ZULULAND DISTRICT HEALTH PLAN 2018/19 - 2020/21€¦ · Zululand District Health Plan 2018/19 Page 5 of 96 3. OFFICIAL SIGN OFF It is hereby certified that this District Health Plan:

ZULULAND

DISTRICT HEALTH PLAN

2018/19 - 2020/21

(KWAZULU-NATAL)

Zululand District Health Plan 2018/19

Page 2 of 96

Contents

1. EXECUTIVE SUMMARY BY THE DISTRICT DIRECTOR .................................................... 3

2. ACKNOWLEDGEMENTS ................................................................................................ 4

3. OFFICIAL SIGN OFF ....................................................................................................... 5

4. EPIDEMIOLOGICAL PROFILE ........................................................................................ 6

5. SERVICE DELIVERY PLATFORM AND MANAGEMENT ............................................... 21

6. QUALITY OF CARE ....................................................................................................... 27

7. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM ........... Error!

Bookmark not defined.31

8. DISTRICT HEALTH EXPENDITURE .................................................................................. 32

9. DISTRICT HEALTH ASPIRATIONS AND INDICATOR TARGETS .................................... 33

10. BOTTLENECKS AND ROOT

CAUSES……………………………………..…………………………………….…………-49

11. KEY INTERVENTION ...................................................................................................... 51

12. INDICTORS FOR MONITORING 2018-2021------------------------------------------------------75


Page 3 of 96

1. EXECUTIVE SUMMARY BY THE DISTRICT MANAGER

None provided


Page 4 of 96

2. ACKNOWLEDGEMENTS

The District Planning Team would like to acknowledge the important contribution of the

following members and stakeholders in the development of the 2018/19 District Health

Plan (DHP):

Provincial Strategic Planning Unit

Provincial Data Management Unit

District Management Team

District Specialist Team members(DCSTs)

Hospital Senior Management Team

District Supporting Partners –Health Systems Trust and Aurum/Accenture

District Programme Managers

Hospital Programme Managers and M& E Managers

District Data Management Section

Facility Information Officers

District Finance Management Section

District Human Resource Management and Development Section

Special acknowledgement and gratitude is extended to the following primary collators of this

document for their tireless efforts and commitments demonstrated throughout the compilation

process:

Ms. S.M Cebekhulu: Deputy District Manager-Planning, Monitoring & Evaluation

Miss N.S Khambule : District Pharmacist

Mrs. T.W Buthelezi : DCS-PHC

Mrs. T.G Msibi---M&E Manager – UPhongolo sub-district

Mrs. S.E Mlambo – M&E Manager- Abaqulusi sub district

Ms. N. C Mngoma – M&E Manager – eDumbe sub-district

Mrs. C.A Zulu – Assistant Manager : Nursing - Ceza hospital –Ulundi sub-district Team leader

Mrs. N.E Mbatha - – M&E Manager – Nongoma sub-district


Page 5 of 96

3. OFFICIAL SIGN OFF

It is hereby certified that this District Health Plan:

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

technical support from the district health services and the strategic planning Units at the

Provincial head office.

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

Zulu Natal Province Department of Health.


Page 6 of 96

4. LIST OF ACRONYMS

Abbreviations Description

A

AIDS Acquired Immune Deficiency Syndrome

ALOS Average length of stay

ANC Ante Natal Care

ART Anti-Retroviral Therapy

ARV Anti-Retroviral

B

BAS Basic Accounting System

BUR Bed Utilization Rate

C

CARMMA Campaign on Accelerated Reduction of Maternal Mortality in Africa

CEO (s) Chief Executive Officer(s)

CCMDD Central Chronic Medicine Dispensing Decentralisation

CCG (s) Community Care Giver(s)

CDC Communicable Disease Control

CDW Community Development Worker

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

DHMT District Health Management Team

DHP(s) District Health Plan(s)

DH(s) District hospital))(s)

DOH Department of Health

DQPR District Quarterly Performance Report

DRTB Drug Resistant Tuberculosis

E

EMTCT Elimination of Mother To Child Transmission


Page 7 of 96

EMS Emergency Medical Services

ESMOE Essential Steps in the Management of Obstetric Emergencies

EPWP Expanded Works Program

F

FHT(s) Family Health Team(s)

G

G&S

Goods and Services

H

HCT Health Counselling and Testing

HIV Human Immunodeficiency Virus

HR Human Resources

HRM Human Resources Manager

I

ICSM Integrated Clinical Services Management

IEC Information , Education and Communication

ISHS Integrated School Health Services

Abbreviations Description

ILS Intermediate Life Support

IMAM Integrated Management of Malnutrition

INP Integrated Nutrition Program

ISHS Integrated School Health Services

IYCF Infant and Young Child Feeding

IUCD Intra Uterine Contraceptive Device

J

K

KINC Kwa-Zulu Nata Initiative on Neonatal Care

L

M

M&E Monitoring and Evaluation

ME Machinery and Equipment


Page 8 of 96

MC&WH Maternal Child & Women’s Health

MDG Millennium Development Goals

MDR-TB Multi Drug Resistant Tuberculosis

MMC Medical Male Circumcision

MMR Maternal Mortality Rate/Ratio

MM Medical Manager

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

MO (s) Medical Officer(s )

MOU Maternity Obstetric Unit

MTEF Medium Term Expenditure Framework

MUAC Mid-Upper Arm Circumference

N

NDOH National Department of Health

NGO(s) Non-Governmental Organization(s)

NIMART Nurse Initiated and Managed Antiretroviral Therapy

NNW National Nutrition Week

NSDA Negotiated Service Delivery Agreement

O

OPD Out-Patients Department

OSD Occupation Specific Dispensation

OSS Operation Sukuma Sakhe

P

PCR Polymerase Chain Reaction

PCV Pneumococcal Vaccine

PDE Patient Day Equivalent

Persal Personnel and Salaries System

PFMA Public Finance Management Act

PHC Primary Health Care

PM&E Planning , Monitoring and Evaluation

PN(s) Professional Nurse

PPSD Provincial Pharmaceutical Supply Depot


Page 9 of 96

PTB Pulmonary Tuberculosis

R

RVD Retro Viral Disease

RV Rota Virus Vaccine

S

SCM Supply Chain Management

SLA Service Level Agreement

SMS Small Message System

SRH Sexual and reproductive health services

Stats SA Statistics South Africa

STI(s) Sexually Transmitted Infection(s)

SVS Stock Visibility System

T

TB Tuberculosis

THPs Traditional Health Practitioner(s)

U

UTT Universal Test and Treat

V

VCT Voluntary Counselling and Testing

W

WBOT(s) Ward based Outreach team(s )

WHO World Health Organization

X

XDR-TB Extreme Drug Resistant Tuberculosis

Y and Z


Page 10 of 96

4. EPIDEMIOLOGICAL PROFILE

District Map with Population distribution, sub district boundaries, and health facility

locations

Zululand District is situated in the north-eastern part of KwaZulu-Natal Province. It is primarily a

rural district and comprises five health sub-districts, namely Nongoma, Ulundi, eDumbe,

uPhongolo and Abaqulusi. The district has a population of 854 894, with a population density of


Page 11 of 96

57.8 persons per km2, and falls into socio-economic Quintile 1, among the poorest districts.

Estimated medical scheme coverage is 5.6%.

Population distribution

Figure 1: Population Pyramid District

Source: StatsSA.2011

Graph 1: Population distribution per Municipality 2016/17

Source: web based DHIS 2018

There is a slight increase of the total population from 844 531 in 2015 to 854 893 in 2016 (1.2%)

and is related to the normal population increase per year, of which 93.50% is uninsured.(DHIS

2015))This is a large portion of the total population fully dependent of public health services,

which indicates a very strong need for the district to develop plans to focus on the prevention

60 40 20 0 20 40 60

under 5 years

10-14 years

20-24 years

30-34 years

40-44 years

50-54 years

60-64 years

70-74 years

80 years and older

Population (inThousands)

Female Male

199 367

136 422

87 277 227 068

204 759

Zululand Sub district Population distribution

Ulundi LM

uPhongolo LM

eDumbe LM

Abaqulusi LM

Nongoma LM


Page 12 of 96

and management of low socio -economic related diseases strategies and activities like

malnutrition and other related social ills as evidenced by the high rates of malnutrition in children

under 5years at Nongoma, Abaqulusi and uPhongolo sub districts. The high number of

population age group between 15 -19, which is a highly active population (teenage stage),

needing special attention in terms of health and other social issues, is concerning and calls for

the district to pay more focus on the implementation of Youth Friendly Service delivery by

introducing the program to all clinics and increasing the number of facilities accredited and

sustaining the program. The marked decrease in the number of 20years and above as

indicated in the population pyramid is related to the high death rate of this category due to TB

and HIV related illnesses(DHB 2014/15), plans are put in place to address the issue under

interventions.

Social Determinants of Health

Sub-Districts Data Source Abaqulusi

Sub-district

eDumbe

Sub-district

Nongoma

Sub-District

Ulundi Sub-

District

UPhongolo

Sub-district District

Un

em

plo

ym

en

t ra

te

Census 2001 59.5% 57.5% 37.7% 66.7% 48.7% 54.02%

Census 2011 40% 39% 71.7% 54% 51% 51%

C/ S 2007 35.3% 37.7% 63% 49.4% 35.5% 44.18%

C / S 2016 41.1%

Tota

l n

um

be

r

of

ho

use

ho

lds Census 2001 37 064 15 824 32 473 34 856 26 954 147 171

Census 2011 39 866 15 147 35 293 38 513 25 740 154 559

C/ S 2007 43 299 16 138 34 341 35 196 28 772 157 746

C / S 2016 43 299 16 138 34 341 35 198 28 772 178 516

Pe

rce

nta

ge

o

f

po

pu

latio

n

livin

g

be

low

po

ve

rty l

ine

of

R2

83

p

er

mo

nth

Census 2001 68% 72% 81% 68% 72% 72%

Census 2011

C/ S 2007 43.3% 43.3% 43.4% 42.3% 41.9%

C / S 2016

Nu

mb

er

of

ho

use

ho

lds

in

Info

rma

l

dw

elli

ng

Census 2001 1261 310 374 1383 398 3726

Census 2011 2 153 339 507 188 1 614 4 801

C/ S 2007 1 743 570 2127 1038 651 6 129

C / S 2016

Nu

mb

er

of

ho

use

ho

lds

in

form

al

dw

elli

ng

Census 2001 20 043 8 696 11 250 13 916 15 605 69 510

Census 2011 26 070 7 596 7 995 14 341 18 481 74 483

C/ S 2007 33 417 11 529 20 307 22 263 23 790 111 306

C / S 2016

Pe

rce

nta

ge

o

f

Ho

use

ho

l

ds

with

ac

ce

ss

to

san

ita

tio

n Census 2001 36.4% 5.2% 6.0% 20.2% 9.1% 15.38%

Census 2011 79% 95% 54% 71% 83% 76%

C/ S 2007 40.9% 5.5% 4.5% 19.1% 11.4% 16.28%


Page 13 of 96

Sub-Districts Data Source Abaqulusi

Sub-district

eDumbe

Sub-district

Nongoma

Sub-District

Ulundi Sub-

District

UPhongolo

Sub-district District

C / S 2016

Ho

use

ho

lds

with

ac

ce

ss t

o

po

tab

le w

ate

r Census 2001 63.5% 62.9% 30.5% 45.8% 60.6% 52.66%

Census 2011 2% 15% 7% 2% 1% 5%

C/ S 2007 38.8% 13.8% 9.6% 22.2% 17.4% 20.36%

C / S 2016

Pe

rce

nta

ge

o

f

Ho

use

ho

lds

with

a

cc

ess

to

ele

ctr

icity

Census 2001 43.2% 31.3% 24.6% 40.2% 53.5% 33.56%

Census 2011 41 % 26% 30% 54% 50% 40%

C/ S 2007 72.1% 62.8% 63.6% 73.4% 73.0% 68.98%

C / S 2016

Ad

ult

lite

rac

y

rate

Census 2001 69.8% 62.3% 54.7% 55% 62.9% 60.94%

Census 2011

C/ S 2007 83.1% 81.7% 79.5% 79.4% 80.1% 80.76%

C / S 2016

Source: StatsSA 2011

The district has a high unemployment rate of 41% as well as a high % of people living below the

poverty line; which is highest at Nongoma sub district and is evidenced there with the highest

rate of malnutrition as well as the death rate of child under-five years from SAM of 13.5 %( DHIS)

2015.This is being addressed through the interdepartmental social cluster (OSS) malnutrition

project that is going to be rolled out to all sub districts. the district has a very high percentage of

the community without access to portable water of 61.2% and is highest at Nongoma at (90.6)

(Stats SA 2011) thus increasing the risk of waterborne diseases within the sub district which

contributes more to childhood diarrhoeal diseases as evidenced by 12.2 (DHIS2015)diarrhoeal

incidence child under five years.


Page 14 of 96

Causes of Mortality

SOURCE: DHB 2014/15

113

147

165

185

191

362

543

625

2338

2891

0 500 1000 1500 2000 2500 3000 3500

Nephritis

Cerebro Vascular Diseases

Road Accidents

Endocine Nutritional Disorders

Cervical Cancer

Meningitis Encephalitis

Diarrhoeal Diseases

Lower Respiratory Infections

HIV/AIDs

Tuberculosis

12

34

56

78

91

0

2891

2338

625

543

362

191

185

167

147

113

0 500 1000 1500 2000 2500 3000 3500

Causes of mortality

Tuberculosis

HIV/AIDS

Lower Respiratory Infections

Diarrhoeal Diseases

Meningitis/ Encephalitis

Cervical Cancer

Endocrine Nutritional Disorders

Road Injuries

Cerebro Vasc ular Diseases

Nephritis


Page 15 of 96

Baseline data for all Theory of Change (Impact, Outcome, and Output) Indicators for

Maternal and Women’s Health, Child Health, HIV and TB, by sub-District and for the

District.

Women and Maternal Health

Impact Outcome Output

Ma

tern

al

mo

rta

lity

in

fac

ility

ra

tio

(pe

r10

0K

)

An

ten

ata

l c

lie

nt

initia

ted

o

n

AR

T

rate

(%

)

De

liv

ery

in

fa

cility

un

de

r 1

8

ye

ars

rate

(%

)

An

ten

ata

l 1

st v

isit

be

fore

2

0

we

ek

s

rate

(%

)

Ce

rvic

al

ca

nc

er

scre

en

ing

co

ve

rag

e (

%)

Co

up

le

ye

ar

pro

tec

tio

n

rate

(WH

O)

(%)

Mo

the

r p

ost

na

tal

vis

it w

ith

in 6

da

ys

rate

(%

)

2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17

Abaqulusi SD Indicator 146.6 99.7 11.5 82.4 82.9 73.4 60.2

Numerator 6 793 478 3 458 3 713 46 444 2 496

Denominator 4 094 795 4 145 4 196 53 736 759 594 4 145

eDumbe SD Indicator - 96.7 6.5 71.2 58.6 74.8 158.9

Numerator - 322 46 1 108 971 17 750 1 119

Denominator 703 333 704 1 556 19 898 284 673 704

Nongoma SD Indicator 105.3 110.9 9.3 73.0 89.8 59.0 32.7

Numerator 5 845 443 3 168 3 384 33 867 1 558

Denominator 4 747 762 4 763 4 338 45 233 689 373 4 763

Ulundi SD Indicator 55.9 98.9 8.8 66.1 73.4 68.4 59.5

Numerator 2 831 315 2 885 2 837 39 086 2 136

Denominator 3 580 840 3 592 4 363 46 403 685 572 3 592

uPhongolo SD Indicator 93.7 97.0 10.3 63.8 99.5 83.3 41.8

Numerator 3 623 334 2 036 2 449 31 940 1 349

Denominator 3 203 642 3 230 3 192 29 542 460 101 3 230

Zululand District Indicator 98.0 101.2 9.8 71.7 82.3 70.5 52.7

Numerator 16 3 414 1 616 12 655 13 354 169 087 8 658

Denominator 16 327 3 372 16 434 17 645 194 813 2 879 313 16 434

KwaZulu-Natal Indicator 106.7 97.2 8.5 70.2 85.6 74.8 66.8

South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3

Source: DHIS.


Page 16 of 96

Annual trends Child Health

Impact Outc

ome Output

Ch

ild

un

de

r 5

ye

ars

dia

rrh

oe

a

ca

se

fata

lity

rate

(%

)

Ch

ild

un

de

r 5

ye

ars

pn

eu

mo

nia

ca

se

fata

lity

rate

(%

)

Ch

ild

un

de

r 5

ye

ars

se

ve

re

ac

ute

ma

lnu

tritio

n

ca

se

fata

lity

rate

(%

)

Inp

atie

nt

de

ath

u

nd

er

1

ye

ar

rate

(%)

In

pa

tie

nt

de

ath

u

nd

er

5

ye

ar

rate

(%)

In

pa

tie

nt

ea

rly

ne

on

ata

l

de

ath

ra

te

(pe

r1K

)

Inp

atie

nt

ne

on

ata

l

de

ath

ra

te

(pe

r1K

)

Infa

nt

PC

R

test

p

osi

tiv

e

aro

un

d

10

we

ek

s ra

te

(%)

Imm

un

iza

tio

n

co

ve

rag

e

un

de

r 1

ye

ar

(%)

In

fan

t

ex

clu

siv

ely

bre

ast

fed

a

t

DTa

P-I

PV

-

Hib

-HB

V

3rd

do

se r

ate

(%

)

Me

asl

es

2n

d

do

se

co

ve

rag

e

(%)

Sc

ho

ol

Gra

de

1

scre

en

ing

co

ve

rag

e

(%)

Sc

ho

ol

Gra

de

8

scre

en

ing

co

ve

rag

e

(%)

Vita

min

A

do

se

12

-59

mo

nth

s

co

ve

rag

e

(%)

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

201

6/1

7

2016

/17

Abaqulusi

SD

Indicator 1.3 1.2 12.5 3.1 2.6 8.1 9.3 0.5 91.7 50.2 104.

2

36.5 20.9 54.7

Numerator 5 5 8 52 62 33 38 6 4

300

2

117

5

008

2

289

1

069

21

472

Denominat

or

391 402 64 1

663

2

376

4

094

4

094

1

093

56

271

4

220

57

657

6

264

5

104

471

024

eDumbe

SD

Indicator 6.7 - 50.0 6.7 2.2 - - 1.6 74.8 61.3 93.1 10.6 5.3 65.4

Numerator 1 - 1 1 1 - - 6 1

503

933 1

916

306 127 10

991

Denominat

or

15 9 2 15 45 703 703 364 24

114

1

521

24

690

2

876

2

413

201

774

Nongoma

SD

Indicator 6.5 6.4 12.4 19.1 10.7 14.3 16.6 0.9 61.6 51.6 79.5 42.3 23.0 97.2

Numerator 16 12 13 108 123 68 79 7 3

451

2

140

4

329

2

167

1

156

41

099

Denominat

or

246 187 105 566 1

149

4

747

4

747

761 67

176

4

144

65

367

5

128

5

036

507

198

Ulundi SD Indicator 2.1 2.0 15.7 9.6 5.9 10.1 11.7 0.5 81.6 50.4 97.0 31.4 16.9 63.7

Numerator 6 2 8 61 70 36 42 4 3

908

2

050

4

680

2

235

1

060

24

682

Denominat

or

287 102 51 633 1

178

3

580

3

580

820 57

441

4

065

57

897

7

125

6

287

464

802

uPhongol

o SD

Indicator 4.1 6.7 22.1 12.9 8.8 6.6 7.2 1.8 77.1 56.2 100.

6

42.3 15.6 48.5

Numerator 7 7 17 40 55 21 23 11 2

486

1

601

3

249

1

940

678 12

508

Denominat

or

171 105 77 311 625 3

203

3

203

616 3870

9

2

849

3876

0

4

581

4

346

309

558

Zululand

District

Indicator 3.2 3.2 15.7 8.2 5.8 9.7 11.1 0.9 77.0 52.6 94.2 34.4 17.6 68.0

Numerator 35 26 47 262 311 158 182 34 1564

8

8

841

1918

2

8

937

4

090

110

752

Denominat

or

1

110

805 299 3

188

5

373

1632

7

1632

7

3

654

2437

11

1679

9

2443

71

3116

88

2782

32

19543

56

KwaZulu-

Natal

Indicator 2.0 1.8 7.4 6.4 4.5 9.7 12.4 1.0 85.8 53.9 99.8 26.2 16.4 62.1

South

Africa

Indicator 2.0 2.0 8.0 6.3 4.4 9.9 12.4 1.3 82.3 41.6 96.2 33.0 19.8 58.0


Page 17 of 96

Annual trends HIV

3rd 90-90-90 2n

d

90

-

90

-90

1st 90-90-90

Impact Outco

me

Output

Ad

ult

with

vir

al

loa

d

co

mp

letio

n

rate

a

t

12

m

on

ths

(%)

Ch

ild

w

ith

vir

al

loa

d

co

mp

letio

n

rate

a

t

12

m

on

ths

(%)

Ad

ult

with

vir

al

loa

d

sup

pre

sse

d

rate

1

2

mo

nth

s

(%)

Ch

ild

w

ith

vir

al

loa

d

sup

pre

sse

d

rate

1

2

mo

nth

s

(%)

Ad

ult

pe

rce

nta

g

e

on

A

RT

aft

er

12

mo

nth

s

(%)

Ch

ild

pe

rce

nta

g

e

on

A

RT

aft

er

12

mo

nth

s

(%)

Clie

nts

rem

ain

ing

on

A

RT

rate

(%

)

Fe

ma

le

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(No

)

HIV

te

st

po

sitiv

e

clie

nt

15

ye

ars

a

nd

old

er

rate

(in

clu

din

g

AN

C)

(%)

HIV

te

stin

g

co

ve

rag

e

(in

clu

din

g

AN

C)

(%)

M

ale

co

nd

om

dis

trib

utio

n

co

ve

rag

e

(No

)

Me

dic

al

ma

le

cir

cu

mc

isi

on

ra

te

(pe

r1K

)

2015 2015 2015 2015 2015 2015 2016/

17

2016/

17

201

6/17

2016/

17

2016/17 2016/17

Abaqulusi

SD

Indicator 27.2 29.9 91.3 82.9 74.1 75.0 - 1.1 - 39.9 42.6 26.9

Numerator - 41 - 34 - 138 - 88 897 - 50 746 3 136

992

2 305

Denominator 2

946

137 802 41 4

129

184 - 971

184

- 1 526

511

883 197 1 028

649

eDumbe

SD

Indicator 51.9 32.4 93.5 81.8 83.3 94.4 - 2.1 - 27.9 61.6 28.8

Numerator - 11 - 9 - 34 - 64 927 - 12 856 1 597

860

893

Denominator 684 34 355 11 836 36 - 366

489

- 552

873

311 139 372 339

Nongoma

SD

Indicator 40.5 44.4 93.8 60.4 78.9 79.9 - 1.7 - 41.0 51.7 58.9

Numerator - 48 - 29 - 111 - 125

398

- 42 826 2 817

082

3 966

Denominator 2

317

108 938 48 3

017

139 - 879

909

- 1 253

631

653 529 807 465

Ulundi SD Indicator 35.7 40.9 90.6 72.2 77.8 82.7 - 1.3 - 35.5 62.5 34.2

Numerator - 54 - 39 - 134 - 94 753 - 37 382 3 471

427

2 300

Denominator 2

273

132 812 54 3

033

162 - 873

246

- 12641

52

666 801 807 801

uPhongolo

SD

Indicator 39.6 35.1 87.8 80.0 65.4 74.0 - 2.4 - 29.3 67.2 16.8

Numerator - 20 - 16 - 77 - 112

721

- 22 008 2 806

018

831

Denominator 997 57 395 20 2

093

104 - 572

952

- 901

974

500 733 592 968

Zululand

District

Indicator 58.0 56.8 91.8 68.5 75.9 78.5 61.3 1.5 11.4 42.5 53.9 30.5

Numerator - 174 - 127 - 494 101

471

486

696

16

808

165

818

13 829

379

10 295

Denominator 217 468 3302 174 13

108

625 171

640

3 663

780

178

755

5 499

141

3 015

399

3 609

222

KwaZulu-

Natal

Indicator 58.0 56.8 91.8 68.5 75.9 78.5 61.3 1.5 11.4 42.5 53.9 30.5

South

Africa

Indicator - - - - - - 55.0 1.3 8.2 35.9 47.5 19.0


Page 18 of 96

4.6.4 TB

Impact Outcome Output Process &

input

TB

de

ath

rate

(ETR

.ne

t)

(%)

TB

DR

clie

nt

de

ath

ra

te

(ED

RW

eb

)

(%)

TB

c

lien

t

lost

to

follo

w

up

rate

(ETR

.Ne

t)

(%)

TB

clie

nt

tre

atm

en

t

suc

ce

ss

rate

(ETR

.ne

t)

(%)

TB D

R c

lien

t

loss

to

follo

w

up

rate

(ED

RW

eb

)

(%)

TB

DR

tre

atm

en

t

suc

ce

ss

rate

(ED

RW

eb

)

(%)

TB

Rifa

mp

icin

resi

sta

nc

e

co

nfirm

ed

clie

nt

rate

(%)

TB

Rifa

mp

icin

resi

sta

nt

clie

nts

tre

atm

en

t

initia

tio

n

rate

(%

)

TB/H

IV

co

-

infe

cte

d

clie

nt

on

AR

T ra

te

(ETR

.Ne

t)

(%)

TB

clie

nt

initia

ted

o

n

tre

atm

en

t

rate

(%

)

TB

sym

pto

m

5

ye

ars

a

nd

old

er

scre

en

ed

in

fac

ility

ra

te

(%

2015 2014 2015 2015 201

4

201

4

2016 2016 2016 2016 2016/17

Abaqulusi

SD

Indicator 7.9 - 2.2 86.7 - - - - 81.9 - 77.3

Numerator 174 - 48 1 914 - - - - 567 - 363 568

Denominat

or

2207 - 2

207

2 207 - - - - 692 - 470 375

eDumbe SD Indicator 7.6 - 0.4 88.0 - - - - 72.5 - 74.4

Numerator 37 - 2 427 - - - - 116 - 146 226

Denominat

or

485 - 485 485 - - - - 160 - 196 587

Nongoma

SD

Indicator 6.1 - 3.4 83.6 - - - - 80.1 - 88.3

Numerator 81 - 46 1 115 - - - - 322 - 329 180

Denominat

or

1334 - 1

334

1 334 - - - - 402 - 372 740

Ulundi SD Indicator 6.7 - 2.6 83.8 - - - - 88.2 - 75.2

Numerator 79 - 30 984 - - - - 402 - 349 030

Denominat

or

1174 - 1

174

1 174 - - - - 456 - 464 337

uPhongolo

SD

Indicator 7.8 - 4.3 83.8 - - - - 91.2 - 86.5

Numerator 76 - 42 820 - - - - 332 - 243 270

Denominat

or

979 - 979 979 - - - - 364 - 281 254

Zululand

District

Indicator 7.2 24.1 2.7 85.1 10.9 59.0 10.3 66.5 83.8 67.0 80.2

Numerator 447 108 168 5 260 49 265 316 210 1 739 2 061 1 431 274

Denominat

or

6

179

449 6

179

6 179 449 449 3

077

316 2 074 3 077 1 785 293

KwaZulu-

Natal

Indicator 5.4 19.0 4.8 82.7 17.2 59.6 7.7 73.8 85.7 62.4 78.3

South Africa Indicator 6.6 23.0 6.4 81.0 17.9 50.5 6.2 68.0 88.3 72.8 51.6

Source: Stats SA 2015; including deaths due to MDR-TB and XDR-TB


Page 19 of 96

Annual trends Non-communicable diseases

Outcome

Diabetes incidence

per1K)

Hypertension incidence (per1K

2016/17 2016/17

Abaqulusi SD Indicator 0.5 8.6

Numerator 105 380

Denominator 2 735 028 528 357

eDumbe SD Indicator 0.7 7.2

Numerator 59 119

Denominator 1 050 825 196 983

Nongoma SD Indicator 6.5 23.6

Numerator 1 327 842

Denominator 2 463 909 427 848

Ulundi SD Indicator 5.3 18.8

Numerator 1 064 680

Denominator 2 399 952 433 734

uPhongolo SD Indicator 1.1 18.7

Numerator 145 432

Denominator 1 642 605 276 678

Zululand District Indicator 3.1 15.8

Numerator 2 700 2 453

Denominator 10 292 319 1 863 600

KwaZulu-Natal Indicator 2.8 21.7

South Africa Indicator 2.5 18.8

Source: DHIS.


Page 20 of 96

5. SERVICE DELIVERY PLATFORM AND MANAGEMENT

Number of facilities per sub-district

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

Abaqulusi 0 3 15 0 1

eDumbe 0 2 6 1 0

Nongoma 1 4 14 0 1

Ulundi 0 6 26 0 2

uPhongolo 0 3 10 0 1

District 1 18 71 1 5

Source: DHIS 2016/17

Abaqulusi Local Municipality experienced an increase in the population to clinics (15) from 14

929 (2015) to 15 137.90 (1.4% increase) and is the highest within the district as compared to other

sub districts with the highest population to mobiles (03) from of 74647 (2015) increasing to 75

689.30; and the second highest head count total of 486403 (DHER 2016) after Ulundi municipality.

This indicates the strain that this sub district is experiencing in the provision of services as

compared to other sub districts. Ulundi Local Municipality has the lowest number of population

to clinics and is due to the highest number of clinics (26) with the highest number of mobiles (06)

as compared to all other sub districts with the highest headcount total of 513201(DHER 2016)

and is only +-27 000 higher than that of Abaqulusi sub district with almost half (15clinics vs

26Ulundi and 3mobiles vs 06 Ulundi the number of PHC facilities compared to Ulundi. Nongoma

Local Municipality has the 2nd highest population to mobiles of 67 544(2015) increasing to 68

253.00 (1% increase) for 14 clinics and only 03 mobiles and one Health post with a headcount

total of 405 736(DHER 2016) including that of the Heath post. Mobiles in this sub-district are

experiencing a strain in case of service delivery and they have a challenge of regular

breakdowns of mobile vehicles due to age. UPhongolo Local Municipality has a total of 10

clinics and 03 mobiles. The current number of clinics may change to 12 once the issue of Fuduka

and Qalukubheka clinics has been finalized as the district map show them to be falling off

Abaqulusi to UPhongolo local municipality.

1 There are no Commlunity 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


Page 21 of 96

5.1 .Human Resources for Health (filled posts)

Co

mm

un

ity

h

ea

lth

wo

rke

r

Nu

rsin

g A

ssis

tan

t

En

rolle

d n

urs

e

Pro

fess

ion

al n

urs

e

Do

cto

r

Ph

arm

ac

ist

De

ntist

Oc

cu

pa

tio

na

l

the

rap

ist

Ph

ysi

oth

era

pis

t

Sp

ee

ch

th

era

pis

t

Au

dio

log

ist

Abaqulusi 234 68 138 268 11 6 2 1 2 0 2

EDumbe 1 12 54 54 4 2 1 0 2 0 0

Nongoma 243 105 173 215 12 3 0 1 1 0 1

Pongola 118 54 110 102 6 3 1 0 2 1 1

Ulundi 353 84 201 269 13 6 1 1 3 1 2

District 949 323 676 908 46 20 5 3 10 2 6

Source: Persal 2016/17

Number of patients to staff type in facilities –Clinics

Organisation

unit Admin Clin. Other Couns. DC GW/C NA PA Basic

PA Post

Basic PN SN Spec.

Ulundi LM 19007.4 18678.5 12830.0 46654.6 18328.6 128300.3

4172.4 7127.8

uPhongolo

LM 36792.0 33919.4 13378.9 32704.0 21024.0 15491.4

5553.5 7547.1

eDumbe LM 132849.0 67489.5 18978.4 18978.4 13284.9 66424.5 66424.5 132849.0 5109.6 4920.3

Abaqulusi LM 28611.9 32232.7 24320.2 121600.8 13146.0 162134.3

48640.3 3986.9 7483.1

Nongoma LM 26657.0 24879.9 9996.4 66642.5 33321.3 22214.2

6151.6 8160.3

Source: DHER 2016

The number of patients to staff type indicates the workload each category of staff experiences

during the day to day service delivery practice, the lower the number of patients to staff type

versus the more the category of personnel indicates less strain that category of staff experiences

at work. The district experienced an increase in the number of patients to PNs from 4 744.4(2015)

to 4994.8 ( 2016);with sub districts having a significantly high number of patients to PNs

increasing from the previous year’s numbers like Nongoma increasing from 5453.1(2015) to

6151.6( 2016); eDumbe increasing from 5399 in 2015 to 5399.2 in 2016 and uPhongolo, increasing

from 4845.6 in 2015 to 5553.5(2016), which indicates a continuously experienced strain by this

category of staff within the district. The moratorium on the filling of posts that came out this year

had a contributing factor in this as people were leaving without any replacements. There are a


Page 22 of 96

noticeable high number of patients to counsellors especially at Abaqulusi sub district increasing

from 23442.0in 2015 to24320.2 in 2016, This is due to the high number of counsellors released for

further development as nurses; they were not replaced as per H.R policies and the

implementation of the provider initiated; counselling and Testing (PICT) program. The high

number of patients to Pharmacist assistants (PAs) indicates special attention to be paid to it

because they will assist in the implementation of Centralised Chronic Medicine Dispensing and

Distribution(CCMDD) program which is going to be run by PAs at clinics, the and PAs’ availability

will also improve medicine availability thus reducing stock out at PHC facilities. The number of

patients to Data Capturers is decreasing but at a very slow pace except at eDumbe where one

data capturers obtained a higher post and could not be replaced, hence an increase. This has

a negative impact on service delivery especially on capturing of patients on ARTs in the 3Tier

system. This situation is going to change as plans are in place for the Provincial HAST unit to

provide the district with seven data capturers for high volume clinics before the end of this

financial year (2017/18). The high number of patients to GW/Cs is noted throughout the district

and is because there are some clinics like Okhukho, Nhlopheni, Mashona and Nkunzana clinic

that are functioning without cleaners, thus creating challenges in terms of IPC and patient

safety.

Number of patients to staff type in facilities –CHCs

Organisation

unit Admin

Clin.

Other Couns. DC GW/C MO NA

PA

Basic

PA Post

Basic Pharm PN SN Spec.

Ulundi LM

uPhongolo LM

eDumbe LM 3832.4

22994.5 91978.0 10219.8 30659.3 9197.8

30659.3 15329.7 2139.0 3537.6

Abaqulusi LM

Nongoma LM

It is noted that in eDumbe CHC the number of patients to staff type in general has slightly

decreased as compared to the last financial year(2015); however there is still some categories of

staff that are still experiencing strain with the high numbers of patients to attend to like PA Post

Basic at 30659.3, MOs at 30659.3, DCs at 91978.0 and GW/C at 10219.8;the sub district is still

experiencing a challenge of running facilities with grossly short staffing of GW/C as there are

three clinics( Luneburg, Hartland and Ophuzane ) that are without any cleaners at all. The

process of acquiring private services provider for cleaning services at clinics without cleaners

(GW/C) (Outsourcing) could not be implemented due to unavailability of funds.


Page 23 of 96

Population to Staff [number]

DHER – 2016 Population to Medical Officer (Sub-District)

Organisation unit Uninsured Population Total Population

Ulundi LM

uPhongolo LM

eDumbe LM 27200.7 29092.3

Abaqulusi LM

Nongoma LM

The population to Medical Officer for eDumbe CHC slightly increased from 26 865.7 in 2015 to

27 200.7 in 2016 with a total population to MOs increasing from 28733.3 in 2015 to 29092.3 in 2016

and is due to the decrease in the number of medical officers from 4 in 2015 to 2 in 2016 as they

resigned and could not be replaced due to the moratorium on the filling of posts. The situation is

different now as there are 04 doctors and 02 clinical associates were appointed in 2017/18

DHER – 2016 Population to Professional Nurse (Sub-District) -

Organisation unit Uninsured Population Total population

Ulundi LM 1515.5 1620.9

uPhongolo LM 2406.7 2574.0

eDumbe LM 1182.6 1264.9

Abaqulusi LM 1740.2 1861.2

Nongoma LM 2945.4 3150.1

In general the district experienced an increase in the number of uninsured population to PNs;

from 1768.18 (2015) to 1958.8(2016) the highest number is noted at Nongoma which was at

2595.4 in 2015 to 2945.4 in 2016 and uPhongolo which was at 1999.3 in 2015 and 2406.7 in 2016,

this is due to the utilization of staff loaned from hospital not linked to PHC on Persal especially at

Nongoma. UPhongolo PNs are working under marked strain more especially because there are

no PNs at PHC that are loaned from hospital since the hospital has a BUR above 70% indicating

strain to the hospital nurses too.


Page 24 of 96

Management and efficiency indicators for the service delivery platform-PHC

(Refer to Annexure C for the templates for the above mentioned).

Sub-

districts

Efficiency Management

Pro

vin

cia

l a

nd

lo

ca

l g

ove

rnm

en

t

dis

tric

t h

ea

lth

se

rvic

es

ex

pe

nd

itu

re p

er

ca

pita

(un

insu

red

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l g

ove

rnm

en

t

prim

ary

he

alth

ca

re e

xp

en

ditu

re

pe

r c

ap

ita

(u

nin

sure

d

po

pu

latio

n)

(Ra

nd

)

Pro

vin

cia

l a

nd

lo

ca

l g

ove

rnm

en

t

ex

pe

nd

itu

re p

er

prim

ary

he

alth

ca

re h

ea

dc

ou

nt

(Ra

nd

)

Pe

rce

nta

ge

of

ass

ess

ed

PH

C

fac

ilitie

s w

ith

90%

of

the

tra

ce

r

me

dic

ine

s a

va

ila

ble

(%

)

Pe

rce

nta

ge

Id

ea

l C

linic

s (%

)

PH

C f

ac

ilitie

s u

sin

g H

ea

lth

Pa

tie

nt

Re

gis

tra

tio

n (

No

)

PH

C U

tilis

atio

n R

ate

(N

o)

PH

C <

5 U

tilis

atio

n R

ate

(N

o)

8 7 6 5 4 3 2 1

Ab

aq

ulu

si Indicator 725.21 725.21 282.26 0% 2.5 3.4

Numerator 159780550 159780550 159780550 0 470375 95695

Denominator 220322 220322 566070 0 205842 28542

eD

um

be

Indicator 1357.02 1357.02 497.32 0 3.2 2.6

Numerator 117213731 117213731 117213731 0 196587 39103

Denominator 86376 86376 235690 0 79,591 12297

No

ng

om

a Indicator 712.09 712.09 279.59 0 3.2 2.4

Numerator 130797179 130797179 130797179 0 372,740 95,073

Denominator 183681 183681 467813 0 165,971 29,433

Ulu

nd

i

Indicator 946.48 946.48 309.83 0 3.9 2.9

Numerator 176034991 176034991 176034991 0 464,337 103,828

Denominator 185989 185989 568165 0 171,138 26,565

UP

ho

ng

ol

o

Indicator 673.79 673.79 262.13 0 3.6 2.5

Numerator 91627458 91627458 91627458 0 281,254 68,300

Denominator 135989 135989 349554 0 125,497 19,171

Zu

lula

nd

Indicator 831.63 831.63 308.81 100% 63% 0 3.2 2.9

Numerator 675459491 675459491 675459491 71 45 0 1 785 293 362 896

Denominator 812208 812208 2187292 71 71 0 748 039 116 008

KwaZulu

-Natal Indicator 1 879 1 213 397

South

Africa Indicator 1 726 1 054 389

Source: DHIS, BAS, Ideal Clinic Information System 2016/17


Page 25 of 96

The district is experiencing a challenge of a chronically low the PHC utilization rate of 2.5(2016);

dropping from 2.7 in the past three years (2013-2015). A number of clinics and the CHC within

the district have experienced a drastic drop in the PHC head count total this year (2016), the

actual cause of which is not clearly known as the assumption that CCMDD had a contribution

has been dismissed since it has been noted that the clinics doing well in CCMDD are mostly the

ones that has gained a few clients / has minimal decrease in the PHC headcount. Ulundi and

Abaqulusi sub districts are the ones that experienced a significant drop in the utilization rate total

from 2.6(2015) to 2.3 (20160 and 3.0 (2015) to 2.8 (2016) respectively whilst uPhongolo remained

at 2.6 for both 2015 and 2016. It is also related to the long waiting times experienced at clinics

due to high number of resignations experienced towards the end of the financial year where

personnel could not be replaced due to the moratorium on the filling of posts. Poor data quality

due to the lack of proper registers (RORs) at clinics also has an impact

Management and efficiency indicators for the service delivery platform - Hospitals

Hospital

Name

District Hospital

Average

length of stay

(days)

Inpatient bed

utilisation rate

(%)

OPD new

client not

referred rate

(%)

Expenditure

per patient

day

equivalent

(Rand)

Inpatient

Crude Death

Rate (%)

23 22 21 20 19

Abaqulusi

Indicator 5.1 71.1 41.6 2.233 5.3

Numerator 80495 80495 14433 242423913 840

Denominator 15883 113102 34658 108531 15883

eDumbe

Indicator - - - - -

Numerator - - - - -

Denominator - - - - -

Nongoma

Indicator 5.8 45 76.1 2.876 5.3

Numerator 74610 74610 18265 274642780 678

Denominator 12854 165698 23994 95505 12854

Ulundi

Indicator 6 56.7 32 3.006 8.6

Numerator 70735 70735 16751 309220208 1013

Denominator 11832 132144 52333 102868 11832

uPhongolo

Indicator 4.9 76.6 7.5 2.317 5

Numerator 43179 43179 3414 149089119 445

Denominator 8917 56216 45576 64339 8917

District

Indicator 5.45 62.35 49.9 2.608 5.2

Numerator 269019 269019 52863 975376020 2976

Denominator 49486 467160 156561 371243 49486


Page 26 of 96

The district is experiencing a challenge of a progressively decreasing Bed utilization rate (BUR)

over the years from 66.7% ( 2014), 65.3% (2015) to 59.9% (2016),as compared to the national

target of 75% for district hospitals. It is highest at Itshelejuba hospital at 76.6 %( 2016) and lowest

at Ceza hospital at 43.5 %( 2016).Benedictine hospital is demonstrating a certain degree of

inefficiency looking at its progressively decreasing BUR over the past three years from

63.1%(2014) , 59.4%(2015) to 45% (2016) as compared to Vryheid hospital which is of its same size

in terms of the number of useable beds ,with a BUR from 68.2(2014), 68.2%(2015) to 71.1%

(2016).The challenge at Benedictine has always been explained by the institutional

management as due to hiccups experienced with the retention of doctors; resulting to limited

number of patients seen in OPD, unfortunately the appointment of sessional doctors to remedy

the situation as promised in(2015) does not seem to be having any positive results in solving the

challenge, it has only been able to reduce patient waiting times from 6hours to less than 3hours

thus the reduction of complaints on long waiting times. The progressively increasing high BUR at

Itshelejuba from 77.3 %( 2014); 77.55(2015) to 76.6 %( 2016) over the years is noted with a

concern though because this hospital has a few number of general patient beds which are

always full to capacity with spillages thus compromising the quality of care. In general the district

is progressing towards the national target of the number of days spent by each patient

admitted in hospital as there is a progressive decline in the ALOS over the years from 6.18days

(2014) , 5.9days(2015) to 5.5days (2016)versus the provincial target of 6days(2016).It is noted that

Ceza hospital has the longest average length of stay ranging from 7.2days (2014), 6.4days(2015)

and 6.1 (2016),indicating that the few patients that get admitted at Ceza are kept for a longer

period of time in hospital, may be trying not to have empty wards. Itshelejuba hospital

management is commended for the progressive decrease in the ALOS from 5.1days (2014),

5.2days (2015) to 4.9days (2016), this is due to the implementation of the previous DHER

recommendations on the implementation of the admission and discharge criteria. The highest

expenditure per PDE in Ulundi (R3 006) and Nongoma (R2 876) sub districts indicates that

hospitals are inefficient in the provision of services; they spend more budgets against limited

service delivery output.

6. QUALITY OF CARE

Top 20 worst performing Ideal Clinic (ICRM) elements in PHC facilities Element (2016)

Element # Element % yes scores

155 There is WEB access 9%

41 80% of Professional Nurse have been trained on Basic Life Support 11%

171 EMS respond according to the pre-determined response time 13%

150 The back-up electrical power supply is checked weekly to determine its functionality 20%

161 There is a functional computerized patient information system 21%

149 There is a functional back electrical supply 23%

137 Clinic space accommodates all services and staff 30%

132 There is a standard security guard room 33%

17 The guideline for filling, archiving and disposal of patient records is adhered to 40%


Page 27 of 96

Element # Element % yes scores

28 Immunization coverage under one year (annualised) is at least 92% or has increased by at

least 5% from the previous year

41%

97 Training records reflect that planned training is conducted as per the district training plan 49%

47 Clinical audit meetings are conducted quarterly in line with the guidelines 53%

124 All toilets are clean, intact and functional 54%

15 Patient record content adheres to ICSM prescripts 54%

16 The provincial/district standard operating procedure/guideline for filling , archiving and

disposal of patient records is available

57%

83 Basic surgical supplies ( consumables) 57%

136 Deficiencies identified during the practice of the emergency evacuation drill are addressed 57%

140 Essential equipment is available and functional in every consulting room 57%

68 The complaints/ compliments /suggestions records show compliance to the National Policy

to manage complaints/ compliments /suggestions

60%

118 Cleaning materials are available 60%

Top 20 worst performance National Core Standards in District Hospitals and PHC clinics

as at [date 2016]

Measure No. Element No scores

3.1.2.1.1.X Tracer medicines as per applicable Essential Drugs List or formulary are available in the

medicine room

5

3.2.1.3.1.E Functional laboratory equipment with appropriate consumables and reagents are

observed

4

3.1.3.5.2.E Physical stock corresponds to the stock reflected in the inventory management system

(as per checklist 31211)

3

3.2.2.8.E There is a recent report (in the last six months) of radiation safety measures showing

actions that have been implemented to limit exposure

2

3.4.1.1.2.E Functional essential equipment as listed in the checklist is available in the Radiology

Department

2

1.8.2.3.1.E Letters to the last five complainants whose cases have been completed are in their files

and include the findings and actions

4

5.2.1.1.2.V

An up-to-date copy of the delegations of authority for the manager of the health

establishment or district details the manager’s authority in terms of financial supply chain

and human resource management

2

5.2.4.1.1.V The health establishment can provide evidence that operational plans are monitored

quarterly against targets and indicators and remedial actions are in place to address

gaps

2

1.1.3.3.1.E Patient satisfaction survey results show that patients are satisfied with linen services of the

health establishment

3

5.2.2.2.2.E The operational plans contain clear service delivery requirements for Finance / HR 4


Page 28 of 96

Measure No. Element

No scores

/ Operations and clinical service components including targets

5.5.2.1.2.E 11. Results of the staff satisfaction survey conducted in the last 12 months shows that staff

feel motivated and engaged in their work

2

4.1.1.2.5.D

12. Management monitors the presenting complaint/disease being seen at the

establishment and up to date communication strategy is available in the health

establishment which includes formal and informal mechanisms for communicating with

the public and the correct authorisation procedure to follow in line with policy

3

5.6.2.1.1.D

An up to date communication strategy is available in the health establishment which

includes formal and informal mechanisms for communicating with the public and the

correct authorisation procedure to follow in line with policy

2

5.6.2.5.1.V

The health establishment has a policy or protocol for the obtaining of patient consent if

patient identifiable information needs to be communicated to a 3rd party

4

7.1.4.1.1.V Maintenance records show that recommendations of annual management inspection

reports on safety hazards and maintenance needs are implemented

3

4.4.1.3.1.E The establishment has a service level agreement for the safe disposal of toxic chemicals

/ radioactive waste and expired medicines with an accredited service provider and the

service levels are monitored for compliance

3

2.6.3.4.3.X Appropriate isolation accommodation exists for patients with communicable diseases -

as a minimum for viral haemorrhagic disease

7

6.6.3.1.1.E All confidential records are archived in a secure / access controlled environment that is

fire proof

6

2.6.1.6.1. E Evidence that at least 50% of health professionals have been trained in standard

precautions in the previous financial year

2

2.1.1.2.1.V There is evidence that the health establishment participates in monthly maternal and

perinatal morbidity and mortality meetings

1

Top 5 challenges reported by patients in patient surveys, and patient complaints (PHC)

# Total

No scores

1. Long waiting times 115

2. Negative staff attitude 93

3. Safety and Security 83

4. Infection control 80

5. unavailability of medicine 70

Period: 4th Quarter 2016/17

Challenges Planned Interventions

1. Waiting times due to staff

shortages in clinics

Reorganize off duties and leaves for staff

Decentralize more patients on CCMDD

Inform Clients in the Clinic promptly about the envisaged waiting times and how


Page 29 of 96

Challenges Planned Interventions

long they going to wait.

Implement fast queues-Prioritize clients that need to be seen first.

Implement appointment system, Retrieve client cards 72 Hours before arrival

2. Staff attitudes Have on-going in-service training of staff on Batho Pele

To monitor customer care

3. Infection control Re enforce handwashing in the for health workers.

Have campaigns on hand washing and IPC

Ensure continuous availability of all hand wash facilities at all levels

4. Availability of medicine Improve management and supply of medicines

5. Cleanliness To have checklists monitored and signed hourly

Conduct hourly hygiene rounds

Allocate a dedicated person to monitor cleanliness hour especially at the

ablutions

Provide monthly IPC support at clinics- IPC Manager


Page 30 of 96

7. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM

DISTRICT HEALTH

SERVICE DELIVERY P;

M&E

DDM: P; M&E

INTEGRATED DISTRICT PUBLIC

HEALTH SERVICE SYSTEM

DDM: Clinical Programs

VACANT

CORPORATE SERVICES:

OFFICE MANAGER

Vacant

DISTRICT CLINICAL

SPECIALISTS TEAM X 04

District

Director

DISTRICT

PHARMACIST

SECRETARY

CEO CEZA HOSPITAL

CEO

NKONJENI

HOSPITAL

CEO

BENEDICTINE

HOSPITAL

CEO

VRYHEID

HOSPITAL

CEO

ITSHELEJUBA

HOSPITAL

AM OMMUNICATIONS

CEO

eDUMBE CHC


Page 31 of 96

8. DISTRICT HEALTH EXPENDITURE

Sub-Programme Budget: Adjusted Appropriation Expenditure TOTAL %

Overspent

(Underspent

)

Province Transfer

to LG *

LG

Own

Province Transfer

to LG

LG Own Budget Expenditure

2.1 District Management 19 103 000.00 0.00 0.00 18 549 100.00 0.00 0.00 19 103 000.00 18 549 100.00 (3%)

2.2 Clinics 382 657 000.00 0.00 0.00 394 534 916.00 0.00 0.00 382 657 000.00 394 534 916.00 3%

2.3 Community Health Centres 54 798 000.00 0.00 0.00 55 051 983.00 0.00 0.00 54 798 000.00 55 051 983.00 0%

2.4 Community Services (incl. PAH) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%

2.5 Other Community Services 94 728 000.00 0.00 0.00 90 940 322.00 0.00 0.00 94 728 000.00 90 940 322.00 (4%)

2.6 HIV/AIDS 254 099 000.00 0.00 0.00 286 011 738.00 0.00 0.00 254 099 000.00 286 011 738.00 (3%)

2.7 Nutrition 4 200 000.00 0.00 0.00 2 681 911.00 0.00 0.00 4 200 000.00 2 681 911.00 (36%)

2.9 District Hospitals 853 688 000.00 0.00 0.00 827 922 075.00 0.00 0.00 853 688 000.00 827 922 075.00 (3%)

2.12 Other Donor Funding

TOTAL DISTRICT 1 663 273 000 0.00 0.00 1 675 692 045.00 0.00 0.00 1 663 273 000.00 1 675 692 045.00 1%

Source: District Health Expenditure Review (2016/17) or BAS

*LG - Local Government

The District Management budget increased from R12 659 000 (15/16) to R19 103 000 (16/17), which was R6 444 000(50%) increase. The

expenditure has increased from R 12 951 360, (15/16) toR18 549 100 in 16/17 (43%). It has under expenditure of R 553,900 (2.9%).It is

recommended that District Management Expenditure be linked to facility performance to justify over and /or under expenditure to avoid this in

future.


Page 32 of 96

9. DISTRICT ASPIRATIONS AND INDICATOR TARGETS

List the District aspirations, and map to the Provincial DoH Strategic Plan 2015-2020 goals.

# District Aspiration Provincial Strategic Plan 2015-2020 Goal(s)

1. Improved Child Health Reduce and manage the burden of disease

2. Improved maternal and women’s health Reduce and manage the burden of disease

3. Improved management and control of HIV and TB Reduce and manage the burden of disease

4. Improve quality of health care Improved quality of healthcare

5. Improved management of non-communicable diseases Reduce and manage the burden of disease

6. Strengthen Primary Health Care Services Strengthen health system effectiveness

7. Strengthened Hospital Services Strengthen health system effectiveness

8. Strengthened Health Support Services Strengthen health system effectiveness

Theory of Change (impact, outcome and output) indicators for all District aspirations, to reach health outcomes.

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Dis

tric

t A

spira

tio

n

#0

1:

Im

pro

ve

d

ch

ild h

ea

lth

Type

Imp

ac

t

Child Under 5years mortality rate 7.3 4.4 5.7 5.6% 4% 3% 2%

Inpatient death under 5years 465 272 305 300 210 156 102

Inpatient separations under 5 years 6,380 6,114 5,342 5288 5265 5183 5131


Page 33 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Child under 5 years diarrhoea case fatality rate 4.7% 3% 3.2% 3.0% 3% 2% 2%

Child under 5years with diarrhoea death 52 34 35 34 34 34 33

Child under 5 years with diarrhoea admitted 1,098 1,124 1,110 1124 1238 1406 1650

Child under 5 pneumonia case fatality rate 4.5% 3.8% 3.2% 3.1% 3% 2% 2%

Child under 5 years with pneumonia death 32 31 26 25 24 23 22

Child under 5 years with pneumonia admitted 705 814 805 814 968 1175 1445

Child under 5 years severe acute malnutrition

case fatality rate

20.3% 7.8% 15.7% 14% 12% 9% 7%

Child under 5 year with severe acute malnutrition

death

47 22 47 44 43 41 39

Child under 5 year with severe acute malnutrition

admitted

231 283 299 310 362 439 536

Imp

ac

t

Death in facility under 1 year rate (annualised 8.3% 5.7% 8.1% 6.1% 6% 4% 2%

Death in facility under 1 year total 357 221 256 259 244 228 213

Inpatient separations under 1 year 4,322 3,886 3,173 4190 4132 5843 9300

Inpatient early neonatal death rate 10.2/1K 7.3/1K 9.9/1K 6.3 5.9 5.5 5.2

Dis

tric

t

Asp

ira

tio

n

#0

1:

Imp

ro

ve

d

ch

ild

he

alth

Imp

ac

t Neonatal death within 7days of birth 169 111 152 100 98 95 90

Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146


Page 34 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Neonatal death in facility rate 12.2/1K 8.8/1K 11.4/1K 7.1/1K 7.1/1K 6.9/1K 6.7/1K

Neonatal 0-28 days death in facility 203 135 176 113 110 108 104

Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146

Ou

tpu

t

Infant 1st PCR test positive around 10 weeks rate 2.4 1.5 0.93 1.1 % 0.8% 0.8% 0.7%

Infant PCR test positive around 10 weeks 170 58 34 28 36 45 45

Infant PCR test around 10 weeks 7,149 3,781 3,647 2661 4505 5574 6919

Infant exclusively breastfed at HipB3rd dose rate 41.7 34.2 52.7 54% 56% 60% 64%

Infant exclusively breastfed at HipB3rd dose 8,025 6,189 8,841 7492 11825 16085 22217

HipB3rd dose 19,251 9,484 16,778 13873 20988 26694 34494

Immunisation under 1 year coverage (annualised) 87.9 78.1 77.0 78.7% 80% 82% 85%

Immunised fully under 1 year new 18,451 16,111 15,647 15994 16413 17217 18063

Population under 1 year 20,713 20,379 20,126 20327 20529 20939 21358

Measles 2nd dose coverage (annualised) 88.9% 72.6% 94.2% 94.5% 94.7% 95.4% 96%

Measles 2nd dose 18,387 14,899 19 182 19209 19442 19880 20148

Population 1 year 20,559 20,389 20,126 20327 20529 20939 20988

Dis

tri

ct

Asp

i

ratio

n

#

02

:

Imp

r

ov

e

d

ma

t

ern

al

an

d

wo

m

en

’s

he

alt

h

Imp

ac

t

Maternal mortality in facility ratio 55.4

/100K

79/

100K

96.3

/100K

63.7

/100K

53.2/

100K

20.9/

100K

19.3

/100k


Page 35 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Maternal death in facility 10 13 16 10 9 4 4

Live births in facility 3 16,614 15,465 15,715 15856 16483 17144 17146

Ou

tpu

t

Vitamin A dose 12-59 months coverage

(annualised)

74.0% 72.9%

94.4% 94.6%

95% 95.3% 95.5%

Vitamin A dose 12 - 59 months 84337 84692 110727 114982 113727 115227 116379

Population 12-59 months (multiplied by 2) 113970 116162 117353 1185237 119712 120909 122118

Antenatal client first visit before 20 weeks rate 60.7 67.0 71.7 72% 75.0% 78.6% 82.4%

Number of ANC 1st visit before 20 weeks 11,994 12,180 12,655 13273 14835 15556 17278

Number of ANC 1st visit total 19,772 18,182 17,642 18182 20771 19795 20977

Antenatal client initiated on ART rate 98,1% 99,3% 101.2% 99,5% 98.% 99,4% 99.75

Number of ANC clients started on ART 4682 3827 3414 3835 3950 4704 5596

Number of ANC clients known HIV +ve but not on

ART at 1st visit

4766 3855 3372 3855 3994 4733 5614

Delivery in facility 10-19years rate 10.1% 9.8% 9.9% 8.9% 8.5% 7.4% 6.4%

Number of deliveries in facility 10-19 years 1,686 1,510 1,558 1411 1401 1268 1098

Number of deliveries in facility 16,614 15,465 15,715 15856 16483 17144 17146

Dis

tric

t

Asp

ira

tio

n

#

02

:

Imp

rov

ed

ma

tern

al

an

d

wo

me

n’s

he

alth

Ou

tpu

t

Couple year protection rate (WHO) 43.2 58.0 70.5 73% 73.2% 73.6% 75%

Contraceptive years dispensed 98670 138921 121970 176446 179705 183512 190114


Page 36 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Population 15-49years- females 234,438 238,741 243,563 241 707 245 499 249 338 253 486

Mother postnatal visit within 6days rate 58.3 59.1 55.1 56.4% 63.4% 78.3% 99.3%

Mother postnatal visit within 6days after delivery 9,684 9,135 8,658 9200 11350 15275 21099

Delivery in facility total 16,614 15,465 15,715 16299 17898 19501 21255

Cervical cancer screening coverage 60.9 80.6 82.3 82.6% 83.8% 87.5% 91.4%

Cervical car screening in women 30years& older 9,319 12,722 13,294 13026 14576 15921 17400

Population 30years and older female/10 15,668 16,110 16,609 15770 17385 18196 19046

Dis

tric

t A

spira

tio

n #

03

: Im

pro

ve

d

ma

na

ge

me

nt

an

d c

on

tro

l o

f H

IV

an

d T

B

Imp

ac

t

TB death rate 6.6% 7.2% 6.8% 4.5 5.9% 5.8% 4.5%

Number of TB client death during treatment 475 447 475 70 455 436 419

Number of TB clients initiated(started) on

treatment

6896 6179 6934 1570 6150 7533 9248

TBDR death rate 24.1% 25% 25% 24 23% 21% 20%

Number of TBDR client death during treatment 108 108 65 63 60 54 50

Number of TBDR clients initiated(started) on

treatment

449 436 283 285 287 290 295

Dis

tric

t

Asp

ira

tio

n

#0

3:

Imp

rov

e

d

ma

na

ge

me

nt

an

d

co

ntr

ol

of

HIV

an

d T

B

TB clients treatment success rate 81.6% 85.1% 85% 90% 86.2% 87.3% 88.5%

Ou

tc

om

e Number of TB clients cured and completed

treatment

5630 5260 5895 1413 6906 7875 9110


Page 37 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21


treatment

6896 6179 6934 1570 6150 7533 9248

TBDR clients treatment success rate 81.1% 75.47% 76.38% 77% 78% 93% 94%

Number of TBDR clients cured and completed

treatment

309 160 152 215 210 269 278


treatment

449 436 283 285 287 290 295

TB/HIV co-infected client on ART rate 73.7% 67% 67.0% 91% 82% 85.7% 90.7%

Number of registered TB/HIV co-infected clients

started on ART

6628 122 2061 4665 3683 5404 8203

Total number of registered HIV positive TB patients 10916 1802 3077 5123 4497 6305 9046

TB clients loss to follow up rate 4.4% 2.7% 3% 3.3% 2.6% 2.4% 2.3%

Number of TB clients lost to follow up 304 168 88 52 204 218 235


treatment

6896 6179 6934 1570 6150 7533 9248

TB DR clients loss to follow up rate 10.9% 10,3% 9,5% 9% 8.8% 8.5%


treatment

449 436 283 285 287 290 295

New smear positive PTB cure rate 83% 81.3% 87,6% 85% 85% 86% 87%

Number of new smear positive pulmonary TB 1079 918 816 1673 1339 1646 1817


Page 38 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

clients

New smear positive pulmonary TB clients cured 1302 1129 932 1965 1582 1907 2126

Adult with viral load completion rate at 6 months 40.6% 40.4% 43.3% 50% 56% 63% 72%

Adult client viral load done at 6months 4760 4405 6129 6129 7185 8501 10148

ART first line regimen plus ART second line regimen 11963 11110 12349 12349 12925 13538 14192

Adult viral load suppression rate at 6 months 92.4% 92.2% 93% 94% 97% 98% 99%

Adult client viral load 400cps/ml(VLS) at 6 months 4388 3959 5116 5201 6019 7100 8397

ARTM viral load done at 6 months 4760 4405 5905 5607 7068 8511 10310

Adult viral load suppression rate at 12months 91.7% 93.1% 93.5% 94% 9%7 98% 99%

Adult client viral load 400cps/ml(VLS) at 12

months

1628 1497 3088 5275 6019 7110 8397

ARTM viral load done at 6 months 1723 1688 3302 5612 7068 8511 10310

Adult with viral load completion rate at 12 months 48.9% 44.2% 44.4% 50% 56% 63% 72%

Adult client viral load done at 12months 1776 1608 745 6129 7185 8501 10148


Child with viral load completion rate at 12 months 44.4% 39.8% 41.7% 55.3% 56% 63% 72%

Child with viral load done at 12 months 4760 4405 6129 6943 7185 8501 10148


Page 39 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Child with viral load due at 12 months 11963 11110 12349 12567 12925 13538 14192

Dis

tric

t A

spir

atio

n #

03

: Im

pro

ve

d m

an

ag

em

en

t a

nd

co

ntr

ol o

f H

IV a

nd

TB

Ou

tpu

t

Child with viral load suppression at 12 months 66.0% 63.5% 72% 72.3 72.5% 73% 73.5%

Child client viral load done at 12months 107 228 127 128 130 133 137


ART client remain on ART end of month - total 75,729 85,939 89,698 109540 106888 124910 138839

Adults remaining on ART end of period - Total 71,193 80,997 85,517 103058 105781 116394 128293

Total children(Under 15 years) remaining on ART-

Total

4,536 4,942 5,173 6381 5537 5933 6363

Pro

ce

ss a

nd

In

pu

t

TB symptoms 5 years and older screened in

facility rate

Not

collected

19.0% 80.2% 83% 86% 90% 946%

TB client 5years and older screened in facility Not

collected 349,260 1,431,274 1580989 1604710 1761463 1938317

PHC Headcount Not

collected

1,840,591 1,785,293 1904806 1874125 1965488 2065135

HIV test positive clients 15 years and older rate

(including ANC)

12.2% 11.4% 9.4% 9.2% 7.6% 6.8% 6.1%

Clients 15years and older (including antenatal

)who tested Positive as a proportion of all clients

15years and older ( including antenatal) on

whom an HIV test was done

21,464 17,256 16,808 16447 18064 17134 16268

HI test client 15 years and older ( Incl ANC) 176,090 151,018 178,755 178 770 237661 251035 265227


Page 40 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

HIV testing coverage (including ANC ) 39.5% 33.1% 39.2% 40.6% 50.4% 52.3% 54.2%

HIV test done total 176,090 151,018 178,755 187693 237661 251040 265227

Denominator 446,073 455,677 455,670 462650 470777 479396 488984

Dis

tric

t A

spira

tio

n

#0

3:

Imp

rov

ed

ma

na

ge

me

nt

an

d

co

ntr

ol

of

HIV

an

d T

B

Ou

tpu

t

Male condom distribution coverage(No) 41.3 72.6 55.0 59.0 61.0 65.0 69.5

Number of condoms distributed 9,943,385 17,852,683 13,829,379 13101915 15150416 16614759 18239567

Population 15-49 years old (males) 211,635 216,936 216,929 219099 214 141 218 514 223 297

Female condom distribution coverage 1.0 2.1 1.6 2.0 1.7 1.8 1.84

Number of Female condom distributed 289,821 644,794 486,696 503486 419535 442883 467981

Population 15-49years- females 234,438 238,741 238,741 241 707 245 499 249 338 253 486

Medical male circumcision performed 8,865 9,827 10,295 9720 11069 11926 12876

Male urethritis syndrome incidence 4.3% 4.0% 2.7% 2.7% 2.6% 2.5% 2.3%

Number of Male urethritis syndrome treatment -

new episode

9,074 8,745 5,883 5824 5613

5355

5064

Dis

tric

t A

spira

tio

n

#0

4:Im

pro

ve

d

ma

na

ge

me

nt

of

no

n-

co

mm

un

ica

ble

dis

ea

ses

Imp

ac

t

Male population 15-49years 211,635 216,936 216,929 219099 214 141 218 514 223 297

Deaths from Malaria 2 0 0 0 1 1 1

Total number of malaria cases reported 14 0 2 2 3 7 7

Ou

tpu

t

Number of new local malaria cases - - - 0 0 0 0

Hypertension incidence 13.9% 14.5% 15.8% 15.3% 16.3% 15.2% 14.2%

Hypertension client treatment new 2,083 2,218 2,453 20824 2311 2184 2065

Population 40years and older 151,987 154,526 155,261 1546813 141844 143635 145451

Dis

tri

ct

Asp

ir

atio

n

#0

4:I

mp

ro

ve

d

ma

n

ag

e

me

nt

of

no

n-

co

m

mu

ni

ca

bl

e

dis

ea

ses

Ou

tp

ut

Diabetes incidence 0.9% 1.9% 3.1% 1.6% 1.4% 1.3% 1.3%

Diabetes client treatment new 749 1,571 2,700 2511 2335 2171 2020


Page 41 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Population Total 844,526 854,892 853,855 864047 880637 891739 894126

Number of clients 40 years and older screened for

hypertension

Not

collected

Not

collected 222739 238331 424105 968316 2448325

Number of clients 40 years and older screened for

diabetes

Not

collected

Not

collected 160018 192022 367052 930162 2465294

Mental disorders screening rate Not

collected 0.7% 15.8% 1.4% 32.7% 31.2% 36.2%

PHC client screened for mental disorders Not

collected 15,549 345,146 32284 804504 804505 965406

PHC headcount - total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469

Dental extraction to restoration ratio 30.2 54.7 37.3 31.0 22 16 12

Tooth extractions 30,486 30,924 31,419 29210 29091 28800 28512

Tooth restorations 1,010 565 842 943 1345 1798 2448

Cataract surgery rate 267.7/ml 77.9 /ml 0.0/1ml 163/ml 62/1ml 61/ml 60/1ml

Cataract surgery done 224 66 0 132 50 50 50

Population un insured 771627 785752 800112 806642 810611 821 302 832188

Dis

tric

t A

spir

atio

n

#0

5:

Imp

rove

d

qu

alit

y

of

he

alth

ca

re

Ma

na

ge

me

nt

an

d Q

ua

lity

Percentage of fixed PHC facilities scoring

above 70% on the ideal clinic dashboard - 34% 63% 77% 94% 100% 100%

Number of Fixed PHC clinics scoring above 70%

on the ideal clinic dashboard - 24 45 55 67 71 71

Total number of fixed PHC facilities - 71 71 71 71 71 71

Complaints resolution rate ( PHC) 73.1% 72.0% 86.4% 90% 90% 92% 94%

Complaints resolved 422 190 203 295 216 223 234

Complaints received 577 264 235 327 239 242 249


Page 42 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Complaints resolution rate within 25 working days

rate(PHC)

80.6% 96.3 % 94.6% 96.8% 97% 97% 97%

Complaints resolved within 25 working days 340 183 192 287 232 235 242

Total number of complaints resolved 422 190 203 295 239 242 249

Hospital achieved 75% and more on

National Core Standards self-assessment

rate (District Hospitals)

50% 50% 50% 100% 100% 100% 100%

Number Hospital achieved 75% and more on

National Core Standards self-assessments

2 2 2 5 5 5 5

Number of DHs doing the NCS self-assessments 4 4 4 5 5 5 5

Ma

na

ge

me

nt

an

d

Qu

ality

Complaints resolution rate (DHs) 56.2% 71.1% 85.5% 86% 86% 89% 90%



Complaints resolution rate within 25 working

days rate(DHs) 76.0% 96.7 % 97.2% 97% 98% 98% 98%

Complaints resolved within 25 working days 76 145 172 155 255 275 278

Total number of complaints resolved 100 150 177 160 260 280 283

Dis

tric

t A

spir

atio

n

#

06:S

tre

ng

the

ne

d P

rim

ary

He

alth

Ca

re s

erv

ice

s

O

utp

ut

Ma

na

ge

me

nt

an

d

effic

ien

cy

Effic

ien

cy

PHC utilisation rate -total 2.7 2.6 2.6 2.7 2.8 2.9 3.0

PHC head count total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469

Population total 844,526 854,892 853,855 864047 880637 891739 894126

PHC utilisation rate under 5years 3.9 3.9 4.0 4.0 4.2 4.2 4.3

PHC head count under 5years 399,484 399,164 401,999 403570 415992 428372 439899

Population under 5years 102,144 101,782 100,226 100854 100167 101229 101549


Page 43 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Expenditure per PHC headcount total 171 195 215 245 246 268 291

Total expenditure PHC( Subprogram 2.2-2.7) 339618750 384698694 422198931 493726362 498713497 501452856 6512396351

PHC head count total 1991311 1976639 1961877 2012126 2027851 2096996 2169513

House hold registration visit coverage 43.9% 27.7% 19.4% 25.7% 32.5% 36.7% 37.4%

Outreach household registration visit 82671 71051 42505 56981 74537 83964 85643

Households in the population 188473 256763 219526 221721 229014 229026 229126

Number of school health teams

(cumulative ) 9 10 11 14 14 14 14

Number of schools accredited as health

promoting ( Cumulative )

31 33 36 46 50 54 60

Number Ward based outreach Teams in 5

most deprived wards(Cumulative) 2 6 10 14

15 16 20

Dis

tric

t A

spira

tio

n

#

07

:Str

en

gth

en

ed

Ho

spita

l Se

rvic

es

School grade 1 screening coverage 29% 51% 24% 59% 30% 37% 45%

School Grade 1 learners screened 7528 13405 82017 14874 2723 3676 4963

School Grade 1 learners – total 26220 26312 2330 25008 8989 9860 10985

School grade 8 screening coverage 6% 9% 25% 27.7% 33% 41% 51%

Ma

na

ge

me

nt

an

d

Eff

icie

nc

y


School Grade 8 learners – Total 44615 44593 6813 6949 7595 8696 10250

Inpatient bed utilisation rate - total 65.3% 62.7% 57.65% 66.7% 67% 67.6% 68%

In-patient days - total 182 101 289969 268916 307286 308 185 309 430 310430

½ Day patients 757 1301 1459 2163 3634 6146 6246

Inpatient bed days available 1235 1235 1235 1235 1235 1235 1235


Page 44 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

Average length of stay - total 6.3 6.2 5.8 5.6 5.3 5.0 5.0

In-patient days - total 182 101 289969 268916 307286 308 185 309430 310430

½ Day patients 744 853 1459 2163 3634 6146 6246

Inpatient separations 27 977 5049486 49 486 55162 58503 62218 62218

Expenditure per patient day equivalent

(PDE) R3 272 R1 923.27 R2627 R1 922 R1 954 R1 996 R2571

Expenditure total R801,383,0

00

R789,609,2

44

R975 376

020

R919,650,951 R975,727,381 R1,040,376

,666

1397172567

Patient day equivalent 244 941 410 556 478 468 478 468 499 293 521 323 543353

Ou

tpu

t

OPD Head count total 350,940 349,731 295,517 361782 374311 387340 400369

OPD new client not referred rate (%) 38.2% 39.9% 36.9% 23% 16% 15.3% 14.8%

New OPD clients not referred as a proportion of

OPD new clients total 80,174 83,395 61,513

82644

60283 59077 57896

OPD new clients total 209,932 209,262 166,534 361782 374311 387340 391213

Dis

tric

t A

spira

tio

n

#

08:

Imp

rov

ed

h

ea

lth

c

are

su

pp

ort

serv

ice

s

Ma

na

ge

me

nt

an

d e

ffic

ien

cy

Tracer medicine stock -out rate (Hospital) 4.2% 6% 5% 2% 1.9% 1.7% 1.4%

The proportion of all fixed DHs/TBHs/Psych

Hospitals that had stock-out of ANY tracer item

for any period as a proportion of fixed DHs/TBHs

and Psych Hospitals

166 176 134 56 55 50 40

Fixed DHs/TBHs and Psych Hospitals s 3951 2892 2952 2952 2952 2952 2952

Tracer medicine stock -out rate (Fixed PHC clinic,

Gateway & Mobile base) 1% 3% 2%

1%

0.5% 0.5% 0.4%

The proportion of all fixed ,CHCs and CDCs that

had stock-out of ANY tracer item for any period

as a proportion of fixed clinics plus fixed

150 725 428

145 140 135 120


Page 45 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

CHCS/CDCs

Fixed clinics plus fixed CHCs/CDCs 29016 26 726 26676 26676 26676 26676 26676

Percentage of expired stock (DHs) 0.64% 0.4% 0.4% <1% <1% <1% <1%

Value expired medicines stock R 514 284 R 303 835 R 265 636 268292.36 270975.28 273685.03 276421.88

Value of total stock in the medicine store room

R 80 354

833

R85 247

911

R 59 386

645 599805511.45 60580316.56 61186119.73 61797980.92

Ma

na

ge

me

nt

an

d E

ffic

ien

cy

Percentage of expired stock (PHC) 0.13% 0.3% 0.04% <1% <1% <1% <1%

Total expired medicines stock R85 522 R 293 541 R 45 045 R40 000 R39 600 R38 800 R37000

Total stock in the medicine store room R 68 410

092

R 107 063

131

R 102 198

224

R 103 220

2016.24

R104 252 408

.30

R105 294 932

.38

R106 347 881

.70

Pharmacies graded A or B 100% 87.5% 87.5% 100% 100% 100% 100%

Pharmacies with A or B Grading 8 7 7 8 8 8 8

Total number of pharmacies 8 8 8 8 8 8 8

Percentage of hospitals with functional PTCs 50% 50% 37.5% 62.5% 100% 100% 100%

Number of hospitals with functional PTCs 4 4 3 5 8 8 8

Total number of hospitals 8 8 8 8 8 8 8

Percentage over/under expenditure per quarter 1% -1% -2% 8% 0% 0% 0%

Total expenditure per quarter (accumulative?) 1740355991 1866535045 195369947

8

1895236708 2212259000 2367118000 2532817000

Total Budget 1722432000 1823049590 191527000

0

2063279500 2212259000 2367118000 2532817000

Percentage maintenance and repairs budget

spent

100% 124% 145% 96% 100% 100% 100%

maintenance and repairs budget spent R6 684 040 R6 247 018 R 12 871 R6 779 534 7591000 8123000 8692000


Page 46 of 96

District

Aspiration

Indicator

Audited

performan

ce 2014/15

Audited

performan

ce 2015/16

Audited

performan

ce 2016/17

Estimated

performance

2017/18

Target

2018/19

Target

2019/20

Target

2020/21

059

Total maintenance and repairs budget R6 679 000 R5 036 000 R 8 907 000 R7 094 000 7591000 8123000 8692000

Number of Hospital Managers who have signed

Performance Agreements (PA’s 5 5 5 5 5 5 5

Number of District Managers who have signed

PA’s

1 1 1 1 1 1 1

Number of ethics workshops conducted 0 0 0 1 1 1 1

10. BOTTLENECKS AND ROOT CAUSES

Bottlenecks / Challenges Root Causes District

Aspiration #

District

Aspiration

1. High child under 5 years deaths due to

diarrhoea

2. Poor implementation of IMCI guidelines in

children.

3. Poor initiation of children under 5years on

ARTs

Poor triaging of babies in OPD

Limited skill in the management of children according to

IMCI at hospitals.

Inadequate Mentorship on ART initiation in children.

Lack of accountability on mentoring NIMART trained nurses.

Poor growth monitoring of children less than 5 years.

Lack of confidence of NIMART trained nurse to initiate

children under 5years on ARTs

Improved child health


Page 47 of 96


Aspiration #

District

Aspiration

4. Low immunization coverage in children

under 1 year.

No standardized system in place for tracking and tracking

children for immunization

Poor implementation of the RED strategy

Lack of integration of services for outreach teams.

Poor data quality

01.

5. Use of alternative medicines.

Cultural believes used in the community in treatment of

childhood illnesses.

Limited involvement of community stakeholders e.g. THP’s

6. Lack of surgical and anaesthetic skills for

newly qualified medical officers.

Lack of mentoring and support for junior medical doctors 01. Improved maternal and

women’s health

Poor support of newly qualified medical officers on

anaesthesia and surgery

7. High number of Teenage pregnancies Poor implementation of Youth friendly services policy in

facilities.

Poor marketing of Long Acting Reversible

Contraceptives(LARCs)

Improved maternal and

women’s health

8. Low number of mothers turning up for

post-natal care .at clinics

Poor linkage of post-delivery women to PHC from hospitals

Lack of tracking and tracing of mothers post-delivery by

facilities.

9. Poor implementation of BANC Plus Poor screening and identification of high risk patients.

Late initiation of HIV positive pregnant women.

02 Improved maternal and

women’s health

10. High number of HIV and TB related illnesses

Deaths in ages 15-24 years females due to

Poor implementation of Integrated HIV /TB

guidelines

Late initiation of ART in co-infected patients

High risk behavior due to peer pressure

Engagement in older Sugar daddy relationships.

03. Improved management and

control of HIV and TB


Page 48 of 96


Aspiration #

District

Aspiration

11. Poor implementation of the National Core

Standards (NCS) findings and QIPs

Lack of buy in into the program by institutional top

management leading to very slow/ non-implementation of

the QIPs

04

Improved quality of health care

12. Poor implementation of the PSSS QIPs Lack of accountability and commitment

13. Poor management of non-communicable

diseases new clients at Clinics

Poor understanding of data elements by PNs leading to

poor data quality.

Poor support of the program at both district and sub-district

levels.

Poor utilization of the policy NCD guidelines at all levels

05 Improved management and

control of non-communicable

diseases (NCDs).

14. Poor access to PHC services leading to:

low PHC utilization rates and High number

of new patients not referred at OPDs(

Benedictine and Vryheid Hospitals)

Poor community mobilization and marketing of health

services

Poor access to health care services at Hard to reach areas

Multiple Headcount collection points at clinics

No gateway clinics at both institutions

06 Strengthened Primary

health care services

15. Poor implementation and monitoring of

Ideal Clinic and Realization and

Maintenance program (ICRM)

Poor support of the program by institutional management 06 Strengthened Primary


16. Shortage of essential equipment

Budgetary constraints

06 Strengthened Primary


17. Dilapidated infrastructure 06 Strengthened Primary


18. Low bed utilization rate at DHs (Benedictine

(45%), Nkonjeni and Ceza (53.5%)

Patients needing admission are not admitted until they are

seriously ill.

07 Strengthened Hospital

Services


Page 49 of 96


Aspiration #

District

Aspiration

19. Long average length of stay at DHs ( Ceza,

Nkonjeni and Benedictine )

Delayed admission of patients visiting OPD until they are

seriously ill at home

No ward rounds taken over weekends and holidays thus

long ALOS

Non implementation of the antibiotic use policy resulting to

patients staying longer.

07 20. High expenditure Per PDE ( DHs)

21. Poor Medicine Supply Management Poor functionality of pharmaceutical governance structures

Poor monitoring of open stock at all levels

Poor supervision and support to PHC facilities

08

Strengthen health systems

effectiveness

22. High tracer medicine stock out Inadequate management of stock at facilities 07 Strengthen health systems

effectiveness

23. Poor decanting of patients to external pick

up points

Insufficient number of clubs and external pick up points 07 Strengthen health systems

effectiveness


Page 50 of 96

11. KEY INTERVENTIONS

District

Aspirati

on #

Population Geography Public Health Intervention Costing

Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**

Key Intervention Root Cause** Service

Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

01

Impro

ved

child

health

<5yea

rs

Children

under 5

years

Nongoma

,

uPhongol

o,

eDumbe

All Ensure management of fast queues for

children under 5years

Conduct integrated quarterly community

health awareness campaigns per sub district

on water prevention and management of

diarrhoea at home

Poor triaging of children

under 5 years in OPDs

Hospitals

&Clinics

<5yea

rs

Children

under 5

years

Nongoma

,

uPhongol

o,

eDumbe

All Conduct community component IMCI for

CCGs and other key stake holders

Train MCWH nurses 2 per facility on IMCI

guidelines.

Conduct refresher course for previously IMCI

trained nurses.

Monitor implementation of IMCI guideline

monthly at each facility.

Train Paeds, OPD and Nursery doctors in IMCI

Provide mentorship and couching of IMCI

trained clinicians

Limited skill in management

of children according to IMCI

Clinics

WBOTs

Community

IMCI trained

clinicians

All All Conduct at least 2 mentorship and couching

support visits per month to all newly trained

IMCI clinicians per month

Inadequate supervision and

mentoring of newly trained

clinicians on IMCI.

Clinics

Include NIMART Support and couching in the

PAs of PHC trainers


Page 51 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

Children

under 5

years

All All Conduct RTHB audit to determine if MUAC,

weight and plotting of graph is done on each

child’s visit to health care facility.

Poor growth recording

monitoring in children less

than 5 years.

Clinics

01

Improv

ed

child

health

<5yea

rs

Children

under 5

years

All All Design a standardized tracking and tracing

register utilizing the vaccinators’ manual

specimen.

No standardized tracking

system

WBOTs

Clinics

Conduct door to door EPI catch up

campaigns targeting the hard to reach areas.

Conduct monthly Monitoring of the

implementation of the RED Strategy

Poor implementation of RED

strategy

All Include case finding on EPI, SAM, TB and HIV in

the package of services provided by the

outreach teams.

Include child health (EPI) in the Pas for WBOTs

Lack of integrated service

delivery for outreach teams

(WBOTs) to provide less 5 year

old services.

Sub districts

WBOTs

Conduct Data verification on weekly basis at

all facilities.

Ensure implementation of the EPI schedule as

per the new RTHCB

Poor data quality

Marketing of the services for “PHILA

MNTWANA” centres.

Poor utilization of PHILA

MNTWANA CENTRES

- THPs- All Convene Meeting with THP to discuss health

related issues involving children.

Poor involvement of

community stakeholders e.g.

Community


Page 52 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

Conduct community dialogues to discuss

negative impact of on alternative medicine

use in children.

THP’s

Cultural believes used in the

community in treating

childhood illnesses.

Adults - Conduct onsite mentoring of NIMART trained

nurses during doctor’s visits to clinics,

Lack of accountability on

mentoring NIMART trained

nurses.

Clinics

02

Improve

d

materna

l and

women’

s health

10 – 49

years

Women of

child

bearing

age

All Monitor Implementation of safe Caesarean

Section principles

Poor support of newly

qualified medical officers on

anaesthesia and surgery

DHs

All Release newly qualifies doctors for supportive

training on anaesthesia and surgery at Queen

Nandi Mother and Child Regional hospital

Conduct onsite mentoring and couching of

newly qualified doctors on anesthesia and

surgery at all district hospitals.

10-18

years

Adolescent

and youth

All Monitor implementation of the six standards of

Adolescent and Youth Friendly Services (AYFS)

policy in all facilities.

Poor implementation of Youth

friendly services policy in

facilities.

Clinics

Train all sexual and reproductive health

(SRH)services champions per facility on the

current guidelines

Identify SRH Champions for

marketing and

implementation of the

program


Page 53 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

10 – 49

years

Women of

child

bearing

age

All Track and trace post-delivery mothers using

the linking list twice a week.

Conduct weekly meetings to review tracked

and traced clients.

Lack of tracking/ tracing of

mothers post-delivery by

facilities

Clinics

Keep updated record of outcomes of all

clients traced back to care.

Poor linkage of post-delivery

women to PHC from hospitals

Community

Monitor implementation of BANC plus at all

facilities

Conduct continuous in-service updates of PNs

on BANC Plus

Late initiation of HIV positive

pregnant women on ARTs

Sub district

Clinic

03

Improve

d

manag

ement

and

control

of HIV

and TB

15-

24year

s

Women

All All Capacitate OMNs (PHC) on supervision

strategies / activities with specific focus to

HAST program

Lack of skills and competency

(OM and PHCC) to supervise

(facility and WBOT)

Sub district

Clinics

All All All All Capacitate on the optimal use of Tier system

to fast track HAST performance

Inefficient utilization of Tier

system to fast track the HAST

performance

District

Conduct advocacy and monitoring of

national guidelines implementation at all

levels to improve clinical management of

clients

Provide VL services after hours, weekends and

Poor implementation of the

HIV guidelines

Sub district

Clinics

Community


Page 54 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

holidays to ensure coverage

Strengthen the use of the standardized

linkage, tracing, and tracking system

Inadequate use of

standardized linkage,

tracing, and tracking system

(ART and TB)

Facilitate signing off of 40 remaining on TB,HTS

modules (THIS)

Align decanted clients (CCMDD Adherence

clubs )with scripts renewal dates as groups

Facilitate (Reach out to all ) targeted HIV/TB

/STI screening and prevention strategies to all

through National Screening Campaigns

(#THUMAMINA) as per the national health

calendar

Poor case identification and

early diagnosis identification

0-

14year

s

Children All All Monitor the implementation of the Unfinished

Business program

Poor management

of HIV and AIDS among

children

Sub district

Clinics

All All All Revive morbidity and mortality meetings to

discuss each and every client’s management

and draw QIPs.

Non functionality of the

morbidity and mortality

meetings at hospitals

Sub districts

All All All Improve infection prevention and control (IPC)

health education of patients with TB

Inadequate IPC health

education given to TB

patients by health workers

Sub district

Clinics

04

Improve

All all Include ICRM in the PAs for senior managers

Identify elements that can be quickly archived

needing no funds and develop the

Poor support of the

program by institutional

management

Sub districts


Page 55 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

d

quality

of

health

care

implementation plan.

Identify and list all the necessary equipment

for procurement

Include equipment the 2018/19 procurement

plan

Place orders at the beginning of the financial

year ( preferably during the 1st quarter)


procurement plan

Monitor progress on implementation of QIPs

Conduct weekly monitoring of the program

progress at EXCO and Cash flow meetings

Implement consequent management for

unexplained poor performance

Non/Poor implementation

of QIPs

Lack of management

accountability and

commitment

Sub districts

Clinics

04

Improve

d

quality

of

health

All All Include PEC surveys monitoring in the PAs for

all CEO’s

Conduct monthly program monitoring and

support

Poor implementation of IPC

guidelines at all levels of

care

Poor support to PHC

facilities by mother hospital

in the provision of supplies

Sub-districts


Page 56 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

care(Co

nt)

(hand wash facilities)

All All Create community awareness on the

complaints/ compliments and suggestions

procedure

Monitor functionality of the sub-district

Complaints/compliments and suggestions

Management Committees

Poor marketing of

complaints management

services service at all levels

In consistency in the sitting

of Complaints/compliments

Management Committees

Hospitals

Clinics

Include management of PHC facilities

complaints/ compliments and suggestions

management in the PAs of all PROs with a

higher than 20% score rating

Poor support of PHC

facilities by Institutional

PRO’s in the management

of complaints/compliments

/ suggestions

District

Sub districts

Clinics

05

Improve

d

manag

ement

and

control

of non-

commu

nicable

diseases

40year

s and

above

Males and

females

Ulundi –

Nkonjeni

ALL Coordinate preparations for the

implementation of the cataract surgery

program

Non availability of an

Ophthalmologists to

cataract surgery within the

district

All ALL

Capacitation OMNs on data quality

management

Incorporate NCD data into the weekly nerve

centre data elements for close monitoring

Poor data quality

management

Clinics

All ALL

Train al operational managers on early malaria

identification and detection

Ensure availability of rapid malaria test strips

rips at all clinics

Poor malaria management

at all levels

Clinics

All All

Conduct training of PNs on Adult Primary

health care guidelines

Poor program support at all

levels

Clinics


Page 57 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

Guidelines

All Male

Females All All

Revive specific program clinics (Chronic

diseases clinics) at all District hospitals

District

Sub district

All All All All

Create community awareness of

communicable diseases through community

dialogues

Promote healthy life style practices at

community level

Community

All All All All

Procure assistive devices during the first quarter

of the financial year

Keep as a standing item in the cash flow

meetings until finalised

Long supply chain

management process for

the procurement of assistive

devices

Include program management as KRA in the

PA s of Medical Managers

Monitor dental fillings versus extraction’s

weekly at hospital

Poor implementation and

monitoring of the program

(oral and Dental health

services )

06

Strength

ened

Primary

Health

Care

Services

All All Ulundi -

Ceza

eDumbe

UPhongol

o

Identify under-utilized staff and use them to

develop at least one new WBOT per sub

district

Allocate one pool vehicle to WBOTs on daily

basis

Conduct monthly WBOTs performance reviews

Poor community mobilization and marketing of

health services

Poor access to health care

services at Hard to reach

areas

Sub districts

Ensure there is only one headcount collection

point at each facility

Monitor implementation of the Health Patient

Multiple Headcount

collection points at clinics

Sub districts


Page 58 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

Registration System(HPRS)

Nongoma

Abaqulusi

Implement integrated clinical Care management

system (ICSM)(Three streams )at ARV clinics

No gateway clinics at

Benedictine and Vryheid

hospitals

Clinics

06

Strength

ened

Primary

Health

Care

Services

(Cont)

All All All All Conduct quarterly community mobilization to

Market services. PHC

Poor community

mobilization and marketing

of PHC services

Community

Conduct quarterly integrated health

screening campaigns to increase access

focusing on hard to reach areas and pension

pay points

Clinics

Implement consequence management for

facilities who do not implement strategies to

increase PHC utilization rate

Poor support by Sub district

management to PHC

services

Sub district

Conduct quarterly community mobilization to

Market services,

Poor community

mobilisation and marketing

of services

Clinics

All All Draw a list /plan of the quick win ICRM

elements needing no budget to implement

from the top 20 list.

Budgetary constraints Sub district

Clinics

All All Monitor implementation of the plan until all

issues are resolved

All All Include essential equipment needs in the next

three year plan per priority of importance

Budgetary constraints Sub district

Clinics

All All Initiate equipment procurement during the 1st Clinics


Page 59 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

quarter of the financial year to avoid

unnecessary delays

06

Strength

ened

Primary

Health

Care

Services

(Cont)

All All Monitor progress through weekly cash flow

meetings until all items are received

Hospital

All All Include clinics’ refurbishment in the sub district

annual infrastructure maintenance plan

Hospital

All All Monitor monthly progress on the maintenance

of facilities through weekly executive

management meetings until resolved.

Hospital

# 07

Strength

en

hospital

services

In

&out

patien

ts

All All Conduct ward rounds daily, over weekends

and holidays and discharge suitable patients.

Monitor implementation of the antibiotic

policy-no unnecessary IVs, Switch IV antibiotics

to orally on day 3 and discharge patients..

Identify cost drivers

Delayed admission of sick

patients from OPD until they

are very sick.


antibiotic policy

Wards rounds not

conducted daily, over

weekends and holidays

Poor monitoring of

expenditure

Hospitals

All All Improve the quality of cash flow meetings to

monitor expenditure against norms/targets.

Poor monitoring Sub districts

In and

outpatients

All All Revive morbidity and mortality meetings to

monitor patient management trends from OPD

until final outcomes


admission and discharge

criteria

08

Strength

Pharmacists

,

All Conduct quarterly sub-district medicine audits Inadequate management

of stock at facilities

Clinics


Page 60 of 96

District

Aspirati

on #


Life

Cours

e

Group

Key

Population

**

(Sub-

district)**

Ward

**


Delivery

Platform*

Amou

nt

Fundin

g

Sourc

e

ened

health

support

services

Nurses, PAs

Doctors, PAs

and Nurses

All Conduct quarterly Pharmacy and

Therapeutic Committee meetings

Inadequate management

of stock at facilities

Sub districts

Patients All Develop adherence and outreach clubs Insufficient number of clubs

and external pick up points

Community

CCMDD

champion,

CCGs& and

WBOT

All Market CCMDD program and pick up points Insufficient number of

adherence clubs and

external pick up points

Clinics

Community

Describe and unpack shortlisted Public Health Interventions into three dimensions

District Aspiration Provincial District Sub-district Facility

District aspiration 1:

Strategy: Reducing child under 5 years mortality from 5.8(31/5373)(2016) to [ 4.0/1K(291/250870by March 2019

Clinical Monitor implementation of

IMCI guideline monthly at

each facility.

Provide mentorship and couching of IMCI

trained clinicians

Monitor implementation of IMCI guideline

monthly at each facility.

Train MCWH nurses 2 per facility on IMCI

guidelines

Conduct monthly Monitoring

of the implementation of the

RED Strategy

Conduct weekly Monitoring of the

implementation of the RED Strategy

Implement the Reach Every Child in the

District ( RED )Strategy


Page 61 of 96


Include case finding on EPI SAM, TB and HIV

in the package of services provided by the

outreach teams.

Conduct RTHB audit to determine if MUAC,

weight and plotting of graph is done on

each child’s visit to health care.

Conduct RTHB audit to determine if

MUAC, weight and plotting of graph is

done on each child’s visit to health care

Conduct community component IMCI

training for CCGs and other key stake

holders

Conduct community component IMCI

training for CCGs and other key stake

holders

Clinical

Conduct community mapping in grey areas

to access children.

Conduct door to door EPI catch up

campaigns targeting the hard to reach

areas

Coordinate the conduction of door to door

EPI catch up campaigns targeting the hard

to reach areas

Convene quarterly Meetings with THP to

discuss health related issues including child

health children.

Convene monthly Meetings with THP to

discuss health related issues including

child health


negative impact on the use of alternative

medicine


negative impact on the use of alternative

medicine

Community Provide intra-campaign

support

Market health care services for “PHILA

MNTWANA” centres through community

structures and OSS

Market health care services for “PHILA

MNTWANA” centres through community

structures and OSS

District Aspiration 02: Improved maternal and women’s health

Strategy : 01 Sustaining maternal mortality rate of below 100 /100K population by March 2019


Page 62 of 96


Clinical Monitor Implementation of

safe Caesarean Section

principles

Release newly qualifies M.Os for supportive

clinical exposure on at Queen Nandi

Hospital

Conduct continuous onsite mentoring and

couching of newly qualified doctors on

anesthesia and surgery at all district

hospitals – District Family Physician

Monitor Implementation of safe Caesarean

Section principles

Implement safe Caesarean Section

principles

Conduct ESMOE drill on the management

of labor and puerperium

Conduct ESMOE drill on the

management intrapartum care

Community

Systems Utilize tracking and tracing systems at

facility levels.

Conduct weekly meetings to review

tracked and traced clients

Keep updated record of outcomes of

all clients traced back to care

Province District Sub district Facility


Strategy:

01

Reducing teenage pregnancy

Clinical Train all sexual and reproductive health

(SRH)services champions per facility on the

current guidelines

Identify SRH Champions for marketing and

implementation of the program

Monitor implementation of

the six standards of

Adolescent and Youth

Monitor implementation of the six standards

of Adolescent and Youth Friendly Services

(AYFS) policy in all facilities

Monitor implementation of the six

standards of Adolescent and Youth

Friendly Services (AYFS) policy in all


Page 63 of 96



Friendly Services (AYFS)

policy in all facilities

facilities


the plans

Ensure Marketing long-term contraceptive

methods

Conduct community awarenesses to

Market long term contraceptives

methods

Community Provide support to facilities s in the

conduction of community dialogues on

teenage pregnancy

Conduct one community dialogue per

quarter on teenage pregnancy

System

Strategy 03 Increasing post-natal care clinic attendance within 6days

Clinical Track and trace post-delivery mothers using

the linking list twice a week

Community Conduct weekly meetings to review tracked

and traced clients

System Monitor implementation of the tracking system

Keep updated record of all tracked patients’

outcomes

Strategy 03 Improving implementation of BANC Plus


BANC Plus at all facilities

Monitor implementation of BANC Plus at all

facilities

Conduct continuous in-service updates of PNs

on BANC Plus

District Aspiration 03: Improved management and control of HIV and TB

Strategy:

1. Improving PMTCT program performance

Clinical Coordinate training of

OMNs on Basic supervision

strategies

Train OMNs on basic supervision focusing

on HAST program


Page 64 of 96



Coordinate OMNs

capacitation workshop on

the use of the 3Tier system

Ensure optimal capacity of PMNs on the

3Tier system to fast track HAST monitoring

and performance

Ensure optimal capacity of OMNs on the

3Tier system to fast track HAST monitoring

and performance

Coordinate signing off of

40 remaining on TB,HTS

modules (THIS)

Facilitate signing off of 40 remaining on TB,HTS

modules (THIS)

Facilitate signing off of 40 remaining on

TB,HTS modules (THIS)

Monitor the advocacy of

the integrated HIV and

AIDS guidelines

Conduct advocacy of the integrated HIV

and AIDS guidelines at all levels to improve

clinical management of clients

Conduct advocacy of the integrated HIV

and AIDS guidelines at all levels to

improve clinical management of clients

Systems Monitor provision of VL

services after hours,

weekends and holidays to

ensure coverage

Monitor provision of VL services after hours,

weekends and holidays to ensure coverage

Provide VL services after hours, weekends

and holidays to ensure coverage


the unfinished business

program

Monitor implementation of the unfinished

business program

Implement the unfinished business

program

Community Strengthen the use of standardized linkage,

tracing and tracking system.

Track and trace post-delivery mothers

using the linking list twice a week.

Monitor Alignment

decanted clients (CCMDD

Adherence clubs) with

scripts renewal dates as

groups

Monitor Alignment decanted clients

(CCMDD Adherence clubs) with scripts

renewal dates as groups

Align decanted clients (CCMDD

Adherence clubs) with scripts renewal

dates as groups

District

Aspiration

3:

Improved management and control of HIV and TB

Provincial District Sub-district Facility

Monitor the implementation of

(Reach out to all ) targeted

HIV/TB /STI screening and

Facilitate implementation of (Reach out to

all ) targeted HIV/TB /STI screening and

prevention strategies to all through

Implement the (Reach out to all )

targeted HIV/TB /STI screening and

prevention strategies to all through


Page 65 of 96



prevention strategies to all

through National Screening

Campaigns (#THUMAMINA) as

per the national health

calendar

National Screening Campaigns


calendar

National Screening Campaigns


calendar

District Aspiration 4: Improved Quality of Health Care

Strategy:

01

Improve performance on the top 20 worst performing ICRM and NCS elements

Clinical

Systems Include ICRM in

the PAs for all

District Directors

Include ICRM in the PAs for

all CEOs

Include ICRM in the PAs for all DMNs,

Finance, PHC and Systems Mangers

Include ICRM in the PAs for all OMNs

Implement consequent

management for

unexplained poor

performance

Identify and implement elements that can

be quickly achieved needing no funds to

implement

Identify elements that can be quickly

archived needing no funds and

implement

Conduct weekly monitoring of the program

progress at EXCO and Cash flow meetings

Implement consequent management for

unexplained poor performance

Include equipment the 2018/19

procurement plan

Place orders at the beginning of the

financial year ( preferably during the 1st

quarter)

Strategy :

02

Improving management of complaints/compliment and suggestions

Community Conduct community awareness on the flow

and management complaints

Conduct community awareness on the flow

and management complaints

District Improved management and control of non- communicable diseases


Page 66 of 96

Aspiration#:

05 Provincial District Sub district Facility

Systems

Monitor functionality

of the sub-district

complaints/

compliments and

suggestions

committees.

Convene weekly complaints/ compliments and

suggestions committee meetings

Convene weekly complaints/ compliments

and suggestions committee meetings

Strategy :

01 Fast tracking the implementing cataract surgery program within the district

Clinical Monitor finalization of the

preparations for the

implementation of the

cataract surgery program

Coordinate preparations for the

implementation of the cataract

surgery program

Finalize preparations for the implementation

of the cataract surgery program

Train nurses on cataract identification

Screen and refer clients for cataract surgery

Community

Systems

Strategy :

02

Improving management of diabetes and hypertension program

Clinical Conduct personnel training on Primary

health care guidelines (diabetes / HPT

)management guideline s

Capacitation OMNs on data quality

management

Monitor data quality -understanding of all

indicators/data elements on HPT and

diabetes

Ensure proper screening for all non-

communicable diseases

Ensure proper screening for all non-

communicable diseases

Community Create community awareness of

communicable diseases through community

dialogues

Promote healthy life style

Conduct community dialogues to promote

healthy life style practices and create

awareness on NCDs

District

Aspiration

Improved management and control of non- communicable diseases

Provincial District Sub district Facility


Page 67 of 96

05 :

Strategy :

03

Improving management and control of malaria

Clinical Train al operational managers on early

malaria identification and detection

Train al operational managers on early

malaria identification and detection

Ensure continuous availability of rapid

malaria test strips at all clinics

Ensure continuous availability of rapid

malaria test strips rips at all clinics

Community Integrate malaria awareness in the

community dialogues for NCDs

Systems

Strategy :

04

Increasing access to Rehabilitations services (wheelchairs)

Community

Systems Initiate procurement/wheelchairs of assistive

devices during the first quarter of the

financial year to give allowance for un

foreseen delays

Conduct continuous follow up in the cash

flow meetings until item delivered


Page 68 of 96

District Aspiration

6 :

Strengthened PHC services

Provincial District Sub district Facility

Strategy: 1. Increasing access to health care services in hard to reach areas

Clinical Conduct monthly WBOTs performance

reviews.

Conduct Integrated health screening

campaigns

Conduct weekly performance reviews

against allocated targets

Conduct Community mobilization to

create awareness of WBOTs program

Community

Systems Monitor WBOTs performance on

monthly basis

Conduct close monitoring and support to

WBOTs

Conduct monthly WBOTs performance

reviews Identify under-utilized staff and use

them to develop new WBOTs

Allocate pool vehicles on daily basis for

WBOTs,

Ensure there is only one headcount collection

point at each facility

Monitor implementation of the Health Patient

Registration System(HPRS)

Provision of resources for outreach

teams like stationery and other

supplies

District Aspiration 6 : Strengthened Primary Health Care services


Strategy : 01 Strengthen implementation of Ideal Clinic Realization and Maintenance program

Clinical


Page 69 of 96

District Aspiration 6 : Strengthened Primary Health Care services


Community

Systems Monitor implementation of the identified

equipment list

Keep a list /plan of identified quick win

essential equipment

Monitor implementation of the plan at monthly

cash flow meetings until resolved

Include essential equipment in the next

three years procurement plan per

priority

Include clinics for refurbishment in the 2018/19

sub-district maintenance plan

District Aspiration

7 :

Strengthened hospital services


Strategy : 01 Increasing he inpatient Bed utilization rate from 58% to 67% by March 2019

Clinical Ensure that patients are admitted and

discharged as per stipulated criteria

Implement the patient admission and discharge

criteria

Systems

Strategy : 02 Reducing the average length of stay from 5.4 to 5.3 by March 2019

Clinical Monitor proper implementation of the

antibiotic policy

Ensure continuous availability of a medical

officer over weekends and holidays to conduct

rounds

Monitor implementation of the

antibiotic Standard operation

procedure(SOP)

Implement the antibiotic Standard operation

procedure

Strategy : 03 Reduce Expenditure Per Patient Day Equivalent from – to by March 2019

Clinical

Community


Page 70 of 96

District Aspiration

7 :

Strengthened hospital services


Systems Conduct monthly monitoring of

expenditure on identified cost drivers

Identify cost driver

Monitor expenditure on cost driver

through weekly cash flow meeting and

monthly expenditure reports

Strategy : 04 Reducing OPD new clients not referred

Clinical

Community

Systems Monitor implementation if the three

streams of care at all institutions

Ensure implementation of integrated clinical

Care management system (ICSM)(Three streams

of care )at all previous ARV /TB clinics

District

Aspiration 8 :

Improved health care support services


Strategy: 1 Improving medicine supply and management at all levels of care

Clinical Monitor functionality of the sub district

Pharmacy and Therapeutic

Committees

Conduct quarterly Pharmacy and Therapeutic

Committee meetings

Community

Systems Monitor Conduction of quarterly sub-

district medicine management and

control through audits

Conduct quarterly medicine stock management

and control through audits

Conduct quarterly sub-district medicine sock

taking

Conduct monthly medicine stock counts

Strategy: 2 Increasing access to pharmaceutical services

Clinical Coordinate development of adherence and Develop adherence and outreach clubs


Page 71 of 96

District

Aspiration 8 :

Improved health care support services


outreach clubs

Community Market CCMDD program and pick up

points

Systems Provide monthly monitoring and

support of the CCMDD program

Conduct weekly CCMDD program performance

review


Page 72 of 96

ANNEXURE A: Indicators for monitoring 2018/19-2020/2021

Zululand Health District

(Administration)

Strategic Objective Statement Indicators Audited/ Actual Performance

Estimated

Performanc

e

Medium Term Targets

2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

1.2.1) Annual unqualified audit opinion

for financial statements and

performance information from 2015/16

onwards

1. Audit opinion from Auditor-General

1.4.1) Connectivity established at 90%

public health facilities by March 2020

2. Percentage of hospitals with

broadband access

Total number of hospitals with minimum 2

Mbps connectivity

Total number of public hospitals 8 8 8 8 8 8 8

3. Percentage of fixed PHC facilities with

broadband access

Not

collected

Not

collected

Not

collected

0% 100% 100% 100%

Number of PHC facilities that have

access to at least 1Mbps connectivity

Not

collected

Not

collected

Not

collected

0 71 71 71

Total number of fixed PHC facilities 71 71 71 71 71 71 71

1.3.1) Costed annual Procurement Plan

for minor and major assets by the end of

April in each reporting year

4. Approved annual procurement plan 1 1 1 1 1 1 1

4.1.2) Review and approve macro and

micro structures aligned to function

5. Number of organizational structures

reviewed & submitted for approval

N/A N/A N/A N/A N/A N/A N/A


Page 73 of 96


Estimated

Performanc

e

Medium Term Targets

2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

4.1.3) Implement the Community Based

Training in a PHC Model in collaboration

with UKZN with Phase 1 pilot

commencing in 2016/17

6. Implement the Community Based

Training in a PHC Model

Draft

Business

Plan

Approve

d Business

Plan

Impleme

nt Model

Implement

Model

Implemen

t Model

4.1.9) Provide sufficient staff with

appropriate skills per occupational group

within the framework of Provincial staffing

norms by March 2020

7. Medical Officers per 100 000 peopled

Number of Medical Officers posts filled

Total population 844,526 854,892 853,855 864047 880637 891739 894126

8. Professional Nurses per 100 000 people

Number of Professional Nurses posts filled


9. Pharmacists per 100 000 people

Number of Pharmacists posts filled


4.2.1) All personnel comply with

performance management requirements

from March 2016 onwards

10. Number of Hospital Managers who

have signed Performance

Agreements (PA’s)

5 5 5 5 5 5 5

11. Number of District Managers who

have signed PA’s

1 1 1 1 1 1 1

12. Percentage of Head Office

Managers (Level 13 and above)

who have signed PA’s


Head Office Managers (level 13 and

above) who signed PA’s in the reporting

cycle


d Indicators 8, 9 and 10: Minimal increase in the number of staff projected based on the funding envelope – change in estimated populations for 2017/18 MTEF affect value per 100 000


Page 74 of 96


Estimated

Performanc

e

Medium Term Targets

2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

Number of Head Office Managers (level

13 and above)


1.1.1) 2017 – 2027 Strategic Position

Statement approved by June 2017 and

Long Term Plan approved by March 2018

13. Approved 2017-2027 Long Term Plan N/A N/A N/A N/A N/A N/A N/A

1.7.2) Hospital Rationalisation Plan

approved by June 2017

14. Approved Hospital Rationalization

Plane

Not

reported

No Hospital

Rationalis

ation Plan

in draft

Not

finalised

Impleme

nt

approve

d plan

Implement

approved

plan

Implemen

t

approved

plan

5.2.5) 100% Public health hospitals score

more than 75% on the Food Service

Monitoring Standards Grading System

(FSMSGS) by March 2020

15. Percentage of public health

hospitals that scored more than 75%

on the Food Service Monitoring

Standards Grading System

Not

reported

Not

reported

25% 25% 50% 62.5% 100%

Public health hospitals that score more

than 75% on the FSMSGS

Not

reported

Not

reported

2 2 4 5 8

Number of public health hospitals

assessed

8 8 8 8 8 8 8

4.1.11) Appoint an average of 10 000

CCGs per annum on contract

16. Number of Community Care Givers

appointed on contract

1039 1039 1039 1041 1041 1041 1041

5.2.6) Conduct at least 40 ethics

workshops per annum from 2017/18

onwards

17. Number of ethics workshops

conducted

Not

reported

Not

reported

Not

reported

1 1 1 1

1.2.3) Monthly submission of disclosures of

donations, sponsorships, and gifts as per

Circular G15/2016

18. Number of complete submissions of

disclosures of donations, sponsorships

and gifts submitted to Finance

Not

reported

Not

reported

Not

reported

8 8 8 8

e The Plan will be incorporated in the Long Term Plan and Turn-Around Plan (not stand-alone)


Page 75 of 96

PHC

Strategic Objective Statement Indicator

Audited/ Actual Performance Estimated

Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

1.6.1) 100% Provincial fixed PHC facilities

score above 70% on the Ideal Clinic

Dashboard by March 2020

1. Ideal clinic status rate - 34% 63% 77% 94% 100% 100%

Ideal clinic status - 24 45 55 67 71 71

Fixed clinics plus fixed CHCs/CDCs - 71 71 71 71 71 71

1.5.3: PHC utilisation rate of at least 2.7

visits per person per year by march

2020

2. PHC utilization rate - total

(Annualised) 2.7 2.6 2.6 2.7 2.8 2.9 3.0

PHC headcount total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469


5.1.7) Sustain a 95% (or more)

complaint resolution within 25 working

days rate in all public health facilities

from March 2020 onwards

3. Complaint resolution within 25

working days rate (PHC) 73.1% 72.0% 86.4% 90% 90% 92% 94%

Complaint resolved within 25

working days 340 183 192 287 232 235 242

Complaint resolved 422 190 203 295 239 242 249

5.1.6) Sustain a complaint resolution

rate of 95% (or more) in all public

health facilities from March 2020

onwards

4. Complaint resolution rate (PHC) 80.6% 96.3 % 94.6% 96.8% 97% 97% 97%


Complaint received 577 264 235 327 239 242 249

2.1.1) Increase the total life

expectancy to 60.5 years by March

2020

5. Life expectancy at birth - Total


2.1.2) Increase the life expectancy of

males to 58.4 years by March 2020 6. Life expectancy at birth - Male


2.1.3) Increase the life expectancy of

females to 62.7 years by March 2020 7. Life expectancy at birth - Female



Page 76 of 96

Strategic Objective Statement Indicator


Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

1.5.4) Under 5 utilisation rate of at least

4.2 visits per child per year

8. PHC utilization rate under 5 years

(Annualised) 3.9 3.9 4.0 4.0 4.2 4.2 4.3

PHC headcount under 5 years 399,484 399,164 401,999 403570 415992 428372 439899

Population under 5 years 102,144 101,782 100,226 100854 100167 101229 101549

1.5.6) Increase the expenditure per

PHC headcount to R 471 by March

2020

9. Expenditure per PHC headcount 171 195 226 232 246 268 291

Total expenditure PHC (Sub-

Programmes 2.2-2.7) 339618750 384698694 922198931 598035993 498713497

56145285

6 632396351

PHC headcount total 1991311 1976639 1961877 2582629 2027851 2096996 2169513

1.5.7) Increase School Health Teams to

245 by March 2020

10. Number of school health teams

(cumulative) 9 10 11 14 14 14 14

1.5.2: Increase the number of ward

based outreach teams to 190 by

March 2020

2 6 10 12 14 15 16 20

1.5.8) Increase the accredited Health

Promoting Schools to 335 by March

2020

31 33 36 46 50 54 60

District Hospitals

Strategic Objective Statement Performance Indicators


Performan

ce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21


Page 77 of 96



Performan

ce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

5.1.2) 60% (or more) public health

hospitals achieved 75% and more on

the National Core Standards self-

assessment rate by March 2020

1. Hospital achieved 75% and

more on National Core

Standards self-assessment rate

(District Hospitals)

50% 50% 50% 100% 100% 100% 100%

Hospital achieved 75% and more

on National Core Standards self-

assessment

2 2 2 5 5 5 5

National Core Standards self-

assessment 4 4 4 5 5 5 5

1.7.3) Improve hospital efficiencies by

reducing the average length of stay

to at least 5.5 days (District), 5.3

(Regional), 15 days (TB), 286.5 days

(Psych), 28.5 days (Chronic), 9 days

(Tertiary), and 8.6 days (Central) by

March 2020

2. Average length of stay - total 80% 80% 100% 80% 80% 100% 80%

In-patient days - total 4 4 5 4 4 5 4

½ Day patients 5 5 5 5 5 5 5

Inpatient separations N/I N/I N/I N/I N/I N/I N/I

1.7.1) Maintain a bed utilisation rate of

75% (or more) by March 2021

3. Inpatient bed utilization rate -

total 60.8% 54.8% 51.8%

66.7%

67% 67.6% 68%

In-patient days - total 354,696 333,392 314,124 307286 308 185 309 430 310430

½ Day patients 744 853 1459 2163 3634 6146 6246

Inpatient bed days available 1235 1235 1235 1235 1235 1235 1235

1.7.4) Maintain expenditure per PDE

within the provincial norms

4. Expenditure per patient day

equivalent (PDE)

R3 272 R1 923.27 R2627 R1 922 R1 954 R1 996 R2571

Expenditure total R801,383,00

0

R789,609,2

44

R975 376

020

R919,650,9

51

R975,727,3

81

R1,040,376

,666

1397172567

Patient day equivalent 244 941 410 556 478 468 478 468 499 293 521 323 543353


Page 78 of 96



Performan

ce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21


working days rate 100 150 177 100 150 177 100

Complaints resolved within 25

working days 178 211 207 178 211 207 178

Complaints resolved 76.0% 96.7 % 97.2% 76.0% 96.7 % 97.2% 76.0%

5.1.6) Sustain a complaint resolution

rate of 95% (or more) in all public

health facilities from March 2020

onwards

6. Complaints resolution rate 73.1% 72.0% 86.4% 90% 90% 92% 94%



2.7.2) Reduce the caesarean section

rate to 26% (District), 37% (Regional),

60% (Tertiary), and 67% or less

(Central) by March 2020

7. Delivery by caesarean section

rate 21.9% 23% 22.0% 22% 22% 21% 20%

Delivery by caesarean section 1902 3411 3 470 3411 3420 3438 3291

Delivery in facility total 8700 14743 15 715 15282 15850 16448 16451

1.7.5) Reduce the un referred

outpatient department (OPD)

headcounts with at least 7% per

annum

8. OPD headcount- total 350,940 349,731 295,517 361782 374311 387340 400369

9. OPD headcount not referred

new

80,174 83,395 61,513 82644 82986 84486 82796


Page 79 of 96

HIV, AIDS, STI & TB



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.3.1) Increase the number of patients

on ART to at least 1.5 million by March

2020 (cumulative)

1. ART client remain on ART end of

month - total 75,729 85,939 89,698 109540

106888

(G)

124910 138839

2. TB/ HIV co-infected clients on

ART rate 73.7% 67% 67.0% 91% 82% 85.7% 90.7%

TB/HIV co-infected clients on ART 6628 122 2061 4665 3683 5404 8203

HIV positive TB client 10916 1802 3077 5123 4497 6305 9046

2.2.2) Test at least 16.5 million people

for HIV by March 2020 (cumulative) 3. HIV test done - total 176,090 151,018 178,755 187693 237661 251040 265227

2.2.3) Increase the male condom

distribution to 220 million by March

2019

4. Male condoms distributed 9,943,385 17,852,683 13,829,379 13101915 15150416 16614759 18239567

2.2.4) Increase number of female

condoms distributed from 489931 to

419535

5. Number of female condoms

distributed 289,821 644,794 486,696 503486 419535 442883 467981

2.2.4) Increase the medical male

circumcisions to 1.1 million by March

2020 (cumulative)

6. Medical male circumcision –

total 8,865 9,827 10,295 9720 11069 11926 12876

2.4.5) Increase the TB clients 5 years

and older start on treatment to 99% by

March 2020

7. TB symptom 5 years and older

start on treatment rate

Not

collected 19.0% 80.2% 83% 86% 90% 946%

TB client 5 years and older start on

treatment

Not

collected 349,260 1,431,274 1580989 1604710 1761463 1938317

TB symptomatic client 5 years and

older tested positive

Not

collected 1,840,591 1,785,293 1904806 1874125 1965488 2065135


Page 80 of 96



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.4.1) Increase the TB client treatment

success rate to 90% (or more) by

March 2020

8. TB client treatment success rate Not

collected 19.0% 80.2% 83% 86% 90% 946%

TB client successfully completed

treatment

Not

collected 349,260 1,431,274 1580989 1604710 1761463 1938317

TB client start on treatment Not

collected 1,840,591 1,785,293 1904806 1874125 1965488 2065135

2.4.6) Decrease the TB client lost to

follow up to 2.6% (or less) by March

2020

9. TB client lost to follow up rate 4.4% 2.7% 3% 3.3% 2.6% 2.4% 2.3%

TB client on treatment lost to follow

up 304 168 88 52 204 218 235

TB client start on treatment 6896 6179 6934 1570 6150 7533 9248

TB DR clients loss to follow up rate 10.9% 10,3% 9,5% 9% 8.8% 8.5%

Number of TBDR clients lost to follow

up 49 45 28 25 20 15

Number of TBDR clients

initiated(started) on treatment 449 436 283 285 287 290 295

2.4.3) Decrease the TB death rate to

2% by March 2020

10. TB client death rate 6.6% 7.2% 6.8% 4.5 5.9% 5.8% 4.5%

TB client death during treatment 475 447 475 70 455 436 419

TB client start on treatment 6896 6179 6934 1570 6150 7533 9248

2.4.4) Increase the MDR-TB treatment

success rate to 75% (or more) by

March 2020

11. TB MDR treatment success rate 81.1% 75.47% 76.38% 77% 78% 93% 94%

TB MDR client successfully

completing treatment 309 160 152 215 210 269 278

TB MDR confirmed client start on

treatment

449 436 283 285 287 290 295

2.4.2) Reduce the TB incidence to 400

(or less) per 100 000 by March 2020

12. TB incidence 981 912 716 715 694 684 682

New confirmed TB cases 8461 6243 6120 6181 6110 6100 6090


Page 81 of 96



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Total population in Zululand 828143 844531 853,855 864047 880637 891739 894126

2.4.7) Improve Drug Resistant TB

outcomes by ensuring that 90% (or

more) diagnosed MDR/XDR-TB patients

are initiated on treatment by March

2020

13. TB XDR confirmed client start on

treatment N/A N/A N/A N/A N/A N/A N/A

2.4.11) Maintain new smear positive PTB

cure rate of 85% or more from March

2017 onwards

14. New smear positive PTB cure

rate 83% 81.3% 87,6% 85% 85% 86% 87%

New smear positive pulmonary TB

client cured 1079 918 816 1673 1339 1646 1817

New smear positive pulmonary TB

client start on treatment 1302 1129 932 1965 1582 1907 2126

2.2.1) Reduce the HIV incidence to 1%

(or less) by March 2020 (ASSA2008

estimates)

15. HIV incidence 1.2% 1.3% 1.4% 1.2% 1.1% 1% <1%

2.2.5) Decrease male urethritis

syndrome to at least 3% by March 2020

16. Male urethritis syndrome

incidence 4.3% 4.0% 2.7% 2.7% 2.6% 2.5% 2.3%

Male urethritis syndrome treated –

new episodes 9,074 8,745 5,883 5824

5613

5355

5064

Male population 15-49 years 211,635 216,936 216,929 219099 214 141 218 514 223 297

2.3.1) Increase the number of patients

on ART to at least 1.5 million by March

2020 (cumulative)

17. ART adult remain on ART end of

period

71,193

80,997 85,517 103058 105781 116394 128293

18. ART child under 15 years remain

on ART end of period 4,536 4,942 5,173 6381 5537 5933 6363


Page 82 of 96

MNC&WH & NUTRITION



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.7.3) Increase the antenatal 1st visit

before 20 weeks rate to 70% (or more)

by March 2020

1. Antenatal 1st visit before 20 weeks rate 59.8% 67% 72% 73% 75% 79% 82%

Antenatal 1st visit before 20 weeks 5959 12180 12655 13010 14023 15556 17277

Antenatal 1st visit total 9962 18182 17645 17822 18686 19796 20978

2.7.4) Increase the postnatal visit within

6 days rate to 70% (or more) by March

2020

2. Mother postnatal visit within 6 days rate 58.3 59.1 55.1 56.4% 63.4% 78.3% 99.3%

Mother postnatal visit within 6 days after delivery 9,684 9,135 8,658 9200 11350 15275 21099

Delivery in facility total 16,614 15,465 15,715 16299 17898 19501 21255

2.5.2) Reduce the mother to child

transmission of HIV to less than 0.5% by

March 2020

3. Infant 1st PCR test positive around 10 weeks

rate - - 0.8% 1 % 0.8% 0.8% 0.7%

Infant PCR test positive around 10 weeks - - 43 28 36 45 45

Infant PCR test around 10 weeks - 5197 2561 4505 5574 6919

2.6.3) Increase immunisation coverage

to 88% or more by March 2020

4. Immunization under 1 year coverage

(Annualised) 87.9 78.1 77.0 78.7% 80% 82% 85%

Immunised fully under 1 year new 18,451 16,111 15,647 15994 16413 17217 18063

Population under 1 year 20,713 20,379 20,126 20327 20529 20939 21358

2.6.4) Maintain the measles 2nd dose

coverage of 90% (or more) from March

2017 onwards

5. Measles 2nd dose coverage (Annualised) 88.9% 72.6% 94.2% 94.5% 94.7% 95.4% 96%

Measles 2nd dose 18,387 14,899 19 182 19209 19442 19880 20148

Population 1 year 20,559 20,389 20,126 20327 20529 20939 20988

2.6.6) Reduce the under-5 diarrhoea

case fatality rate to 2% (or less) by

March 2020

6. Diarrhoea case fatality under 5 years rate 4.7% 3% 3.2% 3.0% 3% 2% 2%

Diarrhoea death under 5 years 52 34 35 34 34 34 33

Diarrhoea separation under 5 years 1,098 1,124 1,110 1124 1238 1406 1650


Page 83 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.6.7) Reduce the under-5 pneumonia

case fatality rate to 2.1% (or less) by

March 2020

8. Pneumonia case fatality under 5 years rate 4.5% 3.8% 3.2% 3.1% 3% 2% 2%

Pneumonia death under 5 years 32 31 26 25 24 23 22

Pneumonia separation under 5 years 705 814 805 814 968 1175 1445

2.6.8) Reduce the under-5 severe

acute malnutrition case fatality rate to

6.5% by March 2020

9. Severe acute malnutrition case fatality under

5 years rate 20.3% 7.8% 15.7% 14% 12% 9% 7%

Severe acute malnutrition death in facility under

5 years 47 22 47 44 43 41 39

Severe acute malnutrition separation under 5

years 231 283 299 310 362 439 536

1.5.9) Increase the number of learners

screened with at least 5% per annum

10. School Grade 1 screening coverage 29% 51% 24% 59% 30% 37% 45%


School Grade 1 learner - total 26220 26312 2330 25008 8989 9860 10985

11. School Grade 8 screening coverage 6% 9% 25% 27.7% 33% 41% 51%


School Grade 1 learner - total 44615 44593 6813 6949 7595 8696 10250

2.7.6) Reduce deliveries under 19 years

to 8.5% or less by March 2020

12. Delivery in 10 to 19 years in facility rate 10.1% 9.8% 9.9% 8.9% 8.5% 7.4% 6.4%

Delivery 10 to 19 years in facility 1,686 1,510 1,558 1411 1401 1268 1098

Delivery in facility - total 16,614 15,465 15,715 15856 16483 17144 17146

2.8.1) Increase the couple year

protection rate to 73.2% by March 2020

13. Couple year protection rate (international) 43.2 58.0 70.5 73% 73.2% 73.6% 75%

Couple year protection 98670 138921 121970 176446 179705 183512 190114

Population 15-49 years females 234,438 238,741 243,563 241 707 245 499 249 338 253 486


Page 84 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.8.2) Maintain the cervical cancer

screening coverage of 75% (or more)

14. Cervical cancer screening coverage 30

years and olderf 60.9 80.6 82.3 82.6% 83.8% 87.5% 91.4%

Cervical cancer screening in woman 30 years

and older 9,319 12,722 13,294 13026 14576 15921 17400

Population 30 years and older female/10 15,668 16,110 16,609 15770 17385 18196 19046

2.7.5) Initiate 99% eligible antenatal

clients on ART by March 2020

16. Antenatal client start on ART rate 98,1% 99,3% 101.2% 99,5% 98.% 99,4% 99.75

Antenatal client start on ART 4682 3827 3414 3835 3950 4704 5596

Antenatal client known HIV positive but not on

ART at 1st visit 4766 3855 3372 3855 3994 4733 5614

2.8.3) Maintain programme to target 9

year old girls with HPV vaccine 1st and

2nd dose as part of cervical cancer

prevention programme

17. Human papilloma virus (HPV) 1st dose 87% 55% 71% 73% 77% 83% 90%

Girl 9 years and older that received HPV 1st dose 12870 9256 7497 8030 9973 13365 18054

Grade 4 girl learners > 9 years 14780 16951 10577 11000 12988 16089 20122

17. HPV 2nd dose 79% 89% 91% 92% 93% 94% 96%

Girl 9 years and older received HPV 2nd dose 8128 11191 10167 10120 12942 16673 21733

Grade 4 girl learners > 9 years 10280 12605 11187 11000 13989 17682 22590

2.7.1) Reduce the maternal mortality in

facility ratio to 100 (or less) per 100 000

live births by March 2020

19. Maternal mortality in facility ratio

(Annualised)

55.4

79 96.3

63.7

53.2 20.9 19.3

Maternal death in facility 10 13 16 10 9 4 4

Live birth in facility plus Born alive before arrival

at facility 16,614 15,465 15,715 15856 16483 17144 17146

2.5.3) Reduce the neonatal death in

facility rate to at least 11.1/1000 by

20. Neonatal death in facility rate 12.2 8.8 11.4 7.1 7.1 6.9 6.7

Neonatal 0-28 days death in facility 203 135 176 113 110 108 104

f Replaced the approved customised indicator “Cervical cancer screening coverage 20 years and older” as per communicate from the Director General Health dates 09 February 2017


Page 85 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

March 2020 Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146

2.5.1) Reduce the infant mortality rate

to 29 per 1000 live births by March 2020

21. Infant mortality rate 8.3 5.7 8.1 6.1 6 4 2



2.6.1) Reduce the under 5 mortality

rate to 40 per 1000 live births by March

2020

22. Under 5 mortality rate 7.3 4.4 5.7 5.6% 4% 3% 2%

Inpatient death under 5years 465 272 305 300 210 156 102

Inpatient separations under 5 years 6,380 6,114 5,342 5288 5265 5183 5131

2.6.10) Reduce under-5 diarrhoea with

dehydration incidence to 10 (or less)

per 1000 by March 2020

23. Diarrhoea with dehydration in child under 5

years incidence (Annualised) 11 9 16 14 13 12 11

Diarrhoea with dehydration new in child under 5

years 1178 1000 1744 1596 1462 1340 1178

Population under 5 years 111379 110953 110213 110777 111347 111922 111379

2.6.11) Reduce the under-5

pneumonia incidence to 63 (or less)

per 1000 by March 2020

24. Pneumonia in child under 5 years incidence

(Annualised) 51.7 52 30 28.3 27 25 22

Pneumonia new in child under 5 years 5296 5296 3305 3126 3003 2729 2481


2.6.2) Reduce severe acute

malnutrition incidence under 5 years to

4.6 per 1000 by March 2020

25. Child under 5 years severe acute

malnutrition incidence (Annualised) 4.0 5.0 3.9 3.0 2.9 2.8 2.7

Child under 5 years with severe acute

malnutrition new 374 543 397 332 318 311 301


2.6.9) Increase the Vitamin A dose 12-

59 months coverage to 64% or more by

March 2020

26. Vitamin A dose 12-59 months coverage

(Annualised) 86.9% 97.0% 118% 98% 98.5% 98.6% 98.8%

Vitamin A dose 12 - 59 months 80428 90822 110752 92263 92436 92468 93495


Page 86 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Population 12-59 months (multiplied by 2) 92525 93656 94097 94145 93843 93781 94630

2.6.12) Reduce the death in facility

under 1 year rate to 5.5% or less by

March 2020

27. Death in facility under 1 year rate

(Annualised) 8.3% 5.7% 8.1% 6.1% 6% 4% 2%



2.6.13) Reduce the death in facility

under 5 years rate to 5.0% (or less) by

March 2020

28. Death in facility under 5 years rate 8 4 6 4% 4 3 2

Death in facility under 5 years total 822 258 311 291 291 272 255

Inpatient separations under 5 years 10649 6073 5373 6833 6833 9462 14667

Disease Prevention and Control (DPC)



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2.9.6) Increase the cataract surgery

rate to at least 850 per 1 mil uninsured

population by March 2020

1. Cataract surgery rate (Annualised) 267.7/ml 77.9 /ml 0.0/1ml 163/ml 62/1ml 61/ml 60/1ml

Total number of cataract surgeries completed 224 66 0 132 50 50 50

Population uninsured 771627 785752 800112 806642 810611 821 302 832188

2.10.2) Reduce the malaria case

fatality rate to less than 0.5% by March

2020

2. Malaria case fatality rate 14% 0% 0 0% 0% 0% 0

Deaths from malaria 2 0 0 0 1 1 1

Total number of Malaria cases reported 14 0 2 2 3 7 7

2.10.1) Zero new local malaria cases

by March 2020

3. Malaria incidence per 1000 population at

risk

- - - 0.2 0.3 0.7 0.9

Number of malaria cases (new) 0 0 0 2 3 7 9


Page 87 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Population Zululand

844,526 854,892 853,855 864047 880637 891739 894126

2.9.3) Screen at least 2.5 million people

(40 years and older) per annum for

hypertension y March 2020

4. Clients 40 years and older screened for

hypertension

Not

Monitore

d

Not

Monitore

d

222739 238331 240 000 256800 274776

2.9.1) Hypertension incidence of 24.6

per 1000 population by March 2020

5. Hypertension incidence (Annualised) 13.9% 14.5% 15.8% 15.3% 16.3% 15.2% 14.2%

Hypertension client treatment new 2,083 2,218 2,453 20824 2311 2184 2065

Population 40 years and older 151,987 154,526 155,261 1546813 141844 143635 145451


(40 years and older) per annum for

diabetes by March 2020

6. Clients 40 years and older screened for

diabetes

Not

collected

Not

collected 160018 192022 367052 930162 2465294

2.9.2) Diabetes incidence of 3.1 per

1000 population by March 2020

7. Diabetes incidence (Annualised) 0.9% 1.9% 3.1% 1.6% 1.4% 1.3% 1.3%

Diabetes client treatment new 749 1,571 2,700 2511 2335 2171 2020



for mental disorders at PHC services by

March 2020

8. Mental disorders screening rate

Not

collect

ed

0.7% 15.8% 20% 33% 35% 38%

PHC client screened for mental disorders

Not

collect

ed

15,549 345,146 469687 804504 902921 1014398

PHC headcount - total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469

2.9.7) Improve the number of

wheelchairs issued to 4 200 by March

2020

9. Wheelchairs issued

Not

collect

ed

Not

collect

ed

Not

collect

ed

250 256 269 283

5.2.7) Improve the restoration to

extraction ratio to 18:1 or less by March

10. Dental extraction to restoration ratio 30.2 54.7 37.3 31.0 22 16 12

Tooth extraction 30,486 30,924 31,419 29210 29091 28800 28512


Page 88 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

2020 Tooth restoration 1,010 565 842 943 1345 1798 2448

Emergency Medical Services (EMS)

Strategic Objective Statement Performance Indicators Audited/ Actual Performance

Estimated

Performa

nce

Medium Term Targets

2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

1.8.4) Improve P1 urban response times

of under 15 minutes to 20% by March

2020

1. EMS P1 urban response under 15 minutes

rate 55.2% 51.7% 41.9% 36.7%

EMS P1 urban response under 15 minutes 16 853 10 298 3 729 4 334

EMS P1 urban calls 43 280 37 390 10 788 5 071

1.8.5) Improve P1 rural response times of

under 40 minutes to 40% by March 2020

2. EMS P1 rural response under 40 minutes

rate

EMS P1 rural response under 40 minutes

EMS P1 rural calls

1.8.6) Increase the inter-facility transfer

rate to 50% by March 2020

3. EMS inter-facility transfer rate

EMS inter-facility transfer

EMS clients total

1.8.1) EMS Turn-Around Strategy

approved by June 2017

4. Approved EMS Turn-Around Strategy


Page 89 of 96

Strategic Objective Statement Performance Indicators Audited/ Actual Performance

Estimated

Performa

nce

Medium Term Targets

2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

1.8.2) Increase the average number of

daily operational ambulances to 220 by

March 2020

5. Average number of daily operational

ambulancesg

1.8.7) Increase number bases with

network access to 50 by March 2020

6. Number of bases with access to intranet/

e-mail

Specialized Psychiatric Hospitals

Strategic Objective Statement Performance Indicator

Audited /Actual Performance

Estimated

Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

5.1.2) 60% (or more) public health hospitals

achieved 75% or more on National Core Standards

self-assessment rate by March 2020




0% 0% 0% 0% 0% 0% 100%



assessment

0 0 0 0 0 0 0

Hospitals conducted National Core

Standards self-assessment

1 1 0 0 1 1 1

5.1.7) Sustain a 95% (or more) complaint resolution

within 25 working days rate in all public health

facilities by March 2020 onwards


working days rate

0 0 100 100 100 100 100

Complaint resolved within 25 days 0 0 1 1 1 1 1

g This will include improved fleet management, maintenance, purchase/allocation of new ambulances and appointment of staff


Page 90 of 96



Estimated

Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21


1.7.3) Improve hospital efficiencies by reducing the

average length of stay to at least 5.5 days (District),

5.3 (Regional), 15 days (TB), 286.5 days (Psych), 25.8

days (Chronic), 9 days (Tertiary), and 8.6 days

(Central) by March 2020

3. Average length of stay – total 12 16 11

Inpatient days-total 6729 6929 7177

½ Day Patients 1.0 0 2

Inpatient separations total 548 542 412

1.7.1) Maintain a bed utilisation rate of 75% (or

more)by March 2020

4. Inpatient bed utilization rate –

total

17.6% 18.1% 18.7% 20% 21% 22%

Inpatient days-total 6729 6929 7177 7535.85 7913 8308.

½ Day Patients 1.0 0 2 2 2 2

Inpatient bed days available 38329 38329 38329 38329 38329 38329

1.7.4) Maintain expenditure per PDE within the

provincial norms

Expenditure per PDE 5214.27 4956.38 4936.97

Total expenditure Psychiatric

Hospitals

43664310.

42

43338588.

66

42354351.

34

Patient day equivalents 8374 8744 8579

1.7.5) Reduce the un referred OPD headcounts

with at least 7% per annum

OPD headcount – total 4896 5,444 3,716

OPD headcount new case not

referred 856 1,450 941


Page 91 of 96

Specialized TB Hospitals



Estimated

Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

5.1.2) 60% (or more) public health hospitals

achieved 75% or more on National Core Standards

self-assessment rate by March 2020




0% 0% 0%



assessment

0 0 0

Hospitals conducted National Core

Standards self-assessment

0 0 0

5.1.7) Sustain a 95% (or more) complaint resolution

within 25 working days rate in all public health

facilities by March 2020 onwards


working days rate

100% 0% 0%

Complaint resolved within 25 working

days

1 0 0

Complaint resolved 1 0 0

1.7.3) Improve hospital efficiencies by reducing the

average length of stay to at least 5.5 days (District), 5.3

(Regional), 15 days (TB), 286.5 days (Psych), 25.8 days

(Chronic), 9 days (Tertiary), and 8.6 days (Central) by

March 2020

3. Average length of stay – total 38 64 56

Inpatient days-total 13260 9834 11417

½ Day Patients 0 0 0

Inpatient separations total 342 152 201

1.7.1) Maintain a bed utilisation rate of 75% (or

more) by March 2020

4. Inpatient bed utilization rate –

total

38% 44.9% 52.1% 55 57 60

Inpatient days-total 8312 9834 11417 11988 12587 13217

½ Day Patients 0 0 0 0 0 0

Inpatient bed days available 21902 21902 21902 21902 21902 21902


Page 92 of 96



Estimated

Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

1.7.4) Maintain expenditure per PDE within the

provincial norms

5. Expenditure per PDE h 2570.97 3697.04 3408.85

Total expenditure TB Hospitals 36908968.

65

40327323.

98

39276871.

69

Patient day equivalents 14359 10908 11522

1.7.5) Reduce the un referred OPD headcounts with

at least 7% per annum

6. OPD headcount – total 3298 3221 3141

7. OPD headcount new case not

referred

164 436 423

Health Sciences & Training



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

4.1.4) Allocate 197 bursaries for first year medicine

students between 2015/16 and 2019/20

1. Number of bursaries awarded for

first year medicine students

4.1.5) Allocate 1 000 bursaries for 1st year nursing

students between 2015/16 and 2019/20

2. Number of bursaries awarded for

first year nursing students

4.3.1) KZNCN accredited as IHE by March 2017 3. KZNCN accredited as Institution of

Higher Education

4.1.9) Increase enrolment of Advanced Midwives

by at least 10% per annumi

4. Number of Advanced Midwifes

graduating per annum

h For planning purposes, NHLS costs for GeneXpert and NPI’s have been included in the projected budget figures i Due to budget constraints the intended 10% increase per annum will be reconsidered year on year in line with the available funding envelope and provision for absorption


Page 93 of 96



Performa

nce

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

4.1.8) Increase the number of MOP’s who

successfully completed the degree course at DUT

to 61 (cumulative) by March 2020

5. Number of MOP’s that successfully

completed the degree course at

DUT

4.1.6) Increase intake of Mid-Level Workers with at

least 10% per annum (pending availability of

budget)

6. Number of new Pharmacy

Assistants enrolled in training

courses

4.1.7) Increase the EMS skills pool by increasing the

number ILS student intakes to 300 by March 2020

7. Number of Intermediate Life

Support graduates per annum

(Health Care Support)



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

1.9.2) Decrease and maintain zero

clean linen stock outs in facilities from

March 2020 onwards

1. Percentage of facilities reporting

clean linen stock outs

14% 18% 13% 12.5% 12.5% 12.5% 12.5%

Number of facilities reporting clean linen

stock out

1 1 1 1 1 1 1

Facilities total 8 8 8 8 8 8 8

1.9.5) Implement the approved

Forensic Pathology Rationalisation

Plan by March 2017

2. Forensic Pathology rationalization

Plan


1.9.1) Increase the number of

operational Orthotic Centres to 4 by

March 2020

3. Number of operational Orthotic

Centres - cumulative



Page 94 of 96



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

5.2.1) Increase the percentage

pharmacies that comply with the SA

Pharmacy Council Standards (A or B

grading) to 100% by March 2020

4. Percentage of Pharmacies that

obtained A and B grading on

inspection

100% 87.5% 87.5% 100%

100% 100% 100%

Pharmacies with A or B Grading 8 7 7 8 8 8 8

Number of pharmacies 8 8 8 8 8 8 8

5.2.3) Decrease medicine stock-out

rates to less than 1% in all health

facilities and PPSD by March 2020

5. Tracer medicine stock-out rate (PPSD) N/A N/A N/A N/A N/A N/A N/A

Number of tracer medicine out of stock N/A N/A N/A N/A N/A N/A N/A

Total number of tracer medicine

expected to be in stock


5.2.4) improve pharmaceutical

procurement and distribution reforms

6. Tracer medicine stock-out rate

(Institutions)

11% 31% 21% 1% 1% 1% 1%

Number of tracer medicines stock out in

bulk store

316 901 562 201 195 185 160

Number of tracer medicines expected to

be stocked in the bulk store

32967 29618 29628 29628 29628 29628 29628

7. Percentage facilities on Direct

Delivery Model for Procurement and

Distribution of Pharmaceuticals

Not

monitored

Not

monitored

100% 100% 100% 100% 100%

Number of facilities on Direct Delivery

Model

Not

monitored

Not

monitored

8 8 8 8 8

Total number of facilities eligible for Direct

Delivery Model

Not

monitored

Not

monitored

8 8 8 8 8

8. Percentage facilities on Cross-

Docking Model for Procurement and

Distribution of Pharmaceuticals


Number of facilities on Cross-Docking

Model



Page 95 of 96



Performanc

e

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

Total number of facilities eligible for Cross-

Docking Model


9. Percentage of items on Direct

Delivery and Cross Docking Model


Number of items on Direct Delivery and

Cross Docking Model


Total number of items in the Provincial

Essential Medicines Catalogue


10. Number of facilities implementing the

CCMDD Programme

Not

monitored

Not

monitored

68 101 101 102 102

11. Number of patients enrolled on

CCMDD programme (cumulative)

Not

monitored

Not

monitored

39894 64830 71391 78531 86384

12. Number of pick-up points linked to

CCMDD

Not

monitored

Not

monitored

179 274 274 274 274

(Health Facilities Management)



Performance

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

3.3.4) Major and minor refurbishment

completed as per approved

Infrastructure Plan

1. Number of health facilities that

have undergone major and minor

refurbishment in NHI Pilot District

0 0 0 0 0 0 0

2. Number of health facilities that

have undergone major and minor

refurbishment outside NHI Pilot

District (excluding facilities in NHI

Pilot Districts).

0 1 1 1 1 2 3


Page 96 of 96



Performance

2017/18

Medium Term Targets

2014/15 2015/16 2016/17 2018/19 2019/20 2020/21

3.2.1) Create 11,800 jobs through the

Expanded Public Works Programme

(EPWP) by March 2020 (cumulative)

3. Number of jobs created through

the EPWP

105 130 142 197 201 220 240

3.3.1) Complete 40 new and replaced

projects by March 2020

4. Number of new and replacement

projects completed

6 5 3 0 1 5 0

3.3.2) Complete 47 upgrade and

addition projects by March 2020

5. Number of upgrade and addition

projects completed

1 1 2

2 1 3 4

3.3.3) Complete 24 renovation and

refurbishment projects by March 2020

6. Number of renovation and

refurbishment projects completed

1 1 2 2 1 3 4

3.3.5) 100% of maintenance budget

spent annually

7. Percentage of maintenance and

repairs budget spent

100%

124%

145%

96%

100% 100% 100%

Maintenance budget expenditure R6 684 040

R6 247 018

R 12 871

059

R6 779 534 7591000 8123000 8692000

Total maintenance budget R6 679 000 R5 036 000 R 8 907 000 R7 094 000 7591000 8123000 8692000

ZULULAND DISTRICT HEALTH PLAN 2018/19 - 2020/21€¦ · Zululand District Health Plan 2018/19 Page 5 of 96 3. OFFICIAL SIGN OFF It is hereby certified that this District Health Plan:

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