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South Africa’s District Health Barometer. Fiorenza Monticelli Health Systems Trust HMN meeting 28-29 Sept 2006. Background. The SA National Health Act of 2003 requires: provinces & districts develop and implement annual plans

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South africa s district health barometer

South Africa’s District Health Barometer

Fiorenza Monticelli Health Systems Trust HMN meeting 28-29 Sept 2006


  • The SA National Health Act of 2003 requires:

    • provinces & districts develop and implement annual plans

    • measure performance & monitor if achieving short term objectives year on year.

  • Oversupply of data coexists with large unmet needs for useful management information.

  • In order to meet this need HST successfully piloted a District Health Barometer in 2005, in collaboration with the National Department of Health.

Scope composition
Scope & Composition

  • Scope: A publication featuring a selection of indicators drawn from a variety of information sources which are measurable at district level on an annual basis.

  • Information Sources:

  • District Health Information System (DHIS) 90%

  • National TB register

  • Statistics South Africa – population data & basis for socioeconomic data

  • Treasury – Financial data (health expenditure).


  • Health Categories covered:

  • HIV/AIDS & PMTCT, TB, Maternal Health, Child Health , Human resources

  • Timeframe:

  • Jan-Dec 2004 (DHB year 1) and Financial years 03/04, 04/05, 05/06 (DHB year 2)

Indicator categories

  • Examples of some Indicators used in the DHB

  • Input:

  • Per capita non-hospital expenditure on health (public sector)

  • Process:

  • Nurse Clinic Workload (PHC)

  • Output:

  • Immunization coverage rate & drop out rate

  • Nevirapine uptake rate among HIV+ pregnant women

  • Nevirapine uptake rate among babies born to HIV+ women

  • Outcome:

  • PHC Utilisation rate

  • Incidence of STI treated*

  • TB cure rate

  • Incidence of diarrhoea under 5 years (per 1000).

  • Impact:

  • Perinatal mortality rate in facility* * Year 2

Example of league table graph comparing all districts
Example of League Table Graph Comparing all Districts

SA ave 56.7%

SA target = 65%

TB Cure Rate 2003

Amajuba 54.9%

Sisonke 23.7%

Example of maps
Example of maps

West Rand 80.4%

Sisonke 36.4%

Overberg 89.6%

Example of maps1
Example of Maps

West Rand 56%, Metsweding 54%

Chris Hani 108%

Target audience
Target Audience

  • Managers at national, provincial and district level

    • Strategic planning, M&E of district performance and health service delivery, resource allocation

    • Tool to improve quality & use of health information

  • Politicians

    • Graphic and pictorial representation giving easy understanding of issues of quality and equity

  • Other Sectors

    • e.g. Treasury, academic sector and international health community gain greater insight into the sector

  • Donors

    • To gain greater insight & identify areas of need.

Support and use
Support and Use

  • Electronic publication received close on 1500 ‘hits’ over 8 months

  • Referenced in published research articles, reports and appeared in press articles

  • National Treasury and NDOH make available information for use + provide letters of support

  • NDOH have contracted HST to improve HIS data quality, data flow, timeliness and use.

Activities and outputs
Activities and outputs

  • Addressing Quality

  • Increased focus and attention on DHIS data quality, analysis, feedback and use.

  • HMIS, the sister project to the DHB, works in all districts to:

    • Improve data collection, flow and quality

    • Support use and interpretation of data by managers

    • Build capacity in HIS at all levels

  • Thus data irregularities identified and highlighted by the DHB, are attended to by the HMIS project on an ongoing basis.

  • Potential impact
    Potential Impact

    • Routine service level data colleted is transformed into information that leads to action

    • Inequities between rural and urban areas are addressed

    • Improved feedback

    • Tool for M&E, strategic planning at province & national level

    • Improved transparency of performance of health sector

    • Continuous improvement of data quality of DHIS

    Limitations and challenges
    Limitations and Challenges

    • Legal framework and access to information

      • Information at district level is not accessible to the public

      • HST apply for permission to publish data

      • Through the DHB, data is publicly available Fear of data going to press, creating a negative image.

    • Ongoing data quality issues limit choice & selection of indicators.


    • Short to medium term: Year 2 and 3

      • Ongoing feedback, improvement and support of the DHIS

      • Improving capacity of all managers in DOH to use & interpret data

      • Develop more accessible formats: available on intranets of DOH, web friendly interface with GIS

      • Increase dissemination (workshops/ presentations)

      • Build capacity at National level to take over the project

    • Long term: NDOH is fully involved and by year 4 manage the DHB as their own project or contract it out on an annual basis.

    • We acknowledge the South African National Department of Health for access to and use of their data for this publication and Atlantic Philanthropies for funding the project

      • The District Health Barometer can be accessed on the HST website at


    • Contact details: [email protected]

    • Thank you