduthamaga SD Greater Tubatse SD Fetakgomo SD Ephraim Mogale SD Mogale Ephraim E Motsoaledi SD South Africa South Limpopo Source: HIS.

609 Section B: NationalProfile Limpopo and District Province Profiles

Annual trends TB LP, DC47, Sekhukhune District Municipality, SEQ 1 (most deprived)

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

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

0 15

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

0

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

40

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

0

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

0

TB Rifampicin 20 resistance confirmed client 10 rate

0 100

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

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

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

610 SectionSection B: National B: Profile and Limpopo District Province Profiles

Non-communicable diseases

Outcome Diabetes Hypertension incidence incidence (per1K) (per1K) 2016/17 2016/17 E Motsoaledi SD Indicator 1.6 19.5 Numerator 416 1 101 Denominator 3 197 397 678 948 Ephraim Mogale SD Indicator 2.0 60.2 Numerator 265 1 703 Denominator 1 593 612 339 348 Fetakgomo SD Indicator 0.7 15.4 Numerator 75 348 Denominator 1 200 987 271 686 Greater Tubatse SD Indicator 1.7 60.0 Numerator 627 4 038 Denominator 4 452 402 807 351 Makhuduthamaga SD Indicator 2.6 20.2 Numerator 736 1 296 Denominator 3 461 568 768 504 Sekhukhune Indicator 1.8 35.5 Numerator 2 119 8 486 Denominator 13 905 966 2 865 837 Limpopo Indicator 2.0 16.5 South Africa Indicator 2.5 18.9 Source: DHIS.

AnnualLP, DC47, trends Sekhukhune District Municipality, SEQ 1 (most deprived)

Measure Names IndValue Prov_av 6_NCDs Diabetes 5 incidence ZA_av

0

2_Outcome 40 Hypertension incidence 20

2010 2011 2012 2013 2014 2015 2016 2017 Year

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

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