UMKHANYAKUDE DISTRICT KWAZULU-NATALUMkhanyakude district is the northernmost district in...

DISTRICT HEALTH PLAN

2015/2016

UMKHANYAKUDE DISTRICT

KWAZULU-NATAL

[UMKHANYAKUDE] DISTRICT HEALTH PLAN 2015/16

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1. ACKNOWLEDGEMENTS

I would like to express my appreciation to District Health Management Team and Program Managers who contributed to development of the DHP 2015/16. The support from the Provincial Planning Unit during the development of this document was of great value. The M&E Team worked tirelessly in co-ordination of the document so that it meets the legislative mandates of the department. The team went beyond their call of duty to ensure that the document is meaningful. The efforts of the district Data Management team are acknowledged as they continued to verify data that was submitted. A special word of appreciation goes to Dr. Immelman who was able to carry dual roles and participated fully in this exercise. Our word of gratitude also goes to the supporting partner (MatCH) who gave technical support to the team. Their contribution kept the team focused to the entire process.


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2. OFFICIAL SIGN OFF

It is hereby certified that this District Health Plan:

Was developed by the district management team of Umkhanyakude Health District with

the technical support from the provincial district development directorate and the

strategic planning unit.

Was prepared in line with the current Strategic Plan and Annual Performance Plan of the

Department of Health of KZN


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3. TABLE OF CONTENTS

1. ACKNOWLEDGEMENTS .............................................................................................. 2 2. OFFICIAL SIGN OFF ...................................................................................................... 3 3. TABLE OF CONTENTS .................................................................................................. 4 4. LIST OF ACRONYMS ..................................................................................................... 6 5. EXECUTIVE SUMMARY BY DISTRICT MANAGER ................................................ 9

PART A - STRATEGIC OVERVIEW .......................................................................... 12

VISION, MISSION & CORE VALUES ............................................................................. 12 6. SITUATIONAL ANALYSIS ......................................................................................... 12

6.1 MAJOR DEMOGRAPHIC CHARACTERISTICS................................................... 14 6.2 SOCIAL DETERMINANTS OF HEALTH .............................................................. 17 6.3 EPIDEMIOLOGICAL (DISEASE) PROFILE OF THE DISTRICT ........................ 20

7. DISTRICT SERVICE DELIVERY ENVIRONMENT .................................................. 22 7.1 DISTRICT HEALTH FACILITIES ..................................................................... 22 7.2 TRENDS IN KEY DISTRICT HEALTH SERVICE VOLUMES ............................ 26

8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S ......... 31 9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH

SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA) .................. 33 10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS

MADE FOR THE PREVIOUS THREE FINANCIAL YEARS ...................................... 35 10.1 INTRA DISTRICT EQUITY IN THE PROVISION OF SERVICES .................... 45

11. ORGANISATIONAL ENVIRONMENT ..................................................................... 50 11.1 Organisational Structure of the District Management Team ................................... 50 11.2 Human Resources ..................................................................................................... 51

12. DISTRICT HEALTH EXPENDITURE ....................................................................... 55

PART B - COMPONENT PLANS ........................................................................... 62

13. SERVICE DELIVERY PLANS for district health services ......................................... 62 13.1 Sub-Programme: District Health Services .............................................................. 62 13.2 Sub-Program: District Hospitals ............................................................................. 72

14. HIV & AIDS & TB CONTROL (HAST) ................................................................ 81 14.1 Programme Overview .............................................................................................. 81 14.2 HIV & AIDS, STI & TB CONTROL (HAST): Strategies/ Activities to be implemented 2015/16 ....................................................................................................... 89

15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION ..................................................................................................................... 90 15.1 Programme Overview .............................................................................................. 90 15.2 Strategies/ Activities to be implemented 2015/16 .................................................. 106

16. DISEASE PREVENTION AND CONTROL (Environmental Health Indicators) ...... 108 16.1 Programme Overview ............................................................................................ 108 16.2 STRATEGIES/ Activities to be implemented 2015/16 ......................................... 114

17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES .......... 115 18. SUPPORT SERVICES ............................................................................................... 117

18.1 PHARMACEUTICAL SERVICES ....................................................................... 117 18.2 EQUIPMENT AND MAINTENANCE ................................................................. 123


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18.3 EMERGENCY MEDICAL SERVICES (EMS) .................................................... 124 SUB PROGRAMME OVERVIEW ............................................................................... 124

19. HUMAN RESOURCES .............................................................................................. 127 20. DISTRICT FINANCE PLAN ..................................................................................... 131

PART C: LINKS TO OTHER PLANS ..................................................................... 133

21. CONDITIONAL GRANTS (Where applicable) ......................................................... 133 22. PUBLIC-PRIVATE PARTNERSHIPS (PPPs) and PUBLIC PRIVATE MIX (PPM)

......................................................................................................................................... 135

PART E: INDICATOR DEFINITIONS ..................................................................... 137


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4. LIST OF ACRONYMS

Abbreviations Description

A

AIDS Acquired Immune Deficiency Syndrome

ANC Ante Natal Care

APP Annual Performance Plan

ART Anti-Retroviral Therapy

ARV Anti-Retroviral

B

BAS Basic Accounting System

BLS Basic Life Support

BUR Bed Utilisation Rate

C

CARMMA Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa

CCG’s Community Care Givers

CEO(s) Chief Executive Officer(s)

CHC(s) Community Health Centre(s)

COE Compensation of Employees

D

DCST(s) District Clinical Specialist Team(s)

DHER(s) District Health Expenditure Review(s)

DHIS District Health Information System

DHP(s) District Health Plan(s)

DHS District Health System

DOH Department of Health

DQPR District Quarterly Progress Report

E

EMS Emergency Medical Services

ETB.R Electronic Tuberculosis Register

ETR.net Electronic Register for TB

F

G

G&S Goods and Services

H

HAST HIV, AIDS, STI and TB

HCT HIV Counselling and Testing

HIV Human Immuno Virus

HOD Head of Department

HPS Health Promoting Schools

HPV Human papilloma virus


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HR Human Resources

HTA High Transmission Area

I

IDP(s) Integrated Development Plan(s)

IPT Ionized Preventive Therapy

J

K

KZN KwaZulu-Natal

L

LG Local Government

M

M&E Monitoring and Evaluation

MDG Millennium Development Goals

MDR-TB Multi Drug Resistant Tuberculosis

MEC Member of the Executive Council

MNC&WH Maternal, Neonatal, Child & Women’s Health

MO Medical Officers

MOU Maternity Obstetric Unit

MTEF Medium Term Expenditure Framework

MTSF Medium Term Strategic Framework

MUAC Mid-Upper Arm Circumference

N

NDOH National Department of Health

NCS National Core Standards

NGO(s) Non-Governmental Organisation(s)

NHI National Health Insurance

NIMART Nurse Initiated and Managed Antiretroviral Therapy

O

OSD Occupation Specific Dispensation

OSS Operation Sukuma Sakhe

P

P1 Calls Priority 1 calls

PCR Polymerase Chain Reaction

PCV Pneumococcal Vaccine

PDE Patient Day Equivalent

Persal Personnel and Salaries System

PHC Primary Health Care

PN Professional Nurse

R

RV Rota Virus Vaccine

S


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SCM Supply Chain Management

SHS School Health Services

SLA Service Level Agreement

Stats SA Statistics South Africa

STI(s) Sexually Transmitted Infection(s)

T

TB Tuberculosis

U

V

VCT Voluntary Counselling and Testing

W

X

XDR-TB Extreme Drug Resistant Tuberculosis

Y and Z


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5. EXECUTIVE SUMMARY BY DISTRICT MANAGER

UMkhanyakude District is one of the most socio-economically deprived districts in the country. It is

bordered by Mozambique and Swaziland resulting in treatment of foreign clients, with

unbudgeted costs.

The District is striving towards elimination of Malaria epidemic since 2012. The malaria case fatality

rate is 1.9%. The District will continue with residual house spraying, and the monitoring of mosquito

insecticide resistance, and parasite resistance to the antimalarial medication which was shown to

be so important in the late 1990s.

HIV/AIDS remains the biggest challenge to the healthcare system in the District. HIV/AIDS adversely

affects life expectancy, maternal mortality, perinatal mortality, child nutrition, child mortality,

tuberculosis incidence and cure, and incidence of MDR-TB and XDR-TB, impeding progress

towards Millennium Development Goals (MDG) 4 (child mortality), 5 (maternal health), and 6

(combating HIV/AIDS and malaria).

Though maternal mortality is decreasing but the child health indicators show increase both in

mortality and morbidity. The district has embarked on implementing MDG Countdown strategies

to improve MCWH indicators. Strategies identified to help accelerate achievement of the MDGs

include: promotion of early antenatal care (ANC) booking, ambulances based at hospitals and

clinics with high numbers of deliveries for rapid transfer of critical patients, improved provision of

antenatal calcium carbonate, promotion of contraception including use of intrauterine devices

(IUDs) and hormonal implants, continuing promotion of male medical circumcision (MMC), and

health counselling and testing (HCT), improved condom distribution including male and female

condoms, improved tuberculosis screening and use of isoniazid preventive therapy.

The District has made a good progress in management of HIV and AIDS. 58,643 persons are now

taking antiretroviral drugs in the District. Prevention of maternal to child transmission (PMTCT) is at

1.7%. There is evidence that life expectancy has increased by about ten years since 2007 as a

result of the HIV&AIDS programme. The District HIV/Aids Antenatal prevalence has dropped from

41% to 35.2%

Teenage pregnancy remains a major challenge despite a collaborative efforts made with other

departments such as Department of Education, Social development and NGOs. The district

increased the number of School health teams from 5 to 10. This will assist in Health promotion at

schools.


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SERVICE DELIVERY PLATFORM:

There are five district hospitals, 56 clinics including four Gateways, and 17 mobile clinics servicing

251mobile stopping points.

The first CHC in the district is currently under construction at Jozini LM and it is expected to be

completed by 2015/16. Commissioning processes for the CHC have started. Hluhluwe clinic (Big

Five False Bay) has been completed awaiting hand over. The construction of Mpophomeni clinic

under UMhlabuyalingana LM is behind schedule. There is unevenness in the distribution of these

resources throughout the District. The most glaring deficiency is the lack of higher level care in

Mtubatuba local municipality. A community health centre for Mtubatuba is planned, but has

been delayed by difficulty acquiring a site, followed by a shortage of funds.

Medical clinic coverage will continue to increase, with the ultimate aim of achieving weekly

medical visits to all clinics.

No Ward based health teams appointed as yet. The district has planned to appoint at least five

teams by end of 2014/15 financial year.

The District will continue to strive for full recruitment District Clinical Specialist Team (DCST), which

presently has only four out of seven posts filled.

All five hospitals and Clinics are striving to implement National Core Standards but none is

compliant due to structural challenges and insufficient essential equipment in all service areas.

Procurement of essential equipment is prioritised in the next financial year.

Monitoring committees in hospitals and at District will be strengthened, including perinatal mortality

meetings, child health forums and pharmacy and therapeutics committees and audit

committees.

SUPPORT SERVICES:

Pharmaceutical support to clinics will improve through increasing deployment of pharmacist

assistants to clinics, improving clinic stock management. Through a full complement of pharmacy

managers in the District, pharmaceutical management in hospitals and clinics is anticipated to

improve.

At present the District has only three obstetric ambulances, but needs at least six to have one for

each hospital and clinic where more than 500 deliveries per year occur. EMRS challenges are still

persistent with serious adverse events.

INFRASTRUCTURE:

Construction of new wards was finalised such as new Peads ward at Bethesda, female ward at

Manguzi and Mosvold these has improved hospital image.


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HUMAN RESOURCES (HR):

There is high staff turnover within the district. This is attributed to the rural nature of the district.

FINANCES:

Strengthening of institutional cash flow committees, including clinic committees, with compulsory

attendance, should improve financial management in the next financial years. The District

Principal Accountant will continue to support institutions.


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PART A - STRATEGIC OVERVIEW

VISION, MISSION & CORE VALUES

Vision

To achieve optimal health status for all persons in UMkhanyakude District

Mission

To develop an integrated, coordinated, comprehensive and sustainable health system at all levels of care based on the Primary Health Care approach through the District Health System.

Core Values

Trust built on truth, integrity and reconciliation

Open communication, transparency and consultation

Commitment to performance

Courage to learn, change and innovative

DISTRICT HEALTH PRIORITIES FOR 2015/16

1. Strengthen Primary Health Care Services

2. Strengthen health system effectiveness

3. Reduce and manage the burden of disease and promote health

4. Strengthen human resources for health

5. Improve quality of health care

6. Improve quality of data

6. SITUATIONAL ANALYSIS

UMkhanyakude district is the northernmost district in KwaZulu-Natal. The district stretches from the

UMfolozi River, near Mtubatuba in the south, to the Mozambique and Swaziland borders in the

north. To the east it borders the Indian Ocean with 175km of pristine beaches. In the west it is

bordered by Zululand District; and UThungulu District to the south. Geographically, uMkhanyakude

is the most sparsely populated district in the province. The district is deep rural, a presidential node

and is ranked number 51/52 of the most deprived districts in the country. There are five local

municipalities with 68 wards.


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The platform for service delivery in the District consists of five district hospitals, 56 PHC facilities

including 4 Gateways (18 Jozini, 18 UMhlabuyalingana, 12 Mtubatuba, 5 Hlabisa and 3 The Big Five

False Bay Local Municipalities). There are 17 mobile teams (2 Hlabisa, 2 Mtubatuba, 6 Jozini and 7

UMhlabuyalingana). There is unevenness in the distribution of these resources throughout the

District. The most glaring deficiency is the lack of higher level care in Mtubatuba local municipality.

Despite holding 28% (179 378) of the District population (638 011), the municipality has no hospital

or Community Health Centre. A Community Health Centre for Mtubatuba is planned, but has

been delayed by difficulty in acquiring a site, followed by a shortage of funds.

The PHC cost per headcount is R108 (range R82.5 -Hlabisa to R116.4 -UMhlabuyalingana) which is

below the national average of R210 due to incorrect linking of expenditure. The district hospitals

and clinics spent 52.4% and 46.7% of the budget respectively. The district PHC expenditure per

capita is R388 and only 3.9% of the district population belongs to medical aid schemes, which

indicates that bulk (96.1%) of population is uninsured and utilizing public health services.

The PHC utilization rate for the district is 3.6 UMhlabuyalingana Local Municipality remains the

highest with the rate of 4.2 and Hlabisa being the lowest with 3.0. The average PN workload in the

district is 46, it ranges between 39.3 at The Big 5 False Bay and 52.5 at Hlabisa.

Access to PHC services in the district is limited due to long distances between where communities

reside and facilities’ location (not all facilities are within 5km radius), poor road infrastructure,

transport flow and cost as well as shortage of clinics.

The district has 5% tarred road and 95% gravel or sandy which contributes to regular breakdowns

of motor vehicles that affects the transport fleet and leads to poor EMRS response time. The

majority of the community rely on public transport in order to access health facilities. During rainy

seasons some areas and facilities are inaccessible.

Doctors from all 5 hospitals within the district visit clinics at least once a month as there are no

doctors allocated in the clinics. More than half of the clinics are visited by the doctor at least once

a week. The doctor work load is 34.2 patients; it ranges between 27.2 in Jozini and 43.3 in

UMhlabuyalingana. The expenditure for these doctors was incurred by hospitals but now they are

linked to PHC support. Other Allied Health Professionals visit clinics at least once a month.


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6.1 MAJOR DEMOGRAPHIC CHARACTERISTICS.

Table 1: District Population 2013/14

Sub-District Total Population % pop uninsured

Uninsured Population

Hlabisa LM 73 059 96.1 70 209

Jozini LM 189 966 96.1 182 556

Mtubatuba LM 179 378 96.1 172 382

The Big 5 False Bay LM 36 172 96.1 34 761

UMhlabuyalingana LM 159 438 96.1 153 220

District 638 011 96.1 613 129 Source: DHER 2012/13


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Figure 1: Population Pyramid Umkhanyakude District 2011 Stats SA

Graph 1: Population distribution per Municipality

Source: DHIS

UMkhanyakude has a total population of 638 011 with a population density of 46 per km2.

53.3% are females and 46.7% are males. 38.5% of the total population are less than 15 years

old and 12.5% are between 15 – 19 years old highlighting the need for Youth Friendly Services.

54% of households are headed by females, while 46% are headed by males, which might be

due to males migrating to bigger cities for employment opportunities and dying early due to

a delay in seeking medical help.

11%

30%

28%

6%

25%Hlabisa LM

Jozini LM

Mtubatuba LM

The Big Five False Bay LM

Umhlabuyalingana LM


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The population is unevenly distributed among the five local municipalities with Jozini LM

having the highest population of 30% and is the second biggest sub-district with an area

covering 3 057km2, UMhlabuyalingana LM has the third highest population 25% and the

biggest sub-district covering 3 621 km2, Mtubatuba LM and Hlabisa LM have a total

population of 28% and 11% respectively and The Big 5 False Bay LM has the lowest population

of 6%. The district is sparsely populated which has an impact on service delivery in terms of

infrastructure. (The population to clinic ratio under UMhlabuyalingana LM indicate fair

distribution of PHC facilities, but due to low density population not all clinics are within 10km

radius compared to Mtubatuba LM. UMhlabuyalingana requires additional PHC facilities to

be constructed. Mtubatuba LM is more densely populated and infrastructure required is less

than in a sparsely populated area.

PHC services in The Big Five will be enhanced by the opening of Hluhluwe Clinic in 2014/15.

Jozini Community Health Centre (CHC) is under construction and will be opened in 2015/16.

Commissioning of the CHC has started in third quarter 2014/15 financial year. This CHC will be

the first in the District, and should increase accessibility to PHC services. UMhlabuyalingana

LM despite having the highest PHC utilisation rate of 4.2 and number of clinics per population

still has underserved pockets of population due to its large area.

Demographic data indicates high percentage of household headed by <19 years old by

2.8%. It points to a high number of orphans with no extended families; this could be attributed

to HIV and aids that is prevalent in the district. This may have contributed to high teenage

pregnancy (11.3%) and illiteracy rates (25%) which could also lead to high incidence of

malnutrition. There is a need to strengthen collaboration with other sector departments

through (Oss) operation Sukuma Sakhe and other departmental initiatives such as Phila

Mntwana centres.


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6.2 SOCIAL DETERMINANTS OF HEALTH

Table 2 (A1): Social Determinants of Health

Name of Sub-district

Data source Development Indicators

Unem

ploy

men

t rat

e

Perc

enta

ge o

f pop

ulat

ion

livin

g be

low

pov

erty

line

of

R283

per

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th

Perc

enta

ge H

ouse

hold

s with

ac

cess

to p

orta

ble

wat

er(in

side)

dw

ellin

g)

Num

ber

of h

ouse

hold

s in

Info

rmal

dw

ellin

g

Num

ber

of h

ouse

hold

s in

trad

ition

al s

truct

ures

Perc

enta

ge o

f Hou

seho

lds

with

acc

ess t

o sa

nita

tion

Perc

enta

ge o

f Hou

seho

lds

with

acc

ess t

o el

ectri

city

Ad

ult l

itera

cy ra

te (i

f av

aila

ble

)

Hlabisa Census 2001 76.1% 33.5% 2.2% 253 5259 - 28.7% 43.0% Community Survey 2007

83% 24% - 409 10 913 70% 35% 67%

Census 2011 52.6% 16.1% 12.5% 97 4075 - 55.4% 21.7% Jozini Census 2001 60.0% 43.0% 3.3% 502 18 649 - 11.8% 50.7%

Community Survey 2007

65% 25% - 359 17 863 60% 32% 63%

Census 2011 44.1% 22.3% 10.9% 1446 8 308 - 29.1% 21.7% Mtubatuba Census 2001 59.7% 27.2% 8.2% 819 9 074 - 45.6% 37.3


38% 22% - 105 1 024 90% 89% 69%

Census 2011 39.0 11.6% 22.1% 1394 5 172 - 65.1 19.7%

The Big Five False Bay

Census 2001 47.1% 36.0% 13.9% 336 2 760 - 21.9% 39.7% Community Survey 2007

64% 23% - 100 2 643 86% 33% 61%

Census 2011 26.5% 17.5% 23.5% 98 1 392 - 65.1% 25.0% UMhlabuyalingana

Census 2001 69.0 48.9% 1.8% 1019 15 698 - 7.0% 53.7% Community Survey 2007

56% 27% - 195 14 679 63% 13% 59%

Census 2011 47.1 29.5% 5.3% 130 13 865 - 14.2% 30.2% District Total Census 2001 53.9 37.7% 4.7% 3873 51 441 - 21.2% 46.3%


63% 29% - 1 168 57 140 68% 34% 63%

Census 2011 42.8 19.4% 13.7% 2092 32 811 - 38.4% 25.0%


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The Health Systems Trust estimates UMkhanyakude to be the second most socio-economically

deprived district in the country.

There are about 128 195 households (according to Stats SA) in the District of which 53.9%

headed by females and only 9.9% households have flush toilets connected to sewerage.

Only 13.4% of households have piped water inside the dwelling and 38.4% have electricity for

lighting. The average household size is 4.7 people per household. 55.3% of the population is

between the ages of 15-64; 25% of the population has no education; 25.4% has matric, and

only about 5% has higher education. The District unemployment rate is 42.8%, with youth

unemployment rate at 51.2%. An inter-sectorial approach, including ward-based structures

such as Operation Sukuma Sakhe (OSS), and the Integrated Development Plan (IDP) forums,

will be used to tackle many of the socio-economic challenges in the District, which impact on

health and healthcare delivery.

Due to the rural nature of the District, households are far apart from each other, and people

travel long distances to the nearest clinic. Transport scarcity and the influx of clients from

neighbouring countries (Swaziland and Mozambique) justify construction of additional clinics

to meet these demands.

Geographically UMkhanyakude District is rural and sparsely populated which has a negative

impact to PHC accessibility. In addition, poor road and transport infrastructure and poor

ambulance response times impede accessibility of health facilities, thus increasing mortality.

Only 4% of the population are covered by a medical aid scheme, and there are no private

hospitals in the District, so most of the population rely on public health facilities for healthcare.

The high illiteracy and unemployment rate and long distances to health care facilities have a

negative impact on health seeking behaviour. The high unemployment rate leads to high

psycho-social illnesses and difficulty affording travel to health facilities. The high illiteracy rate

leads to high level of poverty in the District which aggravates the non-communicable

diseases of lifestyle such as TB and HIV/AIDS. The first health contacts for most patients are

traditional health practitioners which may delay seeking formal medical health assistance.

The high illiteracy rate impairs understanding of information, education, and communication

(IEC) material distributed to the community, thus posing a challenge to changing life styles

and health behaviour.

The severe malnutrition <5years incidence is 6.4/1000 which is above the district target of

6/1000. TB incidence is 832/100 000, which is largely attributed to a high HIV prevalence,

poverty and unemployment.


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Data shows that there is a high diarrhoea incidence for under-5 years within the district

(123/1000 population), especially in the Jozini Local Municipality where it is 152/1000

population. This is mainly attributed to the unavailability of potable water and malnutrition.

These co-morbidities are being addressed through implementation of Operation Sukuma

Sakhe and the Food for All campaign.

There is inadequate electricity supply in many parts of the District, particularly in the

UMhlabuyalingana Municipality, resulting in high use of generators, candles, gas stoves &

wood fires, which are health hazards. All PHC facilities are connected to electricity.


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6.3 EPIDEMIOLOGICAL (DISEASE) PROFILE OF THE DISTRICT

Figure 2: Disease Profile

Maternal Mortality

Indicator 2011/12 2012/13 2013/14 Maternal Mortality rate 68/100k 95/100k 60/100k

Maternal Death in facility 10 14 9 Live Births in Facility 14 695 14 683 14 946

Infant and child mortality

Indicator 2011/12 2012/13 2013/14 Inpatient infant mortality rate 8/1K 10/1K 8/1K

Inpatient Death under 1year 124 146 141

Population estimated Live Births 15 418 14 601 18 649

Inpatient child mortality rate 66/1K 59/1K 50/1K

Inpatient Death under 5 years 171 213 192

Inpatient Separation under 5 years 2 577 3 584 3 847

District HIV & Aids Profile

Indicator 2011/12 2012/13 2013/14 Antenatal HIV prevalence 41.9% 41.1% 35.2%

1.9

1.9

1.9

2.4

2.5

3.6

5.1

8.3

20.5

29.4

0 5 10 15 20 25 30 35

Diabetes Mellitus

Interpersonal Violence

Meningitis & Encephalitis

Transport Injuries

Hypertensive Heart Disease

Cerebrovascular Disease

LRI

Diarrhoeal Disease

TB

HIV/AIDS

109

87

65

43

21

DC

27


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District TB Profile

Indicator 2011/12 2012/13 2013/14 TB cure rate 71.2% 68.0% 72% TB (new pulmonary)client cured 1 275 1 530 1 399 TB(new pulmonary) client initiated on treatment 1 793 2 257 1 935 TB Smear conversion rate at 2 months 65% 68% 62.3% Smear converted at 2months (negative) 1 191 1 305 1 073 New smear positive cases 1 831 1 918 1 721 TB(new pulmonary) defaulter rate 4% 2.5% 3.% TB(New pulmonary) treatment defaulter 72 58 59 TB(New pulmonary) client initiated on treatment 1 793 2 257 1 935 TB AFB Sputum results turnaround time <48 hours rate 61% 56% 63.9% TB AFB Sputum results received within <48 hours 39 618 42 151 35 111

TB AFB sputum sample sent 67 752 75 105 54 910 TB Death rate 6.3% 3.9% 4.7% TB client died during treatment 113 89 90 TB client started on treatment 1 793 2 257 1 935

The table and graph above shows HIV infection to still be the leading cause of mortality in the

District, which also affects TB morbidity and mortality, maternal mortality, and child mortality.

The antenatal HIV prevalence is at 35.2%. Despite the high HIV and TB burden, the District

maternal mortality ratio (MMR) remains low. Infant and child mortality indicators are showing

an increase this financial year (2014/15). The TB cure rate has improved since 2008; however

more effort is needed to achieve the target of 85%.


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7. DISTRICT SERVICE DELIVERY ENVIRONMENT

7.1 DISTRICT HEALTH FACILITIES

7.1.1 PRIMARY HEALTH CARE FACILITIES

Table 3 (NDoH 1): PHC facilities (Provincial and LG combined) per Sub-District as at 31 March 2014

Sub-Districts Health Posts Mobiles Satellites Clinics Community Day Centre1

Community Health

Centres (24 x 7)2

Standalone MOU3

District Hospitals

LG P LG P LG P LG P LG P LG P LG P

Hlabisa LM 0 0 0 2 0 0 0 5 0 0 0 0 0 0 1

Jozini LM 0 0 0 6 0 0 0 18 0 0 0 0 0 0 2

Mtubatuba LM 0 0 0 2 0 0 0 12 0 0 0 0 0 0 0

The Big 5 False Bay LM 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0

UMhlabuyalingana LM 0 0 0 7 0 0 0 18 0 0 0 0 0 0 2

District 0 0 0 17 0 0 0 56 0 0 0 0 0 0 5 Source: DHIS

There are no Health posts, CDCs, Satellites, Stand Alone MOU and Local Government facilities in the district. One CHC at Jozini is under

construction, planned to be opened next financial year May 2015. There are 56 PHC clinics (including 4 Gateway clinics) and 17 mobile teams

servicing 251 points in the district.

1 There are no Community Day Centres in KwaZulu-Natal 2 All Community Health Centres (CHC’s) in KwaZulu-Natal do not have MOU’s according to the definitions used in the DHER 2011/12. All KZN CHC’s operate on a 24 hour, 7 day a week basis. 3 Accordingly to the DHER 2011/12 definitions for Stand Alone MOU’s, there are no Stand Alone MOU’s operational within KwaZulu-Natal


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The construction of Mpophomeni clinic under UMhlabuyalingana LM is behind schedule due to challenges with the awarded contractor. The

construction of Hluhluwe clinic has been completed; and may be operational before the end of 2014/15 financial year. Future planned clinics

on the STP include construction of Mpanzakazi and Mfekayi in Hlabisa and Emfihlweni in Manguzi.

Table 4: Provincial Clinic Facility to Population – 2013/14

Sub-Districts/ District PHC facility per pop ratio - Health Post

PHC facilities per pop - Mob provincial

PHC facilities per pop ratio - Clinical provincial

PHC facilities per pop ratio - CHC provincial

Hlabisa LM 0 36 529 14 612 0

Jozini LM 0 29 994 10 554 0

Mtubatuba LM 0 89 689 14 948 0

The Big 5 False Bay LM 0 0 12 057 0

UMhlabuyalingana LM 0 22 777 8 858 0

District 0 37 530 11 393 0

Source: DHER 2013/14 Customised District Report

The population under UMhlabuyalingana LM indicates fair distribution of PHC facilities, but due to low density population not all clinics are within

10km radius. Hlabisa and Mtubatuba LMs need additional clinics according to population. There are no mobile teams under The Big 5 False Bay

LM; this LM is serviced by Mtubatuba and UMhlabuyalingana LMs mobile teams. 14 mobile points at The Big 5 False Bay are supported by Mseleni

hospital and 3 supported by Mtubatuba LM mobiles, their data are inclusive under Mseleni and Mtubatuba mobiles respectively.


24 | P a g e

Table 5 (NDoH 2): District Hospital Catchment Populations 2013/14

Name of District Hospital 2012/13 2013/14

Beth

esda

Ho

spita

l

Hlab

isa

Hosp

ital

Man

guzi

Hosp

ital

Mos

vold

Ho

spita

l

Mse

leni

Ho

spita

l

Beth

esda

Ho

spita

l

Hlab

isa

Hosp

ital

Man

guzi

Hosp

ital

Mos

vold

Ho

spita

l

Mse

leni

Ho

spita

l

Catchment Population of District Hospital 108 124 249 395 110 885 116 065 82 052 88 039 252 436 100 487 109 726 87 322 Source: DHER 2013/14 (GIS) Note: District Hospital Catchment Populations are calculated according to the catchment population of referring clinics.

Table 6: Beds per population, BUR and ALOS

District Hospitals Population Inpatient Beds

Beds Utilization Rates

Average Length of Stay

Beds Per population

Bethesda 88 039 222 48.3 5.5 1:397 Hlabisa 252 436 275 65.6 6.0 1:918 Manguzi 100 487 284 59.1 5.6 1:354 Mosvold 109 726 244 60.2 6.4 1:450 Mseleni 87 322 219 63.8 4.3 1:399 District 638 011 1 244 60.7 5.5 1:513

Four hospitals are distributed evenly in the north of the district (60-80 kilometres apart) but only1 hospital at Hlabisa on the south of the district.

There is no hospital in Mtubatuba and Hluhluwe. With the establishment of Mtubatuba CHC the situation will improve. There is a difference in

population figures for 2012/13 and 2013/14 due to census 2011. Hlabisa and Mseleni population increased by 1% and 6% respectively in 2013/14,

while there was a decrease in the other hospitals. Hlabisa hospital is serving two sub districts Mtubatuba LM and Hlabisa LM and Mseleni serving


25 | P a g e

part of UMhlabuyalingana LM and The Big Five False Bay LM. Even with the population increase the bed status has not changed. Mosvold

hospital is serving patients from Swaziland and Manguzi is serving patients from Mozambique.

All the hospitals especially Bethesda is also serving cross boundary patients from adjacent districts. According to the table there is an unequal

distribution of beds to population and also unequal utilization of beds.

The cross border and cross boundary movements have a negative impact on service delivery such as poor monitoring of treatment outcomes,

tracking of defaulters and tracking of patients.


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7.2 TRENDS IN KEY DISTRICT HEALTH SERVICE VOLUMES

7.2.1 PRIMARY HEALTH CARE SERVICE VOLUMES AND UTILISATION

Table 7 (NDoH 3): PHC Headcount Trend

Sub-District

2012/13 2013/14 Variation

PHC Headcount – Provincial

PHC Total Headcount

PHC Total Utilisation Rate


PHC Total Headcount



PHC Total Headcount


Hlabisa LM 211 375 211 375 2.1 221 145 221 145 3.0 0.05 0.05 0.43 Jozini LM 652 528 652 528 3.0 699 187 699 187 3.7 0.07 0.07 0.23 Mtubatuba LM 552 737 552 737 3.8 563 149 563 149 3.1 0.02 0.02 -0.18 The Big 5 False Bay LM

116 690 116 690 3.1 129 783 129 783 3.6 0.11 0.11 0.16

UMhlabuyalingana LM

660 784 660 784 4.0 677 732 677 732 4.2 0.03 0.03 0.05

District 2 194 114 2 194 114 3.2 2 290 996 2 290 996 3.6 0.04 0.04 0.13 Source: DHIS downloads

There is a consistent increase of 4% per year (from 2011/12 to 2013/14) in total PHC headcount. The increase of 18% and 11% for The Big 5 LM is

due to better staffing and improved monitoring of utilization rate. Mtubatuba LM has a decrease of 6% in 2011/12 and a slight increase in

2013/14 this could be due to data clean-up.

The district utilization has increased from 3.2 to 3.6 (from 2011/12 to 2013/14); the biggest increase was at The Big 5 False Bay (0.9) which is due to

improvement in staffing followed by UMhlabuyalingana (0.8) and Jozini (0.7). There has been a decrease of 0.4 at Mtubatuba LM, partially due

to increase in population.


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Graph 2: PHC Utilisation (Provincial Clinics) vs. Population to PHC facility (Provincial clinics) – 2013/14

Source: DHIS & DHER 2013/14 Customised District Report

Graph 3: PHC Utilisation rate in relation to PN Workload Provincial Clinics

Source: DHIS, DHER Hlabisa LM has the highest workload of 52.5 and the lowest utilization rate of 3.0. The workload of

52.5 at Hlabisa is not a true reflection of what is happening because of poor recording of workload

for the relieving PNs. Training on recording clinical workload has been conducted and linking of

staff is in progress

Jozini LM has a PN workload of 50.7 and utilization rate of 3.7. This is due to high vacancy rate at

PHC and highest population of this local municipality. HR assessments were conducted by the

District Office with MatCH support which revealed high staff turnover due to dissatisfaction on

management style and personal problems, and remedial action plan for high staff turnover has

been developed and implementation will be monitored.

00.511.522.533.544.5

02000400060008000

10000120001400016000

Population to PHC facility (avg) PHC utilisation Rate

0.0

10.0

20.0

30.0

40.0

50.0

60.0

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Hlabisa LM Mtubatuba LM Umhlabuyalingana LM

Wor

kloa

d Ra

te

PHC

Util

isatio

n Ra

te

PHC Utilisation rate PN Workload


28 | P a g e

UMhlabuyalingana and The Big Five False Bay LMs are well staffed (workload 39.9 and 39.3

respectively) compared to other LMs. UMhlabuyalingana LM has the highest PHC utilization rate of

4.2 which means PHC services are well utilised. The district PHC workload is 46 which is above the

target of 35.

It is recommended that vacant PNs posts be filled to reduce the district PN workload. PHC

supervisors should conduct quarterly productivity reports to determine PNs workloads for PHC

facilities. Table 8 (NDoH 4): District Hospital activities

District Hospitals Year Bethesda

Hospital

Hlabisa Hospital

Manguzi Hospital

Mosvold Hospital

Mseleni

Hospital

District Totals

1. Inpatient Days – total

2012/13 45 282 64 274 58 037 49 812 50 851 268 256

2013/14 39 168 65 844 61 267 53 598 50 898 270 775

Variation -0.1 0.02 0.06 0.08 0 0.01

2. Day patient – total

2012/13 158 84 1 582 24 75 1 923

2013/14 0 30 1 7 157 195

Variation -1 -0.6 -1 581 -0.7 1.1 -0.9

3. OPD Headcount not referred new

2012/13 4 374 5 106 36 987 4 586 13 707 64 760

2013/14 6 011 7 930 39 683 8 547 8 985 71 156

Variation 0.37 0.55 0.07 0.86 -0.34 0.1

4. Inpatient Separations

2012/13 8 129 10 841 10 555 8 517 10 874 48 916

2013/14 7 148 10 904 10 939 8 398 11 877 49 266

Variation -0.12 0.01 0.04 -0.01 0.09 0.01

5. Inpatient Deaths

2012/13 417 772 440 439 357 2 425

2013/14 366 761 397 389 382 2 295

Variation -0.12 -0.01 -0.10 -0.11 0.07 -0.05

6. OPD Headcount – total

2012/13 46 115 85 671 78 425 41 899 57 617 309 727

2013/14 52 490 100 221 89 392 46 242 49 712 338 057

Variation 0.14 0.17 0.14 0.10 -0.14 0.09

7. Emergency headcount total

2012/13 3 182 3 305 4 787 1 016 3 019 15 309

2013/14 1 636 622 5 773 653 973 9 657

Variation -0.49 -0.81 0.21 -0.36 -0.68 -0.37

8. Patient Day Equivalent

2012/13 61 793 93 975 86 565 64 129 71 100 377 563

2013/14 57 192.0 9 9439.7 92 957.4 69 217.5 67 854.6 386 661.2

Variation -0.07 0.06 0.07 0.08 -0.05 0.02

9. Cost per 2012/13 R1 582 R1 592 R1 389 R1 630 R1 391 R1 513


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District Hospitals Year Bethesda

Hospital

Hlabisa Hospital

Manguzi Hospital

Mosvold Hospital

Mseleni

Hospital

District Totals

PDE 2013/14 R1 828 R1 733 R1 610 R1 589 R1 697 R1 675

Variation 0.16 0.09 0.16 -0.03 0.22 0.11

10. Delivery by caesarean section rate

2012/13 23.3 25.9 16.7 20.1 16.6 21.2

2013/14 25.5 24.2 16.9 19.6 20.7 21.6

Variation 0.09 -0.07 0.01 -0.02 0.25 0.02

11. Average length of stay - total

2012/13 5.7 6.0 6.6 5.9 4.7 5.7

2013/14 5.5 6.0 5.6 6.4 4.3 5.5

Variation -0.04 0 -0.15 0.08 -0.09 -0.04

12. Inpatient bed utilisation rate – total

2012/13 56.4 65.3 57.6 55.9 63.4 59.8

2013/14 48.3 65.6 59.1 60.2 63.8 60.7

Variation -0.14 0.004 0.03 0.08 0.01 0.02

13. Total Ambulatory (OPD Headcount Total + Emergency Headcount total)

2012/13 49 297 88 976 83 212 42 915 60 636 325 036

2013/14 54 126 100 843 95 165 46 895 50 685 347 714

Variation 0.10 0.13 0.14 0.09 -0.16 0.07

14. Ratio of Ambulatory to Inpatient Days Total

2012/13 1.0 1.3 1.4 0.8 1.1 1.2

2013/14 1.3 1.5 1.5 0.9 1.0 1.2

Variation 0.3 0.2 0.1 0.1 -0.1 0

Source: DHIS Downloads 2012/13 & 2013/14

Graph 4: District Hospitals Cost per PDE vs. IPD and OPD


R 1 450

R 1 500

R 1 550

R 1 600

R 1 650

R 1 700

R 1 750

R 1 800

R 1 850

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Bethesda Hlabisa Manguzi Mosvold Mseleni

Total IPD as % of PDE Total OPD as % of PDE Cost per PDE


30 | P a g e

The district expenditure per PDE is (R1 675) below the provincial target R1 854. The highest is

Bethesda at R1 828 due to low PDE followed by Hlabisa at R1 733 and Mosvold being the lowest at

R1 589. There was 11% increase in cost per PDE compared to 2012/13. Mosvold cost per PDE has

decreased with 3% due to shortage of staff especially doctors and pharmacists.

There was an increase of 9%in the district OPD headcount. The biggest increase was at Hlabisa

hospital at 17%, Manguzi and Bethesda at 14% and Mosvold at 10%. The increase was due to the

increased number of patients attending PHC facilities and more of them were referred to hospitals.

OPD patients not referred ratio at Mosvold hospital increased from 11% (2012/13) to 19% (2013/14)

due to decreased visits by medical officers to PHC facilities which led to self-referral of patients to

OPD. Certain services such as; dental, rehab services, social services etc. are available on daily

basis at hospitals and only once a month at PHC facilities.

There was a decrease of OPD headcount by 14% at Mseleni hospital; this could be attributed to

the establishment of a Gateway clinic as a cost centre.

Mosvold and Mseleni hospitals have high IPD than OPD headcount (53 598- IPD; 46 242-OPD and

50 898-IPD, 49 712-OPD respectively). This is attributed to waiting mothers being admitted as

inpatients in both hospitals (Mosvold uses lodger beds for waiting mothers and Mseleni they are

included in the usable beds). Manguzi hospital has high IPD headcount due to high number of

MDR patients (catered for the whole district except for Hlabisa) and high OPD headcount due to

monthly MDR follow-ups. There are high self-referrals as there is no Gateway clinic. The other reason

for the increase OPD headcount at Manguzi is due to road construction leading to Mosvold and

sometimes shortage of water supply for services like X-ray and poor medicine supply (stock out) at

PHC facilities which lead to number of patients channelled to hospitals for medication. Data

quality has been a challenge at Manguzi hospital with regards to emergency headcount 2013/14

due to poor understanding and this has been corrected from June 2014 after in-service

education.

Overall there was 2% increase of PDE in the district with the highest increase of 8% at Mosvold

hospital (10% increase of OPD headcount and 8% increase in-patient days) and a decrease of 7%

at Bethesda and 5% at Mseleni hospitals.

The district BUR (60.7%) is below the provincial target (63%-69%). Hlabisa and Mseleni remained

constant, Manguzi and Mosvold slightly increased in BUR due to change in admission criteria. There

was a decrease in BUR at Bethesda hospital, it needs an investigation.


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8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S

Table 9 (NDoH 5): Review of Progress towards the Health-Related Millennium Development Goals (MDG’s) and required progress by 2015

MDG Target Indicator Provincial progress 2013/14

Source of data District progress 2013/14

District targeted progress 2014/15

Goal 1:

Eradicate Extreme Poverty And Hunger

Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Prevalence of underweight children under 5 years of age

DHIS 0.4% 0.7%

Severe malnutrition under 5 years incidence )

DHIS 5.6/1K 6/1k

Goal 4:

Reduce Child Mortality

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Under-five mortality rate – use proxy “Inpatient death under 5 years rate”

DHIS 50/1k 70/1k

Infant mortality rate – use proxy “Child under 1 year mortality in facility rate”

DHIS 67/1k 97/1k

Goal 4:

Reduce Child Mortality

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Measles 2nd Dose coverage DHIS 70.1% 90%

Immunisation coverage under 1 year

DHIS 74.6% 85%

Goal 5:

Improve Maternal Health

Reduce by three-quarters, between 1990 and 2015, the maternal mortality rate

Maternal mortality ratio (only facility mortality ratio)

DHIS 60.2/100K 70/100k

Proportion of births attended by skilled health personnel (Use delivery in facility as proxy indicator)

DHIS 74.5% 87%

Goal 6:

Combat HIV and

Have halted by 2015, and begin to reverse

HIV prevalence among 15- 19-year-old pregnant women

National HIV Syphilis

Not reported according to ages.

Difficult to set a target


32 | P a g e

MDG Target Indicator Provincial progress 2013/14

Source of data District progress 2013/14

District targeted progress 2014/15

AIDS, malaria and other diseases

the spread of HIV and AIDS

Prevalence Survey of SA

HIV prevalence among 20- 24-year-old pregnant women

National HIV Syphilis Prevalence Survey of SA

Not reported according to ages.

Difficult to set a target

Contraceptive prevalence rate (use Couple year protection rate as proxy)

DHIS 32.7% 50%

TB Cure Rate ETR.Net 72% 83.3%


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9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA)

The National Development Plan 2030 was adopted by government as its vision for the health sector. It will be implemented over three electoral cycles of government. The MTSF 2014-2019 therefore finds its mandate from National Development Plan 2030. Table 10: (NDoH): Alignment between NDP Goals 2030, Priority interventions proposed by NDP 2030 and

Sub-outcomes of MTSF 2014-2019

NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)

Average male and female life expectancy at birth increased to 70 years

a. Address the social determinants that affect health and diseases d. Prevent and reduce the disease burden and promote health

HIV & AIDS and Tuberculosis prevented and successfully Managed Tuberculosis (TB) prevention

and cure progressively improved;

Maternal, infant and child mortality reduced

Prevalence of Non-Communicable Diseases reduced by 28%

Maternal, infant and child mortality reduced

Injury, accidents and violence reduced by 50% from 2010 levels

Health systems reforms completed

b. Strengthen the health system

Improved health facility planning and infrastructure delivery

Health care costs reduced

c. Improve health information systems

Efficient Health Management Information System for improved decision making

h. Improve quality by using evidence

Improved quality of health care

Primary health care teams deployed to provide care to families and communities

Re-engineering of Primary Health Care


34 | P a g e

NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)

Universal health coverage achieved

e. Financing universal healthcare coverage

Universal Health coverage achieved through implementation of National Health Insurance

Posts filled with skilled, committed and competent individuals

f. Improve human resources in the health sector g. Review management positions and appointments and strengthen accountability mechanisms

Improved human resources for health

Improved health management and leadership

The NDP 2030, together with the MTSF 2014-2019, forms the umbrella goals for the health sector. These goals are specific but also generic enough to allow District management to develop their own plans in order to achieve the health sector goals but also incorporate priorities, which respond to localised challenges


35 | P a g e

10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS

IMBALANCE IN SERVICE DELIVERY PLATFORM:

District health services are provided at five district hospitals with 56 PHC Facilities including

four gateway clinics and 17 mobile clinics servicing 251 points. Multi-sectoral Teams from

District hospitals are supporting PHC Facilities which relieves congestion in OPD. Five clinics

(Mbazwana, KwaMsane, Jozini, Sipho Zungu and Ndumo) offer 24 hour open door services;

36 clinics offer after hours on-call services; seven clinics do not offer on call services and

delivery services due to lack of space; four do not offer on call services due to shortage of

staff; four gateway clinics are open from Monday to Friday, but do not offer after hours on-

call services. Maputa clinic has been regarded as a gateway clinic whereas in reality it is a

day clinic. Maputa clinic has started to operate on weekends and extended hours of

operation from 16H00 to 18H00 in August 2014 and this has decreased number of patients in

OPD. This is the best practise of decongesting OPD by ±20 patients per day. The full

comprehensive package of services is not offered at all clinics due to space constraints.

Mpembeni clinic was established as a cost centre in April 2014 which will improve spending

patterns in terms of COE. Mobile teams have increased from 14 to 17 and points from 208 to

251 in the past three financial years. There has been a steady increase (4%) in total PHC

headcount, from 2 099 757 in 2011/12 to 2 194 114 in 2012/13, and 2 290 996 in 2013/14,

indicating an overall improved PHC access throughout the District.

The PHC supervision rate is fluctuating for past three years. In 2011/12 it was 97% and declined

in 2012/13 to 89%, in 2013/14 to 85%. Although the PHC supervision rate was high, the

outcome was not satisfactory, based on continuing quality and efficiency challenges

persisting in PHC facilities such as shortage of basic equipment, data quality, etc.

There are no CDCs, Satellites, MOUs and Health posts in the district. A Community Health

Centre (CHC) in Jozini Local Municipality is under construction; Mpophomeni clinic under

UMhlabuyalingana LM (Manguzi) and Hluhluwe clinic under The Big 5 False Bay LM are under

construction. The population under UMhlabuyalingana LM indicate fair distribution of PHC

facilities, but due to low density population not all clinics are within 10km radius. Hlabisa and

Mtubatuba LMs need additional clinics according to population. There are no mobile teams

under The Big 5 False Bay LM; this LM is serviced by Mtubatuba and UMhlabuyalingana LMs

mobile teams. 14 mobile points at The Big 5 False Bay are supported by Mseleni hospital and 3

supported by Mtubatuba LM mobiles, their data is inclusive under Mseleni and Mtubatuba


36 | P a g e

mobiles respectively. Construction of Mtubatuba CHC is on hold due to budgetary

constraints for the next MTEF period. Future planned clinics on the STP include construction of

Mpanzakazi and Mfekayi in Hlabisa and Emfihlweni in Manguzi.

PROBLEMS IN REFERRAL CHAIN:

There are no ward based outreach teams appointed as yet in the district, this compromises

supervision of CCGs. The referral system starts with Community Care Givers and Phila

Mntwana Centres which are based in the community. They refer to mobile clinics then

mobiles refer to fix PHC Facilities. PHC Facilities refer to district hospitals, hospital if necessary

refer to regional hospital. There is no Specialized and Regional hospital in the district which

poses a challenge in the transfer of emergency patients. Emergency patients are transferred

to Ngwelezane hospital and Obstetrics emergency referrals to Lower Umfolozi Memorial

hospital which is about 260 km (single trip) away and Inkosi Albert Luthuli hospital is about 410

km from Mosvold hospital.

The referral hospital for Mental Health Care Users is Ngwelezane which has got a Psychiatric

wing however, there is a space challenge at Ngwelezane and patients are referred to

Madadeni hospital which is about 500km away (single trip from Manguzi hospital). There are

cost implications in transfer to and back of these patients because sometimes there is only

one case that needs transfer.

On discharge of these patients again to fetch one patient at a time has high transport cost

implications

INTRA-DISTRICT REFERRAL:

Bethesda hospital - TOP and Colposcopy services

Manguzi hospital - MDR services for 4 hospitals except for Hlabisa hospital and TOP

services

Mosvold hospital - Cataract surgery

Mseleni hospital - Hip replacements

The services mentioned above are for the entire district.

STAFF MIX AND PROVISION OF CARE:

The district has a challenge in recruiting certain categories of staff; Medical Officers,

Pharmacists, Allied Professionals, Clinical Nurse Practitioners and Specialised Nurses. The

district has a high staff turnover which affects service delivery. Bursaries and training

programmes are offered to train staff and local youth to increase the pool of required skills.


37 | P a g e

Due to the rural nature of the district retention of some categories of staff remains a

challenge as they don’t honour their contractual obligation of serving back the number of

years trained. The hospitals rely on Community Service Officers for sustaining service delivery.

The vacancy rate for Doctors grossly increased from 9% (2012/13) to 32% (2014/15 Q1). At a

glance, the increased vacancy rate is misleading as the actual number of posts increased from 79

to 97 in this financial year. The district has reviewed the accommodation strategy and provided

more capacity building efforts to retain doctors.

Vacancy rate for Pharmacists improved from 42% (2012/13) to 35% (2014/15 Q1). This is attributed

to absorption of Bursary holders and retention of Community Service Pharmacists. The vacancy

rate for Pharmacist Assistants improved from 38% (2012/13) to 16% (2014/15 Q1), because Mosvold

and Mseleni hospitals have appointed 11 and 4 respectively.

There was a 6% vacancy rate of PNs in 2012/13, this increased to 9% in 2014/15, Q1.

DISTRICT HOSPITALS AND PHC INFRASTRUCTURE REVITILIZATION:

There is much improvement in infrastructure development in all district hospitals. New wards

and some of staff residences were constructed according to the specifications of DoH such

as paediatric ward, female ward and Doctors residence at Manguzi, theatre at Hlabisa,

Maternity ward at Mosvold, Peads ward at Bethesda and female and multi-disciplinary

therapy department at Mseleni. Clinics upgrade includes Gwaliweni, Gateway, Makhathini,

Ophansi, Bhekabantu, etc. Hlabisa hospital is under revitalization program.

The aesthetic improvement of some physical facilities has improved staff morale, infection

prevention & control and dignity of patients.

QUALITY OF CARE IMPROVEMENTS:

All facilities are implementing National Core Standards, Infection and Prevention control

policy and developing QIPs (Quality Improvement Plans). Bethesda and Manguzi were

assessed by the Office of Health Standards Compliance and they scored above 70% which is

a remarkable milestone in rural hospitals. There is still a challenge in gap assessments and

implementation of quality improvement plans in all hospitals which needs strengthening. Five

hospitals were assessed in 2013/14 and were all found compliant in IPC.

There is a still a challenge in the implementation of National Core Standards in PHC facilities

and this is attributed to poor supervision and unavailability of basic equipment that is not in

the provincial PHC equipment list e.g. defibrillator. Four clinics (Mboza, Mnqobokazi and


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Zamazama) were visited by office of Health Standards Compliance. Mboza scored 58%;

Zamazama scored 51%, Mnqobokazi scored 43% and Mabibi scored 43%

Complaints mechanism is a challenge at PHC facilities because of complaint boxes not

opened, and when opened not resolved despite support visit. Continuous monitoring will be

conducted to ensure that suggestion boxes are opened at least monthly and complaints

should be resolved within 25 days. The Operational Managers to take full responsibility.

PUBLIC/PRIVATE INTERACTIONS In the past three financial years Umkhanyakude has been supported by various development

partners concentrated on Health Systems Strengthening, and Priority programs. This has

assisted the district in trainings for certain programs and improvement in some indicators e.g.

TB cure rate, ANC 1st visit before 20 weeks, Orientation on data management, MMC uptake,

PMTCT dashboard indicator monitoring, nurses trained on NIMART initiation, etc.

TUBERCULOSIS (TB)

TB treatment outcomes have improved over the last three financial years due to improved

management and monitoring of the programme. The TB cure rate for the district has slightly

improved from 71% in 2011/12, 68% in 2012/13 to 72% in 2013/14. The TB death rate slightly

decreased from 6.3% in 2011/12, 3.9% in 2012/2013 and 4.7% in 2013/14. The increase of new

MDR confirmed cases from 198 in 2011/12 to 284 in 2012/13 and 328 in 2013/14 is attributed to

improved active detection and surveillance, attributed to the use of the GeneXpert

machine; improved data management; and increase in primary MDR cases. MDR-TB patients

began to be initiated on treatment at Hlabisa Hospital in June 2013.

MATERNAL CHILD AND WOMEN’S HEALTH (MCWH)

The district continues to improve in MCWH indicators. The maternal mortality trend declined

from 68/100 000 in 2011/12, 95.3/100 000 in 2012/13 to 60/100 000 in 2013/14. The ‘1st ANC

attendance before 20 weeks rate’ improved from 48% in 2011/12, 54% in 2012/13 and 61% in

2013/14. Under-1 year facility mortality decreased from 8/1000 in 2011/12, 10/1000 in 2012/13

and 8/1000 in 2013/14. Child under-5 years facility mortality rate was 66/1000 in 2011/12 then

decreased to 59/1000 in 2012/13 and 51/1000 in 2013/14.


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The decrease in child mortality under-1 year is attributed to:

implementation of new PMTCT guidelines,

ESMOE trainings, emergency obstetric drills and continuous monitoring of the

programme.

A slight improvement is noted in vitamin A supplementation for children 12 to 59 months,

which was 30.3% in 2011/12, 33.9% 2012/13 and 51.1% in 2013/14. There is still a challenge in

administering vitamin A to children in pre-schools and crèche’s. The Phila Mntwana

Campaigns should improve vitamin A uptake and detection of malnutrition. There are still

areas that are affected with severe malnutrition within the district. Severe malnutrition case

fatality rate under 5 years was 8.2/1k in 2011/12, increased to 9.2/1k in 2012/13 and

decreased in 2013/14 to 5.6/1k.

HIV AND AIDS

The district is still having a challenge of Antenatal HIV prevalence which is very high for the

past three years in the District being 41.9% in 2011/2012, 41.1% in 2012/13 and 35.2%in 2013/14.

All five hospitals and All 56 clinics are now implementing the 3-TIER Strategy. 53 Clinics have

been signed off on TIER.net. All PHC clinics have at least one nurse trained on NIMART and all

are initiating. The total number of patients on ART continued to increase from 43 332 in

2011/12, 53 373 in 2012/13 to 58 643 in 2013/14.

In total 236 (2012/13) PNs have been NIMART trained in the district. In 2013/14 additional 144

PNs were trained on NIMART.

The STI programme management remains a challenge in the district. The incidence of STI

remains high at 84/1k in 2011/12, 80/1k in 2012/13 and 84/1k in 2013/14. The STI partner

treatment rate has increased from 14% in 2012/13 to 14.9% in 2013/14. Condoms are

distributed by the health facilities, and through private distributers. Total number of condoms

distributed in 2013/14 is 3 852 193 by health facilities and private distributers.

Mkuze High Transmission area (HTA) site is functional and Mtubatuba HTA is not yet functional.

The district has never reached MMC target set by the Province. Male Medical Circumcision

numbers are increasing with the support from partners. From 3 890 circumcisions performed in

2011/12, 6 275 were performed in 2012/13 and10 153 for 2013/14. Mobilisation strategies need

to be reviewed.


40 | P a g e

NON COMMUNICABLE DISEASE:

In line with output 1 of the NSDA, the district provides services to promote a healthy lifestyle,

prevent, detect early and manage non communicable diseases. There is a very slight

decrease in the incidence of hypertension over the past three years. In 2011/12 it was

25.9/1000(2737), 24.5/1000(2622) in 2012/13 and 22.2/1000(2588) in 2013/14. The incidence of

diabetes mellitus in 2011/12 was 08.3/1000(545), 0.63 /1000(423) in 2012/13 and 0.8/ 1000(527)

in 2013/14. Whilst the incidence of diabetes mellitus seems to be fluctuating, the number of

diabetic amputations is escalating. In 2011/12 there were 15, 17 in 2012/13 and 25 in 2013/14.

The increase could be attributed to late case detection and sub optimal management. The

district needs to strengthen promotion of healthy lifestyle.

There are two sight saver sites in the district, one at Hlabisa and The other at Mosvold. There is

one Ophthalmic Medical officer who roves between the two sites for cataract surgery. The

Cataract Surgery Rate in 2011/12 was 679/1mil, 735/1mil in 2012/13 and 798/1mil in 2013/14.

DISABILITY & REHABILITATION:

The District continues to offer disability and rehabilitation services. There has been a steady

increase of people with disabilities accessing disability services for the past three years from

63 544 in 2012/13 to 71 783 in 2013/2014. Issuing of hearing aids was 174 in 2011/2012 and

decreased to 80 in 2012/2013 financial year, this was due to shortage of audiologists in the

district. In 2013/2014 financial year the number of hearing aids issued increased to 316 due to

an increase number of community service audiologists in the district. The issuing of

wheelchairs also continued to increase from 322 in 2011/2012 to 480 in 2012/2013 due to an

improved procurement processes and a huge backlog at Hlabisa hospital. In 2013/2014

financial year there was a decrease in the issuing of wheelchairs to 387. The district has six

functional wheelchair repair sites which help in recycling of wheelchairs. The recruitment of

permanent appropriate Rehabilitation Therapists staff of all 4 categories in all District hospitals

remains a major challenge especially of Audiologists and therapy assistants due to difficulty in

recruiting this category and one year program is being offered for Therapy assistants to be

bridged as Therapy Technicians. Bursaries are also offered for prospective candidates.

Physical accessibility still remains a challenge especially in PHC Facilities and several toilets for

the disabled were non-functional due to poor maintenance. It needs to be prioritised on

annual maintenance plans. There are only two Community based Rehabilitation workers

(CBRs) in the district as per Disabled Persons’ South Africa (DPSA) and Department of health

Service Level Agreement; one based at Kwa-Ngwanase and Mtubatuba Municipalities.

Ideally each Local Municipality will need to have one CBR as these two CBRs are unable to


41 | P a g e

service the whole district. The district will continue to liaise with the Provincial office to review

this issue.

MALARIA:

The District is moving towards elimination of Malaria with an incidence of 0.33/1000

population per year. A threat to malaria control in the District is the cessation of insecticide

spraying on the Mozambique side of the border, as well as the emergence of mosquito

resistance to insecticides. Increased entomological surveillance is required with an improved

insectary at Malaria Control and this matter has been referred to entomologist. The current

first line treatment of malaria, artemether-lumefantrine still appears to be effective, supported

by an audit of its efficacy in 2012. Malaria elimination in South Africa is aimed for 2018.

Malaria case fatality rate was 1 % in 2011/12, 1% in 2012/13 and 1.9% which indicates that

there are still clients that delay in seeking medical help. Indoor spraying coverage has

decreased over the past 3 years due to certain individuals refusing to have their houses

sprayed. The coverage has decreased from 93% in 2011/12, 82% in 2012/13 and 75% in

2013/14.

EMERGENCY MEDICAL SERVICES (EMS):

EMS response time has not improved in the past three years, contributing to adverse events

and negative publicity. Poor road infrastructure further hinders response time. The District has

18 operational ambulances but the response time is not improving. Response time is presently

29% ambulances arriving within 60 minutes. The Turn-Around-Strategy was developed but

EMRS challenges are persistent.

INFRASTRUCTURE:

Unreliable water supply, especially in Bethesda, Mosvold, Hlabisa and some of their clinics

contributes to service delivery challenges, including non-functioning laundry, X-ray and

autoclaving machines. Lack of water also increases likelihood of machine breakdown,

increased staff overtime with unbudgeted costs.

An improvement is noted in delivery of capital projects; however, there are still backlogs,

especially with clinic building, including Mtubatuba CHC, Ezibayeni and Mpembeni clinics.

HUMAN RESOURCES

The overall vacancy rate has improved from 20% in 2011/2012 to18% 2012/13 and to 14% in

2013/14. Although this indicates improvement but the challenge still remains in the


42 | P a g e

recruitment of critical (Artisans) and clinical personnel (Pharmacists, Medical Officers). There is

high staff turnover in the district which compromises service delivery. HR assessments were

conducted which revealed dissatisfaction on management style and social personal

problems to be the leading causes of staff turnover. Turnaround strategies have been

developed and their implementation to be monitored.

There is increased absenteeism due to ill health of staff that ends up in prolonged sick leave

which affects service delivery and high COE for staff that does not render services as was

appointed to. Staff wellness programmes are implemented in all hospitals and PILLIR

procedures to be implemented.

The total of 129 employees benefited on training programmes in 2011/12 and massively

improved to 781 in 2012/13 and 415 in 2013/14.Theses training programmes are intended to

capacitate the employees to improve service delivery.

19 Local youth has been awarded prospective bursaries to study Health sciences in SA and

35 Cuban Doctors bursaries have been awarded in 2012, 17 prospective bursaries, 27 Cuban

Doctors bursaries awarded in 2013 and 6 prospective bursaries, 12 Cuban Doctors bursaries

and 3 Manipal Phase 1 bursaries have been awarded in 2014. These bursaries are intended to

increase the pool of the required skills that are currently scarce to improve service delivery.

Although training of Local youth is seen as a solution in retaining staff, some of them fail to

honour their contractual obligation due to departmental policy on bursary holders. This

matter has been brought to the attention of the department.

The district managed to retain 12 bursary holders in 2012, 7 in 2013 and 21 in 2014.

29 CCGs have been trained as Nutritional advisors in 2012 and 26 in 2014 and all clinics have

one nutritional advisor.

FINANCE:

The district spent 100.09%, 100.01% and 100.81% in 20011/12, 2012/13 and 2013/14

respectively. This is attributed to regular movements of funds and balancing of expenditure.

1% of the allocation was for Management, 47% for PHC and 52% for District Hospitals in

2013/14. There has been an increase in percentage spent by PHC from the district total

expenditure (45% in 2012/13 to 47% in 2013/14), this improvement is noticeable, but it could

be more than this if journaling and staff linking was accurate.


43 | P a g e

There has been a slight increase in cost per headcount in the past three years (R94, R97 and

R108 in 2011/12, 2012/13 and 2013/14 respectively. Expenditure per PDE shows an increase

when comparing the past three years; R1 295 in 2011/12, R1 539 in 2012/13 and R1 675 in

2013/14.

Medical supplies are high cost driver at R45.90 followed by medicines at R36.80 in the non-

negotiable items. This is attributed to unavailability of storage space, poor stock

management and journaling. Continuous training and support are conducted to all

institutions with a minimal change. Computerised stock management system will be

introduced.

The district is still struggling with the linking of staff especially in nursing category where Nurses

are allocated under PHC facilities and their salaries paid from hospitals. Finance and HR

sections are not informed about these movements so as to channel expenditure accordingly.

This gives a skewed picture in terms of expenditure management. Collaboration between HR,

Finance and Nursing management needs to be strengthened.

DATA MANAGEMENT

Data quality remains a challenge in the district despite trainings and support given to health

facilities. The information management teams meet infrequently. The data quality audits

reveal that there is poor understanding of certain data elements and data collection tools

are not used. 44/56 clinics have data capturers. Training of PHC Operational Managers has

been conducted. A plan is to train all Operational Managers and Area Managers at hospitals

in Monitoring and Evaluation.

25 Data capturers have been trained by Enhance Strategic Information (ESI) on DHIS, data

quality and indicators.

PHC RE-ENGINEERING DISTRICT CLINICAL SPECIALIST TEAM (DCST)

The District has so far appointed four members of the DCST: Specialist Family Physician,

Specialist Midwife, Primary Healthcare Nurse, and Specialist Paediatric Nurse. There have

been no applicants for the posts of Obstetrician, Paediatrician or Anaesthetist. Three of the

first-appointed team members underwent induction training.


44 | P a g e

SCHOOL HEALTH TEAMS School health teams in the District have increased from five to ten, each containing two-

three nurses. Seven school health teams are linked to PHC facilities. Clinics have school health

components in their structure but lack transport for school health nurses to travel to schools

from clinics. Vehicles are presently a limiting factor for proper functioning of school health

teams as there is no budget for school health team vehicles. Motivation for vehicles budget

will be sent to Head Office by the District. It is hoped that these teams can reduce teenage

pregnancy and HIV infection in teenagers, particularly females. The introduction of the HPV

vaccine has increased the awareness of cervical cancer to learners and parents.

COMMUNITY CARE GIVER (CCG) PROGRAMME

The number of Community Care Givers has increased from 686 in 2011/12 to 749 in 2012/13

and 783 CCGs in 2013/14.The increase is not according to the demand of the programme

because of limited budget. All 68 Municipal wards have CCGs but some areas do not have

CCGs as 1 CCG is allocated 60 homesteads .Over the past 3 years 125 CCGs were career

pathed as enrolled nurses and 22 as Enrolled Nursing Assistants.55 CCGs were career pathed

as Nutritional Advisors They are performing community health functions including: home

based care, community profiling, and referral of pregnant women to health facilities, vitamin

A administration and administration of directly observed treatment (DOT) of tuberculosis

medication. They attend weekly war-rooms at ward level. The TB cure rate and vitamin A

coverage in the District has improved in recent years due to their involvement. Antenatal

booking rate before 20 weeks gestation has also improved. CCGs are also allocated to work

in Phila Mntwana centres where they weigh babies, administer vitamin A and do health

education. The appointment of CCG is centrally done at the District Office which poses a

challenge in the management of their HR related matters such as leaves and service

termination. Proposal has been made to Head Office to link the CCGs to their mother

hospitals.

FAMILY HEALTH TEAMS:

No family health team has yet been appointed in the district and no vehicles allocated for

the service. A family health team consists of a PN, clinical nurse practitioner, EN, ENA, and six

CCGs per team. It is planned to appoint five teams in the District in the 2014/15 financial year.

The teams are intended to provide healthcare in the community.


45 | P a g e

10.1 INTRA DISTRICT EQUITY IN THE PROVISION OF SERVICES

Table 11 (NDoH 6): PHC Expenditure

Sub-District PHC Expenditure / Uninsured Capita

PHC Utilisation Rate Patient to PN Provincial clinics

% Share of District Population

Hlabisa LM R259.70 3.0 7 224.2 11%

Jozini LM R417.10 3.7 5 286.4 30%

Mtubatuba LM R346.60 3.1 6 869.8 28%

The Big 5 False Bay LM R412.20 3.6 6 830.7 6%

UMhlabuyalingana LM R514.80 4.2 5 343.8 25%

District R390.08 3.6 7 250.0 100%

Source: DHER 2013/14 Customised District Report, DHIS

Graph 5: Equity of resources vs population and headcount – 2013/14


UMhlabuyalingana LM has the highest PHC expenditure per uninsured population (R514.8),

utilization rate of 4.2 and cost per headcount (R116.40) compared to Hlabisa with the lowest

PHC expenditure per uninsured population (R259.7), lowest cost per headcount (R82.5) and

lowest utilization rate of 3. This shows that UMhlabuyalingana LM has more focus on PHC than

district hospital.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

% Share of PN's % Share of Population % Share of Expenditure % share of PHC headcount


46 | P a g e

There are still instances of staff deployment from Hospitals to PHC facilities for service delivery

demands and vice versa due to poor communication about staff allocation. This results in the

number of filled posts not matching with the number of actual staff working in the facilities.

This is problematic since it skews the expenditure which requires constant journaling. The main

reason for staff deployment is poor management. This happens in all cadres of staff but

nursing being the mostly affected component. Working relationships between Finance, HR

and component Managers especially nursing must be encouraged as this is not happening

at institutions. Unfreezing and filling of posts to be done to ensure proper allocation of staff.

The above graph indicates low % share PN in Hlabisa (7%) compared to population,

expenditure and headcount. It must be taken to account that Mpembeni clinic is completely

staffed by Hlabisa hospital nurses and journaling not done.

Jozini and UMhlabuyalingana LMs have high % share PN (31.3% and 31.6% respectively)

compared to population and headcount, but a little bit more expenditure due to

demographics and topography. Mtubatuba LM has high population with low % expenditure

due to population density that may be corrected with the construction of the CHC in future.

The Big 5 False Bay has a relatively low expenditure compared to population and headcount,

but that will be corrected by the opening of Hluhluwe clinic in the near future.

Proper linking of staff as per staff establishment is recommended and implementation of

Workload Indicators of Staffing Needs (WISN).


47 | P a g e

Table 12 (NDoH 7 (a)): Number of patients to staff type (Sub-District) – PDoH PHC Clinics

Sub-District

Adm

inist

rat

or

Clin

ical

Sta

ff O

ther

Cou

nsel

lor

Data

C

aptu

rer

Gen

eral

W

orke

r /

Cle

aner

Med

ical

O

ffice

r

Nurse

As

sista

nt

Phar

mac

ist

Assis

tant

Ba

sic

Phar

mac

ist

Assis

tant

Po

st Ba

sic

Phar

mac

ist

Prof

essio

nal

Nurse

Staf

f Nur

se

Spec

ialis

t

Hlabisa LM 36 121.0 0 11 287.8 60 201.7 20 067.2 0 90 302.5 0 0 0 7 24.2 5 826.0 0

Jozini LM 81 561.9 0 15 430.6 51 903.0 21 145.7 0 28 547.7 0 0 0 5 286.4 5 437.5 0

Mtubatuba LM 47 464.4 0 15 356.1 47 464.4 30 712.2 0 174036.0 522 108 0 0 6 869.8 7 566.8 0

The Big 5 False Bay LM

43 261.0 0

21 630.5 6 4891.5 43 261.0 0

6 4891.5 0 0 0

6 830.7 7 210.2 0

UMhlabuyalingana LM

80 157.1 0

12 197.8 35 068.8 12 197.8 0

35 068.8 0 0 0

5 343.8 5 906.3 0

District 71 593.6 0 16 722.6 545261.1 22 683.1 0 57 274.9 2 290 996 0 0 5 862 7 687.9 0


The above table indicates a huge discrepancy amongst sub-districts and in all categories of staff. It is difficult to compare because of

unavailability of staffing norms; fast tracking of WISN implementation could assist. Nevertheless Jozini and UMhlabuyalingana have high patient

to Admin staff ratio compared to other sub-districts, because of the lack of support staff at PHC facilities. High patient to Counsellors, Data

Capturers and General Worker’s ratio at The Big 5 False Bay will be improved with the opening of Hluhluwe clinic.

There are 5 Pharmacist Assistants in the clinics one at KwaMsane clinic in Mtubatuba LM and four appointed at Mosvold clinics under Jozini LM.

The province is planning to create Pharmacist Assistants post in remaining PHC facilities. The patient to PN ratio is high at Hlabisa LM however this

is not taking into account PNs deployed from the hospital. Mtubatuba LM has high patient to SN ratio, but again these officials are deployed at

clinics by Hlabisa hospital. There are NAs at some clinics throughout the district, but their scope of practice is limited.


48 | P a g e

There are reviewed PHC structures but budgetary constraints hinders filling of posts. PHC support expenditure (COE) is linked to hospital but

render services to clinics, but all other goods and services items e.g. transport are paid from district hospital. This is not giving the true picture of

goods and services expenditure and it affects planning and budgeting. It is recommended that cost centre management be improved to allow

accurate costing of all PHC activities.

Table 13 (NDoH 7 (b)): Number of patients to staff type (Sub-District) – CHC’s

Sub-District

Adm

inist

rato

r

Clin

ical

Sta

ff O

ther

Cou

nsel

lor

Data

C

aptu

rer

Gen

eral

W

orke

r /

Cle

aner

Med

ical

O

fficer

Nur

se

Assis

tant

Phar

mac

ist

Assis

tant

Ba

sic

Phar

mac

ist

Assis

tant

Pos

t Ba

sic

Phar

mac

ist

Prof

essio

nal

Nurse

Staf

f Nur

se

Spec

ialis

t

Sub-District 1

Sub-District 2


Note: There are no CDC’s operational in KwaZulu-Natal. Note: There are no Stand-Alone MOU’s in KwaZulu-Natal.


49 | P a g e

Table 14 (NDoH 8): Population to Staff per sub-district – 2013/144

Sub-District Population to Medical Officers Population to Professional Nurses

Total Population Uninsured Population Total Population Uninsured Population

Hlabisa LM 12 021 11 552 415 399

Jozini LM 5 817 5 590 760 730

Mtubatuba LM 0 0 2 360 2 268

The Big 5 False Bay LM 0 0 1 904 1 830

UMhlabuyalingana LM 5 076 4 878 571 549

District 6 935 6 664 798 766


Note: The National Table A12 has been combined to incorporate both Medical Officers and Professional Nurses.

Hlabisa LM has the lowest ratio of Medical Officers compared to UMhlabuyalingana LM. Hlabisa employed eight sessional Doctors who only take

calls and work on weekends instead of appointing full time doctors. This has a negative impact on clinical service delivery like medical coverage

at clinics and continuity of care. There is a need to review the appointment of Sessional Doctors in the district.

Hlabisa has the highest number of PNs 154, some of these PNs are allocated at PHC facilities to sustain services and the expenditure is not the

true reflection because they get paid from the hospital budget. This number is inclusive of Operational Managers. There is an improvement in

staffing compared to previous years and improved health outcomes like decreased Maternal Mortality Rate (MMR) and improved TB cure rate.

However there is a need of staffing norms for appropriate interpretation of the tables.

There are 125 PNs per 100 000 population in the district, this is lower than 2013 figures for KZN Province of 171 PNs per 100 000 population and is

lower than the National average which is at 147 PNs per 100 000. (Source: http://indicators).

4 District hospital plus PHC


50 | P a g e

11. ORGANISATIONAL ENVIRONMENT

11.1 ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM

The post of Hospital Manager at Mseleni remains vacant, having been so since 2010. It is in

the process of being filled and there is hope of attracting a suitable candidate because the

requirements cover a wide spectrum of health professionals.

The District Clinical Specialist Team (DCST) is still incomplete, requiring an obstetrician,

paediatrician and anaesthetist. The Manager: Medical Service: Senior is acting as the DCST

Family Physician.

The post of Manager Emergency Medical Services (EMS) is presently vacant, having been

vacated in December 2013. EMS is a vertical programme and the District Office provides

oversight.


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11.2 HUMAN RESOURCES

The 2015/16 to 2017/18 Human Resource Plan has the following priorities:

- To reduce skills shortage for the clinicians and critical skills e.g. the artisans (review and

implement employee retention strategies)

- To strengthen the capacity of employees in the district through HRD initiatives

- To strengthen leadership and governance by training and mentoring

- To reduce high absenteeism and increased labour turn over

- To recruit and fill critical post including non-clinical post according to the approved

structure

The district had a challenge in recruiting and retaining clinical and critical support staff, which

is still persistent in this financial year. This was more evident in recruitment of DCST, PHC

Outreach and School health teams, Pharmacists, Artisans, Specialized Nurses, Clinical Nurse

Practitioners, Medical Officers (especially at Hlabisa hospital) and Allied Health Professionals.

There is an uneven distribution of Community Care Givers and there is no coordination

between DoH and DSD- CCGs. Regular audits on the implementation of PHC and District

hospital service delivery packages are not done.

It is difficult to address staff shortage since staff is not properly placed according to staff

establishment (see annexure B). Necessary corrective measures such as correct linking of

staff, training programs, bursaries and recruitment will be instituted.

Organisational review has been done but it is not realistic since it’s a one size fits all. Individual

institutional assessments were not conducted resulting in the organisational structure not

talking to the organisational needs in terms of service demands. It has a lot of medical

specialist’s posts, Medical Officers posts and inadequate PNs posts for wards coverage yet all

wards should be under the PNs supervision. Budget limitations stagger the process of creating

and filling of posts thus resulting in high overtime expenditure. There are delays in migration of

staff from the old hospital organizational structures to the new (head office is facilitating the

process). There is no consistency in the filling of high level posts in the institutions which results

in cost inefficiency and affects service delivery.

There is a small margin of extra capacity to allow the district to absorb additional patients

activity at all levels of care. The high turnover of staff put the district at higher risk.


52 | P a g e

The district has a high labour turn-over rate in certain categories of staff e.g. Doctors,

Professional Nurses, Allied Health Professionals and District Office Staff. This affects service

delivery in that there is no consistency, continuity, and reliability in the provisioning of the

health services. The exit interviews should be strengthened to determine and address main

concerns.

While the district has taken the initiatives to train several speciality nursing posts such as PHC

nurses, advanced midwives, theatre nurses, paediatric nurses and orthopaedic nurses, and

more capacity building efforts to retain doctors, long term retention still remains a challenge.

The district is creating opportunities for career-pathing. Thus far, 125 CCGs have been trained

as ENs, 22 as ENAs and 55 as Nutrition Advisors. Mseleni Hospital is offering courses for Enrolled

Nursing Assistants to be capacitated as Enrolled Nurses. Hlabisa and Bethesda Hospitals are

offering bridging courses for Enrolled Nurses to be trained as Registered Nurses.

A number of training programs have been conducted to capacitate managers on

leadership and governance. This includes the Advanced Management and Development

Program (AMDP), Khaedu, Albertina Sisulu Training Program, Evidence Based Decision

Making, APSTAR and Mentoring for Growth.

Absenteeism is a continued challenge as there is a weak system regarding leave monitoring

at Hospitals and PHCs. This has been worsened by the disease profile of the staff which is

suffering from chronic diseases and HIV/AIDS. More staff is sickly thus increase absenteeism.

Strategies to be implemented to reduce high absenteeism include strengthening of

Employee Assistance Programme (EAP), Employee Health and Wellness Programme,

Improved management and supervision with emphasis on the EPMDS, timeous

implementation of PILIR for prolonged sicknesses and institute disciplinary measures for

unauthorized absence.


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Table 15: Patient to Staff type Ratio in Facilities [per 10 000] – Provincial Clinics

Sub-Districts MO to Patient Provincial Clinics

PN to Patient Provincial Clinics

EN to Patient Provincial Clinics

ENA to Patient Provincial Clinics

Data Capturer to Patient Provincial Clinics

General Worker to Patient Provincial Clinics

Hlabisa LM 0 7 224.2 5 826.0 90 302.5 60 201.7 20 067.2

Jozini LM 0 5 286.4 5 437.5 28 547.7 51 903.0 21 145.7

Mtubatuba LM 0 6 869.8 7 566.8 174 036 47 464.4 30 712.2

The Big 5 False Bay LM 0 6 830.7 7 210.2 64 891.5 64 891.5 43 261.0

UMhlabuyalingana LM 0 5 343.8 5 906.3 53 068.8 35 068.8 12 197.8

District 0 5 862 7 687.9 57 274.9 545 261.1 22 683.1


The table indicates that there are no Medical officer’s posts at the PHC facilities but Medical

officers employed at district hospitals are visiting PHC facilities. The district needs to create

Medical Office’s posts under PHC support. Hlabisa, Mtubatuba and The Big Five False Bay

need to employ more PNs. Mtubatuba and The Big Five False Bay need to appoint more ENs.

All LMs except for UMhlabuyalingana needs to appoint more Data Capturers.

Table 16: Cost per Headcount in relation to Workload

Sub-Districts and District Total Staff Cost per PHC Headcount

PN Workload Patient to Staff ratio at Provincial Clinics - PN

Hlabisa LM R50.55 52.5 7 224

Jozini LM R76.70 50.7 5 286

Mtubatuba LM R79.12 48.8 6 870

The Big 5 False Bay LM R71.16 39.3 6 831

Umhlabuyalingana LM R85.56 39.9 5 344

District R77.08 46.0 5 862


The above table indicates that Hlabisa has the lowest COE cost per headcount, high PN

workload and high patient to PN ratio This implies that Hlabisa LM requires more PNs, however

the COE for some PNs are incurred by the hospital in some clinics. Moreover the full

complement of Mpembeni staff is from Hlabisa hospital. This is being currently corrected as

there is a signed staff establishment and staff will be appointed. Jozini and Mtubatuba LMs

need to employ more PN to bring their workload to be in line with the Provincial norm of 35 –

40.


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Table 17: District Hospital Staff to PDE Ratio

District Hospital

Total Medical Staff to PDE ratio

Total Nursing Staff to PDE ratio

Total Pharmacy Staff to PDE ratio

Total Clinical Staff to PDE ratio

Total Support Staff to PDE ratio

Bethesda Hospital 3011.1 312.6 6356.7 2383.7 440.1

Hlabisa Hospital 5851.4 331.6 7105.2 6217.1 588.6

Manguzi Hospital 4649.5 340.6 9298.9 3099.6 726.5

Mosvold Hospital 4945.2 329.7 5325.6 3461.7 438.2

Mseleni Hospital 3992.4 292.5 6787.1 3572.2 449.5 Source: DHER 2012/13 Customised District Report

The above table indicates adequate Pharmacy staff to PDE ratio at Mosvold hospital

compared to Manguzi hospital. The district hospitals need to employ at least one Pharmacy

supervisor and more Pharmacist assistants. According to the new structure Assistant Manager:

Pharmaceutical Services has been replaced by Deputy Manager Pharmaceutical Services

which would assist in attraction and retention of staff.

Hlabisa has the lowest ratio of Medical Officers compared to Bethesda hospital. Hlabisa

employed eight sessional Doctors who only take calls and work on weekends instead of

appointing full time doctors. This has a negative impact on clinical service delivery such as

medical coverage at clinics and continuity of care. There is a need to review the

appointment of Sessional Doctors in the district.

Mosvold and Bethesda are well staffed with Administration Support staff and Manguzi has

least. Mseleni appears to be well staffed in nursing staff compared to Manguzi.

Hlabisa has the lowest Allied Clinical staff to PDE compared to Bethesda who seems to be

well staffed. Hlabisa must employ more Allied Health Professionals.

Hlabisa has the highest number of PNs (154), some of these PNs are allocated at PHC facilities

to sustain services and the PN to PDE ratio is not the true reflection. This number is inclusive of

Operational Managers.

Over all for the district there is an improvement in staffing compared to previous years and

improved health outcomes like decreased Maternal Mortality Rate (MMR) and improved TB

cure rate. However there is a need of staffing norms for appropriate interpretation of the

tables.


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12. DISTRICT HEALTH EXPENDITURE

Table 18 (NDoH 9): Summary of District Expenditure

Data element (Budget, Province) (Budget, Transfer to LG) (Budget, LG Own) (Expenditure,

Province) (Expenditure, Transfer to LG)

(Expenditure, LG Own)

DF - 2.1: District Management 10 605 000 0 0 10 799 016 0 0

DF - 2.2: Clinics 247 452 000 0 0 247 334 420 0 0

DF - 2.3: Community Health Centres

0 0 0 0 0 0

DF - 2.4: Community Services 0 0 0 0 0 0

DF - 2.5: Other Community Services

141 182 000 0 0 140 432 723 0 0

DF - 2.6: HIV/AIDS 187 431 000 0 0 186 746 261 0 0

DF - 2.7: Nutrition 3 328 000 0 0 3 327 630 0 0

DF - 2.9: District Hospitals 636 481 000 0 0 647 730 390 0 0

DF – 2.12: Donor Funding 0 0 0 0 0 0

Source: DHER 13/14 District Customised Template The district slightly overspent overall by 0.8% (R9 891 440). This mainly occurred in District Hospital line under Goods and Services which could be

attributed to poor stock management and on transfers due to unpredictable exits. Poor stock management will be addressed through

implementation of electronic system and continuous training will be conducted. The hospitals overspent by R11 249 390 (1.8%) because of some


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payments for clinics (PHC management, PHC Support & School Health Services) borne by hospitals. Community Health Clinics have been

underspending for the past 3 years which is a great concern. Clinics grossly underspent in minor assets especially under Equip <R5000: Medical &

Allied and domestic equipment. This could be attributed to delays in obtaining specifications from Health Technology Services (HTS) and delays

in approval of prohibited items by Provincial Office. It is worth mentioning that the PHC Operational Managers, PHC Supervisors and SCM officers

are contributing towards underspending because of lack of management skills and accountability. PHC Operational Managers were trained in

M&E; hopefully this training will improve their scope of supervision. The introduction of Rx Solution (stock management system), in-service training

and continuous monitoring will be conducted. The Provincial Office is in a process of creating posts for Pharmacist Assistants at PHC level which

will assist in medicine stock management. Hospitals are issuing stock to clinics and journaling of expenditure to PHC facilities not accurately

done. A team that is going to monitor PHC functioning has been proposed.


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Table 19 (NDoH 10): Capita PHC expenditure per sub-district – 2013/14

Sub-Districts and District

Total Expenditure

Population District Service Delivery

PHC Expenditure / Capita (Total Population)

PHC Expenditure / Uninsured Capita

% Uninsured population compared to District

% Expenditure compared to District

Cost per Uninsured Capita 2011/12

Cot per Uninsured Capita 2012/13

Hlabisa LM R18 234 152 R701 R259.70 11% 7% R583 R511.6

Jozini LM R76 149 277 R791 R417.10 30% 31% R490 R347.2

Mtubatuba LM

R59 742 537 R514 R346.60 28% 24% R350 R220

The Big 5 False Bay LM

R14 327 503 R568 R412.20 6% 6% R373 R330.9

Umhlabuyalingana LM

R78 880 275 R1 009 R514.80 25% 32% R741 R483.7

District R247 334 420 R744.82 R390.08 100% 100% R522 R377.4

Source: DHER 2013/14 Customised District Report, DHER 2011/12 and 2012/13

Note: The PHC expenditure is inclusive of sub-programmes 2.2 to 2.7

Table 20 (NDoH 11): PHC Budget and Expenditure (%) excluding “Other Donor Funding” – 2013/14

Budget Amount Budget Expenditure Amount Expenditure

District Management (2.1) 10 605 000 1% R10 799 016 1%

PHC (2.2 – 2.7) 579 393 000 47% R577 841 034 47%

District Hospitals (2.9) 636 481 000 52% R647 730 390 52%


Note: The National Table for District Finance Proportional Expenditure [%] is included in Table A15 above.

Table 21 (NDoH 12): PHC Cost per Headcount– 2013/14

LG PHC Facilities Provincial PHC Facilities Total Staff Cost per PHC Headcount

District N/A R108 R77.08


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Table 22: District Hospital Expenditure

District Hospital Expenditure per PDE ALOS BUR Proportion (%) of expenditure spent

on staff (CoE)

Bethesda Hospital R1 828 5.5 48.3 78%

Hlabisa Hospital R1 733 6.0 65.6 79%

Manguzi Hospital R1 610 5.6 59.1 80%

Mosvold Hospital R1 589 6.4 60.2 81%

Mseleni Hospital R1 697 4.3 63.8 82%

District R1 675 5.5 60.7 80%


Graph 6: District Hospital Expenditure in relation to Service Delivery – 2013/14

Source: DHER 2013/14 Customised District Report Table 18 shows high variations in cost per capita due to change in population figures and

change in municipal boundaries at Hlabisa LM and Mtubatuba LM (8 clinics transferred to

Mtubatuba LM from Hlabisa LM). Umhlabuyalingana has 25% share of total population and

more clinics (18) due to the lower population density, whilst Mtubatuba has higher population

density and fewer clinics (12). It is more cost effective to render services in densely populated

area.

Table 19 shows 1% of budget allocated to District Management, 47% to PHC and 52% to

District Hospitals. There was a slight over-expenditure at district hospital (1.8%). A slight

increase in % spent on PHC has been noted compared to previous years, in 2013/14 was 47%

from 45% in 2012/13 which is encouraging. This indicates that the district is changing focus to

PHC. Much as there is a substantial increase in PHC allocation and expenditure a picture

may be better than this if journals and linking of staff are properly done.

Table 20 indicates that PHC facilities has R108 cost per headcount and R77.08 staff cost per

headcount. Percentage spent on COE is 71% which is higher than the national norm (65%).

R 378 R 343 R 339 R 284 R 284

R1 450 R1 390 R1 271 R1 305 R1 413

R - R 200 R 400 R 600 R 800

R 1 000 R 1 200 R 1 400 R 1 600 R 1 800 R 2 000

Bethesda Hospital Hlabisa Hospital Manguzi Hospital Mosvold Hospital Mseleni Hospital

CoE / PDE Cost / GS


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The 71% includes rural allowance and increase on staff appointment e.g. Staff Nurses and

Nutritional Advisors.

The district expenditure per PDE is (R1 675) below the provincial target R1 854. The highest is

Bethesda at R1 828 due to low PDE followed by Hlabisa at R1 733 and Mosvold being the

lowest at R1 589.

The district BUR (60.7%) is below the provincial target (63%-69%). Hlabisa and Mseleni

remained constant, Manguzi and Mosvold slightly increased in BUR due to change in

admission criteria. There was a decrease in BUR at Bethesda hospital, it needs an

investigation.

The increase in Bed Utilization Rate (BUR) and Average Length of Stay (ALOS) is noticeable at

Mosvold which is attributed to availability of Doctors, but limited skills and experience

contributed to the increased ALOS. The district is within the provincial target of 5.5.

Table 23: Non-Negotiable Expenditure per PDE

Non-Negotiable [Rands per PDE] Bethesda Hospital

Hlabisa Hospital

Manguzi Hospital

Mosvold Hospital

Mseleni Hospital

Infrastructure Maintenance 2.0 0.0 1.4 0.0 1.3

Food Services 33.20 40.10 26.7 46.3 35.0

Medicine Expenditure 50.8 51.2 21.8 40.2 36.8

Medical Sundries (Supplies) Expenditure

69.9 55.9 41.9 59.5 45.9

Essential Equipment 7.7 1.1 7.3 8.0 5.6

Laundry Expenditure 0.0 0.0 0.0 0.0 0.0

Vaccination Expenditure 6.8 7.9 -0.38 4.2 -0.02

Blood Support Expenditure 16 16 10.8 15.1 12.6

Infection Control Expenditure 32.2 43.9 41.4 37.9 24.2

Medical Waste Expenditure 10 8.3 9.2 12.3 9.1

Laboratory Services Expenditure 0.0 0.0 0.0 0.0 0.0

Security Services 29.3 17.7 17.6 0.0 22.4


Hlabisa hospital overspent in medicines due to poor journaling of clinics mainly at Sipho

Zungu and Mpembeni clinics, and misallocation of expenditure for MDR medication

(allocated under district hospital instead of TB sub-program). Bethesda and Mseleni keep

buffer stock for PHC facilities.


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There was a shortage of blood in the whole country and this caused low cost per PDE in

blood services. Monthly reviews are done.

High cost for Infection control - cleaning services especially at Manguzi and Hlabisa hospitals

due to exorbitant rates for outsourced companies and the provision of cleaning material &

protective clothing by the hospital.

The district failed to spend in maintenance remarkable underspending noted at Mosvold and

Hlabisa hospitals, despite continuous support by District office. Poor planning and

implementation of maintenance plans contributed to a 50% reduction of the maintenance

budget by Provincial Office. As from 2014/15 financial year motivations for projects by

institutions must be submitted to Infrastructure Provincial Office.

There was a 73% discrepancy in food services per PDE between Mosvold and Manguzi

hospitals, criteria for ordering special diets needs to be revisited.

Low cost per PDE in essential equipment at Hlabisa because the institution was under

revitalization program.

There is a negative cost per PDE in vaccines at Manguzi and Mseleni hospitals, this attributed

to over journaling of clinics compared to Hlabisa which is the highest at R7.90.

Laundry services are in-house in all the hospitals. The district is experiencing challenges due to

continuous breakages. This is aggravated by water shortages and electricity outage, which

compromise IPC practices and unnecessary overtime and negative media publicity. A

turnaround strategy is being developed by the district office.

High cost of medical supplies per PDE at Bethesda (R69.9) compared to the lowest at

Manguzi (R41.9) due to poor stock management. It is recommended that if a computerized

stock management system could be fast tracked in order to reduce discrepancies.

High cost of medical waste per PDE at Mosvold, this could be attributed to poor waste

management. Continuous training and monitoring are conducted.


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High cost of security services at Bethesda (R29.3) due to increased number of security officers

compared to Manguzi (R17.6), Hlabisa (R17.7) and Mseleni (R22.4). No expenditure at

Mosvold as security services are paid by Provincial Office. Payments of Laboratory services

are centralized in the Provincial Office.


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PART B - COMPONENT PLANS

13. SERVICE DELIVERY PLANS FOR DISTRICT HEALTH SERVICES

13.1 SUB-PROGRAMME: DISTRICT HEALTH SERVICES

13.1.1 PHC SUB-PROGRAMME OVERVIEW

District Health Services comprise Primary Health Care, District Hospital and Programmes.

The purpose of District Health Services is to ensure effective and efficient provision of

health services in the district according to PHC and District Hospital package of services.

There are 56 PHC facilities including four Gateway clinics, 17 mobile teams servicing 251

stopping points. Five clinics (Mbazwana, Ndumu, Kwa Msane, Jozini and Sipho Zungu offer

24 hrs. open Door services, 36 clinics offer on call services and seven are day clinics due

to shortage of accommodation. The district has good medical coverage at PHC facilities

with weekly coverage at UMhlabuyalingana LM (both Manguzi and Mseleni hospitals)

and Bethesda.

One CHC (Jozini) is under construction, to be finalised by 2015/16. Commissioning

processes have been started. Hluhluwe clinic under The Big 5 False Bay LM has been

completed, awaiting handing over.

Mtubatuba clinic is fully congested; there is a need to fast track construction of

Mtubatuba CHC. The PHC Utilisation rate (3.6) is increasing which indicates that the PHC

facilities are accessed.

None of the PHC facilities at the district are compliant with National Core Standards due

to structural challenges but some of them are conditionally compliant.

There is poor handling of complaints especially at PHC facilities. This has been

emphasized with minimal change.

39/56 PHC facilities have appointed Clinic Committees by MEC for Health. The Family

Health Teams are not yet appointed. There is a plan to fill these posts before the end of

the financial year 2014/15.

The PHC supervision rate (85%) remains good; however; performance does not match this

high rate. Monitoring the quality of the supervisors visit will be done.


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STRATEGIC CHALLENGES

- Poor handling of complaints

- Lack of implementation of SCM procedures

- Poor Maintenance services

- Poor quality of PHC supervision

- PHC facilities not compliant to NCS

- Failure to recruit Clinical Nurse Practitioners


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Table 24 (NDoH 13): Situation Analysis: Indicators for District Health Services 2013/14 Financial Year

Indicators Type Hlabisa LM Jozini LM Mtubatuba LM The Big 5 False Bay LM Umhlabuyalingana LM District Average

1. National Core Standards self-assessment rate (PHC Facilities)

Quarterly %

40% 77.7% 83% 100% 83.3% 78.6%

National Core Standards self-assessment

No 2 14 10 3 15 44

Fixed PHC clinics/fixed CHCs/CDCs

No 5 18 12 3 18 56

2. Quality Improvement plan after self-assessment rate (PHC Facilities)

Quarterly %

50% 36% 40% 100% 73% 54.5%

Quality improvement plan after self-assessment

No 1 5 4 3 11 24

Fixed PHC clinics/fixed CHCs/CDCs (PHC Fac

conducted Self-assessment)

No 2 14 10 3 15 44

3. Percentage of fixed PHC facilities compliant with all extreme measures of the National Core Standards

Quarterly %

0% 0% 0% 0% 0% 0%

Fixed PHC facilities compliant with all the extreme measures of the

National Core Standards for health facilities

No 0 0 0 0 0 0

Fixed PHC clinics plus fixed CHCs / CDCs (PHC Facilities conducted

Self-assessment)

No 2 14 10 3 15 44

4. Patient satisfaction survey rate (PHC Facilities)

Quarterly %

100% 72% 75% 100% 94.4% 84%

Fixed PHC facilities that have conducted Patient Satisfaction

Surveys

No 5 13 9 3 17 47

Fixed PHC clinics plus fixed CHCs / CDCs

No 5 18 12 3 18 56


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Indicators Type Hlabisa LM Jozini LM Mtubatuba LM The Big 5 False Bay LM Umhlabuyalingana LM District Average

5. PHC patient satisfaction rate at PHC facilities

Annual %

80% 81% 80% 82% 84% 81.5%

Patient satisfied with health services

No 32 225 176 49 268 750

Patients participating in PSS No 40 280 220 60 320 920

6. OHH registration visit coverage

Annual %

No WBOT appointed as yet






OHH registration visit No

OHH in Population No

7. Number of District Clinical Specialist Teams (DCST’s)

Quarterly No

N/A N/A N/A N/A N/A 1 incomplete team

8. PHC utilisation rate Annual No

3.0 3.7 3.1 3.6 4.2 3.6

PHC headcount total No 221 145 699 187 563 149 129 783 677 732 2 290 996

Population Total No 73 058 189 965 179 378 36 172 159 438 638 011

9. Complaints Resolution Rate Quarterly %

100% 57% 39% 78% 87% 72%

Complaints resolved No 19 78 47 50 292 486

Complaints received No 19 138 120 64 335 676

10. Complaint resolution within 25 working days rate

% Quarterly

84% 83% 66% 96% 96% 91%

Complaint resolved within 25 working days

No. 16 65 31 48 281 441

Complaint resolved No. 19 78 47 50 292 486


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Table 25 (NDoH 14): District Performance Indicators – District Health Services

Indicator Data

Source Frequenc

y Type

Audited/ Actual Performance Estimated Performance

Medium Term Targets Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Proportion of fixed PHC facilities compliant with all the extreme measures of the National Core Standards

QA assessment records

% Quarterly

0% 0% 0% 0% 8.8% 17.2% 25.8%

Fixed PHC facilities compliant with all

the extreme measures of the

National Core Standards for health

facilities


No 0 0 0 0 5 10 15

Fixed PHC clinics plus fixed CHCs /

CDCs(PHC Facilities conducted Self-

assessment)

DHIS calculates

No 54 55 44 56 57 58 58

2. Patient satisfaction survey rate (PHC Facilities)

QA calculates

% Quarterly

59% 64% 84% 89.2% 91.2% 95% 100% 100%

Fixed PHC facilities that have

conducted Patient Satisfaction Surveys

OSS records

No 32 35 47 50 52 55 58 594

Fixed PHC clinics plus fixed CHCs /

CDCs

DHIS calculates

No 54 55 56 56 57 58 58 594


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Indicator Data

Source Frequenc

y Type



2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

3. PHC patient satisfaction rate at PHC facilities

DHIS calculates

% Annual

76.5% 77% 81.5% 83.3% 85.3% 87.6% 90% 75%

Patient satisfied with health services

PSS results No 490 540 750 1250 1280 2190 2600 -

Patients participating in PSS

PSS records

No 640 700 920 1500 2080 2500 2900 -

4. OHH registration visit coverage

DHIS calculates

% Annual

WBOT Not yet appointed

WBOT Not yet appointed

WBOT Not yet appointed TBD TBD TBD TBD 51.7%

OHH registration visit

DHIS/Tick register WBOT

No 62 422

OHH in Population District Records

No 113 495

5. Number of District Clinical Specialist Teams (DCST’s)

Persal/ District Records

Quarterly No

0 1(incomplete) 1(incomplete) 1(incomplete) 1(incomplete)

1 1 2 Complete teams and remaining 9 teams with all Nursing post filled.

6. PHC utilisation rate

DHIS calculates

Annual No

3.2 3.3 3.6 3.5 3.5 3.6 3.6 3.0

PHC headcount total

DHIS/PHC tick register

No 2 097 010 2 194 114 2 290 996 2 236 354 2 273 754 2 360 221 2 379 359 32 234 839

Population Total DHIS/Stats SA

No 660 354 666 523 638 011 643 759 649 644 655 617 660 933 10 688 165

7. Complaints Resolution Rate

DHIS calculates

Quarterly %

63% 67% 72% 80.3% 81% 83% 86% 80%

Complaints resolved

DHIS / Complaint records

No 277 332 486 368 486 540 602 3 520


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Indicator Data

Source Frequenc

y Type



2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Complaints received


No 438 493 675 488 600 650 700 4 400


DHIS calculates

Quarterly %

100% 100% 91% 82% 85% 90% 95% 90%

Complaint resolved within 25 working

days


No. 277 332 441 300 413 486 572 3 168

Complaint resolved DHIS / Complaints record

No. 277 332 486 368 486 540 602 3 520

Table 26 (Table 15): District Specific Objectives and Performance Indicators – District Health Services

Strategic Objective Performance Indicators Data Source Frequency Type Audited/ Actual Performance Estimated

Performance Medium Term Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. 1.1 PHC utilisation rate under 5 years (annualised)

DHIS calculates

Quarterly %

4.7 4.9 4.8 4.9 4.9 5.0 5.1

PHC headcount under 5

DHIS/PHC tick register

No 400 518 402 194 415 991 427 492 417 411 416 795 417 848

Population under 5 years

DHIS/Stats SA No 82 577 81 136 86 746 86 748 85 186 83 359 81 931

1.2 PHC Total Headcount under 5 years

DHIS/Tick register SHS

No 400 518 402 194 415 991 427 492 417 411 416 795 417 848


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

2. 2.1 Expenditure per PHC headcount

DHIS/BAS Quarterly R

R96 R97 R108 R124 R132 R136 R145

Total expenditure PHC BAS (R’000) R’000 R201 289 144

R212 533 460

R247 333744

R277 342 093 R300 756 040

R321 808 963

344 335 590

PHC headcount total DHIS calculates

No 2 097 010 2 194 114 2 290 996 2 236 354 2 273 754 2 360 221 2 379 359

3. 3.1 Number of School Health Teams (cumulative)

District Records/ Persal

Quarterly No

5 8 9 10 11 12 13

4. 4.1 Number of accredited Health Promoting Schools (cumulative)

Health Promotion database

Quarterly No

9 9 9 11 12 13 14

5. 5.1 Dental extraction to restoration ratio

DHIS calculates

Quarterly Ratio

14:1 14:1 13:1 8:1 8:1 8:1 8:1

Tooth extraction DHIS/Tick register

No 30 887 35 665 40 037 32 548 32 223 31 901 31 582

Tooth restoration DHIS/Tick register

No 2 284 2 504 3 057 3 904 4 028 3 988 3 948

6. 6.1 Percentage of PHC facilities conditionally compliant to the National Core Standards


Annual %

0% 0% 66% 80% 83% 88% 93%

Clinics conditionally compliant (50%-75%)to

National Core Standards


No 0 0 37 45 48 52 55

CHC’s and clinics total DHIS calculates

No 54 55 56 56 58 59 59

7. 7.1 District PHC expenditure per uninsured person

BAS / Stats SA

R R321 R377 R403 R448 R482 R500 R520

Total expenditure on PHC services

BAS R’000 R201 289 144

R212 533 461

R247 333744

R277 342 093 R300 756 040

R321 808 963

R344 335 590


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Number of uninsured people in the DC27

(Stats SA)

DHIS / Stats SA

No 627 336 563 211 613 129 618 650 624 310 643 039 662 330

8. 8.1 PHC supervisor visit rate (fixed clinic/ CHC/ CDC)

DHIS % 97% 89% 85% 91% 92% 95% 97%

PHC supervisor visit (fixed clinic/ CHC/ CDC)

Supervisor checklists

No 624 589 573 612 640 673 687

Fixed clinics plus fixed CHCs/CDCs

DHIS Calculates

No 54 55 56 56 58 59 59

9. 9.1 Number of functional Ward Based Outreach Teams (Family Health Teams) (cumulative) (Transport depended)

District Management / Appointment letters

No 0 0 0 3 5 9 12

10. 10.1 School ISHP coverage (annualised)

DHIS % Not reported

Not reported

52%

60% 65% 70% 75%

Schools with any learner screened

DHIS / Tick register SHS

No 285 330 359 389 418

Schools – total DHIS / DoE database

No 550 550 552 555 557

11. 11.1 Number of Primary Health Care Clinics that qualify as Ideal Clinics

No 0 0 0 0 5 5 5

12. 12.1 Number of Primary Health Care Clinics with functional Clinic Committees

No 50 51 50 52 53 54 55


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13.1.2 District Health Services: Strategies /Activities to be implemented 2015/16

Strategies Activities

1. To improve the quality of PHC

supervision

- Monitor reports submitted by PHC Supervisors

- Review performance agreement by managers

2. To ensure that PHC facilities are

accredited to NCs

- Conduct gap and self-assessments on NCS

- Develop and implement QIPs

- Monitor QIP implementation

3. To improve complaints handling at

PHC facilities

- Standardization of complaints handling procedure at PHC level

- Appointment of complaints handling committees

- Submission of reports

4. Improve implementation of SCM

procedures

- Monitoring of SCM procedures implementation

- Conduct on job trainings on SCM procedures

- Strengthen clinics cash flow

5. Improve maintenance services - Strengthen support visit to PHC by maintenance team

- Dedicated PHC maintenance team

- Availability of material and working tool

- Proper maintenance plan


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13.2 SUB-PROGRAM: DISTRICT HOSPITALS

13.2.1 Sub-Programme Overview

The purpose of the District Hospital Programme is to render level 1 hospital services to the

District population. The District has five District Hospitals, all providing the full district hospital

package of services and open 24 hours per day.

Two Hospitals (Manguzi and Mseleni) are under UMhlabuyalingana LM, two Hospitals

(Mosvold and Bethesda) under Jozini LM, one Hospital (Hlabisa) under Hlabisa LM. There are

no Hospitals at Big 5 False Bay and Mtubatuba LM’s which poses a challenge especially at

Mtubatuba as it is along the N2 which is a high accident zone.

Hlabisa MDR site has been established and has assisted in the initiation of MDR patients. This

has reduced unnecessary delays caused by unavailability of EMRS transport and shortage of

beds at King Dinuzulu Hospital. This has compromised bed status at Hlabisa because medical

beds were converted to MDR beds without additional facility.

The Medical coverage improved in Hospitals though Hlabisa and Mosvold are slightly

understaffed. More medical posts are to be filled in this current and next financial year. There

is a problem in attraction of Community Service Officers at Mosvold; there is a need to

strengthen exit interviews and analysis thereof.

The Caesarean Section rate is at 21.6 at the district Hospital. Bethesda is the highest in the

district at 25.5, which might be attributed to cross boundary movement of patients from

Zululand district. However this figure does not include approximately 3000 babies born each

year in District clinics

None of the hospitals are fully compliant with the NCS due to infrastructural challenges. Gap

assessments are conducted and QIPs developed with minimal implementation.

New wards have been opened at Manguzi, Bethesda and Mosvold Hospitals, with a new

Female ward at Manguzi and Mosvold, paediatric ward opened at Bethesda Hospitals and a

new mortuary at Mosvold Hospital and Operating Theatre upgrade at Hlabisa. There is a new

Therapy department and staff residence at Mseleni hospital

Average length of stay in the District Hospitals is at 5.5 days. The bed occupancy rate

appears low at 60.7%, however it is suspected that poor data quality, inflating the real

number of beds available, contributes to this surprisingly low figure.


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All five district hospitals are conditionally compliant with the National Core Standards.

Compliance with vital and extreme measures remains a challenge.

Accommodation remains a challenge at all hospitals, exacerbated by an expansion of

services and staff providing those services, including dental, dietician, optometry, psychology

and speech therapy services.

STRATEGIC CHALLENGES:

Inadequate accommodation at hospitals

Poor data quality

Non-Compliance with National Core Standards

Shortage of Doctors including attraction of Community Service Officers


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Table 27 (NDoH 16): Situational Analysis Indicators for District Hospitals – 2013/14 Financial Year

Indicators Type Bethesda hospital

Hlabisa hospital Manguzi hospital Mosvold hospital Mseleni hospital District Average

1. National Core Standards self-assessment rate

Quarterly

% 100% 100% 100% 100% 100% 100%

National Core Standards self-assessment No 1 1 1 1 1 5

District Hospitals total No 1 1 1 1 1 5

2. Quality Improvement plan after self-assessment rate

Quarterly

% 100% 100% 100% 100% 100% 100%

Quality Improvement plan after self-assessment

No 1 1 1 1 1 5


3. Percentage of District Hospitals compliant to all extreme and vital measures of the National Core Standards

Quarterly

% 0% 0% 0% 0% 0% 0%

District Hospitals fully compliant (75%-100%) to all extreme and vital measures of

National Core Standards

No 0 0 0 0 0 0


4. Patient satisfaction survey rate 100% 100% 100% 100% 100% 100%

Number of district hospitals that have conducted patient satisfaction surveys

No 1 1 1 1 1 5


5. Patient satisfaction rate Annual

% 80% 75% 72% 75% 75% 78%

Number satisfied customers No 116 45 43 15 45 264

Number users participated in survey No 140 60 60 20 60 340


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Indicators Type Bethesda hospital

Hlabisa hospital Manguzi hospital Mosvold hospital Mseleni hospital District Average

6. Average length of stay Quarterly

Days 5.5 6.0 5.6 6.4 4.3 5.5

In-patient days No 39 168 65 844 61267 53 598 50 898 270 775

Day patients No 0 30 1 7 157 195

Inpatient separations No 7 148 10 904 10 939 8 398 11 877 49 266

7. Inpatient bed utilization rate Quarterly

% 48.3 65.6 59.1 60.2 63.8 60.7

In-patient days No 39 168 65 844 61267 53 598 50 898 270 775

Day patients No 0 30 1 7 157 195

Inpatient bed days available No 222 275 284 244 219 1 244

8. Number of District Mental Health Teams Established

No 0 0 0 0 0 0

9. Expenditure per PDE Quarterly

R R1 828 R1 733 R1 610 R1 589 R1 697 R1 675

Expenditure total R’000 R106 146 720 R168 794 888 131 405 193 111 548 859 R111 476 545 R629 372 216

Patient day equivalent No 57 210 99 473 92 989 69 233 67 871 386 777

10. Complaint resolution rate Quarterly

% 53% 94% 93% 76% 95% 85%

Complaint resolved No 17 16 106 82 76 297

Complaint received No 32 17 114 108 80 351


Quarterly

% 71% 6% 100% 100% 97% 93%

Complaint resolved within 25 days No 12 1 106 82 75 276

Complaint resolved No 17 16 106 82 76 297

Note: Indicator 9, [data element Expenditure total]: Expenditure should be for all hospital expenditure that occurs at a hospital level, not only sub-programme 2.9. Expenditure at community level is not included in this figure.


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Table 28 (NDoH 17): Performance Indicators for District Hospitals

Indicator Data Source Frequency Type



2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1 National Core Standards self-assessment rate

QA/DHIS calculates

Quarterly

%

100% 100% 100% 100% 100% 100% 100% 100%

National Core Standards self-assessment


No 5 5 5 5 5 5 5 37

District Hospitals total DHIS calculates

No 5 5 5 5 5 5 5 37

2 Quality Improvement plan after self-assessment rate

QA/DHIS calculates

Quarterly

%

0% 100% 100% 100% 100% 100% 100% 100%

Quality Improvement plan after self-assessment


No 0 5 5 5 5 5 5 37

District Hospitals total QA assessment records

No 5 5 5 5 5 5 5 37

3 Percentage of District Hospitals compliant to all extreme and vital measures of the National Core Standards

QA/DHIS calculates

Quarterly

%

0% 0% 0% 0% 0% 0% 0% 14%

District Hospitals fully compliant (75%-100%) to all extreme and

vital measures of National Core Standards


No 0 0 0 0 0 0 0 5


No 5 5 5 5 5 5 5 37

4 Patient satisfaction survey rate

QA / DHIS calculates

Quarterly %

100% 100% 100% 100% 100% 100% 100% 100%


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Number of district hospitals that have conducted patient

satisfaction surveys


No 5 5 5 5 5 5 5 37


No 5 5 5 5 5 5 5 37

5 Patient satisfaction rate DHIS calculates

Annual

%

80% 87% 78% 85% 87% 88% 90% 90%

Number satisfied customers PSS No 80 87 264 492 609 704 900 7 290

Number users participated in survey

PSS No 100 100 340 582 700 800 1000 8 100

6 Average length of stay DHIS calculates

Quarterly

Days

6.3 Days 5.7 Days 5.5 Days 5.9 Days 5.7 Days 5.6 Days 5.5 Days 5.8 Days

In-patient days Midnight census

No 272 529 268 256 270 775 272 948 261 576 256 345 251 218 2 049 076

Day patients Midnight census

No 102 357 195 86 90 95 100 11 865

Inpatient separations DHIS calculates

No 43 327 46 993 49 266 46 612 45 898 45 767 45 685 348 922

7 Inpatient bed utilisation rate

DHIS calculates

Quarterly

%

60.8% 59.8% 60.7% 60% 56.3% 55.1% 54.% 64.7%

In-patient days Midnight census

No 272 529 268 256 270 775 272 948 261 576 256 345 251 218 2 049 076

Day patients Midnight census

No 102 357 195 86 90 95 100 11 865

Inpatient bed days available Management

No 1 240 1 240 1 244 1 244 1 274 1 274 1 274 3 173 310

8 Number of District Mental health Teams Established

No 0 0 0 0 1 1 1 11


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

9 Expenditure per PDE BAS/DHIS Quarterly

R

R1 295 R1 539 R1 675 R1 854 R2 024 R2 210 R2 413 R 1 808

Expenditure total BAS R’000 R504 771 573 R581 413 915 R629 372 216 703 819 607 753 086 980 805 803 069 862 209 283 5 309 057

Patient day equivalent DHIS calculates

No 389 785 377 563 386 777 379 640 372 047 364 606 357 314 2 935 044

10 Complaint resolution rate DHIS Quarterly

%

89% 79% 85% 47% 70% 80% 90% 75%

Complaint resolved PSS No 170 271 297 232 379 476 590 2 100

Complaint received PSS No 192 341 351 492 541 595 655 2 800

11 Complaint resolution within 25 working days rate

DHIS Quarterly

%

100% 100% 93% 97% 98% 98% 99% 85%

Complaint resolved within 25 days

PSS No 170 271 276 224 371 467 584 1 785

Complaint resolved PSS No 170 271 297 232 379 476 590 2 100


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Table 29 (NDoH 18): District Strategic Objectives and Annual Targets for District Hospitals

Strategic Objective Statement

Performance Indicator Data Source Frequency Type

Audited/ Actual Performance Estimated Performance Medium Term Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. Delivery by caesarean section rate

DHIS calculates

Quarterly %

22.3% 21.2% 21.6% 20.3% 20% 20% 20%

Delivery by caesarean section Delivery register

No 2 669 2 483 2 620 2 600 2 680 2 814 2 955

Delivery in facility total Delivery register

No 11 541 11 960 12 140 12 756 13 402 14 072 14 776

2. OPD headcount- total DHIS/OPD tick register

Quarterly No

337 166 309 727 338 057 312 252 296 645 281 813 267 722

3. OPD headcount not referred new

DHIS/OPD tick register

Quarterly No

51 437 64 760 71 156 68 002 61 198 55 078 49 571

4. Number of District Hospitals with functional boards

5 5 5 5 5 5 5

5. Proportion of District Hospitals conditionally compliant to National Core Standards

QA / DHIS calculates

Quarterly %

0% 100% 100% 100% 100% 100% 100%

District Hospitals conditionally compliant


No 0 5 5 5 5 5 5

District Hospitals Total DHIS calculates

No 5 5 5 5 5 5 5


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13.2.2 District Hospitals: Strategies /Activities to be implemented 2015/16


1. Improve Data quality - Monitor functionality of information meetings

- Conduct data quality audits

2. Improve implementation of the NCS vital and

extreme measures

- Conduct NCS audits

- Set targets for vital and extreme measures

- Monitor quality improvement program on gap analysis

3. Rational use of accommodation at hospitals - Review accommodation policy at hospitals

- Enforce monthly occupancy returns

- Establishment of housing committee

4. Recruitment of Doctors - Advertising of posts

- Attend to exits interviews findings


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14. HIV & AIDS & TB CONTROL (HAST)

14.1 PROGRAMME OVERVIEW

The purpose of the HAST Programs

The purpose of the HAST Programme is to promote prevention of HIV, TB and sexually

transmitted infections, ensure necessary treatment of persons infected with HIV, TB and STIs,

and bring relief to persons infected and affected by these diseases.

The district planned to test 162 160 clients for HIV in 2013/14, however, the targets set was not

met and only 149 277 clients were tested. This was due to the shortage of staff and vehicles

for community outreach. The target for clients to be tested for HIV in 2014/15 is 148 332. In

Quarter 1 and quarter 2 of 2014/ 15, the district tested 81 218 clients and was above the

target of 74 166.

The 2014/15 target for High Transmission Areas (HTA) was two but only one site was functional

i.e. Mkuze HTA. The second site (Mtubatuba, could not be opened due to challenges with

the Local Municipality. One CNP appointed for Mtubatuba HTA, but allocated to Mtubatuba

clinic.

54 PHC facilities (including Mosvold and Hlabisa gateway), three mobile teams (Manguzi)

and 5 hospitals are initiating clients on ART and nurses have been trained on NIMART. In

2013/14, the district had a total of 58 643 clients remaining in care and this was below the

target of 63 476. The figure was decreased by the implementation of Tier.net system, where

clients that were already out of care were removed from the system, and this was not

possible with the paper register. The target for 2014/15 for clients remaining in care is 68 606

and at the end of the 2nd Quarter, the total was 59 760. All ART sites are implementing Tier.net

system and 55 facilities have been audited and Data signed off as clean.

Male condom distribution in the district remains below the target. This is due to the absence

of Service Providers to distribute condoms in the community. However, partnership has been

formed with Family Health International to support the district in distributing male condoms as

from the 3rd quarter of 2014/15. The total male condoms distributed end of quarter 2 of

2014/15 was 2 566 146 and female condoms was 62 130.


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The target for Male medical Circumcision for 2013/14 was 17 848 and the district circumcised

10 737 and this was below the set target. In 2014/15, the target is 23 465.At the end Q2 of

2014/15, the district circumcised 5 014. The poor performance is due to the shortage of MMC

Teams in hospitals and poor mobilization of clients for MMC.

The Pulmonary Tuberculosis incidence is at 831/100k populations with a cure rate of 77%. The

death rate among TB patients is at 4.7% and is above the district target of 4%. This might be

attributed to co-infection, late presentation to health facilities and defaulters.

92% of clients on TB treatment have DOT Supporters; this program needs to be monitored

closely in relation to TB treatment outcomes. The district is experiencing a high number of new

MDR TB cases with an MDR TB initiation rate of 100%. The MDR TB 24 month cure rate is at 61%

with a defaulter rate of 3%.

The death rate among MDRTB clients is at 7.3% and is above the district target of 6%. The

district needs to do early diagnosing and initiation on MDRTB using Gen-Xpert and contact

tracing.

STRATEGIC CHALLENGES

Inadequate MMC teams

Poor Community Mobilization for MMC

High incidence of MDR TB

Poor HAST data management


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Table 30 (NDoH 19): Situational Analysis Indicators for HIV & AIDS, STI’s and TB Control - 2013/14 Financial Year

Indicator Type Hlabisa LM Jozini LM Mtubatuba LM The Big Five False Bay LM

Umhlabuyalingana LM

District Average

1. Total clients remaining on ART month

Quarterly No 6 180 16 503 17 177 3 222 15 561 58 643

2. Clients tested for HIV (incl. ANC)

Quarterly No 12 189 51 884 22 375 7 087 52 408 145 943

3. TB symptom 5 years and older screened rate

Quarterly % 3.2 2.3 1.8 2.8 2.0 2.2

Client 5 years and older screened for TB symptoms

No. 5 925 12 678 8 665 3 073 11 257 41 598

PHC headcount 5 years and older No. 183 457 557 587 472 039 107 899 554 216 1 875 198

4. Male condom distribution Rate Quarterly Rate per male

36.6 19.7 8.9 12.4 36.4 22.1

Male condoms distributed No 709 480 1 005 056 450 236 132 480 1 554 491 3 852 193

Population 15 years and older male Population 19 370 51 085 50 444 10 700 42 694 174 293

5. Female condom distribution Rate

Quarterly Rate per female

1.2 0.8 0.4 0.3 1 0.8

Female condoms distributed No 29 407 48 937 27 320 3 266 55 031 163 961

Population 15 years and older female

Population 24 684 63 866 61 596 12 580 55 406 218 132

6. Medical male circumcision performed – Total

Quarterly

No

3 905 3 195 181 484 2 972 10 737

7. TB client treatment success rate Quarterly % 82.2% 86.7% 79.8% 80% 79.7% 81.7%

TB client successfully completed treatment

No 282 360 451 76 412 1 581

TB client start on treatment No 343 415 565 95 517 1 935


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Umhlabuyalingana LM

District Average

8. TB client lost to follow up rate Quarterly % 1.7% 0.5% 5.7% 4.2% 2.9% 3%

TB client lost to follow up No 6 2 32 4 15 59


9. TB client death Rate Annual

%

6.1% 3.6% 4.8% 4.2% 4.4% 4.7%

TB client died during treatment No 21 15 27 4 23 90


10. TB MDR confirmed treatment start rate

Annual

%

0% 0% 0% 0% 100% 100%

TB MDR confirmed client start on treatment

No 0 0 0 0 328 328

TB MDR confirmed client No 0 0 0 0 328 328

11. TB MDR treatment success rate Annual % 0% 0% 0% 0% 10% 10%

TB MDR client successfully treated

No. 0 0 0 0 27 27


No. 0 0 0 0 278 278


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Table 31 (NDoH 20): Performance Indicators for HIV & AIDS and TB Control




2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Total clients remaining on ART month

DHIS calculates

Quarterly No

43 332 53 373 58 643 64 375 82 273 95 769 106 769 1 276 200

2. Clients tested for HIV (incl. ANC)

DHIS calculates

Quarterly No

141 422 123 806 145 943 153 492 155 000 160 000 150 000 2 067 065 (4 134 130 Cumulative)

3. TB symptom 5 yrs. and older screened rate

DHIS Quarterly %

Not collected

Not collected

2.2% 2.4% 2.5% 2,6% 2,7% 20%

Client 5 years and older screened for TB symptoms

TB Register No. 41 598 43 730 47 935 52 843 58 168 6 417 887

PHC headcount 5 years and older DHIS calculates

No. 1 875 198 1 808 862 1 917 394 2 032 437 2 154 384 32 089 437

4. Male condom distribution Rate

DHIS calculates

Quarterly Rate per male

15 15 22.1 28 37 42 47 62.9

Male condoms distributed DHIS/Stock cards

No 2 856 684 2 969 851 3 852 193 5 042 180

6 746 528 7 755 048 8 851 839 212 000000

Population 15 years and older male

DHIS/Stats SA

Population

192 984 197 233 174 293 177 682 181 017 184 644 188 337 3 370 509

5. Female condom distribution Rate

DHIS calculates

Quarterly Rate per female

0.4 0.5 0.8 0.6 0.9 1 1.1 0.9

Female condoms distributed DHIS/Stock cards

No 80 035 105 900 163 961 123 368 195 536 229 181 257 142 3 500 000


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Population 15 years and older female

DHIS/Stats SA

Population

205 222 209 591 218 132 221 426 224 680 229 181 233 765 3 892 659

6. Medical male circumcision performed – Total

DHIS / MMC register

Quarterly

No

3 890 6 275 10 737 9 894 29 080 34 696 41 396 631 374 (Cumulative)

7. TB client treatment success rate

ETR.Net calculates

% 71.2% 68% 81.7% 83.3% 85% 86.7% 88.4% 85%

TB client successfully completed treatment

TB Register No 1 275 1 530 1 581 1 644 1 711 1 780 1 852 32 257

TB client start on treatment TB Register No 1793 2257 1 935 1 974 2 013 2 053 2 095 37 949

8. TB client lost to follow-up rate ETR.Net calculates

Quarterly%

4% 2.5% 3% 3% 2.8% 2.5% 2.3% 3.9%

TB client lost to follow up TB Register No 72 58 59 59 56 51 48 1 530

TB client start on treatment TB Register No 1 793 2 257 1 935 1 974 2 013 2 053 2 095 38 255

9. TB client death Rate ETR.Net calculates

Annual %

6.3% 3.9% 4.7% 4.5% 4.3% 4% 3.8% 4%

TB client died during treatment

TB Register No 113 89 90 89 87 82 80 1 140

TB client start on treatment TB register No 1793 2257 1 935 1 974 2 013 2 053 2 095 28 500

10. TB MDR confirmed treatment start rate

ETR.Net calculates

Annual %

100% 100% 100% 100% 100% 100% 100% 60%


TB Register No 198 284 328 420 400 390 350 -

TB MDR confirmed client TB Register No 198 284 328 420 400 390 350 -

11. TB MDR treatment success rate

EDR calculates

Annual %

62% 40% 10% 50% 60% 62% 64% 60.9%

TB MDR client successfully treated

EDR Register No 123 113 27 210 240 242 224 -


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16


EDR Register No 198 284 278 420 400 390 350 -

Table 32 (NDoH 21): District Strategic Objectives and Annual Targets for HIV & AIDS

Strategic Objectiv

e Performance Indicator Data

Source Frequency Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. Number of patients that started regimen iv treatment (MDR-TB)

EDR.Net calculates

Annual No

334 310 328 420 400 390 350

2. MDR-TB Six month interim outcome EDR.Net calculates

Annual %

68% 52.4% 30% 60% 62% 64% 66%

Number of clients with a negative culture at 6 months who started

treatment for 9 months

EDR Register

No 134 149 100 252 248 250 231

Total patients who started treatment in the same period

EDR Register

No 198 284 328 420 400 390 350

3. Number of patients that started XDR-TB treatment

ETR.Net calculates

Annual No

Reported at King Dinuzulu







4. XDR-TB Six month interim outcome EDR.Net calculates

Annual %








Number of clients with a negative culture at 6 months who started

treatment for 9 months

EDR Register

No

Total patients who started treatment in the same period

EDR Register

No

5. TB incidence (per 100 000 population)

ETR.Net Annual No per 100,000

1095/100K 955/100K 831/100K 723/100K 629/100K 547/100K 476/100K

New TB infections ETR.Net No 7 232 6 365 5 305 4751 4 257 3 813 3 418


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Strategic Objectiv

e Performance Indicator Data

Source Frequency Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Total population in DC27 DHIS/Stats SA Population 660 354 666 523 638 011 657 151 676 866 697 172 718 087

6. HIV incidence (annual) ASSA2008 Annual %

3.4% 3.1% 2.4% 2.5% 2% 1.5% 1%

7. STI treated new episode incidence (annualised)

DHIS calculates

Quarterly No per 1000

84/1k 80/1k 84/1k 80/1k 77/1k 74/1k 71/1k

STI treated new episode DHIS/Tick register PHC/ casualty

No 33 977 35 424 33 716 3 2 646 32 319 31 996 31 676

Population 15 years and older DHIS/Stats SA

Population 406 827 440 763 399 121 405 711 417 882 430 419 443 331

8. TB (new pulmonary) defaulter rate

ETR.Net calculates

% 4% 2.5% 3% 3% 2.8% 2.5% 2.3%

TB(new pulmonary)treatment defaulter

TB Register No 72 58 59 59 56 51 48

TB(new pulmonary)client initiated on treatment

TB Register No 1 793 2 257 1 935 1 974 2 013 2 053 2 095

9. TB AFB sputum result turn-around time under 48 hours rate

ETR.Net calculates

% 61% 56% 63.9% 65% 67% 70% 74%

TB AFB sputum result received within 48 hours

TB Register No 39 618 42 151 35 111 36 405 38 276 40 789 43 982

TB AFB sputum sample sent TB Register No 67 752 75 105 54 910 56 008 57 128 58 270 59 436

10. TB (new pulmonary) cure rate ETR.Net calculates

% 71.2% 68% 72% 83.3% 85% 86.7% 88.4%

TB (new pulmonary) client cured TB Register No 1 275 1 530 1 399 1 644 1 711 1 780 1 852

TB (new pulmonary) client initiated on treatment

TB Register No 1 793 2 257 1 935 1 974 2 013 2 053 2 095


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14.2 HIV & AIDS, STI & TB CONTROL (HAST): STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16


1. Increase MMC uptake - Appoint more MMC Coordinators

- Increase the no of MMC camps

- Use of OSS to market the service

2. Reduce MDR cases - Strengthen defaulter tracing at hospitals

- Early screening of patients

3. Reduce STI (new) - Conduct health education in sexual reproductive health at school

- Increase partner treatment

4. Improve the quality of HAST data - Monthly verification of data

- Participate on monthly information team meetings

- Provide monthly data feedback session


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15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION


MCWH

The purpose of the program is to improve Maternal, Child and Women’s Health and

Nutrition through preventive, promotive curative and rehabilitative services.

Nine maternal deaths reported in 2013/14, which gave the District a Maternal Mortality

ratio of 60/100k live births. Seemingly there is a projected increase in 2014/15 because up

to this far (end of Q2 of 2014/15) the district has 7 of which 2 were from Mozambique.

63% Achievement in antenatal 1st visit before 20 weeks is due to regular monitoring and

implementation of Dashboard indicators especially at Hlabisa and Bethesda Hospitals

with the support of 20 000+.

There is a high teenage delivery rate of 11.4% despite collaborative efforts with other

departments. There is a need to strengthen implementation of youth friendly services and

multi-sectoral approach in dealing with teenage pregnancy. Intensified trainings on the

long acting reversible contraceptives are on-going and uptake of these methods in

young girls will reduce teenage pregnancy.

In 2013/14 the district achieved 5% in child under 5 death rate which is below a set District

target of <7%. In Q2 of 2014/15 it increased to 6.3% which is above the district target of

<5%. Proper audit will be conducted to identify the root cause by the DCST.

49 Phila Mntwana Centres were established at UMkhanyakude where CCGs are

allocated to do health services such as administering of Vitamin A, weighing of children,

referrals, health education etc. Some centres have limited resources and MatCH has

committed to support. On-going trainings will be conducted. The DCST and Program

Coordinators needs to monitor functionality of the Phila Mntwana Centres vs Child Health

outcomes.

District performance showed a decrease in all EPI indicators due to poor performance,

lack of commitment and accountability at all levels of care. Continuous onsite training is

being conducted.


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Cervical cancer screening has decreased as a result of improved understanding of this

data element and poor performance.

The District achieved the target of 50% (Q1 and Q2 of 2014/15) in the couple year

protection rate, due to Implanon insertion.

PMTCT

The District successfully implemented PMTCT guidelines which contributed much in

reduction of Mother to Child Transmission to 1.2% (for Q1 and Q2 of 2014/15) which is

below the district target of 1.3% around 6 weeks and 1.4% at 18 months below the set

target of 2%.

Antenatal clients initiated on HAART rate is at 82.9% as at the end of 2nd quarter.

NUTRITION

The annual underweight for age incidence for children <5 years is at 27.9/k which is far

above the district target of 16/k. The annual weighing rate in proportion to the headcount

<5 is at 80% and which is within the target of 80% and this is due to the fact that children

are visiting facilities frequently.

Percentage of Children admitted with Severe Acute Malnutrition (SAM) is at 7.3% and this

within the targeted range of 8% for the year.

The Severe Acute Malnutrition case fatality rate for the year is at 12 above the target of

10%. All clinics have appointed Nutrition Advisors.

Vitamin A coverage for 12 – 59 months increased from 43.7% to 54.4% in the 2nd quarter of

2014/15. This could be attributed to immunisation catch-up drive conducted in August

2014.

INTEGRATED SCHOOL HEALTH SERVICES

Integrated School Health service is offered in the District in collaboration with

Departments of Education and Social Development.

School health teams in the District have increased from five to ten, seven of the School

Health Teams are linked to PHC facilities (Ndumo, Mahlungulu, KwaMsane, Inhlwathi,

Mduku, Ntshongwe, Somkhele) and the three are linked to district hospitals (Bethesda,

Manguzi and Mosvold). There is a shortage of transport resulting in teams sharing vehicles,

which has negative impact on School Health coverage.


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The introduction of the HPV vaccine has increased the awareness of cervical cancer to

learners and parents.

Challenges

- Poor ANC at all levels

- Increased <5 deaths due to severe malnutrition especially at Jozini LM and Diarrhoea at Hlabisa LM

- High teenage delivery rate

- Poor integration of SRH into other programs such as HIV and AIDS and School Health

- Poor functioning of Phila Mntwana Centres


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Table 33 (NDoH 22): Situational Analysis Indicators for MCNWH & N – 2013/14 Financial Year


Umhlabuyalingana LM

District Average

1. Antenatal 1st visit before 20 weeks rate

Quarterly % 59.0% 58.4% 56.7% 61.3% 69.6% 61.2%

Antenatal 1st visit before 20 weeks No 1 193 3 133 2 592 584 3 283 10 785

Antenatal 1st visit total No 2 022 5 179 4 575 953 4 714 17 443

2. Proportion of mothers visited within 6 days of delivering their babies

Quarterly % 18.2% 122.3% 151.0% 325.9% 92.5% 87.3%

Mother postnatal visit within 6 days after delivery

No 770 5 733 1 708 453 4 365 13 029

Delivery in facility total No 4 242 4 687 1 131 139 4 720 14 919

3. Antenatal client initiated on ART rate

Annual %

108% 89.0% 63.8% 37.3% 58.5% 73.1%

ANC client started on ART ART Register 579 1 193 1 020 104 611 3 507

ANC client eligible for ART initiation ART Register 536 1 340 1 598 279 1 044 4 797

4. Infant 1st PCR test positive around 6 weeks rate

Quarterly % 2.5% 1.6% 1.5% 1.5% 1.6% 1.7%

Infant 1st PCR test positive around 6 weeks

No 17 27 25 5 25 99

Infant 1st PCR test around 6 weeks No 669 1 715 1 622 334 1 530 5 870

5. Immunisation coverage under 1 year (annualised)

Quarterly % 64.7% 86.1% 57.9% 69.1% 85.1% 74.6%

Immunised fully under 1 year new No 1 477 4 854 2 972 680 3 964 13 947

Population under 1 year No 2 211 5 460 4 973 952 4 510 18 106

6. Measles 2nd dose coverage Quarterly % 69% 76% 63% 70% 75% 71%

Measles 2nd dose No 1 478 4 072 3 108 644 3 282 12 584

Population 1 year No 2 134 5 350 4 905 919 4 378 17 686


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Umhlabuyalingana LM

District Average

7. DTaP-IPV-HepB-Hib 3 - Measles 1st dose drop-out rate

Quarterly %

4.5% 4.7% 7.9% 4.3% 5.0% 5.5%

DTaP-IPV-HepB-Hib 3 to Measles1st dose drop-out

No 79 247 297 34 211 868

DTaP-IPV-HepB-Hib 3rd dose No 1 738 5 201 3 778 784 4 235 15 736

8. Child under 5 years diarrhoea case fatality rate

Quarterly % 8.6% 2.8% 0% 0% 2.7% 4.5%

Child under 5 years with diarrhoea death

No 26 7 0 0 12 45

Child under 5 years with diarrhoea admitted

No 304 253 0 0 438 995

9. Child under 5 years pneumonia case fatality rate

Quarterly % 5.0% 2.5% 0% 0% 2.4% 2.9%

Child under 5 years pneumonia death

No 8 6 0 0 12 26

Child under 5 years pneumonia admitted

No 159 237 0 0 492 888

10. Child under 5 years severe acute malnutrition case fatality rate

Quarterly % 12.0% 19.8% 0% 0% 4.3% 12.2%

Child under 5 years severe acute malnutrition death

No 9 19 0 0 4 32

Child under 5 years severe acute malnutrition admitted

No 75 96 0 0 92 263

11. School Grade R screening coverage

Quarterly % 0% 7% 0% 5.5% 2.3% 4%

School Grade R learners screened

No. 0 304 0 60 81 445

School Grade R learners - total

No. 534 4 374 1 071 1 082 3 602 10 663

12. School Grade 1 screening coverage

Quarterly % 44% 14% 35 59% 83% 39%


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Umhlabuyalingana LM

District Average

School Grade 1 learners screened

No. 885 1051 1838 503 3575 7852

School Grade 1 learners - total

No. 2033 7508 5226 851 4284 19902


Quarterly % 11% 7% 6% 21% 61% 17%


No. 259 451 262 109 1504 2585


No. 2444 6102 4103 530 2485 15664

14. Couple year protection rate Quarterly % 40.8% 33.6% 19.7% 21.0% 45.0% 32.7%

Contraceptive years dispensed No 7 694 17 401 9 444 2 101 19 585 56 325

Population 15-49 years female No 1 907 52 218 48 789 10 126 43 933 174 083

15. Cervical cancer screening coverage (amongst women)

Quarterly % 21.1% 53.3% 31.4 35.3% 87.5% 51.5%

Cervical cancer screening in women 30 years and older

No 276 1 748 1 028 241 2 702 5 995

Population 30 years and older female/10

No 13 328 33 444 33 400 6 972 31 459 118 603

16. Human Papilloma Virus Vaccine 1st Dose coverage

Annual %

89% 95% 96% 91% 88% 93%

Numerator No 705 2378 1740 456 1788 7064

Denominator No 795 2504 1808 504 2029 7640

17. Vitamin A dose12 – 59 months coverage

Quarterly % 33.9% 67.5% 29.7% 49.8% 63.7% 51.1%

Vitamin A dose 12 - 59 months No 5 532 28 119 11 511 3 517 21 560 70 239

Population 12-59 months (multiplied by 2)

No 8 168 20 843 19 179 3 534 16 918 68 642

18. Maternal mortality in facility ratio

Annual No per 100K

47.1/100K 63.3/100K 0/100K 0/00K 85.3/100K 60.2/100K


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Umhlabuyalingana LM

District Average

Maternal death in facility No 2 3 0 0 4 9

Live birth in facility No 4 250 4 739 1 127 142 4 688 14 946

19. Early neonatal death in facility rate

Annual Per 1 000

0.7/1K 4.9/1K 3.5/1K 0/1K 6.4/1K 4/K

Death in facility 0-7 days No 3 23 4 0 30 60

Live birth in facility No 4 250 4 739 1 127 142 4 688 14 946


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Table 34 (NDoH 23): Performance Indicators for MCWH&N

Indicators Data Source Frequency Type



2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Antenatal 1st visits before 20 weeks rate

DHIS Quarterly %

48% 54.2% 61.2% 60.3% 68% 69% 70% 60%

Antenatal 1st visit before 20 weeks DHIS / Tick register PHC

No 8 446 9 176 10 785 10 162 11 606 11 894 12 187 139 012

Antenatal 1st visit total DHIS calculates

No 17 545 17 075 17 443 16 854 17 067 17 238 17 410 231 686

2. Proportion of mothers visited within 6 days of delivering their babies

DHIS Quarterly %

60.6% 70% 87.3% 75% 77% 78% 79% 74.4%

Mother postnatal visit within 6 days after delivery

DHIS / Tick Register PHC

No 8 948 10 093 13 029 11 824 12 275 12 559 12 845 151 711

Delivery in facility total DHIS / Delivery register

No 14 756 14 443 14 919 15 776 15 942 16 101 16 262 203 910

3. Antenatal client initiated on ART rate

DHIS calculates

Annual %

84.4% 84% 73.1% 85% 87% 89% 92% 95%

ANC client started on ART ART Register No 1 413 1 099 3 507 3 878 4 077 4 254 4 485 -

ANC client eligible for ART initiation

ART Register No 1 674 1 313 4 797 4 550 4 686 4 780 4 875 -

4. Infant 1st PCR test positive around 6 weeks rate

DHIS Quarterly %

3.4% 3.3% 1.7% 1.2% 1.1% 1.1% 1% <1%

Infant 1st PCR test positive around 6 weeks

DHIS / Tick register PHC

No 210 203 99 74 70 71 65 905

Infant 1st PCR test around 6 weeks DHS / Tick Register PHC

No 6 182 6 226 5 870 6 260 6 351 6 414 6 479 90 535

5. Immunisation coverage under 1 year

DHIS Quarterly %

102.5% 104% 74.6% 91% 92% 93% 94% 90%

Immunised fully under 1 year new DHIS / Tick register PHC

No 15 097 14 636 13 947 15 350 16 044 16 705 17 391 193 933


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Population under 1 year DHIS / Stats SA

No 14 969 14 176 18 106 16 929 17 439 17 962 18 501 215 481

6. Measles 2nd dose coverage DHIS Quarterly %

88% 83% 71% 96% 96% 97% 98% 85%

Measles 2nd dose DHIS / Tick register PHC

No 13 713 12 910 12 584 16 386 16 880 17 567 18 280 183 159

Population 1 year DHIS / Stats SA

No 15 636 15 468 17 686 17 073 17 583 18 110 18 653 215 481

7. DTaP-IPV-HepB-Hib 3 - Measles 1st Dose drop-out rate

DHIS Quarterly %

2.9% 4.3% 5.5% 2.9% 2.8% 2.6% 2.5% 7.5%

DTaP-IPV-HepB-Hib 3 to Measles1st dose drop-out


No 461 687 868 482 474 444 432 -

DTaP-IPV-HepB-Hib 3rd dose DHIS / Tick register PHC

No 16 113 16 038 15 736 16 762 16 926 17 095 17 266 -

8. Child under 5 years diarrhoea case fatality rate

DHIS Quarterly %

4% 8% 4.5% 6.2% 5.5% 5.2% 5% 3.2%

Child under 5 years with diarrhoea death

DHIS / Tick register

No 17 47 45 64 55 51 47 329

Child under 5 years with diarrhoea admitted

Admission Records

No 387 590 995 1 040 1 009 979 949 10 224

9. Child under 5 years pneumonia case fatality rate

DHIS Quarterly %

5% 2% 2.9% 3.8% 3.3% 3% 2.8% 2.4%

Child under 5 years pneumonia death


No 17 11 26 30 25 22 20 227

Child under 5 years pneumonia admitted

Admission records

No 322 590 888 788 764 741 719 9 199

10. Child under 5 years severe acute malnutrition case fatality rate

DHIS Quarterly %

18% 10% 12.2% 12% 10% 9% 8% 8%

Child under 5 years severe acute malnutrition death


No 35 21 32 32 26 23 20 256


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Child under 5 years severe acute malnutrition admitted

Admission records

No 199 209 263 266 260 256 250 3 200

11. School Grade R screening coverage

DHIS Quarterly %

Not collected

Not collected

4% 6% 8% 10% 12% 40%

School Grade R learners screened


No. 445 1 005 1 380 1 777 2 196 -

School Grade R learners - total

DHIS / DoE database

No. 10 663 16 745 17 247 17 765 18 298 -


DHIS Quarterly %

Not collected

Not collected

39% 41% 43% 45% 47% 55%



No. 7852 9 589 10 359 11 166 12 012 -


DHIS / DoE database

No. 19902 23 389 24 091 24 814 25 558 -


DHIS Quarterly %

Not collected

Not collected

17% 20% 24% 26% 28% 40%



No. 2 585 3 603 4 453 4 969 5 512 -


DHIS / DoE database

No. 15 664 18 015 18 555 19 112 19 685 -

14. Couple year protection rate DHIS Quarterly %

27.8% 30% 32.7% 33% 35% 37% 39% 55%

Contraceptive years dispensed DHIS calculates

No 46 454 51 261 56 325 58 092 63 512 69 155 75 080 1 611 360

Population 15-49 years female DHIS/Stats SA No 157 935 161 816 174 083 176 177 181 462 186 906 192 513 2 929 745

15. Cervical cancer screening coverage (amongst women)

DHIS Quarterly %

90.6% 82.9% 51.5% 44% 50% 55% 60% 75%

Cervical cancer screening in women 30 years and older

DHS / Tick register PHC / Hospital register

No 8 667 8 152 5 995 5 376 6 271 7 105 7 984 175 671


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Population 30 years and older female/10

DHIS / Stats SA

No 94 984 97 675 118 603 121 774 125 423 129 186 133 061 234 228

16. Human Papilloma Virus vaccine 1st Dose coverage

DHIS Annual %

Not reported

Not reported

93% 94% 95% 96% 98% 85%

Girls 9 years and older HPV 1st

dose


No 7064 7 215 7 511 7 817 8 220 -

Grade 4 girl learners ≥9 years DHIS / DoE enrolment

No 7640 7 676 7 906 8 143 8 388 -

17. Vitamin A dose12 – 59 months coverage

DHIS Quarterly %

30.3% 33.9% 51.1% 54% 60% 63% 65% 60%

Vitamin A dose 12 - 59 months DHIS / Tick register PHC

No 42 845 45 219 70 239 74 968 87 386 94 508 100 434 1 072 060

Population 12-59 months (multiplied by 2)

DHIS / Stats SA

No 70 634 68 532 68 642 68 264 72 822 75 006 77 257 1 786 768

18. Maternal mortality in facility ratio

DHIS Annual No per 100K

68.1/100K 95.3/100K 60.2/100K 70/100K 63/100K 56/100K 49/100K 120/100K

Maternal death in facility DHIS / Midnight census

No 10 14 9 11 10 9 8 242

Live birth in facility DHIS / Delivery register

No 14 695 14 683 14 946 15 672 15 841 16 158 16 481 202 473

19. Early neonatal death in facility rate

DHIS Annual Per 1 000

6.7/1K 6.1/1K 4/K 5.4/1K 4.6/1K 4/1K 3.5/1K MCW

Death in facility 0-7 days No 98 90 60 84 72 65 58 -

Live birth in facility No 14 695 14 683 14 946 15 672 15 841 16 158 16 481 202 473


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Table 35 (NDoH 24): District Objectives and Annual Targets for MCWH & Nutrition


Performance Indicators Data Source Frequency

Type

Audited/actual Performance Estimated Performance Medium Term Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. 1.1 Neonatal mortality in facility rate (annualised)

DHIS calculates

Quarterly Rate per 1000

7.6/1K 6.5/1K 4.4/1K 6.6/1K 6/1K 5.5/1K 5/1K

Inpatient death neonatal

DHIS/Midnight census

No 115 99 68 116 108 102 95

Population estimated live

births

DHIS/Delivery register

No 15418 14601 18649 17 437 17 962 18 501 19 056

2. 2.1 Infant mortality rate Inpatient death under 1 year Inpatient separation under 1year

ASSA2008

Annual Rate per 1000 No No

84/1K 124 1 476

75/1K 146 1 942

67/1K 141 2 009

108/1K 200 1 850

96/1K 180 1 882

84/1K 160 1 901

78/1K 150 1 920

3. 3.1 Child under 1 year mortality in facility rate (annualized)

DHIS Annual Per 1 K

8/1K 10/1K 8/1K 11.5/1K 10/1K 9/1K 8/1K

Inpatient death under 1 year

DHIS calculates

No 124 146 141 200 180 160 150

Population estimated live

births

DHS calculates No 15418 14601 18649 17 437 17 962 18 501 19 056


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Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

4. 4.1 Under 5 mortality rate

Inpatient death under 5 years Population estimated live births

ASSA2008 DHIS calculates DHIS calculates

Annual Rate per 1000 No No

11.3/1K 171 15 418

14.1/1K 213 14 601

10.7/1K 199 18 649

14/k 244 17 439

11/k 200 17 962

9.7/k 180 18 501

8.9/k 170 19 056

5. 5.1 Inpatient death under 5 years rate

DHIS Annual Per 1 K

66/1K 59/1K 51.7/1K 67.5/k 57.5/k 53.9/k 53/k

Inpatient death under 5 years

DHIS calculates

No 171 213 199 244

200 180 170

Inpatient separations

under 5 years

DHS calculates No 2 577 3 584 3 847 3 616 3 480 3 341 3 207

6. 6.1 Child under 5 years diarrhoea with dehydration incidence (annualised)

DHIS calculates

Annual No per 1000

16.5/1K 17.2/1K 8.24/1K 6.9/k 6.3/k 5.9/k 5.4/k

Child under 5 years diarrhoea

with dehydration new

PHC Tick Register

No 1365 1393 715 592 557 529 502


DHIS/Stats SA No 82 577 81 136 86 746 85 189 87 745 90 377 93 088

7. 7.1 Child under 5 years pneumonia incidence (annualised)

DHIS calculates

Annual No per 1000

127.4/1K 121.8/1K 104.6/1K 84/k 77/k 71/k 66/k

Child under 5 years with

pneumonia new

PHC Tick Register

No 10522 9885 9072 7156 6774 6435 6113


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Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18


DHIS/Stats SA No 82 577 81 136 86 746 85 189 87 745 90 377 93 088

8. 8.1 Child under 5 years severe acute malnutrition incidence (annualised)

DHIS calculates

Annual No per 1000

8.2/1K 9.2/1K 5.6/1K 9.5/1K 5.8/1K 5.3/1K 5/1K

Child under 5 years with severe

acute malnutrition new

DHIS/Tick register PHC

No 677 745 556 808 505 474 469


DHIS/Stats SA No 82 577 81 136 86 746 85 189 87 745 90 377 93 088

9. 9.1 Weighing coverage under 1 year (annualised)

DHIS calculates

Quarterly %

Not reported 89% 68.3% 81% 80% 81% 82%

Children under 1 year weighed

DHIS/Tick register PHC/CCG records

No 151 914 153 196 164 306 167 414 174 591 182 050

Population under 1 year

DHIS/Stats SA No 14 176 18 106 16 929 17 439 17 962 18 501

10. 10.1 Child under 2 years underweight for age incidence (annualised)

DHIS No per 1000 Annual

Not reported Not reported 38.1/1K 59/1K 55/1K 54/1K 50/1K

Child under 2 years

underweight - new (weight

between - 2SD and - 3SD new)


No 1 397 2 000 1 926 1 947 1 857


DHIS / Stats SA No 35 796 34 002 35 022 36 073 37 155


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Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

11. 11.1 Deworming dose 12-59 months coverage (annualised)

DHIS Quarterly %

Not reported Not reported 37.5% 52.5% 60% 65% 70%

Numerator Tick Register PHC

No. 45885 71 654 87 386 97 508 108 160

Population 12-59 months

(multiplied by 2)

DHIS / Stats SA No 70 634 68 532 68 642 68 264 72 822 75 006 77 257

12. 12.1 Measles 1st dose under 1 year coverage (annualized)

DHIS Quarterly %

105% 108% 82% 96% 96% 96% 96%

Measles 1st dose under 1 year


No 15 643 15 351 14 868 16 280 16 741 17 244 17 761


DHIS / Stats SA No 14 969 14 176 18 106 16 929 17 439 17 962 18 501

12.2 PCV 3rd dose coverage (annualized)

DHIS Quarterly %

106% 107% 82% 97% 97% 97% 97%

PCV 3rd dose DHIS / Tick Register PHC

No 15 820 15 160 14 860 16 368 16 916 17 423 17 946


DHIS / Stats SA No 14 969 14 176 18 106 16 929 17 439 17 962 18 501

12.3 RV 2nd dose coverage (annualised)

DHIS Quarterly %

109% 113% 87% 98% 98% 98% 98%

RV 2nd dose DHIS / Tick Register PHC

No 16 309 15 993 15 804 16 658 17 090 17 603 18 130


DHIS / Stats SA No 14 969 14 176 18 106 16 929 17 439 17 962 18 501


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Type


2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

13. 13.1 Infant given NVP within 72 hours after birth uptake rate 5

DHIS Quarterly %

100.5% 99% 99.6% 99.5% 99.5% 99.6% 99.7%

Infant given NVP within 72 hours

after birth

DHIS / Tick register OPD/ PHC, delivery register

No 4 804 5 116 4 995 5 050 5 111 5 178 5 245

Live birth to HIV positive woman

DHIS / delivery register

No 4 855 5 183 5 016 5 076 5 137 5 199 5 261

14. 14.1 Delivery in facility under 18 years rate

DHIS Annual %

10.4% 11.3% 11.3% 11% 10.5% 10.2% 10%

Delivery in facility to woman under

18 years

DHIS / Delivery register

No 1 537 1 628 1 680 1 734 1 674 1 642 1 626

Delivery in facility total

DHIS / Delivery register

No 14 756 14 443 14 919 15 776 15 942 16 101 16 262

15. 15.1 Infants exclusively breastfed at Hepatitis B 3rd dose

DHIS Quarterly %

37.5% 66.9% 44.1% 50% 52% 53% 55%

Infant exclusively breastfed at

HepB3rd dose

Tick register PHC

No 2 211 10 817 7 132 8 394 8 928 9 281 9 825

HepB 3rd Dose Tick register PHC

No 16 572 16 180 16 182 16 834 17 169 17 512 17 863

5 Baby Nevirapine uptake rate


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15.2 STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16


1. Improve Antenatal care - Audit implementation of BANC

- Audit all causes of still births

2. Implement KZN 5 point contraceptive

strategy and to reduce high teenage

pregnancy

- Monitor the availability of contraceptive method mix in PHC facilities

- Monitor integration of SRH in HIV/TB and School Health.

3. Improve community involvement in

MCWH&N issues through OSS

- Sensitise all community stakeholders on MCWH&N issues.

4. Strengthen functionality of Phila Mntwana

centres

- Ensure availability of basic equipment

- Conduct adequate training of cadres working at Phila Mntwana Centres

- Marketing of Phila Mntwana centres

- Increase number of Phila Mntwana centres under Jozini and Hlabisa

5. Implement MDG Count-down to April 2015

- Train health workers in management of malnutrition

- Train, monitor and conduct partogram audits in all facilities

- conducting deliveries

- Promote and support breastfeeding

6. Strengthen implementation of CARMMA - Monitor implementation of Mom Connect, BANC, post natal care, PMTCT,

contraception and HIV & AIDS


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- Conduct audits

7. Improve IMCI implementation - Train health workers on IMC implementation

- Monitor implementation of IMCI guidelines

8. Improve access to quality skilled birth

attendants - Train, monitor and mentor maternity staff on implementation ESMOE

- Monitor functionality and effectiveness of EMS harmonization

9. Improve management of gastroenteritis and

pneumonia - Train health workers on management of gastroenteritis and pneumonia

- Audit implementation of gastroenteritis and pneumonia treatment guidelines


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16. DISEASE PREVENTION AND CONTROL (ENVIRONMENTAL HEALTH INDICATORS)


The purpose of this programme is to prevent and control communicable and non-

communicable diseases in the District.

The district is aiming towards elimination of malaria. The Malaria incidence is 0.33/1k

population, below the target of <1/1k population.

207 Malaria cases identified in 2013/14 financial year with four deaths reported which gives

a case fatality rate of 1.9% and which is very high compared to previous years. Mortality

reviews and training on Malaria management need to be strengthened.

Mosvold hospital has been the only site for cataract surgery for the past 10 years. Hlabisa

started doing the cataract surgery as from April 2014 with the support from the cataract

surgeon from Mosvold hospital. In 2013/14 489 operations were done which gives a

cataract surgery rate of 798/mill population which is below the provincial target of 1

430/mill pop. The district will revive Cataract Finders.

There is an increase in new cases of hypertension and diabetes. The district needs to

strengthen promotion of Healthy Life Style. 13 amputations performed as at the end of

second quarter 2014/15 due to diabetes, which indicates poor management of diabetes

and delay in seeking medical attention.

Some hospitals have established outreach teams (Mpilonde Chronic Medication

dispensation) to communities to dispense chronic medications. This initiative has reduced

congestion in clinics and hospitals and it has reduced patient waiting times in facilities.

1/5 (Hlabisa) has no Mental Health seclusion ward. The hospital is in a process to identify a

corner for seclusion. The district is experiencing a high defaulter rate of Mental Health Care

Users. The programme will be linked to CCG programme.

There have been no cases of cholera reported in the past ten years.

The District continues to monitor for notifiable medical condition including meningococcal

meningitis and hepatitis B. There were isolated food poisoning outbreaks.

STRATEGIC CHALLENGES FOR THE SUB-PROGRAM

- Shortage of Cataract Surgeons


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- Increased number of amputations due to diabetic complications

- Poor implementation of health lifestyle practises in the community


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Table 36 (NDoH 25): Situational Analysis for Disease Prevention and Control - 2013/14 Financial Year


UMhlabuyalingana LM District Avg

1. Clients screened for hypertension Quarterly No Not Collected on DHIS

Not Collected on DHIS



Not Collected on DHIS Not Collected on DHIS

2. Clients screened for diabetes Quarterly No






3. Percentage of people screened for mental disorders Quarterly % Not Collected on DHIS





PHC Client screened for mental disorders No

PHC headcount total No

4. Percentage of people treated for mental disorders Quarterly % Not Collected on DHIS





Client treated for mental disorders at PHC level No

Clients screened for mental disorders at PHC level No

5. Cataract surgery rate No per million uninsured population

0.0/mil 2568.7/mil 0.0/mil 0.0/mil 0.0/mil 798/mil

Cataract surgery total No 0 489 0 0 0 489

Population uninsured total No 70 209 182 556 172 382 34 761 153 220 613 129

6. Malaria case fatality rate % 14.3% 0% 0% 0% 1.1% 1.9%

Malaria death reported No 2 0 0 0 1 4

Number of malaria cases (new) No 21 51 41 3 95 211


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Table 37 (NDoH 26): Performance Indicators for Environmental Health Services

Data

Source Frequency

Type

Audited/ Actual Performance Estimated Performance Medium Term Targets Provincial

Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Clients screened for hypertension


Quarterly

No

Not collected

Not collected

Not collected

Not collected TBD TBD TBD Establish baseline

2. Clients screened for diabetes


Quarterly

No

Not collected

Not collected

Not collected


3. Percentage of people screened for mental disorders

DHIS calculates

Quarterly % Not collected

Not collected

Not collected


PHC Client screened for mental disorders


No

PHC headcount total DHIS / Tick Register

No

4. Percentage of people treated for mental disorders

DHIS Calculates

Quarterly % Not collected

Not collected

Not collected


Client treated for mental disorders at PHC level


No

Clients screened for mental disorders at PHC level


No

5. Cataract surgery rate DHIS Quarterly

No per 1 mil uninsured population

679/1mill 735/1mill 798/1mill 1374/1mill 1410/mil 1400/mill 1434/mill 930/mil

Cataract surgery total DHIS / Theatre register

No 426 414 489 850 880 900 950 8 895

Population uninsured total DHIS / Stats SA

No 627 336 563 211 613 129 618 650 624 310 643 039 662 330 9 566 487

6. Malaria case fatality rate Malaria Register

Annual

%

1% 1% 1.9% 1.6% 1.3% 1% 0.5% <0.5%


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Data

Source Frequency

Type

Audited/ Actual Performance Estimated Performance Medium Term Targets Provincial

Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Malaria death reported Malaria register / Tick register PHC

No 2 2 4 3 3 2 1 -

Number of malaria cases (new) Malaria register / Tick register PHC

No 187 172 211 207 203 199 195 -

Table 38 (NDoH 27): District Objectives and Annual Targets for Environmental Health Services




2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. Malaria incidence per 1000 population at risk

Malaria register

Annual

Per 1000 population at risk

0.28/1K 0.25/1K 0.33/1K 0.31/1K 0.30/1K 0.29/1K 0.27/1K

Number of malaria cases (new)

Malaria register/Tick register PHC

No 187 172 211 200 195 194 186

Population Umkhanyakude

DHIS/Stats SA Population 660 354 666 523 638 011 643 757 649 646 669 135 689 209

2. Hypertension incidence (annualised)

DHIS

Quarterly

No per 100

25.9/1K 24.5/1K 22.2/1K 25.2/1K 20.7/1K 19.5/1K 18.5/1K


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Hypertension client treatment new

DHIS / PHC tick registers

No 2 737 2 622 2 588 2 798 2548 2 497 2 447

Population 40 years and older

DHIS / Stats SA

No 105 077 106 077 118 315 120 836 124 463 128 197 132 043

3. Diabetes incidence (annualised)

DHIS

Quarterly

No per 1000

0.83/1K 0.63/1K 0.8/1K 0.85/1K 0.8/1K 0.76/1K 0.72/1K

Diabetes client treatment new

DHIS / PHC tick registers

No 545 423 527 546 519 509 499

Population Umkhanyakude

DHIS / Stats SA

No 660 354 666 523 638 011 643 757 649 646 669 135 689 209


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16.2 STRATEGIES/ ACTIVITIES TO BE IMPLEMENTED 2015/16


1. Improve case management of malaria - Conduct training twice a year on Malaria management

- Conduct Annual mortality review for Malaria

2. Improve cataract surgery rate - Identify Cataract Case Finders

- Request Regional Hospitals to provide Eye Surgeon through flying

Doctors

3. Strengthen Healthy life style - Conduct awareness campaign

- Encourage Work and Play Programs at all institutions

4. Strengthen surveillance system - Active and passive case finding

- Conduct patient follow-ups

- Submit notifiable medical condition forms

5. Improve diabetic and hypertension - Early screening and diagnosis

- Follow the treatment guidelines


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17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES

Table 39 (NDoH 38): Performance Indicators for Health Facilities Management

Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Expenditure on facility maintenance as % of total district health expenditure

% 1.32% 1.19% 1.29% 1.7% 2.1% 2.6% 3%

Numerator R14 482 215

R14 460 032

R17 883 045

R24 922 181 R30 828 223

R40 570 253

R49 738 402

Denominator

R1 097 927 372

R1 220 019 345

R1 383 028 895

R1 466 010 629

R1 468 010 629

R1 557 971 266

R1 657 946 742

2. Number of facilities that have undergone major and minor refurbishment

1 2 2 1 1 2 3

3. Fixed PHC facilities with access to continuous supply of clean portable water

% 70% 67% 66% 66% 67% 67% 67%

Numerator 38 37 37 37 38 39 39

Denominator 54 55 56 56 57 58 58

4. Fixed PHC facilities with access to continuous supply of electricity

% 100% 100% 100% 100% 100% 100% 100%

Numerator 54 55 56 56 57 58 58

Denominator 54 55 56 56 57 58 58

5. Fixed PHC facilities with access to sanitation 100% 100% 100% 100% 100% 100% 100%

Numerator 54 55 56 56 57 58 58

Denominator 54 55 56 56 57 58 58

6. Fixed PHC facilities with access to fixed telephone line % 100% 98% 98% 98% 100% 100% 100%

Numerator 54 54 55 55 57 58 58


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Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Denominator 54 55 56 56 57 58 58

7. Percentage of PHC facilities with network access 0% 0% 1.8% 1.8% 35% 70% 100%

(Provincial competency) Numerator 0 0 1 1 20 40 58

Denominator 54 55 56 56 57 58 58

8. Number of additional clinics and community health centres constructed

0 0 1 1 2 0 0


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18. SUPPORT SERVICES

18.1 PHARMACEUTICAL SERVICES

The purpose of this program is to ensure availability of medicines and compliance to

Pharmacy legislatives

PHC Medicine Supply Management (MSM) remains a challenge in the District, because there

are no dedicated Pharmacist Assistants PAs appointed at PHC. 5/62 PHC facilities (including

mobile bases) have appointed Pas, and the Province is in the process of creating more posts

for the remaining facilities as the proposed new PHC structure. This initiative is aiming at

improving PHC MSM.

The District has a high turnover of Pharmacy Managers at Manguzi, Mosvold and Mseleni. It is

also difficult to attract and retain production level pharmacists in the District because of its

deep rural nature. The district relies on Community Service Pharmacists for continuity of

services. To address the attraction and retention of pharmacists, the District plans to

implement the new Pharmacy structure in all hospitals within the District which will improve

the Pharmacy Managers posts from being Assistant Managers to Deputy Manager:

Pharmaceutical Services.

The District office is planning to unfreeze and fill two pharmacists and two PAs posts to

strengthen Pharmaceutical Services support to PHC facilities and to assist District hospitals

when there is a shortage of hospitals pharmacists.

Pharmaceutical and Therapeutics Committees (PTC) are being re-vitalised in the District. The

District is in the process of formally selecting and appointing members of the District PTC. The

Terms of Reference (TOR) have been approved with relevant attachments. TOR for formally

establishing hospital PTC has been circulated to hospitals and it is anticipated that the

hospitals PTC will be formally appointed by the end of 2014/15 financial year.

Compliance with South African Pharmacy Council (SAPC) standards remains a challenge in

the District as there were only two hospital who received an A grading (Bethesda and Hlabisa

– until end of December 2015) and one hospital received B grading (Mseleni – until end of

December 2014). It is anticipated that Mseleni hospital will not retain its B grading in 2015 as

pharmacists are leaving the institution (four full time pharmacists). High turnover of Pharmacy

Managers at Manguzi, Mosvold and Mseleni resulted in these hospitals not being graded.


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Tracer medicines stock out rate was 6% (2nd Quarter 2014/15) compared to 10% (annual

2013/14) for Institutions. Although this is slightly above the target (5%), stock out of medicines

remains unacceptable and would result in poor patient outcomes. Provincial Pharmaceutical

Supply Depot (PPSD) order schedules were issued on a month to month basis and were

unpredictable form the beginning of the year, as result there was a lag time of about two

weeks between anticipated dates resulting in some facilities ordering in six weeks instead of

four weeks intervals.

CHALLENGES

- High turnover of Pharmacists

- Unavailability of PHC Pharmacist Assistant posts

- Poor monitoring of (MSM) in hospitals and PHC facilities

- Noncompliance with Standard Treatment Guidelines (STGs) and Essential Medicines

Lists (EML) in hospitals and PHC facilities


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Table 40 (NDoH 39): Pharmaceutical Services Performance Indicators

Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

1. Percentage of institutions (District Hospitals and CHC’s) with functional of Pharmaceutical and Therapeutics Committees (PTC’s)

% 80% 60% 80% 80% 100% 100% 100%

Number of CHC’s and District Hospitals with functional

Pharmaceutical and Therapeutic Committees

4 3 4 4 6 6 6

Number of District Hospitals and CHC’s

5 5 5 5 6 6 6

2. Any ARV Drug Stock Out Rate % Indicator not clearly defined

Indicator not clearly defined






Number of ARV drug’s out of stock

Number of ARV’s drugs

3. Any TB Stock Out Rate % Indicator not clearly defined








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Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Number of TB drugs out of stock

Number of TB drugs

4. Percentage of Hospitals with Pharmacists

% 100% 100% 100% 100% 100% 100% 100%

Number of District Hospitals with Pharmacists

5 5 5 5 5 5 5

Number of District Hospitals 5 5 5 5 5 5 5

5. Percentage of CHC’s with Pharmacists

% N/A N/A N/A N/A 100% 100% 100%

Number of CHC’s with pharmacists

1 1 1

Number of CHC’s 1 1 1


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Table 41 (NDoH 30): Pharmaceutical Services

Strategic Objective Performance Indicator Data source Type


Medium Term Targets

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. 1. Percentage of Pharmacies that obtained A and B grading on inspection

Pharmacy records

Annual

%

40% 40% 60% 40% 83% 100% 100%

Pharmacies with A or B Grading

Pharmacy records

No 2 2 3 2 5 6 6

Number of pharmacies Pharmacy records

No 5 5 5 5 6 6 6

2. Tracer medicine stock-out rate (PPSD)

Pharmacy records

Quarterly

%

N/A N/A N/A N/A N/A N/A N/A

Number of tracer medicine out of stock

Pharmacy records

No

Total number of tracer medicine expected to be in stock

Pharmacy records

No

3. Tracer medicine stock-out rate (Institutions)

Pharmacy records

Quarterly

%

2% (incl. PHC) 6% 6% 6% 5% 5% 5%

Number of tracer medicines stock out in bulk store

Pharmacy records

No 92 196 200 200 200 200 200

Number of tracer medicines expected to be stocked in the bulk store

Pharmacy records

No 6 009 3 300 3 300 3 240 3 888 3 888 3 888

2. 4. Number of mortuaries rationalised

Management Annual

No

0 0 0 0 0 1 1


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1. Strengthen Pharmaceuticals services

HR - Implement new District hospital Pharmacy structure

- Expand the District Office Pharmaceutical Services to strengthen PHC support

- Create PAs posts at PHC facilities to improve PHC MSM

2. Strengthening of District and Hospital

Pharmaceutical and Therapeutics

Committees to ensure adequate

training on EML/STGs

- Revitalize and establish PTC committees

- Conduct audits on Standard Treatment Guidelines implementation and training

- Conduct National Core Standards (NCS) audits

3. Strengthen stock management in all

facilities - Monitoring of MSM in hospitals and PHC facilities

- Conduct stock taking


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18.2 EQUIPMENT AND MAINTENANCE

Acquisition plan attached as annexure B

Table 42: District Equipment and Maintenance

Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target 2015/16

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

1. Percentage of maintenance budget spent

Annual

%

88% 99% 100% 109% 100% 100% 100%

Expenditure on maintenance (preventive

and scheduled)

No 14 482 215 14 4600 032 17 883 045 18 306 921 20 137 613 22,151,374 24,366,512

Maintenance budget No 16 365 312 14 548 000 17 883 000 16 833 000 20 140 000 22 168 000 24 405 000

2. Proportion of Programme 8 ( infrastructure budget) spent on all maintenance (preventative and scheduled)

Annual

%

Monitored by Provincial infrastructure Office







Expenditure on maintenance (preventive

and scheduled)

No

Infrastructure budget No

3. Number of health facilities that have undergone major and minor refurbishments

Annual

No.

1 2 2 1 1 2 3


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18.3 EMERGENCY MEDICAL SERVICES (EMS)

SUB PROGRAMME OVERVIEW

The District has a challenge of having insufficient vehicles, inadequate staff and skills to meet

the service demand. Currently (end of Q2 2014/15) there are 12 ambulances (1:53 167

population), whereas the National Standard and Norms is 1:10 000.

The response times are still a big challenge due to poor road infrastructure, poor road

signage and geographic nature of area. The ambulances take hours to get on scene

especially on gravel roads and the sense of direction from callers sometimes it possess a

challenge, whereby landmarks are not fixed and visible. The district has insufficient staff both

in the Administration and Operations side, this compromises service delivery especially when

it comes to daily operations. The district has limited skilled individuals on the operation

(Roads) there are less Advance Life Support (ALS) and Intermediate Life Support (ILS) to meet

our daily demands.

The terrain for UMkhanyakude District is very bad, which contributes to poor response times.

The patient pick up points are very far from the bases, which can cause a response time of 4

hours from Base to scene.

The absence of Regional and Tertiary hospitals in the District causes EMS to have a high rate

of Inter-facility Transfers.


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Table 43 (NDoH 31 (a)): Operational Ambulances per 10,000 Population Coverage (inclusive of LG)

District Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Hlabisa Local Municipality Ratio 1,93158 0.274 (2/7.31) 0.547 (4/7.31) 0.547 (4/7.31) 1 (7/7.31) 1 (7/7.31) 1 (7/7.31)

Jozini Local Municipality Ratio 1,24241 0.368 (7/19) 0.474 (9/19) 0.474 (9/19) 1 (19/19) 1 (19/19) 1 (19/19)

Mtubatuba Local Municipality Ratio 1,21244 0.167 (3/18) 0.167 (3/18) 0.167 (3/18) 1 (18/18) 1 (18/18) 1 (18/18)

Big 5 False Bay Local Municipality Ratio 1,14878 0.5 (2/4) 0.5 (2/4) 0.5 (2/4) 1 (4/4) 1 (4/4) 1 (4/4)

UMhlabuyalingana Local Municipality

Ratio 1,11175 0.438 (7/16)

0.563 (9/16) 0.563 (9/16) 1 (16/16) 1 (16/16) 1 (16/16)

UMKHANYAKUDE Ratio 1,34038 0.328 (21/64) 0.422 (27/64) 0.422 (27/64) 1 (64/64) 1 (64/64) 1 (64/64)

Table 44 (NDoH 31 (b)): Ambulance Response Time Rural under 40 minutes (Inclusive of LG)

Audited/ Actual performance Estimate MTEF Projection Provincial Target 2015/16

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Hlabisa Local Municipality 26% (3314/12746)

21% (645/3050) 9% (451/4986) 23% (942/4127) 60% (2750/4551) 75% (3421/4551) 75% (3421/4551)

Jozini Local Municipality 15% (4392/29280)

25% (1052/4289) 20% (1315/6431) 18% (1342/7289) 54% (4351/8000) 63% (5012/8000) 63% (5012/8000)

Mtubatuba Local Municipality 29% (3899/13445)

12% (537/4330) 20% (1130/5771) 19% (1224/6521) 48% (3455/7230) 65%(4723/7230) 65%(4723/7230)

Big 5 False Bay Local Municipality 31% (4572/14748)

17% (361/2075) 12% (311/2649) 17 % (676/3942) 42% (1730/4150) 68%(2834/4150) 68%(2834/4150)


28% (3062/10936)

25% (915/3636) 16% (801/5093) 19% (1046/5621) 47% (3116/6511) 77% (4987/6511) 77% (4987/6511)

UMKHANYAKUDE 26% (19239/73996)

20% (3510/17380)

16% (4008/24930)

19% (5230/27500)

51% (15402/30402)

69% (20986/30402)

69% (20986/30402)

33%

(71 802/217 229)


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Table 45 (NDoH 31(c)): Ambulance Response Times Urban under 15 minutes (Inclusive of LG)

Ambulance Response Time: Urban Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

N/A %

N/A %

N/A %

N/A %

N/A %

N/A %

District Average %

Table 46 (NDoH 31 (d)): EMS Inter-facility Transfer Rate

District Type Audited/ Actual performance Estimate MTEF Projection Provincial Target

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16

Hlabisa Local Municipality % 10%(838/8758) 14%(1345/9562) 17%(1508/9134) 14%(171012426) 16%(2000/12500) 16%(2000/12500) 16%(2000/12500)

Jozini Local Municipality % 10%(768/7851) 11%(912/8230) 14%(1214/8671) 15%(1324/9145) 18%(1700/9300) 18%(1700/9300) 18%(1700/9300)

Mtubatuba Local Municipality % 2%(102/5624) 2%(167/7490) 2%(92/7812) 1%(67/8423) 4%(310/8500) 4%(310/8500) 4%(310/8500)

Big 5 False Bay Local Municipality % 2%(98/4621) 2%(135/5432) 1%(53/6512) 1%(45/6812 2%(170/7000) 2%(170/7000) 2%(170/7000)


% 12%(708/5822) 13%(854/6756) 14%(983/7193) 18%(1341/7354) 21%(1590/7700) 21%(1590/7700) 21%(1590/7700)

UMKHANYAKUDE % 8%(2514/32676) 9%(3413/37470) 10%(3850/39322) 10%(4487/44160) 13%(5770/45000) 13%(5770/45000) 13%(5770/45000) 37% (230 000/620 000)


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19. HUMAN RESOURCES

Table 47 (NDoH 32): Performance for Human Resources

TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Health district Personnel category1

Hlabisa PHC facilities

Medical officers 0 0 0 0 0 0 0

Professional nurses 32 47 22 27 30 30 33

Pharmacists 0 0 0 0 0 0 0

District hospitals




Radiographers 3 3 3 4 4 4 5

Jozini PHC facilities




District hospitals






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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

CHC facilities





The Big 5 False Bay PHC facilities




District hospitals





Mtubatuba PHC facilities




District hospitals





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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18


UMhlabuyalingana PHC facilities




District hospitals





District PHC facilities




CHC





District hospitals


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2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18



Pharmacists 14 16 15 17 20 20 23

Radiographers 13 13 13 15 15 16 19 Table 48 (NDoH 33): Plans for Health Science and Training

CONTINUOUS PROFESSIONAL CAPACITY BUILDING / TRAINING 6 INDICATORS Estimated

performance Medium term targets

2014/15 2015/16 2016/17 2017/18

Clinical Training for Medical and Allied Professionals Number of trained employees 20 25 25 30

Mid-Level Worker Training Number of trained employees 40 60 50 50

HIV/AIDS Management Number of trained employees 60 60 60 60

Nursing Education and Training Number of trained employees 120 120 140 140

Management and Leadership Number of trained employees 200 100 150 150

Finance Management Number of trained employees 40 30 30 30

Artisan Training Number of trained employees 40 40 25 25

Human Relations Training Number of trained employees 300 250 250 250

Compulsory Induction Programme Number of trained employees 250 200 100 100

6 This would include formal and informal (short courses, refreshers, etc.) courses.


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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / TRAINING 6 INDICATORS Estimated performance

Medium term targets

2014/15 2015/16 2016/17 2017/18

Internship for Unemployed Graduates Number of trained employees 11 11 11 11

Adult Education and Training Number of trained employees 60 50 50 50

Strategic Management Number of trained employees 10 10 10 10

Health and Safety Related Training Number of trained employees 40 50 50 60

Generic Skills Training Number of trained employees 20 20 20 20

Employee Assistance Programme Training Number of trained employees 4 5 4 4

Supervisory Skills Training Number of trained employees 80 80 50 50

20. DISTRICT FINANCE PLAN

Table 49 (NDoH 34): District Health MTEF Projections

Sub-programme Audited outcome Main appropriation

Adjusted appropriation

Revised estimate

Medium term expenditure estimates

R’ thousand 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

District Management

R8 148 487 R11 777 427 R10 799 016 12 077 000 - R11 825 665 12 653 462 13 539 204 14 486 943

Clinics R201 289 144 R212 533 461 R247 334 420 281 418 000 - 277 342 093 300 756 040 321 808 963 344 335 590

Community Health Centres

0 0 0 0 - 0 44 815 000 47 952 000 51309 000

Community Services

R4 026 000 0 0 0 - - - - -

Other Community R49 563 803 R60 235 212 R77 083 822 87 468 000 - 88 656 011 94 861 932 101 502 267 108 607 426

Coroner Services R8 669 009 R8 317 815 8 884 511 9 376 000 - 9 195 439 9 839 119 10 527 858 11 264 808


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HIV and AIDS R108 569 728 R147 645 551 R186 746 261 193 425 000 - 257 985 513 274 974 499 294 222 714 314 818 304

Nutrition R3 428 103 R3 321 474 R3 327 630 3 213 000 - 2 970 044 3 177 947 3 400 404 3 638 432

District Hospitals R500 869 279 R581 413 915 R647 730 390 691 354 000 - 703 819 607 753 086 980 805 803 069 862 209 283

Environmental Health Services

R56 982 768 R57969 536 R63 348 901 64 968 000 - 59 453 402 63 615 140 68 068 200 72 832 974

TOTAL R941 546 321 R1 082 214 391 R1 245 254 951 1 343 299 000 - 1 397 451 108 1 499 272 686 1 604 221 774 1 716 517 298

Table 50 (NDoH 35): District Health MTEF Projections per Economic Classification

R’ Thousands Audited Outcomes Main appropriation

Adjusted appropriation

Revised estimate

Medium-term estimate

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Current payments R1 080 020 000

R1 202 156 473

R1 229 247 093 R1 466 558 000 - 1 534 429 726 1 689 939 807 1 860 023 593 2 015 954 245

Compensation of employees

R811 601 015 R898 522 385 R 933 530 703 R1 114 323 000 - 1099 494 391 1 211 858 999 1 334 877 129 1 469 413 528

Goods and services R268 418 985 R303 634 088 R295 716 390 R352 235 000 - 434 935 335 478 080 808 525 146 465 576 545 717

Transfers and subsidies to R4 146 922 R3 404 006 R6 544 568 R2 796 000 - 9 373 158 10 094 279 10 801 329 11 556 522

Payments for capital assets R13 483 710 R14 458 866 R9 589 043 R2 646 000 - 9 055 344 10 039 218 1 116 963 12 296 151

Total economic classification

R1 097 927 372

R1 220 019 345

R1 245 380 704 R1 472 000 000 - 1 552 858 228 1 710 073 304 1 881 941 885 2 069 811 917


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PART C: LINKS TO OTHER PLANS

21. CONDITIONAL GRANTS (WHERE APPLICABLE)

Table 51 (NDoH 36): Outputs of a result of Conditional Grants

Name of conditional grant

Purpose of the grant Performance indicators

(extracted from the Business Case prepared for each Conditional Grant

Indicator targets for 2015/16

COMPREHENSIVE

HIV AIDS

CONDITIONAL

GRANT

(Applicable to

all Districts)

To enable the health sector to

develop an effective response to

HIV and AIDS including universal

access to HIV Counselling and

Testing

To support the implements of the

National operational plan for

comprehensive HIV and AIDS

treatment and care

To subsidise in-part funding for the

antiretroviral treatment plan

Total Number of fixed public health facilities offering ART

Services (including two Gateways)

62

Number of new patients that started on ART

15 000

Total number of patients on ART remaining in care.

84 769

Number of beneficiaries served by CCGs categories

89 662

Number of active CCGs receiving stipends

823

Number of male and female condoms distributed 5 100 000

Number of High Transmission Areas (HTA) intervention sites

2


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Number of Antenatal Care (ANC) clients initiated on lifelong

ART

Number of babies Polymerase Chain Reaction (PCR) tested at

6 weeks

1. 3420

Number of HIV positive clients screened for TB

1682

Number of HIV positive patients that started on IPT

12430

Number of active lay counsellors on stipends 4990

Number of clients pre-test counselled on HIV testing (including

Antenatal) 162160

Number of HIV tests done 162160

Number of health facilities offering MMC services 12

Number of Medical Male Circumcisions performed 17 848

Sexual assault cases offered ARV prophylaxis

<320


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Doctors and professional nurses training on HIV/AIDS, STIs, TB

and chronic diseases

40

22. PUBLIC-PRIVATE PARTNERSHIPS (PPPS) AND PUBLIC PRIVATE MIX (PPM)

Table 52 (NDoH 38): Outputs as a result of PPP and PPM

Name of PPP or PPM Purpose Outputs Current Annual Budget (R’Thousand) Date of Termination Measures to ensure smooth transfer of responsibilities

1. MAtCH Health systems

strengthening

DoH outputs Not known 2017 Capacity building

done to DoH staff

2. SACTWU MMC DoH outputs Not known Capacity building

done to DoH staff

3. FSH 360 Integration of

MCWNH, Nutrition

and PMTCT

DoH outputs Not known Capacity building

done to DoH staff

4. Star for Life Youth and

Adolescent life skills

& HCT


done to DoH staff

5. Mpilonhle School Health

Services


done to DoH staff


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Name of PPP or PPM Purpose Outputs Current Annual Budget (R’Thousand) Date of Termination Measures to ensure smooth transfer of responsibilities

6. UNPFA Sexual

Reproductive

Health

,Safeguarding

young People


done to DoH staff

7. UMTHOMBO

YOUTH

DEVELOMENT

Health Professional

Bursary Scheme

DoH outputs Not known 2019


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PART E: INDICATOR DEFINITIONS Indicator Short Definition Purpose of

Indicator Primary Source

APP Source

Method of Calculation Calculation Type

Type of Indicator

Reporting Cycle

Data Limitations

Desired Performance

Indicator Responsibility

Use this template if district has added any indicators throughout the document.

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