Using strategic information to identify areas of intervention for Health Systems Strengthening

Transcription

1 Using strategic information to identify areas of intervention for Health Systems Strengthening Fiorenza Monticelli Symposium on Health Systems Strengthening, 16 August Anova Health Institute, Johannesburg

2 Presentation Outline Overview Data sources: The District Health Barometer, Deprivation Index, Facilities Audit Comparing districts with the most and least deprived populations in SA by: Burden of Disease Selected Health Indicators (Input, Process, Output, Outcome and Impact) Health Facilities, HR and Services

3 The District Health Barometer An objective tool to monitor and compare primary health care service delivery amongst and across districts & provinces. A central repository of key health and A central repository of key health and socioeconomic indicators which is universally accessible

4 The District Health Barometer Data sources include: District Health Information System (DHIS) National Treasury expenditure data Electronic TB register (ETR.net) National Antenatal HIV seroprevalence survey National Health Laboratory Services data Statistics South Africa census and surveys (GHS, Community Surveys) Municipal Demarcation Board Medical Schemes Council Vital statistics (mortality data) for calculation J of burden of disease profiles (2010/11 edition)

5 Facilities Audit The National Health Care Facilities Baseline Audit was conducted in 2011.(HST, HISP, NDOH, MRC, Arup, Exponant) The overall objective: to collect baseline data from all (>3900) public health facilities in the country using standardised and existing measurement tools and capturing the data collected into the National Core Standards database established by the NDoH. Data belongs to and resides with the NDOH

6 Deprivation Index 2007

7 West Coast 0.88 Deprivation Index by District, 2007 Umzinyathi 4.47 Jeanette R Hunter

8 Burden of Disease Leading causes of Years of Life Lost (YLL) in South Africa 2008

9 Leading causes of Years of Life Lost (YLL) in South Africa 2008

10 Leading causes of Years of Life Lost (YLL) in Umzinyathi, 2008

11 Leading causes of Years of Life Lost (YLL) in West Coast, 2008

12 Selected Indicators Surprisingly, both districts West Coast and Umzinyathi, performed very similarly across a range of health indicators, and in many instances performance was above average. The selection of indicators that follow are illustrative of some of the differences between the districts.

13 1. Socio-demographic and Input Indicators Population est Population Density 2008 % Access to piped water 2008 % Access to Medical Insurance (2010) Non-hospital per capita expenditure on PHC 2010/11 Cost per Patient Day Equivalent (District Hospitals) 2010/11 West Coast (<1 year=5 912) 1.7% 11 per km 2 Mostly rural Umzinyathi (< 1 year=12 391) 2.4% 59 per km 2 Mostly rural 98.7% 56.6% 27.8% 8.8% R575 R1469 (7 DH, 363 Usable beds) R392 R1196 (3 DH, 920 Usable beds)

14 Input and process indicators The proportion of District Health Services that West Coast spends on District Management is higher than in Umzinyathi 5.1% vs 1.5% (SA ave 5.4%) The proportion that West Coast (7 DH, 393 beds) and Umzinyathi (3 DH, 920 beds) spend of District Health Services on District Hospitals is close, with Umzinyathi 6.4 percentage points higher. WC 51.3% vs. Umz 57.7% (SA ave = 39.8%) The bed utilisation of District Hospitals in Umzinathi is lower than West Coast, (BUR=55.4% vs. 71.4%) and on average patients remain in hospital longer (4.5 days vs. 2.7days)

15 Process: Clinic supervision rate The supervision rate is the number of fixed PHC facilities visited by a clinical supervisor at least once a month, as a proportion of the total number of fixed PHC facilities in the district or sub-district. Highly important from the perspective of quality assurance Target is 100% The average for South Africa was 68.8% for 2010/11 - a decrease of 1.1 percentage points from the previous year.

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17 Output: PHC utilisation rate

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20 Output: Baby PCR coverage The proportion of estimated infants born to HIV positive mothers who receive a PCR test before 2 months of age. Indicator SA average Umzinyathi West Coast HIV prevalence among ANC clients tested National Survey) Baby PCR coverage

21 Outcome Indicators: TB Reported cases New Sm+ per (2010) TB cure rate 2009 TB Defaulter rate 2009 Smear conversion rate 2010 New HIV+ screen TB West Coast Umzinyathi SA ave % 81.5% 77.1% 6.4% 2.7% 7.1% 69.8% 73.3% 68.1% 68.3% 64.9% 67.7% New HIV+ Confirm TB 10.6% 2.5% 7.1%

22 Output and outcome: The number of male condoms distributed - to patients at the facility or through other channels - per male 15 years and older in 2010 was 13.9 condoms in Umzinyathi vs 47.1 in West Coast (SA ave 14.5) The percentage of people 15 years and older that have been treated for a new episode of an STI in 2010 was 6.2% in Umzinyathi vs 2.8% in West Coast (SA ave is 3.9%)

23 5. Impact: Perinatal mortality and stillbirth rate in facility

24 Public Health Services Facility Umzinyathi West Coast Population PHC 45 clinics 19 satellite clinics and 30 clinics Level one (DH) 3 District Hospitals, 920 beds 7 District Hospitals, 363 beds Level 2 none none Level 3 none none Specialised 2 Specialised TB hospitals, 271 beds 1 Specialised TB hospital, 55 beds

25 Umzinyathi West coast OUTPATIENT SERVICES District Satellite District Clinic Clinic hospital Clinic Hospital # of Facilities Immunisation 91% 67% 100% 100% 71% Outpatient - TB treatment 91% 67% 100% 100% 86% HCT 91% 100% 100% 100% 100% Outpatient - ARV treatment 91% 67% 63% 50% 71% Outpatient - PMTCT 91% 67% 100% 100% 100% Contraceptive services 91% 67% 100% 100% 86% Termination of pregnancy counselling and referral 76% 100% 90% 97% 71% Termination of pregnancy procedure 4% 33% 0% 3% 86% Post exposure prophylaxis 87% 100% 42% 60% 100% Cervical screening 91% 67% 100% 100% 43% Syndromic management for STIs 89% 100% 100% 100% 71% Outpatient - Dental 31% 100% 47% 67% 43% Outpatient - Mental health 89% 100% 90% 100% 86% Occupational health 40% 67% 58% 53% 43%

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27 Outcome scores on quality and infrastructure

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29 Human resources: Full time vs Part time - Umzinyathi

30 Human resources: Full time vs Part time West Coast

31 Thank You