National Primary Health Care Facilities Survey 2000 Northern Province

Transcription

1

2 National Primary Health Care Facilities Survey 2000 North West Gauteng Mpumalanga Northern Cape Free State KwaZulu- Natal Eastern Cape Western Cape COMPILED BY: Renier Viljoen, Christo Heunis, Ega Janse van Rensburg, Dingie van Rensburg, Annalize Fourie, Francois Steyn, Zacheus Matebesi of Centre for Health Systems Research & Development, University of the Free State 2000

3 This Publication is ALSO Available on the Internet Commissioned and Published by the Health Systems Trust Health Systems Trust Tel: (031) Maritime House Fax: (031) Salmon Grove Victoria Embankment Web: Durban 4001 ISBN #: Funders of the Health Systems Trust include Department of Health () Department for International Development (UK) Henry J. Kaiser Family Foundation (USA) Commission of the European Union Rockefeller Foundation The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes. Designed and Printed by The Press Gang, Durban - Tel: (031)

4 Acknowledgements The Centre for Health Systems Research & Development hereby wishes to express its sincere gratitude to all those who contributed generously to the realisation of this report, in the form of financial support, work, information, advice and enthusiasm. We are particularly grateful to the Health Systems Trust for approaching CHSR&D with the research objective - and to Gcinile Buthelezi - HST coordinator of the project. The work of the following people is acknowledged with due appreciation: Researchers: Renier Viljoen, Annalize Fourie, Christo Heunis, Ega Janse van Rensburg and Zacheus Matebesi. Fieldwork managers for : Zacheus Matebesi and Hannes Pelser. The provincial head and senior managers of Department of Health who authorised and facilitated the survey; all managers and staff of clinics who facilitated the research and generously shared their knowledge. Data encoders: Mariëtte van Rensburg, Corrie le Roux, Leona de Villiers and Ria van Niekerk; data processing and computerisation, Kate Smith; editorial and secretarial support, Una van der Walt; administrative support, Tankiso Rammile. Editing of final report: Gcinile Buthelezi Dingie van Rensburg Bloemfontein November 2000 This provincial report is an extract from the comprehensive report entitled National PHC Facilities Survey 2000 published by the Health Systems Trust. Whereas this provincial report deals with a selection of indicators only, the national report coves a much broader scope of issues and includes comparisons between urban and rural areas, as well as between provinces. i

5 Contents Acknowledgements... i Chapter 1: Survey Focus and Scope... 1 Method of data collection... 2 Chapter 2: Services at PHC facilities Availability of services Availability and turn-around time of tests Emergency services Chapter 3: Human resources Average number of patients Nurse supervisor visits Availability of medical doctors Chapter 4: Equipment and infrastructure Availability of PHC equipment Means of communication Electricity Chapter 5: Drugs and supplies STD drugs EPI vaccines Chapter 6: Community participation...19 Chapter 7: Conclusion Bibliography...21 ii

6 Tables Table 1 Availability of immunisation fixed and satellite (2000)... 4 Table 2 Availability of family planning fixed and satellite (2000)... 5 Table 3 Availability of antenatal care fixed and satellite (2000)... 5 Table 4Availability of postnatal care fixed and satellite (2000)... 6 Table 5 Distance from facility to hospital where emergency cases are referred to fixed and satellite (2000) Table 6 Availability of equipment fixed (2000) and satellite (2000) Table 7 Availability of communication equipment fixed (1998, 2000 provincial, other) Table 8 Availability of communication equipment satellite (2000) Table 9 Availability of selected EDL drugs also used for STD treatment fixed (1998, 2000) and satellite (2000) Table 10 Availability of EPI vaccines fixed (provincial, other) and satellite (2000) Figures Figure 1 Availability of immunisation fixed (1998, 2000)... 4 Figure 2 Availability of family planning (1998, 2000)... 4 Figure 3 Availability of antenatal care (1998, 2000)... 5 Figure 4Availability of postnatal care fixed (1998, 2000 provincial, other)... 6 Figure 5 Availability of HIV testing fixed (1998, 2000) and satellite... 7 Figure 6 Mean turn-around time for HIV tests fixed (1998, 2000) and satellite (2000) (Average number of days)... 7 Figure 7 Availability of syphilis testing fixed (1998, 2000) and satellite (2000) (percentage with test available)... 8 Figure 8 Mean turn-around time for syphilis tests fixed (1998, 2000), and satellite (2000) (Average number of days)... 8 Figure 9 Availability of TB sputum testing fixed (1998, 2000) and satellite (2000) (percentage with test available)... 9 Figure 10 Mean turn-around time for TB sputum results fixed (1998, 2000) and satellite (2000) (Average number of days)... 9 Figure 11 Emergency vehicle response time fixed (1998, 2000) Figure 12 Average number of patients attended to per nurse* per month fixed (1997, 2000) and satellite (2000) Figure 13 Nurse supervisor visits fixed (1997, 2000) Figure 14Availability of doctor fixed (1997, 2000) and satellite (2000) Figure 15 Availability of electricity fixed (2000) and satellite (2000) Figure 16 Uninterrupted electricity supply fixed (1998, 2000) and satellite (2000) Figure 17 Functioning health committees fixed (1998, 2000) and satellite (2000) (percentage where health/clinic committee exists) iii

7 iv

8 Chapter 1 Background and methodology This status report on Primary Health Care Facilities (PHC) in is one of a series of reports that was compiled from data collected for purposes of a National PHC Facilities Survey during July/ August In addition to the nine provincial reports, the findings of the national survey are contained in a report entitled National PHC Facilities Survey 2000, all published by the Health Systems Trust. Whereas the provincial reports focus on the status of PHC in the respective provinces, with selected comparisons to the situation nationally, the national report contains inter-provincial comparisons on a wider range of indicators. The provincial reports are best read in conjunction with the national report. The National PHC Facilities Survey 2000 follows on two similar surveys that were conducted in 1997 and 1998 respectively, the results of which were also published by the Health Systems Trust. However, the 2000 survey was not a replication of the previous two since it focused on community health centres, fixed, satellite and mobile clinics 1 (excluding district hospitals), while the previous surveys focused on fixed clinics and district hospitals (excluding satellite and mobile clinics). In addition, the dynamics of the health care system, as well as differences in design and conceptualisation between the surveys requires that comparisons should be interpreted with due caution. The general aim of this study is to provide a cross-sectional snapshot description of the status of of first level PHC, and to identify changes and developments that could signify relative progress (or lack thereof) towards equity in PHC provision in the public sector in generally and in particular, the Northern Province. The study as it pertains to serves three major purposes: It constitutes a comparative follow-up of the 1997 and 1998 surveys in a longitudinal endeavour to monitor the status of PHC as provided in fixed clinics in the public sector. It establishes a baseline of data on the status of PHC as provided by satellite clinics/visiting points and mobile clinics. (Mobile and satellite clinics/visiting points were not included in previous surveys.) In this survey, equity and quality of PHC care was measured quantitatively and the survey does not incorporate user perceptions. Inferences about equity and quality of PHC were made on the basis of services provided, as well as the availability of equipment, infrastructure, personnel, medicine and supplies, and the level of community participation in PHC facilities. These inferences are based on the assumption that the availability and accessibility of services and resources at PHC facilities are indicative of the levels and standards of care (i.e. quality of care) that is reasonably possible. The national 2000 survey was based on a random sample of 445 PHC facilities. In each province, 10% of each of fixed, satellite clinics/visiting points and mobile clinics were included in the sample which constituted a stratified proportion of the three types of facilities in each province. For the purposes of sampling, community health centres were included in the same stratum as fixed clinics. The range of variation on a national scale is sufficiently covered by this sample. Along the provincial divide generalisation is more limited in those cases were n-values are low. 1 Type of PHC facilities in this case refers to Fixed facilities PHC clinics are community health centres with permanent staff and equipment providing an eight to twenty-four hour service per day for five or more days per week. Satellite clinics PHC Clinics drawing staff and/or equipment and/or drugs and supplies from a source facility and provide services on a non-continuous basis, but at regular intervals. Mobile clinics Vehicles equipped for PHC provision transporting health workers from a source facility to stopping points where services are rendered. 1

9 In a total of 68 facilities were surveyed, and included a proportional stratification of 48 fixed clinics, seven satellite clinics/visiting points 2 and 13 mobile clinics. Data Collection Process The structure of the report is determined by the main categories of indicators according to which equity and quality in PHC were operationalised for purposes of this survey. Firstly, findings pertaining to the range and frequency of services rendered by PHC facilities are presented. This is followed by findings pertaining to human resources, equipment and infrastructure, drugs and supplies and community participation. In each section, a description of the current situation, according to selected indicators is followed by comparisons to the current national situation, as well as to national and provincial situations as portrayed by the previous two surveys where possible and/or relevant. 2 In visiting points are more familiar than satellite clinics. As PHC facilities these visiting points function largely similarly to satellite clinics in other provinces. For purposes of this survey visiting points are thus incorporated under satellite clinics, and the two used interchangeably. Visiting points should be distinguished from mobile stopping points, a concept pertaining to the mobile clinic system. 2

10 Chapter 2 Services rendered Main findings trends and comparisons There was an increased availability of immunisation and antenatal services on a daily basis at fixed clinics in. Availability of family planning services stayed at 100% and postnatal services decreased. The availability of both these services in the was found to be higher than nationally. Just less than two in ten fixed clinics in the province provides HIV testing. The availability of syphilis testing decreased dramatically by almost 50% at fixed clinics since There was a slight increase in the availability of TB sputum testing at fixed clinics. There was an increase in the mean turn-around time for HIV tests, and a decrease in the mean turnaround time for syphilis tests at fixed clinics in the province. There was a marked decrease in the emergency vehicle response time in the province Availability of services Immunisation There has been an increase in the availability of immunisation services on a daily basis at fixed clinics in (as well as nationally) since In fact, more than nine in ten fixed clinics in Northern Province, compared to seven in ten nationally, offer immunisation on a daily basis. Figure 1 Availability of immunisation - fixed (1998, 2000) (percentage offering service on a daily basis) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Immunisation services are offered by all surveyed satellite clinics/visiting points and mobile clinics in the province and nationally. 3

11 Table 1 Availability of immunisation - fixed, satellite and mobile (2000) Province Fixed Satellite Mobile Offering service % Daily service % Offering service % Daily service % Offering service % Family planning Since 1998 the situation regarding the availability of family planning services on a daily basis has remained constant in, with all the fixed clinics offering this service. In contrast, the availability of family planning services nationally is somewhat lower at 87.1%. Figure 2 Availability of family planning (1998, 2000) (percentage offering service on a daily basis) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 With the exception of fixed clinics nationally, family planning is offered at all clinics (fixed, satellites/ visiting points and mobiles) in and in the country as a whole. Table 2 Availability of family planning - fixed, satellite and mobile (2000) Province Fixed Satellite Mobile Offering service % Daily service % Offering service % Daily service % Offering service % Antenatal and postnatal care The availability of antenatal care on a daily basis has improved both in and nationally since However, this service is far more readily available in with almost all (95.8%) fixed clinics providing antenatal care, compared to about 60 % nationally. 4

12 Figure 3 Availability of antenatal care (1998, 2000) (percentage offering service on a daily basis) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 In the and nationally, all the surveyed fixed, satellite clinics/visiting points and mobile clinics antenatal care is less readily available than immunisation and family planning services in both the NP and Nationally, across the spectrum of facilities visited. Table 3 Availability of antenatal care - fixed, satellite and mobile (2000) Province Fixed Satellite Mobile Offering service % Daily service % Offering service % Daily service % Offering service % Unlike antenatal care the availability of postnatal care on a daily basis at fixed clinics in has declined slightly since Despite this decline postnatal care is available at nine in ten fixed clinics in compared to seven in ten nationally. While almost 100% of provincial clinics provide postnatal care daily, 60% of local authority clinics do likewise. Figure 4 Availability of postnatal care -fixed (1998, 2000) (percentage offering service on a daily basis) % 40% 60% 80% 100% Fixed 1998 Fixed

13 Looking at the availability of postnatal care at fixed, satellite and mobile clinics in the province, the same overall pattern (perhaps worse for mobiles) that pertained to antenatal care also occurs with regard to postnatal care. More fixed and satellite clinics in offer postnatal care than nationally. Table 4 Availability of postnatal care - fixed, satellite and mobile (2000) Province Fixed Satellite Mobile Offering service % Daily service % Offering service % Daily service % Offering service % Availability and turn-around time of tests Availability of HIV testing in is limited 14.6% of fixed clinics, a decline from 20% since In % of fixed clinics offered this service on a daily basis, but by 2000 this declined to 14.6% of fixed clinics doing HIV testing. This places far below the national average of availability of HIV testing (56.2%). Strangely, satellites/visiting points and mobile clinics in the province have a somewhat higher availability of HIV testing than fixed clinics. Figure 5 Availability of HIV testing - fixed (1998, 2000), satellite and mobile (2000) (percentage with test available) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Satellite 2000 Mobile 2000 Nationally, the mean turn-around time for HIV testing at fixed clinics decreased from eight to six days since 1998; in contrast, in the it increased from seven to nine days. The turn-around times for satellite and mobile clinics in the province are seven and twelve days respectively. 6

14 Figure 6 Mean turn-around time for HIV tests - fixed (1998, 2000), satellite and mobile (2000) (Average number of days) Days Fixed 1998 Fixed 2000 Satellite 2000 Mobile 2000 The availability of syphilis testing at fixed clinics in both and nationally is considerably higher than HIV testing. Since 1998, it nevertheless deteriorated drastically from 84% to around 38% in, and slightly from 80% to around 75% nationally. The level of availability of syphilis testing at fixed clinics in is now markedly lower than the national average. Availability of these tests at satellites/visiting points and mobile clinics is also well below the national average. Figure 7 Availability of syphilis testing - fixed (1998, 2000), satellite and mobile (2000) (percentage with test available) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Satellite 2000 Mobile 2000 Whilst the mean average turn-around time for HIV testing at fixed clinics in has worsened since 1998, it has improved from eleven to nine days for syphilis testing. 7

15 The situation pertaining to turn-around time for syphilis testing at satellite and mobile clinics is slightly better off than that at fixed clinics. Nationally, satellite and mobile clinics have a one-day advantage over the province. Figure 8 Mean turn-around time for syphilis tests - fixed (1998, 2000), satellite and mobile (2000) (Average number of days) Days Fixed 1998 Fixed 2000 Satellite 2000 Mobile 2000 Since 1998 the availability of TB sputum testing at fixed clinics improved slightly both in Northern Province and nationally, from 56% to around 60% and from 74% to around 83%, respectively. Looking at the availability of TB sputum testing at fixed, satellite and mobile clinics the situation seems to be better nationally than in. Sputum testing is much less readily available at satellite clinics/visiting points and mobile clinics. For example only four in ten satellites/visiting points and five in ten mobile clinics in the province offer the service. Figure 9 Availability of TB sputum testing - fixed (1998, 2000), satellite and mobile (2000) (percentage with test available) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Satellite 2000 Mobile

16 Turn-around time for TB sputum results at fixed clinics in has since 1998 remained the same at 10 days since 1998, but has improved from 7 to 6 days during the same period nationally. Amongst all PHC facilities in, local authority fixed clinics boast the shortest turn-around time for TB sputum testing (five days). Figure 10: Mean turn-around time for TB sputum results - fixed (1998, 2000), satellite and mobile (2000) (Average number of days) Days Fixed 1998 Fixed 2000 Satellite 2000 Mobile Emergency services A comparison of the 1998 and 2000 information indicates that nationally the situation regarding emergency vehicle response time has remained largely unchanged - 55% in 1998 and 57.7% in In Northern Province the situation has deteriorated somewhat 65% in 1998 to 52.1% in Figure 11: Emergency vehicle response time - fixed (1998, 2000) (percentage with a response time of one hour or less) % 40% 60% 80% 100% Fixed 1998 Fixed

17 In the average distance from fixed clinics to the nearest hospital is 27 kilometers and almost double that distance from satellite clinics/visiting points (at 51 kilometers). The national average distances from fixed and satellite clinics respectively are almost the same (at around 30 kilometers). All fixed and satellite clinics in refer emergency cases to the nearest hospital. Nationally, more than nine in ten fixed clinics do refer emergency cases to the nearest hospital. However, as far as satellite clinics are concerned, this figure is only about eight in every ten cases. Table 5 Distance from clinic to hospital where emergency cases are referred to - fixed and satellite (2000) Province Fixed Satellite Average distance Nearest hospital Average distance Referral to nearest hospital nearest hospital Km % Km %

18 Chapter 3 Human resources This section describes the average number of patients consulted by nurses, the frequency of nurse supervisor visits, and the availability of medical doctors. Main findings trends and comparisons The 2000 survey shows that professional nurses at fixed clinics in now have a substantially lower patient load than in The number of patients at mobile clinics is almost half of the national average. There was a marked decrease from nine in ten to seven in ten - of nurse supervisor visits to fixed clinics since The availability of doctors to consult patients has improved since 1997, although the percentage of visits in the province is far lower than the national percentage. 3.1 Average number of patients Interviewed health managers varied in their views of a realistic number of patients the average professional nurse could be expected to consult per day or per month. Their answers ranged from patients per day or patients per month (should a 24-day month be used as basis for calculation). The 2000 survey shows that professional nurses at fixed clinics in are dealing with an average of 421 patients per month. This is a substantially lower patient load than the 530 reported in the 1997 survey. Nationally, there has also been a decline in patient load from 553 in 1997 to 474 in 2000 in fixed clinics. Nurses at satellite clinics/visiting points and mobile clinics in the province experience a far lighter patient load than their counterparts at fixed clinics. However, there is great variation between the patient load at the various types of PHC facilities in the province and nationally. 11

19 Figure 12 Average number of patients attended to per nurse* per month - fixed (1997, 2000), satellite and mobile (2000) Number of Patients Fixed 1997 Fixed 2000 Satellite 2000 Mobile 2000 * Nurses = Includes professional and enrolled nurses and excludes nurse assistants. Average calculated by dividing the total number of patients consulted per month during the second quarter and dividing it by the average number of nurses in the sample. 3.2 Nurse supervisor visits Nurse supervisor visits to fixed clinics have declined both in and nationally since It has declined by around 17 percentage points in the province and by 12 percentage points nationally. The average frequency of nurse supervisor visits to fixed provincial and local authority clinics in Northern Province is only slightly better than the national average. Figure 13 Nurse supervisor visits - fixed (1997, 2000) (percentage where a nurse supervisor visited the facility in the preceding month) % 40% 60% 80% 100% Fixed 1997 Fixed

20 3.3 Availability of medical doctors The availability of doctors to consult patients at fixed clinics has improved markedly since The 2000 survey indicates that nationally the proportion of facilities visited by a doctor in the month preceding the survey has improved since 1997 to from 54% to 63% in In similar improvements from 18% to 29% was observed. Despite this improvement, the availability of doctors at fixed clinics in the province remains low at three in ten being visited by a doctor. It is also clear that doctors are available at only four in ten local authority clinics in the province. Quite striking is that not a single doctor is available at satellite clinics/visiting points in. Nationally, only about two in every ten satellite clinics had a doctor available in the month preceding the survey. Figure 14 Availability of doctor - fixed (1997, 2000) and satellite (2000) (percentage visited by a doctor to consult patients in the preceding month) % 40% 60% 80% 100% Fixed 1997 Fixed 2000 Satellite

21 Chapter 4 Equipment and infrastructure This section deals with the availability of clinic equipment, means of communication, and electricity. Main findings trends and comparisons Fixed and mobile clinics in are worse off with regard to available PHC equipment than is the case nationally. Satellite clinics/visiting points are better resourced with baby scales and stethoscopes. The availability of telephones at fixed clinics in the province has not changed much since 1998, with almost seven in ten clinics having a telephone. Four in ten satellites/visiting points and one in ten mobiles are equipped with a radiophone. The availability of electricity in is on par with the national situation, with almost nine in ten fixed clinics being supplied with electricity. A serious situation exists at satellites/visiting points regarding electricity. Four in ten fixed clinics experienced an interruption in the electricity supply in the month prior to the survey. 4.1 Availability of PHC equipment In general around nine in ten fixed clinics in are equipped with essential PHC equipment expected to be available (except for diagnostic kits). The availability of diagnostic kits is most problematic in the province. Nationally fixed and mobile clinics are better supplied with PHC equipment than fixed and mobile clinics in the province. Satellite clinics/visiting points in the province are better equipped with baby scales and stethoscopes than is the case nationally. The fact that no refrigerators are available in this type of facility may be related to the already mentioned fact that what is nationally called satellites are to a large extent visiting points in this province. 14

22 Table 6 Availability of equipment - fixed, satellite and mobile (2000) (percentage with at least one of the indicated types of equipment in working condition) Type Province Fixed Satellite Mobile % % % Adult scales Baby scales Stethoscopes Refrigerators NA NA Blood pressure Diagnostic kits Means of communication Since 1998 there was a very slight increase in the availability of telephones at fixed clinics in Northern Province, and notable improvement nationally. The fact that only around seven in ten fixed clinics in the province have telephones available is of concern, but still better than at satellite clinics/visiting points where no telephones are available. Table 7 Availability of communication equipment - fixed , 2000 Province Telephone Fax % % % % % Results of the survey hint at an almost total collapse of communication at satellite clinics/visiting points in. The only means of communication available at these facilities in the province are radiophones. Even then, only 43% of such facilities have radiophones to their avail. Table 8 Availability of communication equipment - satellite Province Telephone Cell. Phone Radiophone Two-way radio Fax % % % % % %

23 Table 9 Availability of communication equipment - mobile Province Telephone Cell. Phone Radiophone Two-way radio Fax % % % % % % Regarding mobile clinics, only four in ten have access to telephones, and less than one in ten to radiophones and to . Whilst some mobile clinics nationally have two-way radios and fax machines, these forms of communication equipment are not available at all in. 4.3 Electricity Nationally, a substantial proportion of fixed clinics have electricity to their avail. On the contrary, availability of electricity is slightly worse at fixed clinics in. The availability of electricity remains a major problem at satellite clinics/visiting points in the province, at only around half the proportion of such facilities compared to the national average. Figure 15 Availability of electricity - fixed (2000) and satellite (2000) (percentage where electricity is available) % 40% 60% 80% 100% Fixed 2000 Satellite Since 1998, more clinics in the Northern province experienced an interruption in electricity supply, whereas nationally such interruption rates remained more or less the same. Two in ten local authority clinics did experience an interruption in electricity supply, compared to four in ten provincial clinics. Nationally the situation at fixed and satellite clinics was similar, whereas in twice as many fixed clinics did not have an interruption in the electricity supply. 16

24 Figure 16 Uninterrupted electricity supply - fixed (1998, 2000) and satellite (2000) (percentage where electricity was not interrupted in the preceding month) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Satellite

25 Chapter 5 Drugs and supplies This section report on the availability of selected EDL drugs also used for the rendering of STD care, and EPI vaccines. Main findings- trends and comparisons There was an increase in the availability of the following STD drugs at fixed clinics in Northern Province since 1998: benzathine penicillin injectables, cotrimoxozale and ciprofloxacin. Mobile clinics are well stocked with doxycycline, cotrimoxazole and erythromycin. On the whole satellite clinics/visiting points are poorly stocked with STD drugs. With regard to EPI vaccines, fixed clinics in are better stocked with tetanus toxoid, DP/DPT and hepatitis B vaccines than fixed clinics nationally. Mobiles are well stocked with DP/DPT, measles and hepatitis B vaccines, while satellite clinics/visiting points are poorly stocked with all EPI vaccines. 5.1 STD drugs The availability of benzathine penicillin injectables at fixed clinics in and nationally increased from respectively around 91% and 90% in 1998 to around 98% and 96% in 2000 respectively. The availability of cotrimoxazole and ciprofloxacin has also increased slightly in the province. Slight decreases in the availability of doxycycline tablets (from 93.3% to 89.6%) and erythromycin tablets (from 84.4% to 66.7%) have occurred since Penicillin is markedly less available at mobile clinics compared to other EDL drugs. The results also indicate that satellite clinics/visiting points are worst off with regard to EDL drugs used for STD treatment, while mobile clinics are generally better stocked than fixed clinics, with the exception of penicillin and ciprofloxacin. One explanation for this could be the difficulty for mobile clinics of treating anaphylactic shock. Indeed, when compared with the national average of availability of EDL drugs, appears to be less inclined to stock all the mentioned types of STD drugs at satellite clinics/visiting points. 18

26 Table 10 Availability of selected EDL drugs also used for STD treatment - fixed (1998, 2000), satellite and mobile (2000) (percentage with the indicated drugs/supplies in stock) Type Province Fixed (%) Satellite (%) Mobile (%) Bensathine Penicillin injectables Doxycycline tablets Cotrimoxazole Erythromycin Ciprofloxacin EPI vaccines There seems to be a low availability of BCG vaccine, both nationally and in. Tetanus toxoid, DT/DPT, measles and hepatitis B vaccines are are more readily available nationally and in the province. Notably, all satellite clinics/visiting points in indicated that they do offer immunisation services. However, less than half of them stock any of the selected EPI vaccines included for purposes of this survey. This could possibly be explained by the fact that as visiting points, vaccines and drugs are probably transported there on visiting days. Table 11 Availability of EPI vaccines - fixed, satellite and mobile (2000) (percentage with the indicated vaccines) Type Province Fixed Satellite Mobile % % % BCG Combac HIB Polio Tetanus toxoid DT/DPT Measles Hepatitis B

27 Chapter 6 Community participation This section describes progress made in implementing community health committees or clinic committees as a reflection of community participation and involvement in matters pertaining to health. Main finding Marked progress has been made in in facilitating community participation in PHC since 1998 three quarters of the fixed clinics had a functioning health committee. While there has been a decrease in the number of functioning health/clinic/community committees nationally, some progress has been made in this regard in. Figure 17 Functioning health committees - fixed (1998, 2000) and satellite (2000) (percentage where health/clinic committee exists) % 40% 60% 80% 100% Fixed 1998 Fixed 2000 Satellite

28 Chapter 7 Conclusion The purpose of the 2000 National PHC Facility Survey was to gauge progress in the move towards equity in PHC provision across the provinces. The National Report provides more indicators than included in the provincial reports. From the indicators included in this provincial report a tentative picture of the status of PHC in emerges: Regarding the availability of PHC services, slight improvements have been recorded for immunisation and antenatal care. The availability of family planning has been maintained at 100%, while a slight decrease in postnatal services is noted. Of great concern is the decrease in the availability of HIV and syphilis testing at fixed clinics. The turnaround time for HIV tests have increased and are still below the national turn-around time. The availability of TB sputum testing in improved somewhat, while the turn-around time for these tests has remained constant since The response time of emergency vehicles has substantially decreased in the past two years in the province whereas the national average has increased slightly. Nurses at fixed clinics in carry lighter patient loads compared to the national average. Furthermore, the number of patients consulted by mobile clinic nurses is about half the national average. The availability of doctors to consult patients at fixed clinics in is much higher (about 10%) than two years ago, but still way below the national average. Although slightly more than the national average, a significant decrease was recorded in the regularity of nurse supervisors visiting PHC facilities in. The availability of the PHC equipment at fixed and mobile clinics in is slightly below the national average. Slight improvements have been made regarding the availability of telephones at fixed clinics in Northern Province, although the communication infrastructure available at mobile clinics is relatively poor. Fewer fixed clinics in experienced interruptions in electricity supply during 2000 compared to In general, the availability of STD drugs and EPI vaccines at PHC facilities in compares favourably with the national average, with satellite clinics/visiting points being somewhat worse off than their national counterparts. PHC facilities have made significant progress with the establishment of committees to facilitate community participation. Overall it can therefore be concluded that some improvements have been made in most areas of PHC provision in. Components that need special attention include the availability of HIV, syphilis, and TB sputum testing, as well as the communication infrastructure at the avail of mobile clinics. 21

29 Buthelezi G, Barron P, Makhanya N & Edwards-Miller J 1997 Measuring the move towards equity. Durban: Health Systems Trust Department of Health 1999 Health sector strategic framework Pretoria: Department of Health Department of Health 1999/2000 Annual report. Pretoria: Department of Health Bibliography Mahlalela X, Rohde J & Bennett J 1998 The status of primary health care services in the Eastern Cape Province. Bisho: Management Sciences for Health Ntuli A, Khosa S & McCoy D 1999 The equity gauge. Durban: Health Systems Trust Pick W, Fisher B, Kowo H, Conway S, Kgosidintsi N & Weiner R 1998 Measuring quality of care in n Clinics and Hospitals. (Technical Report to Chapter 14 of the n Health Review 1998). Durban: Health Systems Trust Sharp B, Martin C, Nawn J, Curtis B, Boulle A & Le Sueur D 1998 A collation of the current health boundary and facility data for. Pretoria: Department of Health Health Systems Trust 1998 n Health Review Durban: Health Systems Trust 22