FOREWORD BY THE MEMBER OF THE EXECUTIVE COUNCIL ( MEC) 4 STATEMENT BY THE HEAD OF DEPARTMENT (HOD) 6 OFFICIAL SIGN OFF 7 1. PART A: STRATEGIC OVERVIEW 8 1.1. VISION, AND VALUES 8 1.2 STRATEGIC GOALS 8 1.3 SITUATIONAL ANALYSIS 10 1.4 PROVINCIAL SERVICE DELIVERY ENVIRONMENT 15 1.5 PROVINCIAL ORGANISATIONAL ENVIRONMENT 28 1.6 LEGISLATIVE AND OTHER MANDATES 30 1.7 OVERVIEW OF THE 2009/10 BUDGET AND MTEF ESTIMATES 30 2. PART B : PROGRAME AND SUB-PROGRAMME PLANS 35 2.1 PROGRAMME 1: ADMINISTRATION 35 2.2 PROGRAMME 2: DISTRICT HEALTH SERVICES 52 2.3 PROGRAMME 3: EMERGENCY MEDICAL SERVICES 94 2.4 PROGRAMME 4: PROVINCIAL HOSPITALS 102 2.5 PROGRAMME 5: CENTRAL AND 111 2.6 PROGRAMME 6: HEALTH SCIENCES AND TRAINING 118 2.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES 128 2.8 PROGRAMME 8: HEALTH FACILITIES MANAGEMENT 135 3. PART C: LINKS TO OTHER PLANS 145 3.1 INFFRASTRUCTURE/CAPITAL PLANS 145 3.2 CONDITIONAL GRANTS 147 3.3 PUBLIC-PRIVATE PARTNERSHIPS (PPPs) 150 4. CONCLUSION 152 ANNEXURES 153
1.4.2 REVIEW OF PROGRESS TOWARDS THE MILLENNIUM DEVELOPMENT GOALS (MDGS) The Department will accelerate progress towards the MDGs through implementation of activities as reflected below. MILLENNIUM DEVELOPMENT GOALS MDGs Target Indicator Limpopo progress in 2004-2009 Source of data Limpopo required progress by 2015 Goal 1: Eradicate Extreme Poverty And Hunger Halve, between 1990 and 2015, the proportion of people who suffer from hunger Prevalence of underweight in children (under 5 years of age) 14.2% South Africa Demographic and Health Survey (SADHS) 2003 7.1% Incidence of severe malnutrition in children (under 5 years of age) (Wasting) 3.8% South Africa Demographic and Health Survey (SADHS) 2003 2% Goal 4: Reduce Child Mortality Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Under-five mortality rate 43.9 per 1000 live births South Africa Demographic and Health Survey (SADHS) 2003 40.9 per 1 000 live births Infant mortality rate 34.1 per 1000 live births SADHS 2003 31.1 per 1000 live births Proportion of children under 1yr immunized against Measles 83.5% (109566 of 131217) District Health Information System (DHIS), 2009 90% Goal 5: Improve Maternal Health Reduce by between 1990 and 2015, the maternal mortality rate Maternal mortality ratio 182.9 per 100 000 live births Saving Mothers report 2007 136.5 per 100 000 live births Proportion of births attended by skilled health personnel 87.6% SADHS 2003 95%
Improve utilisation rate Community mobilization Marketing of PHC services PHC utilisation rate to increase from 2.9 to 3.5 OUTPUT 4: STRENGTHENING HEALTH SYSTEM EFFECTIVENESS Health Care financing and Management Plan for the implementation of the NHI Readiness strategy on NHI implementation developed Implement readiness strategy on NHI in health facilities Improved health care financing and management systems Implement best practices in line with legislative prescripts and guidelines Unqualified financial audit opinion OUTPUT 4: STRENGTHENING HEALTH SYSTEM EFFECTIVENESS Human Resources for Health Improve access to human resources for health Review the departmental HR Plan in line with the National Human Resource Plan 2014/15 HR Plan, which reflects an appropriate skills mix between health professionals produced Reduction of vacancy rate Implement Departmental recruitment and selection strategy Vacancy rate of the following categories reduced to: -Medical Specialists- 59% -Medical Officers- 11% -Professional Nurses- 28% -Pharmacists- 5%
2.1.4 PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR ADMINISTRATION STRATEGIC GOALS 1: Effective corporate governance provided STRATEGIC OBJECTIVES FOR ADMINISTRATION Strategic objective Performance indicator Strategic plan target Means of verification/ Data source Audited/ Actual performance Estimated performance 2010/11 Medium term targets 2007/08 2008/09 2009/10 2011/12 2012/13 2013/14 Implement effective and efficient monitoring and evaluation systems Number of performance monitoring reviews conducted Establish effective and efficient monitoring and evaluation (M&E) systems in the Department by 2014 Documented evidence 4 4 4 4 4 4 4 Number of research studies conducted Documented evidence No baseline No baseline No baseline No baseline 3 research reports produced -client surveys -Time flow studies -Burden of diseases study 1 research report produced on Burden of disease 1 research report produced on Burden of disease Number of Health facilities certificated for Accreditation Documented evidence No baseline No baseline 1 1 121 of 483 121 of 483 121 of 483
Provide risk management services Number of institutions conducting risk assessments Maximise implementation of risk management strategy in the Department by 2014 Documented evidence 25 30 40 46 73 of 504 100 of 504 200 of 504 Provide security management services Percentage compliance of institutions to departmental security management plan Improve physical and information security measures in the department by 2014 Documented evidence No baseline No baseline No baseline No baseline 483 of 483 80 % 483 of 483 85 % compliance 483 of 483 90 % Knowledge, records, information management systems and technology (KRIMST) established Knowledge and information management strategy and Policy developed and implemented Improve data quality and records management by 2014 Documented evidence No baseline No baseline No baseline No baseline Approved strategy and policy Reviewed and Reviewed and implement document
and operational Number of facilities that meet minimum requirements in terms of National Archives and Records Service Act Documented evidence No baseline No baseline No baseline 100/486 Institutions assessed for complying to 60% Records Management Legislation 40 45 50 Information Technology Strategy and Policy developed and implemented Documented evidence No baseline No baseline No baseline No baseline Develop and ICT strategy and Policy Reviewed and implement Reviewed and implement Number of Sites with PHIS fully implemented Hospital/ Facility fully automated Core modules in all hospitals Core modules in all hospitals Core modules in all hospitals Core modules implemented in all hospitals 6 180 283 Number of sites with Telemedicine infrastructure Site Signed off No baseline No baseline No baseline 10 29 (19 new) 210 (181 new) 381 (171 new) implement implement implement
Number of facilities that meet minimum requirements for data quality Documented evidence No baseline No baseline 84 64 90 new 122 126 Provide effective and efficient services Number of facilities implementing strategy To improve communication services at all levels by 2014 Documented evidence No baseline No baseline No baseline 52 483 of 483 483 of 483 483 of 483 STRATEGIC GOALS 2 & 3: Appropriate human resources management and development provided Strategic objective Performance indicator Strategic plan target Means of verification/ Data source Audited/Actual performance Estimated performance 2010/11 Medium term targets 2007/08 2008/09 2009/10 2011/12 2012/13 2013/14 Provide human resource management Number of Medical doctors and dentists appointed Enhance human resource availability PERSAL 43 48 91 263 325 341 327
Provide efficient and effective financial management system Revenue collected Implement sound financial system in line with the prescribed prescripts by 2014 BAS R83 million R87 million R111.6 million R98 million R107 million R112 million R117 million Audit opinion on financial management expressed by the Auditor General Auditor General report Qualified Qualified Qualified Unqualified Unqualified 2.1.5 QUARTERLY TARGETS FOR 2011/12 ADMINISTRATION PROVINCIAL QUARTERLY TARGETS FOR 2011/12 Performance indicator Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Number of performance monitoring reviews conducted Quarterly 4 1 1 1 1 Number of research studies conducted Annually 2 research reports produced client satisfaction surveys Time flow studies 2 Research proposals developed Commissioning 2 studies Data collection and analysis phase(2 studies) 2 research reports produced 1 burden of
1 burden of diseases study commissioned diseases study commissioned Number of Health facilities certificated for Accreditation Annually 121 facilities certificated for Accreditation 40 facilities prepared for certification for Accreditation 40 facilities prepared for certification for Accreditation 41 facilities prepared for certification for Accreditation 121 facilities certificated for Accreditation Number of institutions conducting risk assessments Quarterly 73 of 504 12 21 20 20 Percentage compliance of institutions to departmental security management plan Quarterly 483 of 483 80 % compliance 121 of 483 80 % compliance 142 of 483 80 % compliance 362 of 483 80 % compliance 483 of 483 80 % compliance Knowledge and information management Strategy and Policy developed and implemented Quarterly Approved strategy and policy documents First draft Final draft and approval Implementation Implementation Number of Institutions that meet minimum requirements in terms of National Archives and Records Services Act Quarterly 40 10 20 30 40 Information Communication Strategy Technology and Policy developed and implemented Quarterly Develop and ICT strategy and Policy First draft Final draft and approval Implementation Implementation Number of Sites with PHIS fully implemented Annually 6 Project plan completed Procurement phase completed Infrastructure deployment completed 6 Number of sites with Annually 29 (19 new) 14 14 14 29 (19 new)
individual (HDI) Percentage of bids awarded to women Annually 50% 50% 50% 50% 50% Percentage of bids awarded to disabled Annually 1% 1% 1% 1% 1% Percentage of bids awarded to Youths Annually 35% 35% 35% 35% 35% Percentage of bids awarded to small medium and micro enterprises (SMMEs) Annually 58% 58% 58% 58% 58% Percentage of institutions with credible asset registers Quarterly 100% (58) 100% (58) 100% (58) 100% (58) 100% (58) Revenue collected Quarterly R107 million R11million R40 million R16 million R40 million NATIONAL QUARTERLY TARGETS FOR 2011/12 Performance indicator Reporting period Annual target 2011/12 Quarterly Targets Q1 Q2 Q3 Q4 Vacancy rate for professional nurses Annually 41% (5462/13473) 43% (5462/13473) 42% (5563/13473) 41% (5563/13473) 41% (5462/13473) Vacancy rate for doctors Annually 44% (1296/2892) 55% (1591/2892) 53% (1532/2892) 50% (1446/2892) 44% (1296/2892) Vacancy rate for medical specialists Annually 71% 82% 81% 80% 71%
(289/404) (331/404) (327/404) (323/404) (289/404) Vacancy rate for pharmacists Annually 27% (153/559) 39.5% (221/559) 35.5% (199/559) 31.8% (178/559) 27% (153/559) 2.1.6 RECONCILING PERFORMANCE TARGETS WITH ESTIMATES: ADMINISTRATION Sub-programme Audited outcome Main appropriation Adjusted appropriation Revised estimate Medium term expenditure estimates 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 MEC’s Office 719 843 1,421 1,420 1,420 1,420 1,498 1,580 1,667 Management 160,618 190,641 202,314 270,721 260,721 260,721 272,902 281,733 302,562 TOTAL 161,337 191,484 203,735 272,141 262,141 262,141 274,400 283,313 304,229 Audited Outcomes Main appropriation Adjusted appropriation Revised estimate Medium-term estimate 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Current payments 158,037 185,840 198.066 264,261 249,167 249,167 263,852 274,775 295,264 Compensation of employees 90,815 119,437 136,123 190,867 171,867 171,867 179,870 188,433 209,044 Goods and services 67,222 72,661 61,366 73,394 77,300 77,300 83,982 86,342 86,220 Financial transactions in assets and liabilities 9,181 577 Transfers and subsidies to 1,430 2,372 4,877 3,880 4,094 3,880 4,094 4,249 4,462 Provinces and municipalities EXPENDITURE SUMMARY ECONOMIC CLASSIFICATION
Departmental agencies and accounts 1,117 2,013 2,452 3,001 7,001 7,001 3,162 3,203 3,363 Households 313 359 2,425 879 1,408 1,408 932 1,046 1,099 Payments for capital assets 1,870 2,025 792 4,000 4,565 4,565 6,454 4,289 4,503 Machinery and equipment 1,870 2,025 792 4,000 4,565 4,565 6,454 4,289 4,503 Software and other intangible assets Total economic classification 161,337 191,484 203,735 272,141 262,141 262,141 274,400 283,313 304,229 2.1.7 PERFORMANCE AND EXPENDITURE TRENDS The objective of this Programme is to provide overall strategic management, administration, legislative and communication services through the MEC’s office. The allocated budget has a direct impact on the achievements of targets in the following ways: Foster the improvement of financial management and control in the department as a whole, e.g. policies and procedure manuals are developed, implemented and monitored throughout the department. Improvement of the effectiveness and efficiency of the supply chain management Intensify the implementation and monitoring of the risk management strategy throughout the department. The department has spent a total of R570.7 million in 2007/8 to 2009/10 while the 2010/11 budget amounts to R272.1 million. The proposed MTEF from 2011/12 to 2013/14 is projected at R956.9 million which will be used to maintain and improve the current services. The funding has therefore been aligned to the various key strategic focus of the programme. 2.1.8 RISK MANAGEMENT
Percentage of complaints of users of PHC Services resolved within 25 days Documentary evidence % No baseline - - - - - Annual indicators DHIS CHCs/CDCs with resident doctor rate Documentary evidence % 3 2 0 1 0 0 Number of PHC facilities assessed for compliance against the 6 priorities of the core standards Assessment report No No baseline - - - - - Fixed PHC facilities' means fixed clinics plus community health centres. 'Public' means provincial plus local government facilities. 2. Community Health Centres and Community Day Centres 2.1.2 PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISTRICT MANAGEMENT, COMMUNITY HEALTH CENTRES, CLINICS, COMMUNITY BASED SERVICES AND OTHER COMMUNITY SERVICES GOALS 5 & 6: Strengthen district health and hospital services and Improve quality of health care PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISTRICT MANAGEMENT, COMMUNITY HEALTH CENTRES, CLINICS, COMMUNITY BASED SERVICES AND OTHER COMMUNITY SERVICES Strategic Performance Strategic Means of Audited/ Actual performance Estimated Medium term targets
NATIONAL QUARTERLY TARGETS FOR DISTRICT MANAGEMENT, COMMUNITY HEALTH CENTRES, CLINICS, COMMUNITY BASED AND OTHER COMMUNITY BASED SERVICES FOR 2011/12 Indicator1 Type Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Provincial PHC expenditure per uninsured person R Quarterly 482 120.5 120.5 120.5 120.5 PHC total headcount No Quarterly 16.5m 4m 4.25m 4.25m 4m PHC total headcount under 5 years No Quarterly 3 849 674 962 418 962 418 962 418 962 418 Utilisation rate – PHC % Quarterly 4.0 4.0 4.0 4.0 4.0 Utilisation rate under 5 years- PHC % Quarterly 6.8 6.8 6.8 6.8 6.8 Percentage of fixed PHC facilities with a monthly supervisory visit rate % Quarterly 80 80 80 80 80 Expenditure per PHC headcount R Quarterly 165 165 165 165 165
2.2 PROVINCIAL STRATEGIC OBJECTIVES AND PROVINCIAL PERFORMANCE INDICATORS FOR DISTRICTHOSPITALS STRATEGIC GOALS 5 & 6: Strengthen District health and hospital services and Improve quality of health care PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISTRICT HOSPITALS Strategic objective Performance indicators Strategic plan target Means of verification/ Data source Audited/ Actual performance Estimated performance 2010/11 Medium term targets 2007/08 2008/09 2009/10 2011/12 2012/13 2013/14 Provide district hospital services package Number of hospitals complying with 75% of district hospital service package Increase from 20 to 30 by 2014 Assessment Reports 23 of 30 28 of 30 23 of 30 25 of 30 30 of 30 30 of 30 30 of 30 Strengthen Primary Health Care service delivery systems Percentage of fixed PHC facilities supported by a doctor at least once a week Increase access to PHC services Documented evidence 57% 237 of 416 59% 245/416 56.6% 255/451 58% 257/443 60% 266/443 62% 275/443 64% 284/443 NATIONAL PERFORMANCE INDICATORS FOR DISTRICT HOSPITALS Indicator Data source Type Audited/ Actual performance Estimate 2010/11 Medium-term targets National target 2014/15 2007/08 2008/09 2009/10 2011/12 2012/13 2013/14 Caesarean section rate DHIS % 15.5 14.9 16.1 15 15 15 15 15 or above
Separations - Total DHIS No 235 792 332 748 264 387 259 203 264 387 270 435 278 545 - Patient Day Equivalents – Total DHIS No 1 456 266 1 490 925 1 672 949 1 640 146 1 672 949 1 754 400 1 807 032 - OPD Headcounts - Total DHIS No 1 253 719 1 395 009 1 397 435 1 370 034 1 397 435 1 435 345 1 478 405 - Average length of stay DHIS Days 4.3 4.2 4.3 4 4 3.9 3.8 3.5 days Bed utilisation rate DHIS % 64.1 68.1 67.1 70 71 72 75 75 or above Expenditure per patient day equivalent (PDE) BAS/DHIS R R1,498 R1,318 R1,375 R1,457 R1,500 R1,650 R1,700 Percentage of complaints of users of District Hospital Services resolved within 25 days evidence % No baseline No baseline 100 100 100 100 100 - Percentage of District Hospitals with monthly Mortality and Morbidity Meetings evidence % 76.6 (23 of 30) 80 (24 of 30) 100 (30 of 30) 100 100 100 100 100 Annual indicators District Hospital Patient Satisfaction rate DHIS: Patient Satisfaction % No baseline No baseline No baseline 65 70 75 80 -
SITUATION ANALYSIS INDICATORS FOR HIV & AIDS, AND TB CONTROL Quarterly Indicator Data source Type Province wide value 2009/10 Capricorn 2009/10 Mopani 2009/10 Sekhukhune 2009/10 Vhembe 2009/10 Waterberg 2009/10 National Average 2009/10 Total number of patients (Children and Adults) on ART DHIS No 64 636 13 700 18251 9080 17 143 8814 1 063 644 Male condom distribution rate DHIS No 14.4 14.4 19.3 13.2 13 10.5 13.2 New smear positive PTB defaulter rate ETR.net % 8.1% 711 of 8 738 5.2 94 of 1 836 6.9 148 of 2 150 9.5 182/170 of 1 791 7.1 131 of 1 842 113 212 of 1 629 7.4 PTB two month smear conversion rate ETR.net % 63.3 5 880 of 9 164 63.3 1 162 of 1 836 64.2 1 380 of 2 1510 56.2 1 006 of 1 791 77.3 1 425 of 1 842 57.3 934 of 1 629 Percentage of HIV-TB patients placed on ART TB registers % No baseline No baseline No baseline No baseline No baseline No baseline New indicator HCT Testing rate DHIS % 83.6 83.9 88.4 84.6 78.9 81.0 New indicator Annual indicators New smear positive PTB cure rate ETR.net % 67.0 5 858/8 738 72.3 1 043/ 1 442 69.3 1 328/ 1 917 59.9 1199/2 001 75 1 323/1 763 58.7 792/ 1 498 66%
HIV testing rate among TB patients ETR.net 48.5% (3 305 of 6 815) 77.3% (5 773 of 7 468) 87% (5 129 of 5 859) 100% 100% 100% 100% Percentage of MDR-TB patients started on ARVs TB registers No baseline No baseline 50.4 25 0f 48 100% 100% 100% 100% Percentage of XDR-TB patients started on ARVs TB registers No baseline No baseline 100% 2 of 2 100% 100% 100% 100% Percentage of TB patients with MDR-TB ETR.net No baseline No baseline No baseline 0.25% 1% 1.2% 1.8% TB incidence rate ETR.net 143/100 000 181/100 000 141/ 100 000 130/ 100 000 125/ 100 000 000 115/100 000 NATIONAL PERFORMANCE INDICATORS FOR HIV & AIDS, AND TB CONTROL Quarterly Indicator Data source Type Audited/ actual performance Estimate MTEF projection National Target 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Total number of DHIS No 31 800 43 625 64 636 102 400 148 970 198 130 247 663 3.2 million
patients (Children and Adults) on ART Male condom distribution rate DHIS No 13 13 14.4 16 17 18 19 60 New smear positive PTB defaulter rate ETR.net % 8 545 of 6 815 7.9 590 of 7 468 8.1 711 of 8730 7.5 (634 of 8 456) 7.2 (560 of 7 780) 6.5 (465 of 7 158) 5.5 362 of 6 585 <5 PTB two month smear conversion rate ETR.net % 54.4 2 937 of 5 401 58.5 5 113 of 8 743 63.3 5 800 of 9 164 63.5 5 369 of 8 456 65 5 057 of 7 780 67 4 796 of 7 158 68 4 478 of 6 585 75 Percentage of HIV-TB patients placed on ART TB register % No baseline No baseline No baseline 40 100 100 100 100 HIV Testing rate DHIS % 74.5 88.8 83.6 90 95 95 95 Annual indicators New smear positive PTB cure rate ETR.net % 56.5 3 850 of 6 815 61.7 4 504 of 7 468 67.0 5 858 of 8 738 67.2 5 682 of 8 456 67.5 5 252 of 7 780 73 5 225 of 7 158 80 5 268 of 6 585 85 # The target is to distribute 1 billion condoms, and there are about 16.5m males 15 years and older (StatsSA 2009 midyear estimates). This equates to approximately 60 condoms per male 15 years and older 2.3.3 QUARTERLY TARGET FOR HIV & AIDS, AND TB CONTROL
PROVINCIAL QUARTERLY TARGETS FOR HIV & AIDS, STI AND TB CONTROL FOR 2011/12 Performance indicators Reporting period Annual target 2011/12 Quarterly Targets Q1 Q2 Q3 Q4 Proportion of HIV exposed babies testing positive Quarterly <5% <5% <5% <5% <5% Percentage of HIV exposed infants who are PCR positive initiated on ART Quarterly 95% 95% 95% 95% 95% Percentage of pregnant women who are tested for HIV Quarterly 95% 95% 95% 95% 95% ART service points registered Quarterly 483 483 483 483 483 Number of newly diagnosed eligible HIV positive patients starting IPT Quarterly 4 000 1000 1000 1000 1000 Percentage of TB patients with a DOT supporter (DOT Coverage) Quarterly 87% (6 768 of 7 780) 87% (6 768 of 7 780)) 87% (6 768 of 7 780) 87% (6 768 of 7 780) 87% (6 768 of 7 780) Treatment Success Rate (Cure Rate plus Completion Rate) Quarterly 75% (5 835 of 7 780) 75% (1 459 of 1 945) 75% (1 459 of 1 945) 75% (1 459 of 1 945) 75% (1 459 of 1945) HIV testing rate among TB patients Quarterly 100% 100% 100% 100% 100% Percentage of MDR-TB patients started on ARVs Quarterly 100% 100% 100% 100% 100%
Percentage of XDR-TB patients started on ARVs Quarterly 100% 100% 100% 100% 100% Percentage of TB patients with MDR-TB Quarterly 1% 1% 1% 1% 1% TB incidence rate Quarterly 125/ 100 000 125/ 100 000 125/ 100 000 125/ 100 000 125/ 100 000 NATIONAL QUARTERLY TARGETS FOR HIV & AIDS, STI AND TB CONTROL FOR 2011/12 Performance indicator Reporting period 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Total number of patients (Children and Adults) on ART Quarterly 148 970 112 480 124 100 136 270 148 970 Male condom distribution rate Quarterly 17 17 17 17 17 New smear positive PTB defaulter rate Quarterly 7.2% ( 560 of 7 780) 7.2% (140 of 1 945) 7.2% (140 of 1 945) 7.2% (140 of 1 945) 7.2% (140 of 1 945) PTB two month smear conversion rate Quarterly 65% 5 057 of 7 780 65% 5 057 of 7 780 65% 5 057 of 7 780 65% 5 057 of 7 780 65% 5 057 of 7 780 Percentage of HIV-TB Co-infected patients placed on ART Quarterly 100% 100% 100% 100% 100% HIV Testing rate Quarterly 95% 95% 95% 95% 95%
New smear positive PTB cure rate Annually 67.5% 67.5% 67.5% 67.5% 67.5% SUB-PROGRAMME 2.4: MATERNAL, CHILD AND WOMEN’S HEALTH AND NUTRITION 2.4.1 SITUATION ANALYSIS FOR MCWH & N SITUATION ANALYSIS INDICATORS FOR MCWH & N Quarterly Indicator Data source Type Province wide value 2009/10 District Capricorn 2009/10 District Mopani 2009/10 District Sekhukhune 2009/10 District Vhembe 2009/10 District Waterberg 2009/10 National Average 2009/10 Immunisation coverage under 1 year DHIS % 99.2 102.8 99.2 97.6 102 102.8 95.5 Vitamin A coverage 12-59 months DHIS % 32.8 32.6 31.9 44 27.1 27.1 36.6 Measles 1st dose under 1 year coverage DHIS % 107.3 111,9 100,5 104,4 100,2 99,8 98.8 Pneumococcal Vaccine(PCV) 3rd Dose coverage DHIS % No baseline No baseline No baseline No baseline No baseline No baseline Rota Virus (RV) 2ndt Dose Coverage DHIS % No baseline No baseline No baseline No baseline No baseline No baseline
Cervical cancer screening coverage DHIS % 8.3 7.3 7.2 12.4 8.6 6.6 47.6 Antenatal visits before 20 weeks rate DHIS % 42.9 42.4 41.9 43.3 43.5 43 34.5 Baby tested PCR Positive six weeks after birth as a proportion of babies tested at six weeks DHIS % 10.4 5.7 7.9 17.3 17 4.5 11 Annual indicators Couple year protection rate DHIS % 24.4 21.9 29.1 24.6 25.1 20.1 31.7 Public Health Facility maternal mortality rate DHIS No per 100000 No baseline - - - - - New indicator Delivery rate for women under 18 years DHIS % 8.4 7.9 8.4 8.0 9.3 8.3 8.2 Public Health Facility Infant mortality rate(under 1) rate DHIS No per 1000 13.4 14 15 20.6 9.4 14.2 9.9 Public Health Facility Child mortality (under 5) rate DHIS No per 1000 9.2 9.7 11.5 9.7 8.3 8.4 6.4 2.4.2 PROVINCIAL STRATEGIC OBJECTIVES AND NATIONAL PERFORMANCE INDICATORS FOR MCWH&N
STRATEGIC GOALS 4, 5 & 6 : Implementation of comprehensive care and management of HIV and AIDS,TB, STIs and other communicable and non communicable diseases accelerated; Strengthen District health and hospital services and Improve quality of health care PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR MCWH&N Strategic objective Performance indicators Strategic plan target Means of source Audited/ Actual performance Estimated performance Medium term targets 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Strengthen programmes on maternal, child, woman, youth and adolescent health Percentage ante natal care before 13wks Reduce maternal deaths from 182.9 to 100 per 136.5 per 100 000 live births DHIS No baseline No baseline 16.6% 20% 25% 30% 35% Percentage of institutions (CHCs and hospitals) implementing 80% of from the saving mothers report Documented evidence No baseline 63.2% 39 of 62 77% 48 of 62 100% 64of 64 100% 61 of 61 100% 61 of 61 100% 61 of 61 Number of PHC facilities with 60% IMCI saturation Child mortality from 43.9 to 40.9 per Documented evidence 311 of 416 351/416 374/416 391/416 416/464 416/464 416/464
coverage under 1 year 10 431 of 131 217 109 566 of 131 217 130 167 of 131 217 118 095 of 131 217 118 095 of 131 217 118 095 of 131 217 118 095 of 131 217 Vitamin A coverage- 12 -59 months DHIS % 24 84 847 of 353 530 36.7 129 745 of 353 530 32.8 146 290 of 353 530 45 159 088 of 353 530 50 176 765 of 353 530 55 194 441 of 353 530 60 80 Measles 1st dose coverage under 1 year DHIS % 90 118 095 of 131 217 85 111 534 of 131 217 107.3 140 795 of 131 217 103.7 136 072 of 131217 90 118 095 of 131 217 90 118 095 of 131 217 90 118 095 of 131 217 90 Pneumococcal (PCV) 3rd Dose Coverage DHIS % No baseline No baseline No baseline 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 Rota Virus (RV) 2nd Dose Coverage DHIS % No baseline No baseline No baseline 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 (118 095 of 131 217) 90 Diarrhoea incidence under 5years DHIS Per 1000 203/1000 209/1000 200/1000 180/1000 170/1000 160/1000 -
Pneumonia incidence under 5 years DHIS Per 1000 62.9/1000 60/1000 65/1000 62/1000 60/1000 58/1000 56/1000 - Cervical cancer screening coverage DHIS % 4.7 42 134 of 1 027 665 6.7 68 854 of 1 027 665 8.3 85 287 of 1 027 665 18 184 980 of 1 027 665 60% 616599 of 1027665 65 667982 of 1 027 665 70 719365 of 1 027 665 70 Ante natal visit before 20 weeks rate DHIS % 32 No baseline 40.1 No baseline 43.7 50 60 70 80 70 Baby tested PCR Positive six weeks after birth as a proportion of babies tested at six weeks DHIS % 20 2 082/10 411 18 2 192/12 107 10.4 114 of 10926 5 <5 <5 <5 <5 Annual indicators Couple year protection rate DHIS % No baseline 23.6 24.4 35 40 45 50 75 Public Health Facility Maternal mortality rate DHIS No per 100000 182.9/ 100 000 182.9/ 100 000 182.9/ 100 000 182.9/ 100 000 171.4/ 100 000 159.9/ 100 000 148.4/ 100 000 Provincial Delivery rate for women under 18 years DHIS % 8.5 9.1 8.4 7.5 7 6.5 6
Number of PHC facilities implementing Community Component of IMCI Quarterly 300 of 443 210 of 443 230 of 443 250 of 443 300 of 443 Percentage of primary schools receiving phase 1 of school health services Quarterly 97% (2513 of 2591) 24% 628 of 2 591 48% 1 256 of 2 591 72% 1 884 of 2 591 97% 2 513of 2 591 Proportion of births attended by skilled health professionals Quarterly 90% 90% 90% 90% 90% NATIONAL QUARTERLY TARGETS FOR MCWH & N FOR 2011/12 Performance indicator Reporting period 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Immunisation coverage under 1 year Quarterly 90% 118 095/ 131 217 90% 118 095/ 131 217 90% 118 095/ 131 217 90% 118 095/ 131 217 90% 118 095/ 131 217 Vitamin A coverage- 12 -59 months Quarterly 50% (176 765 of 353 530) 50% (176 765 of 353 530) 50% (176 765 of 353 530) 50% (176 765 of 353 530) 50% (176 765 of 353 530) Measles 1st dose coverage under 1 year Quarterly 90% (118 095 of 131 217) 90% (118 095 of 131 217) 90% (118 095 of 131 217) 90% (118 095 of 131 217) 90% (118 095 of 131 217)
SUB-PROGRAMME 2.5: DISEASE PREVENTION AND CONTROL 2.5.1 SITUATION ANALYSIS FOR DISEASE PREVENTION AND CONTROL SITUATION ANALYSIS INDICATORS FOR DISEASE PREVENTION AND CONTROL Annual Indicator Data source Type Province 2009/10 Capricorn 2009/10 Mopani 2009/10 Sekhukhune 2009/10 Vhembe 2009/10 Waterberg 2009/10 National Average 2009/10 Malaria fatality rate Malaria surveillance programme % 1.09 2842 cases & 31 deaths 5.88 0.67 0 1.19 1.59 Cholera fatality rate Documented evidence % 0.65 0,63 1 of 159 0 8,5 4 of 47 0 0 Cataract surgery DHIS No per million population 3607 2372 195 348 692 0
NATIONAL PERFORMANCE INDICATORS FOR THE EMS AND PATIENT TRANSPORT Indicator Data Source Type Audited/ actual performance Estimate MTEF projection National target 2014/15 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 Rostered Ambulances DHIS per 10000 population 0.35 0.4 0.08 0.55 0.66 0.76 0.83 1 per 10000 population P1 calls with a response time of <15 minutes in an urban area DHIS % 70% 55.5% 65% 55% 60% 65% 70% 80% P1 calls with a response time of <40 minutes in a rural area DHIS % 70% 70% 81% 55% 60% 65% 70% 80% All calls with a response time within 60 minutes DHIS % 84% 94% 92% 60% 70% 80% 90% 100%
2.3.5 QUARTERLY TARGETS FOR EMERGENCY MEDICAL SERVICES AND PATIENT TRANSPORT PROVINCIAL QUARTERLY TARGETS FOR EMS FOR 2011/12 Performance Indicators Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Ratio of Ambulance per population Quarterly 1: 15 000 1:15000 1: 15000 1:15000 1: 15000 EMS Response times in urban and rural areas Quarterly 20 20 20 20 20 40 40 40 40 40 Number of stations established Annually 19 (4 new) 15 16 16 19 (4 new) Number of Emergency Care Practitioners providing EMS Annually 2503 (450 new) 450 ECPs posts advertised Applications processed 450 ECPs appointed 2503 (450 new) Number of Planned Patients Transported Quarterly 140 000 35 000 35 000 35 000 35 000
Expenditure per patient day equivalent (PDE) BAS R R 1,294 R 1,182 R 1,305 R 1,383 R 1,465 R 1,552 R 1,645 Percentage of complaints of users of Regional Hospital Services resolved within 25 days Documented evidence % No baseline No baseline 100 100 100 100 100 Percentage of Regional Hospitals with monthly Mortality and Morbidity Meetings Docemented evidence % 100 100 100 100 100 100 100 Annual indicators Percentage of users of regional hospital services satisfied with the services received (Regional hospitals patient satisfaction rate) Survey reports % No baseline 75% (manual) No baseline 73.4% (manual) 64.6% 65% 70% 75% 80% Number of Regional Hospitals assessed for compliance with the 6 priorities of the Assessments reports No No baseline No baseline No baseline 2 5 5 5
Strategic Objective Performance indicator Strategic plan target Means of verification/ Data source Audited/ Actual performance Estimated performance Medium-term targets 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Implement quality improvement programme in Provincial hospitals Average length of stay (acute) Implement quality in three (3) specialized hospital by 2014 DHIS 20 33.2 33.5 20 20 20 20 ALOS (Sub-Acute) DHIS 50 days 38 days 46.5 days 40 days 40 days 40 days 40 days Bed utilisation Rate DHIS 85.2% 85.5% 88% 80% 80% 80% 80% Percentage of Mental Health Care Users (MHCU) on leave of absence Documented evidence 4.8% 53 of 1 114 6.2% 69 of 1 114 6.18% 10% 10% 10% 10% Number of specialised hospitals assessed for compliance with the 6 priorities of the core standards Assessment reports No baseline No baseline No baseline No baseline 3 3 3 QUARTERLY TARGETS FOR SPECIALISED HOSPITALS QUARTERLY TARGETS FOR SUB-PROGRAMME SPECIALISED HOSPITALS FOR 2011/12 Performance indicator Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4
Average length of stay (acute) Quarterly 20 20 20 20 20 ALOS (Sub-Acute) Quarterly 40 days 40 days 40 days 40 days 40 days Bed utilisation rate Quarterly 80% 80% 80% 80% 80% Percentage of MHCU on leave of absence Quarterly 10% 10% 10% 10% 10% Number of specialised hospitals assessed for compliance with the 6 priorities of the core standards Quarterly 3 Training conducted 1 1 1 2.4.5 RECONCILING PERFORMANCE TARGETS WITH EXPENDITURE TRENDS EXPENDITURE ESTIMATES: PROVINCIAL HOSPITAL SERVICES Sub-programme Audited outcome Main appropriation Adjusted appropriation Revised estimate Medium term expenditure estimates
Strengthen Tertiary/ academic services Number of tertiary disciplines provided 34 NTSG report 17 23 26 28 of 50 32 of 50 33 of 50 34 of 50 Transfer rate outside the province 15% Register 5.4 % (1816) 5.4% (1630) 5.1% (1 884) 5% 4% 4% 4% Number of registrars appointed Increase number of registrars by 10% Persal Reports No baseline No baseline 31 34 64 70 77 Strengthen secondary Hospital services Number of clinical disciplines conducting outreach programmes Increase number of disciplines conducting outreach by 10% Clinical Reports 20 22 19 22 of 38 30 of 38 35 of 38 38 of 38 Number of institutions using Telemedicine 89 Clinical Reports No baseline 4 pilot sites 0 10 29 49 69 NB: Telemedicine includes implementation of Tele-Consultation, Tele-radiology, Tele-dermatology, Tele-dentistry NATIONAL PERFORMANCE INDICATORS TERTIARY HOSPITALS Quarterly Indicators Data Source Type Audited/ actual performance Estimated performance MTEF projection National target 2014/15 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Caesarean section rate DHIS % 24.3 25.4 27.1 28 30 30 30
SUB PROGRAMME 6.1: HUMAN RESOURCE DEVELOPMENT PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR HUMAN RESOURCE DEVELOPMENT Strategic objective Performance indicator Strategic plan target Means of Source Audited/ Actual performance Estimated performance Medium term targets 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Provide human resource training and development Number of new bursaries awarded Strengthen the skills and human resource base Documented evidence 495 1219 229 266 375 475 515 Number of new participants appointed in the internship programme Documented evidence 971 1043 373 699 391 481 571 Number of new participants appointed in the learnership programme Documented evidence 24 35 37 45 397 397 397 QUARTERLY TARGETS FOR HUMAN RESOURCE DEVELOPMENT PROVINCIAL QUARTERLY TARGETS FOR HUMAN RESOURCE DEVELOPMENT FOR 2011/12
Performance indicator Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Number of new bursaries awarded Bi-annually 375 190 175 10 375 student progress monitored Number of new participants appointed in the internship programme Annually 391 Applications processed 391 391 interns inducted 391 interns inducted Number of new participants appointed in the learnership programme Bi-annually 397 37 360 397 learners inducted 397 learners inducted SUB-PROGRAMME 6.2: NURSE TRAINING COLLEGES PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR NURSE TRAINING COLLEGES Strategic objective Performance indicator Strategic plan target Means of verification/ Data Source Audited/ Actual performance Estimated Medium term targets 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Train and develop nurse professionals Number of post basic nurse professionals trained Train 340 nurses by 2014 Documented evidence/ College records 237 248 248 310 310 310 310 Number of professional nurses trained Train 2 500 nurses y 2014 Documented evidence/ College / campus records 566 443 783 800 800 800 800
Train and develop Emergency Care Technicians (ECT) Number of personnel trained as ECT 180 Course audit report No baseline No baseline 15 30 60 60 90 QUARTERLY TARGETS FOR HEALTH SCIENCES AND TRAINING FOR 2011/12 Performance indicator Reporting period Annual target 2011/12 Quarterly targets Q1 Q2 Q3 Q4 Number of personnel trained as Emergency Care Technicians (ECT) Quarterly 60 30 Applications processed 30 Applications processed NATIONAL PERFORMANCE INDICATORS FOR HEALTH SCIENCES AND TRAINING Annual indicators Data Source Audited / actual performance Estimate Medium term goals National target 2014/15 Type 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Intake of nurse students Documented evidence No 860 982 998 1 300 1 500 1 600 1 700 Students with bursaries from the province Documented evidence No 1 298 2 287 2216 250 350 450 490
Provide healthcare support services Number of hospitals with full complement of clinical health support services Provide full complement of clinical healthcare support services in all health facilities by 2014 Documented evidence 23 of 40 27 of 40 29 of 40 30 of 40 32 of 40 40 of 40 40 of 40 SUB-PROGRAMME: FORENSIC PATHOLOGY SERVICES Develop forensic pathology services Number of forensic pathology facilities developed 13 Documented evidence 7 9 12 12 13 - - 2.7.4 QUARTERLY TARGETS FOR HEALTH CARE SUPPORT SERVICES
2.8.3 PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR HEALTH FACILITIES MANAGEMENT STRATEGIC GOAL 9: Improve infrastructure development and maintenance PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR HEALTH FACILITIES MANAGEMENT Strategic objective Performance indicator Strategic Plan target Means of verification/ Data Source Audited/ actual performance Estimated Medium term targets 2007/08 2008/09 2009/10 2010/11 2011 /12 2012/13 2013/14 Develop, upgrade and maintain Health facilities Number of new and upgraded PHC facilities completed 77 IRM Reporting Model) 31 20 18 17 27 15 15 Number of EMS facilities completed 20 IRM 3 4 2 4 4 6 13 Number of hospitals on revitalization 6 hospitals revitalised IRM 2 0 0 7 2 2 2 Number of hospitals on revitalization under construction IRM 4 6 6 4 4 4 5 Number of hospitals on revitalization completed IRM 1 0 0 1 2 1 1
Number of Forensic Pathology Services (FPS) facilities completed 2 IRM 5 2 2 2 1 None None Number of Malaria facilities completed 15 IRM No baseline None 2 2 10 2 1 Malaria Head Office’s upgrade completed No baseline No baseline No baseline None 1 None None Number of new staff accommodation units / rooms completed per annum (18 ten bedroom blocks -180 rooms) 68 units IRM 87 None 157 94 18 (180) 18 (180) 17 (170) Develop, upgrade and maintain Health facilities Number of health institutions provided with own source of water 150 IRM 50 50 49 35 30 30 30 Number of health institutions provided with pollution free sanitation units 150 IRM 114 70 10 30 30 30 30 Number of health institutions with upgraded electrical supply 22 IRM 29 27 2 10 3 3 3
Number of health institutions with upgraded electrical supply Annually 3 One health facility at 75% electrical supply upgrade 2 health facilities at 25% electrical supply upgrade One health facility completed – 100% 2 health facilities at 25% electrical supply upgrade 2 health facilities at 75% electrical supply upgrade 2 health facilities completed – 100% Number of EMS facilities completed Annually 4 One at 75% construction progress 1 1 2 Number of hospitals on revitalization Annually 2 10% IPIP development 30% IPIP development 80% peer review National approval Number of hospitals on revitalization under construction Annually 4 4 hospitals under construction 4 hospitals under construction 4 hospitals under construction 4 hospitals under construction Number of hospitals on revitalization completed Annually 2 0 0 0 2 complete. Number of Forensic Pathology Services (FPS) facilities completed Annually 1 25% construction progress 50% construction progress 75% construction progress One FPS facility completed -100% Number of Malaria facilities completed Annually 10 2 6 at 75% construction progress 6 2 Malaria Head Office’s upgrade completed Annually 1 25% construction progress 50% construction progress 75% construction progress 100% completed
Health Professions training & Development grant Division of Revenue Act 12 of 2009 To support provinces to fund costs associated with training of health professionals; development and recruitment of medical specialists in under-served provinces; and support and strengthen under graduate and post graduate teaching and training processes in health facilities Number and composition of health sciences students by province and training institution (Under graduate) Number of registrars per discipline and per institution (post graduate Number of specialist per discipline Expanded specialist and teaching infrastructure in target provinces 348 students in various categories undergoing training 63 registrars appointed 90 specialists in various disciplines providing teaching in hospitals 50 specialists providing expanded teaching. Teaching aids available in hospitals National Tertiary Services Grant To compensate tertiary facilities for the additional costs associated with spill over effects to ensure the adequate provision of tertiary health services for all South African citizens. Number of tertiary health services provided 32 of 50 tertiary services
3.3 PUBLIC-PRIVATE PARTNERSHIPS (PPPs) Name of PPP Purpose Outputs Current annual budget (R’thousand) Date of termination Measures to ensure smooth transfer of responsibilities Limpopo Renal Dialysis Unit To Form partnership for financing, constructing, equipping, maintaining, operating and co-staffing an enlarged and refurbished renal facility; and Provide full range of haemodialysis and provision of support to the peritoneal outpatients services by private parties High quality serviced health facility delivered Facilities and management service consistent with the ethos, goals and values of the Department provided High quality renal services consistent with the international standards provided R14 million November 2016 Project Steering Committee established to ensure: Compliance to service level agreement skills transfer to the project team by the private partner that funding for the project is available decision to re- advertise or perform internally to be taken three years prior to termination (2013) Phalaborwa Hospital Acquire full PPP for financing, designing, upgrading, and refurbishment of the Phalaborwa Health Centre as a private hospital facility Private hospital established through PPP 15 years Agreement signed R200 000 December 2025 Project Steering Committee established to ensure: Compliance to service level agreement decision to re- advertise or perform internally to be taken three years prior to termination (2022)
Big bang project To explore the construction, upgrade, equipping and maintenance of all hospitals and Primary Health Care (PHC) facilities in a limited, conceded time frame to ensure fit for purpose built facilities in which health care can be rendered Hospitals and PHC facilities constructed, upgraded, equipped and maintained to benefit the total population of Limpopo in which quality health care will be provided R 20 million March 2012/13 (Feasibility Study Report) Project Steering Committee established to ensure: terms of reference for the feasibility study are completed transactional advisor is appointed feasibility study report is completed decision by the Department based on the recommendations of the feasibility study report is recorded Limpopo Academic Hospital Acquire full PPP for financing, designing and building the academic hospital High quality academic hospital services consistent with the international standards provided Transactional Advisor appointed in R10 million - Achievement of milestones as per PPP manual Laundry Acquire full PPP for financing, designing, upgrading, and refurbishment and building of the laundry High quality serviced health facility delivered High quality renal services consistent with the international standards provided R3 million - Achievement of milestones as per PPP manual
Provide security management services Improve physical and information security measures in the Department by 2014 Security management plan available Ensure compliance with security measures Secured and safe departmental environmental assets New Strategic objective Knowledge, Records, Information and management systems technology (KRIMST) established and operational Develop, implement and review KRIMST strategy and Policy by 2014 Standalone policies available. Records and information management units available and operational PHIS and DHIS available To provide and implement and integrated KRIMST strategy and Policy Improved accountability on resources resulting in and managed health services Strategic objective modified Programme 2: District Health Services Strengthen district health and hospital services Strengthen programmes on maternal, child, woman, youth, adolescent health and nutrition Reduce maternal deaths from 182.9 to 136.6 per 100 000 live Mortality under five reduced from 43.9 to 40.9 per 1000 live births by 2014 591 (18.9) reported maternal deaths for 3 years and 43.9/1000 live births for under 5 years mortality rates Implement programmes on MCWH and nutrition to reduce morbidity and mortality rates Improved child survival Strategic objective statement target changed Provide nutrition services Increase number of greenery projects from 506 to 756 506 Reduce malnutrition Improved nutritional status Strategic objective removed
Programme 5 Central and Tertiary Services Tertiary services developed Strengthen secondary hospital services Increase number of registrars by 10 % by 2014 31 Registrars Improve quality and access to care Improved quality of care Strategic objective modified Increase number of clinical disciplines conducting outreach by 10% by 2014 22 Reduce referrals to other provinces by 15% by 2014 5.3% Increase number of telemedicine from 3 pilot sites to 89 4 Pilot sites New strategic objective statement Promote health research Increase health research projects by 8% by 2014 104 Improve the quality of tertiary services Improved quality of care Strategic objective removed Programme 7: Health care support services Strengthen district health and hospital services Develop forensic pathology services Develop 13 forensic pathology facilities by 2014. 11 forensic pathology facilities established Response to medico legal and diagnosis requirements Improved access to forensic pathology services New strategic objective Programme 8 Health facilities management Improved infrastructure development and maintenance Develop, upgrade and maintain health facilities Construct 68 new staff accommodation units by 2014 417 staff accommodation constructed Part of the strategy to attract and retain health staff Improved quality of care Strategic objective statement target changed
OPD General clinic new case not referred rate” Number of General OPD clinic new cases (seeking medical attention for a condition for the first time) that report to the General OPD department without being referred from a PHC facility or doctor during the reporting period in all Hospitals (district, regional, tertiary and central) as a percentage of the OPD General headcount new visits total. Patients with General OPD follow-up visits, visiting specialised OPD clinics and Emergency patients are not counted in denominator, because this is not regarded as PHC level of care. Tracks the utilisation of Hospitals by patients to access PHC services, which in fact should be accessed at PHC services. This could also points to the needs for PHC services or gaps in PHC service delivery DHIS Numerator: OPD General clinic headcount case not referred. Denominator = OPD General clinic headcount new Sum of : OPD General clinic case referred OPD General clinic -new case not referred Accuracy of headcount depends on the reliability of district hospital record management at facility level Output Percentage Quarterly Yes Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Programme Manager
Incidence of severe malnutrition in children (under 5 years of age) The number of children who weigh below 60% Expected Weight for Age (new cases per month) per 1000 children in the target population Essential for growth monitoring in children DHIS Numerator The number of children who weigh below 60% Expected Weight for Age during the reporting period Denominator Children under 5 years x 1000 Accuracy dependent on quality of data from reporting facility Outcome Number per 1000 Quarterly (Indicator must be annualised) No Lower levels of prevalence of underweight (children under 5) are desired Health Information, Epidemiology and Research Programme Nutrition Programme Maternal, Child and Women’s Health Programme Infant mortality rate Number of children less than one year old who die in one year, per 1000 live births during that year Monitors trends in infant mortality South African Demographic And Health Surveys (SADHS) Numerator Number of children less than one year old who die in one year Denominator Total number of live births during that year x 1000 Data are not frequently available. Empirical data are available from the SADHS, which is conducted every 5 years Outcome Number per 1000 (rate) Empirical data are provided by the SADHS every 5 years No Lower Infant Mortality Rates are desired Maternal, Child and Women’s Health Programme
Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Measles coverage under 1 Percentage of children under 1 year who received their first measles dose Monitors measles coverage DHIS Numerator: Measles 1st dose before 1 year Denominator: Population under 1 year Reliant on under 1 population estimates from StatsSA Output Percentage Quarterly No Higher proportions of children immunised against measles are desired. Expanded Programme on Immunisation (EPI) Manager Maternal mortality ratio Number of women who die as a result of childbearing, during pregnancy or within 42 days of delivery or termination of pregnancy in one year, per 100,000 live births during that year Monitors trends in maternal mortality SADHS Numerator Number of women who die as a result of childbearing, during pregnancy or within 42 days of delivery or termination of pregnancy in one year Denominator Total number of live births during that year x 100,000 Data are not frequently available. Empirical data are available from the SADHS, which is conducted every 5 years Outcome Number per 100,000 Empirical data are provided by the SADHS every 5 years No Lower Maternal Mortality Ratios are desired Lower Health Information, Epidemiology and Research Programme MCWH Programme Proportion of births attended by skilled health personnel Percentage of women who gave birth in the 5 years preceding the South African Demographic Survey (SADHS) Monitors trends in maternal mortality SADHS Numerator Number of women who gave birth in the 5 years preceding the survey who reported Data are not frequently available. Empirical data are available from the Output Empirical data are provided by the SADHS every 5 years No Higher levels of skilled births attended by skilled health personnel are desired Health Information, Epidemiology and Research Programme
who reported that medical assistance at delivery from either a doctor, nurse or midwife that medical assistance at delivery from either a doctor, nurse or midwife Denominator Total number of women who gave birth in the 5 years preceding the survey SADHS, which is conducted every 5 years MCWH Programme Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility HIV and AIDS prevalence among 15-19 year old group (antenatal) Percentage of women aged 15-19 years surveyed testing positive for HIV Tracks prevalence of HIV and AIDS in younger women of reproductive age, and the success of efforts to combat HIV and AIDS in South Africa Annual Antenatal and HIV Survey Numerator: Women aged 15 – 19 years who tested HIV positive during the survey; Denominator: Women aged 15 – 19 years who were tested for HIV during the survey Reflects prevalence in surveyed women, not entire population. Outcome Percentage Annual No Lower levels of HIV and AIDS prevalence are desired Health Information, Epidemiology and Research Programme HIV and AIDS Programme
HIV and AIDS prevalence among year old group (antenatal) Percentage of women aged 20-24 years surveyed testing positive for HIV Tracks prevalence of HIV and AIDS in young adult women of reproductive age, and the success of efforts to combat HIV and AIDS in South Africa Annual Antenatal and HIV Survey Numerator: Women aged 20– 24 years who tested HIV positive during the survey; Denominator: Women aged 20 – 24 years who were tested for HIV during the survey Reflects prevalence in surveyed women, not entire population Outcome Percentage Annual No Lower levels of HIV and AIDS prevalence are desired Health Information, Epidemiology and Research Programme HIV and AIDS Programme Contraceptive Prevalence Rate Percentage of women of reproductive age (15-44) who are using (or whose partner is using) a modern contraceptive method. Contraceptive methods include female and male sterilisation, injectable and oral hormones, intrauterine devices, diaphragms, spermicides and condoms, natural family Track the extent of the use of contraception (any method) amongst women of child bearing age SADHS Data are not frequently available. Empirical data are available from the SADHS, which is conducted every 5 years Output Percentage Empirical data are provided by the SADHS every 5 years No Higher Contraceptive prevalence levels are desired Health Information, Epidemiology and Research Programme MCWH&N Programme
planning lactational amenorrhoea. Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility New smear positive PTB cure rate Percentage of patients who are proved to be cured using smear microscopy at the end of the treatment (bacteriological proof) Tracks the success of efforts to combat Tuberculosis in South Africa ETR.net (TB information system) Numerator: New smear positive cured Denominator: New smear positive newly registered Accuracy dependent on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicate better cure rate for the province TB Programme Manager 5.2 PROGRAMMES AND SUB-PROGRAMMES 1: ADMINISTRATION TABLES 6, 10 & 13: NATIONAL PERFORMANCE INDICATORS FOR HUMAN RESOURCES Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Medical officers per 100,000 people Medical officers in posts on last day of March per 100 000 Tracks the number of filled Medical officer’s posts as part of monitoring availability of Human Resources for Persal Medical Officers in posts ---------------- Total Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of medical officers contributes to improving HRM
people. Health population X 100 000 access to and quality of clinical care Medical officers per 100,000 people in rural districts Medical officers in posts employed in the Rural districts on last day of March per 100 000 people. Tracks the number of filled Medical officer employed in the rural districts, as part of monitoring availability of Human Resources for Health in Rural Districts. This indicator also assists in assessing urban /rural equity. Persal Medical Officers in posts- Rural ---------------- Total population in Rural Districts X 100 000 Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of medical officers in rural districts i contributes to improving access to and quality of clinical care in rural district. HRM Professional nurses per 100,000 people Professional Nurses in posts on last day of March per 100 000 people. Tracks the number of filled Professional Nurses posts , as part of monitoring availability of Human Resources for Health Persal Professional Nurses in posts ---------------- Total population X 100 000 Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of professional nurses contributes to improving access to and quality of health services HRM Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Professional nurses per 100,000 people in rural districts Professional Nurses in posts employed in rural districts on last day of March per Tracks the number Professional Nurses posts filled in rural districts, as part of monitoring availability of Human Resources for Health in Rural Persal Professional Nurses in posts- Rural ---------------- Total population in Rural Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of professional nurses in rural districts contributes to improving HRD
100 000 people. Districts. This indicator also assists in assessing urban /rural equity. Districts X 100 000 access to and quality of health services rural districts Pharmacists per 100,000 people Pharmacists in posts on last day of March per 100 000 people. Tracks the number of filled Pharmacists posts to monitor availability of Human Resources Persal Pharmacists in posts ---------------- Total population X 100 000 Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of Pharmacists lead to better quality of care HRD Pharmacists per 100,000 people in rural districts Pharmacists in posts employed in rural districts on last day of March per 100 000 people. Tracks the number Pharmacists posts filled in rural districts, as part of monitoring availability of Human Resources for Health in Rural Districts. This indicator also assists in assessing urban /rural equity Persal Pharmacists in posts - Rural ---------------- Total population in Rural Districts X 100 000 Dependant on accuracy of Persal system. Input Ratio per 100 000 population Annual No Increase in the number of Pharmacists in rural districts lead to better quality of care in these rural districts HRD Vacancy rate for professional nurses Percentage of funded vacant professional Nurses posts on the last day of the reporting period Tracks the number of funded vacant Professional Nurses posts to monitor availability of Human Resources Persal Total Number of funded vacant Professional Nurses posts ---------------- Total number of Dependant on accuracy of Persal data Process Ratio per 100 000 population Quarterly No Increase in the number of professional nurses lead to better quality of care HRD
Vacancy rate for medical specialists Percentage of funded vacant medical specialists posts on the last day of the reporting period Tracks the number of funded vacant medical specialists posts to monitor availability of Human Resources Persal Total Number of funded vacant medical specialists posts on the last day of the reporting period ---------------- Total number of medical specialists funded posts in the province Dependant on accuracy of Persal data Process Percentage Quarterly No Decrease in the vacancy rate lead to better quality of care Human Resources Management Vacancy rate for pharmacists Percentage of funded vacant pharmacists posts on the last day of the reporting period Tracks the number of funded vacant pharmacists posts to monitor availability of Human Resources Persal Total Number of funded vacant Pharmacists posts on the last day of the reporting period ---------------- Total number of funded pharmacists posts in the province Dependant on accuracy of Persal data Process Percentage Quarterly No Decrease in the vacancy rate lead to better quality of care Human Resources Management
TABLE 11 AND 12: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR ADMINISTRATION Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Type of Indicator Calculation Type Cycle New Indicator Desired Indicator Number of performance monitoring reviews conducted Examination and assessment of performance against set targets Track performance of programs or projects Monitoring and Evaluation Numerator Number of performance review conducted Denominator Number of performance review targeted None Output Sum total Quarterly No Output reflect progress monitoring Monitoring and Evaluation Number of research studies commissioned Formal study conducted through rigorous process to measure satisfaction rates of clients To improve quality of services Monitoring and Evaluation Study completed output Sum total annual yes improved quality of services Monitoring and Evaluation Number of Health facilities certificated for Accreditation ‘Certification for Accreditation’ shall mean the determination by the Accreditation body that an eligible Health facilities is certificated in compliance with applicable predetermined standards To provide quality of health services Compliance Reports Numerator Number of facilities certificated for accreditation Denominator Total number of facilities output Sum total annual yes improved quality of services Monitoring and Evaluation Number of institutions conducting risk assessments All institutions should conduct a risk assessment. In order to have a risk profile that keeps us aware of all operational PFMA Impact X Likelihood= Inherent risk control of risk output Basic maths quarterly No Risk culture Risk Management and all employees.
surprises that have an adverse effect towards achievement of objectives effectiveness= residual risk. content Number of institutions implementing security management plan Percentage compliance of institution Compliance include the following: Monitoring of service level agreement, conforming to the provisions of minimum information on security standards The identification of physical security measures that can be applied at institutions to safeguard or protect departmental assets – people, property and information Provide safe and secure environment for Departmental assets – property and information Minimum information Security Standards Numerator Number of institutions Denominator Total number of targeted institutions depends on credible security report process Number Quarterly No Secure and safe for assets Security management directorate
Number of sites with telemedicine infrastructure The total number of health sites that are equipped with telemedicine infrastructure To ensure all sites have telemedicine infrastructure for improved patient management Number of site telemedince infrastructure Only is Output Number Quarterly Yes Availability of in sites GITO Number of facilities that meet minimum requirements for data quality in terms of South African Statistics Quality Assurance Framework (SASQAF) Number of hospitals, PHCs and District offices with data that is accurate, reliable, complete, relevant and timeous. To provide credible information for informed decision making and planning DHIS Documented evidence Numerator Number of Institutions assessed for data quality Denominator Total number of all Health Institutions within the Province depends on quality of data from the Outcome Number Quarterly No High quality data in all Institutions is desired GITO Number of health professionals appointed 20 specialists, 340 medical offices, 37 dentists, 1417 professional nurse, 55 pharmacists & 312 Emergency care Practitioners appointed Tracks the appointment of the core health professionals to reduce the vacancy rate Persal & Vulindlela (HRM information System) Returns on appointments Headcount not yet captured are not reflected Job offers reported as Output Number Quarterly No Reaching the target Reduction of vacancy rate Human Resource Management
Percentage of people with disabilities employed Equity targets of People with Disability of affirmative action at the work place Equity Act People with Disability appointed --------------- Total number of personnel X 100. to the work place Output Ratio Bi annual No Equity achieved. Human Resource Planning and Research Percentage of bids awarded to Historically disadvantaged individual (HDI) Percentage of bids awarded to Historically disadvantaged individual (HDI) Bring the historically disadvantaged to the mainstream economy Consolidated procurement report Numerator Number of bids awarded to HDI Denominator Total bids awarded by 100% on the accuracy of data by end users Process Percentage Quarterly and annual No Address the imbalances of the past Supply Chain Management Percentage of bids awarded to Women Percentage of bids awarded to Women Improve participation of women in economic activities Consolidated procurement report Numerator Number of bids awarded to women Denominator Total bids awarded by 100% on the accuracy of data by end users Process Percentage Quarterly and annual No Address the imbalances of the past Supply Chain Management Percentage of bids awarded to Disabled Percentage of bids awarded to Disabled Improve participation of disabled in economic activities Consolidated procurement report Numerator Number of bids awarded to Disabled Denominator Total bids awarded by on the accuracy of data by end users Process Percentage Quarterly and annual No Address the imbalances of the past Supply Chain Management
100% Percentage of bids awarded to Youths Percentage of bids awarded to Youths Economic empowerment to the youth Consolidated procurement report Numerator Number of bids awarded to youths Denominator Total bids awarded by 100% on the accuracy of data by end users Process Percentage Quarterly and annual No Improved youth participation in economic activities Supply Chain Management Percentage of bids awarded to Locality Percentage of bids awarded to Locality Support local economic growth Consolidated procurement report Numerator Number of bids awarded to locality Denominator Total bids awarded by 100% on the accuracy of data by end users Process Percentage Quarterly and annual No Stimulate economic growth within the local Supply Chain Management Percentage of bids awarded to small medium and micro enterprise (SMME) Percentage of bids awarded to small medium and micro enterprise (SMME) Empower small medium and micro enterprise (SMME) to sustain themselves and create jobs Consolidated procurement report Numerator Number of bids awarded to SMMEs Denominator Total bids awarded by 100% on the accuracy of data by end users Process Percentage Quarterly and annual No and job creation Supply Chain Management
Percentage of institutions with credible asset registers Percentage of institutions with credible asset registers Proper recording assets Excel asset register BAS Numerator Number of institutions with credible asset register Denominator Total number of institutions by 100% on the accuracy of data by Process Percentage Annual No Account for all government assets Supply Chain Management Revenue collected Amount of revenue collected for the year Supplement resources to implement government programmes BAS Amount collected against the set target Rely on payment by patients process Amount Annual No Improved funding for delivering of services to the community Financial budgeting and revenue Audit opinion on financial management expressed by the Auditor General Financial statement fairly presented without any reservations To obtain unqualified audit report Auditor General’s report Audited annual financial statement Financial controls and with financial Process N/A Annual Yes and value for money CFO PROGRAMME 2; DISTRICT HEALTH SERVICES TABLES 17, 19 AND 21: NATIONAL PERFORMANCE INDICATORS FOR DISTRICT HEALTH SERVICES Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Provincial Total expenditure To monitor BAS Numerator Input Annual Annul No Higher levels DHS
PHC expenditure per uninsured person by the Provincial DoH on PHC services adequacy of funding levels for PHC services Total expenditure of the Province on PHC services (Programme 2) Denominator Number of uninsured people in the Provinces as indicated in STATSSA or Council for Medical Scheme data of expenditure reflect prioritisation of PHC services Programme Manager Financial Management Officials PHC total headcount Number of PHC patients seen during the reporting period. Each patient is counted once for each day they appear at the facility, regardless of the number of services provided on the day(s) they were seen Tracks the uptake of PHC services at each PHC site for the purposes of allocating staff and other resources. DHIS Sum total of PHC headcounts during the reporting period Accuracy of headcount depends on the reliability of PHC record management at facility level Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system DHS Programme Manager PHC total headcount – under 5 years Number of PHC patients under the age of 5 years seen during the reporting period. Each patient is Tracks the children under 5 uptake of PHC services at DHIS Sum of PHC headcount under 5 years during the reporting Accuracy of headcount depends on the reliability of PHC record Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease DHS Programme Manager
counted once for each day they appear at the facility, regardless of the number of services provided on the day(s) they were seen each PHC site for the purposes of allocating staff and other resources. period management at facility level amongst children, or greater reliance on public health system Utilisation rate - PHC Rate at which services are utilised by the target population, represented as the average number of visits per person per period in the target population. Tracks the uptake of PHC services at each PHC site for the purposes of allocating staff and other resources. DHIS - PHC Total Headcount StatsSA - Total Population Numerator: PHC total headcount Denominator: Total Population Dependant on the accuracy of estimated total population from StatsSA Output Annualised rate Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Programme Manager Utilisation rate - PHC under 5 years Rate at which services are utilised by the target population under 5 years, represented as the average number of visits per person per period in the target population. Tracks the uptake of PHC services at each PHC site for the purposes of allocating staff and other resources. DHIS - PHC headcount under 5 years StatsSA - Population under 5 years Numerator: PHC headcount under 5 years Denominator: Population under 5 years Dependant on the accuracy of estimated population 5 years an under from StatsSA Output Annualised rate Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Programme Manager Percentage of fixed PHC facilities that were visited by a supervisor Percentage of fixed PHC facilities that were visited by a supervisor at least once every month (official Tracks the supervision rate of all PHC facilities. DHIS Numerator: Number of fixed PHC facilities that were visited by a Dependant on the reporting the purpose of the visit by the supervisor to Quality Percentage Quarterly No Higher levels indicate better support to the PHC facility QA Programme Manager
at least once every month supervisor report completed) supervisor Denominator: Total number of fixed PHC facilities the PHC facility. Expenditure per PHC Headcount Expenditure per PHC headcount by provincial DoH at provincial PHC facilities. Tracks the cost to provincial DoH for every visit to provincial PHC facility. DHIS – PHC Total Headcount BAS – Expenditure on PHC by provincial DoH Numerator: Expenditure on PHC by provincial DoH Denominator: PHC Total Headcount Accuracy of headcount depends on the reliability of PHC record management at facility level and accuracy of expenditure depends on the accuracy of correct expenditure allocation Efficiency Rate Quarterly No Lower expenditure could indicate efficient use of financial resources, or incomplete provision of the comprehensive PHC package DHS Programme Manager Community Health Centres (CHCs) and Community Day Centres (CDCs) with resident doctor rate Percentage of CHCs and CDCs with at least one resident Doctor. Tracks the national norms of the PHC package QA Numerator: Total number of CHCs and CDCs with at least one resident Doctor. Denominator: Total number of CHCs and CDCs in the province Accuracy dependant on the quality of data from the reporting facility Input Percentage Quarterly Yes Higher percentage indicates better compliance to the national norms Human Resources Management Districts and Development
Number of PHC facilities assessed for compliance against the 6 priorities of the core standards Total number of PHC facilities assessed for compliance against the core standards Tracks the levels of compliance against the core standards QA Total number of PHC facilities assessed against the core standards. Process Sum Annual Yes Higher number indicates better compliance with the core standards Quality Assurance TABLES 18 AND 20: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISTRICT HEALTH SERVICES Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Type Reporting Cycle New Desired Performance Indicator
Number of Districts with functional District Management Teams Total quantity of Districts with management teams Support efficiency of the District Health Services DHIS N/D-total number of Districts that are having management teams over total number of district that exist in the Province Accuracy of the quality of data Output Quarterly no All Districts DEM Number of districts implementing the District Health Plan Total quantity of Districts who are implementing DHP Accelerating service delivery at District level DHIS N/D-number of districts who are implementing district health plan over the existing number of district in the Province Data subject to manipulation Output Quarterly No All Districts DEM Percentage supervision of PHC facilities Number of visits by the supervisor to PHC facilities To monitor and evaluate the of PHC service delivery DHIS N/D- number of visits done to PHC facilities by the supervisor over total number of visits to the existing PHC facilities Data collected subject to manipulation Output Quarterly No All PHC facilities to be honestly supervised Percentage of PHC facilities implementing full PHC package Percentage of PHC facilities that are implementing PHC package fully Access PHC facilities that provide all services that are mend for PHC level DHIS N/D-number of PHC facilities that implement PHC package over the total number of PHC facilities in the Province Data collected subject to manipulation output Quarterly No All PHC facilities DEM Percentage of facilities providing 24 hours service Percentage of PHC facilities that are providing 24hours service Access PHC services DHIS Numerical Manipulation of data Output Quarterly No All PHC facilities to provide 24 hours service DEM Number of NPOs supporting provision of PHC package NPOs are mainly HBC who are funded to support deliver of PHC package Community Home based Care services reports Additional : Waterberg: 26 Capricorn:79 Vhembe :120 Mopani:58 Total= 370 Process Addition ¼ none Target 400 Senior Manager NPO funding SUB PROGRAMME: DISTRICT HOSPITALS:
TABLES 22, 24 26: INDICATORS FOR DISTRICT HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Caesarean section rate in district hospitals Caesarean section deliveries in hospitals expressed as a percentage of all deliveries in hospitals. Track the performance of obstetric care of the district hospitals DHIS Numerator: Number of Caesarean sections performed Denominator: Total number of deliveries in facility Accuracy dependant on quality of data from reporting facility Output Percentage Quarterly No Higher percentage of Caesarean section indicates higher burden of disease, and/or poorer quality of antenatal care. MCWH&N Programme Manager Total separations in District Hospitals Recorded completion of treatment and/or the accommodation of a patient in district hospitals. Separations include inpatients who were discharged, transferred out to other hospitals or who died and includes Day Patients. Monitoring the service volumes DHIS Sum of: Inpatient deaths Inpatient Inpatient transfer out Day patient Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system District Health Services
Patient Day Equivalent in District Hospitals Patient day equivalent is weighted combination of inpatient days, day patient days, and OPD/Emergency total headcount, with inpatient days multiplied by a factor of 1, day patient multiplied by a factor of 0.5 and OPD/Emergency total headcount multiplied by a factor of 0.33. All hospital activity expressed as a equivalent to one inpatient day Monitoring the service volumes DHIS Sum of: Inpatient days 1/2 Day patients 1/3 OPD -total 1/3 OPD Headcount total = sum of: OPD specialist clinic + OPD general clinic Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system District Health Services OPD Headcount in district hospitals A headcount of all outpatients attending an outpatient clinic. Monitoring the service volumes DHIS Sum of: OPD specialist clinic OPD general clinic Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system District Health Services
District hospitals with monthly Maternal Mortality and Morbidity Meetings Percentage of district hospitals having monthly Maternal Mortality and Morbidity Meetings (3 per quarter) To monitor the quality of hospital services, as reflected in levels of diseases adverse events; and proportion of deaths Quality Assurance (QA) Numerator: Number of district hospitals having Maternal Mortality and Morbidity every month Denominator: Total number of district hospitals Accuracy dependant on quality of data from reporting facility Quality Percentage Quarterly No Higher percentage suggests better clinical governance Quality Assurance (QA) Percentage of complaints of users of District Hospital Services resolved within 25 days Percentage of complaints of users of District Hospital Services resolved within 25 days To monitor the management of the complaints in District Hospitals Quality Assurance Numerator: Total number of complaints resolved within 25 days during the quarter Denominator: Total number of complaints during the quarter Accuracy of information is dependent on the accuracy of time stamp for each complaint Quality Percentage Quarterly Yes Higher percentage suggest better management of complaints in District Hospitals Quality Assurance
Percentage of users of District Hospital Services satisfied with the services received The percentage of users that participated in the District Hospital Services survey that were satisfied with the services Tracks the service satisfaction of the District Hospital users QA Numerator: Total number of users that were satisfied with the services rendered in District Hospitals Denominator: Total number of users that participated in the Client Satisfaction Survey (in District Hospitals) Generalizability depends on the number of users participating in the survey. Output Percentage Annual Yes Higher percentage indicates better levels of satisfaction in District Hospital services Quality Assurance Percentage of District Hospitals facilities assessed for compliance against the 6 priorities of the core standards Percentage of District Hospitals assessed for compliance against the core standards Tracks the levels of compliance against the core standards QA Numerator: Total number of District Hospitals assessed against the 6 priority areas of the core standards. Denominator: Total number of District hospitals in the province. Process Sum Annual Yes Higher number indicates better compliance with the core standards in District Hospitals Quality Assurance
TABLES 23 AND 25: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISTRICT HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Type of Type Cycle New Desired Performance Indicator Number of hospitals complying with service package Number of hospitals which attain 80% in the District hospitals package Norms and Standards tool (NDOH) Track extent of provision of District Hospital services. Hospital Survey Sum of all hospitals which attain 80% or more in the District hospitals Norms and Standards tool Accuracy dependant on quality of data from reporting facility Quality Sum Annual No Higher performance indicates better compliance with Package District Health Services SUB PROGRAMME: HIV AND AIDS, TB AND STI CONTROL: TABLES 27, 29 31. SITUATION ANALYSIS INDICATORS FOR HIV & AIDS, AND TB CONTROL Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Total number of patients (Children and Adults) on ART Number of patients on an ARV regimen Track the number of patients on ARV Treatment CCMT Cumulative total of Number of patients on an ARV regimen Input Cumulative total Quarterly No Higher total indicates a larger population on ART treatment HIV/AIDS Programme Manager Male condom distribution rate Number of male condoms distributed within the province at public health facilities per male population 15 years and over Track the contraceptive measures DHIS Numerator: Male condoms distributed within province Denominator: Male population 15 and over Indicator reliant on accuracy of population estimates from StatsSA Process rate Quarterly No Higher rate indicates better contraceptive measures which should lead to decrease in HIV/AIDS incidence. HIV/AIDS Programme manager or
New smear positive PTB defaulter rate Percentage of smear positive PTB cases who interrupted (defaulted) treatment ETR Numerator: All smear positive defaulted Denominator: All smear positive newly registered Output Percentage Quarterly No Lower levels of interruption reflect improved case holding, which is important for facilitating successful TB treatment Smear result time under 48 hours rate Percentage of TB sputa tests completed with turnaround time of less than 48 hours Monitor the turnaround times of the sputa samples DHIS Numerator: TB sputa specimens with turnaround time less than 48 hours Denominator: All TB sputa specimens Accuracy of capturing the date/time sampled dispatched and/or received Quality Percentage Quarterly No Higher percentage indicate faster turnaround TB Programme manager Percentage of HIV-TB Co-infected patients placed on ART Percentage of HIV and TB patients placed on Ante retrovirus Treatment (ART) Monitors the coverage of ART among co-infected population ETR. Net Numerator: Total number of HIV and TB co-infected people placed on ART Denominator: Total number of people with a CD4 count of 350 or less. Dependant on the accuracy of the Electronic TB Register. Output Percentage Quarterly Yes Higher percentage indicate better coverage TB Programme Manager
28 30: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR HIV & AIDS, AND TB CONTROL Indicator Title Short Definition Source Method of Calculation Data Limitation Type of indicator Calculation Type Reporting Cycle New indicator Desired Performance Indicator Proportion of HIV exposed babies testing positive Babies born to known HIV positive mothers who were tested for HIV and found to be positive Measures transmission of HIV DHIS Numerator: Baby PCR test positive around 6 weeks & Baby HIV antibody test positive at 18 months Denominator: Baby PCR test around 6 weeks & Baby antibody test at 18 months None Output % Quarterly No Less positive babies reduce transmission rate PMTCT Programme Manager Percentage of HIV exposed infants who are PCR positive initiated on ART Percentage of HIV positive children below one year initiated on ART Measure if all children who are HIV positive below one year are initiated on treatment DHIS Numerator: number of PCR positive initiated on ART Denominator: Number of exposed babies testing PCR positive No yet aggregated on the DHIS Output % Quarterly Yes All antenatal clients to be tested for HIV PMTCT Programme Manager % of pregnant women who are tested for HIV The proportion of pregnant women tested for HIV for the first time during their current pregnancy Measures women testing for HIV during the current pregnancy DHIS Numerator: Antenatal clients HIV test Denominator: Antenatal clients eligible for HIV test (clients with unknown status) Not yet incorporated on DHIS for collection Output % Quarterly Yes All antenatal clients to be tested for HIV PMTCT Programme Manager ART service points registered Hospitals & PHC facilities accredited as ART services Measures competence in initiating HAART on pregnant women DHIS No of hospitals & PHC NGOs, correctional services facilities offering ART long life treatment None Input % Quarterly No Higher ART services points indicate adequate accessibility of services HIV/AIDS Programme Manager
Number of newly diagnosed eligible HIV positive patients starting INH Prophylactic Treatment HIV positive antenatal clients who are medically eligible for HAART, who were initiated on HAART therapy during the pregnancy Measures competence in initiating HAART on pregnant women DHIS Antenatal clients initiated on HAART Antenatal clients eligible for HAART Clients initiated on HAART is sourced from ART Data file Output % Quarterly No All eligible pregnant women initiated on HAART PMTCT Programme Manager Percentage of TB patients with a DOT supporter (DOT Coverage) Percentage of TB patients with a DOT supporter (DOT Coverage) Monitor directly observed treatment TB Register and ETR Numerator: TB patients with a DOT Supporter Denominator: All TB Patients Accuracy dependent on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicates better DOT coverage TB Programme Manager Treatment Success Rate (Cure Rate plus Completion Rate) Cure Rate (proven with smear microscopy at the end) plus Completion Rate ( not proven to be cured) Monitor success of treatment ETR Numerator: New smear positive cured plus cases who completed treatment Denominator: All PTB cases Accuracy dependant on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicate better success rate TB Programme Manager HIV testing rate among TB patients Percentage of TB patients tested for HIV Monitor testing rate for HIV ETR Numerator: Number tested for HIV Denominator: All PTB cases Accuracy dependent on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicate better testing rate for HIV TB Programme Manager Percentage of MDR-TB patients started on ARVs Percentage of co-infected MDR-TB patients started on Arts Monitor rate of initiation of ARVs on patients EDR Numerator: Number of co-infected MDR-TB patients initiated on ARVs Accuracy dependent on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicates better ARV uptake TB Programme Manager
Denominator: All co-infected MDR-TB cases Percentage of XDR-TB patients started on ARVs Percentage of co-infected XDR-TB patients started on ARVs Monitor rate of initiation of ARVs on patients EDR Numerator: Number of co-infected XDR-TB patients initiated on ARVs Denominator: All co-infected XDR-TB cases Accuracy dependent on quality of data from reporting facility Outcome Percentage Quarterly No Higher percentage indicates better ARV uptake TB Programme Manager Percentage of TB Patients with MDR-TB Percentage of patients with Drug resistance out of a total of TB patients Proper management of drug susceptible TB ETR.net Numerator: Number of MDRTB patients x 100 Denominator Total number of TB patients Errors in reporting Outcome Percentage Quarterly No Less than 2% Recording and reporting manager TB incidence rate New cases of TB per 100,000 Access & Quality of TB services Register Numerical Errors in reporting Outcome Number Annual No ½ by 2015 Snr Manager TB SUB PROGRAMME: MATERNAL, CHILD AND WOMAN HEALTH & NUTRITION TABLES 32, 34 36: NATIONAL PERFORAMANCE INDICATORS FOR MCWH & N Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility
Denominator: Population under 1 year Pneumococcal 3st dose coverage under 1 year Percentage of children under 1 year who received Pneumococcal 3st dose Monitor the Pneumococcal coverage DHIS Numerator: Pneumococcal 3rd doses before 1 year Denominator: Population under 1 year Reliant on under 1 population estimates from StatsSA Output Percentage Annualised Quarterly No Higher percentage indicate better Pneumococcal coverage EPI Programme manager Rota Virus 2nd dose coverage under 1 year Percentage of children under 1 year who received Rota Virus 2nd dose Monitor the Rota Virus coverage DHIS Numerator: Rota Virus 2nd doses before 1 year Denominator: Population under 1 year Reliant on under 1 population estimates from StatsSA Output Percentage Quarterly No Higher percentage indicate better Rota Virus coverage EPI Programme manager Cervical cancer screening coverage Percentage of women from 30 years and older who were screened for cervical cancer Monitor cervical cancer screening coverage DHIS Numerator: Cervical smear in woman 30-years and older screened for cervical cancer Denominator: Female population years Reliant on population estimates from StatsSA for women in age category years Output Percentage Annualised Quarterly No Higher percentage indicate better cervical cancer coverage MNCWH Programme Manager Antenatal visits before 20 weeks rate The percentage of women who have a booking visit (first visit) Utilisation of ANC services DHIS Numerator: Antenatal 1st visits before 20 weeks Reliant on accuracy of number of weeks the client is Process Percentage Quarterly No Higher percentage indicates better access to antenatal MNCWH programme Manager 59
before they are 20 weeks (about half way) into their pregnancy. Denominator: Antenatal 1st visits pregnant care. Couple Year Protection Rate Percentage of women of reproductive age (15-44) who are using (or whose partner is using) a modern contraceptive method. Contraceptive methods include female and male sterilisation , injectable, and oral hormones, intrauterine devices, diaphragms, spermicides and condoms Track the extent of the use of contraception (any method) amongst women of child bearing age DHIS SADHS Couple year protection rate: Numerator Contraceptive years equivalent = Sum: Male sterilisations x 20 Female sterilisations x10 Medroxyprogesterone injection /4 Norethisterone enanthate injection /6 Oral pill cycles /13 IUCD x 4 Male condoms /500 Denominator: Female target population 15-44 years Reliant on accuracy of data collection Output Percentage Annual No Higher protection levels are desired Health Information, Epidemiology and Research Programme MCWH&N Programme Delivery rate for women under 18 years Percentage of deliveries where the mother is under 18 years on the day of delivery. Monitor the percentage of deliveries among teenagers DHIS Numerator: Total number of Deliveries in province to woman under 18 years Denominator: Total Deliveries in province Outcome Percentage Annual No Higher percentage indicates increase in the number deliveries among teenagers. MCWH Programme manager facility Maternal Number of Confidential DHIS Numerator: Reliant on Outcome Ratio per Annual No Lower MNCWH
transfer out < 1) Facility child mortality (under 5 years) rate The number of children who have died in a health facility between birth and their fifth birthday, expressed per thousand live births in facility Monitoring of children deaths on a routine basis is very important to monitor progress towards MDG. DHIS Numerator: Total number of inpatient deaths under 5 years Denominator: Inpatients separations under 5 year (Sum of Inpatient discharge < 5 year and Inpatient transfer out < 5) Reliant on accuracy of in facility live births reporting Outcome Rate Annual No Lower children mortality rate N/A TABLE 33 AND 35 PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR MCWH&N
schools health services services Percentage of from the saving mothers report in all institutions Percentage of facilities implementing 8 out of 10 recommendations from the saving mothers report Monitors implementation of 8 out of 10 recommendations from the saving mothers report Reports Numerator: number of hospitals providing maternity care Denominator: Number of hospitals implementing 8 out of 10 recommendations from the saving mothers report Reliant on accuracy of the reports from institutions Process Percentage Quarterly No Higher percentage indicates better access quality maternal health services MNCWH programme Manager SUB PROGRAMME: DISEASE CONTROL AND PREVENTION
TABLES 38 AND 40: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR DISEASE CONTROL AND PREVENTION Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Type Reporting Cycle New Indicator Desired Indicator Number of dwellings sprayed Total quantity of dwellings sprayed with an insecticide by the malaria control spray teams A measurement of the of the main malaria control intervention Malaria Information system Numerical Accuracy dependant on quality of data from malaria spray teams Output Quarterly No Higher levels indicates better prevention against malaria in at risk Senior Manager: Malaria TABLES 37 AND 39: NATIONAL PERFORMANCE INDICATORS DISEASE CONTROL AND PREVENTION Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Malaria fatality rate (annual) Deaths from malaria as a percentage of the number of cases reported Monitor the number deaths caused by Malaria Numerator: Deaths from malaria Denominator: Total number of Malaria cases reported Accuracy dependant on quality of data from health facilities Outcome Rate Annual No Lower percentage indicates a decreasing burden of malaria Communicable Diseases
P1 calls with a response time of <40 minutes in a rural area Percentage of P1 call outs to rural locations with response times within national rural target (40 mins) Monitor Response times within national rural target EMS Information Systems Numerator: No priority 1 rural calls where Response times within national rural target Denominator: All priority 1 rural Call outs Accuracy dependant on quality of data from reporting EMS station Quality Percentage Quarterly No Higher percentage indicate better response times in the rural areas EMS Manager All calls with response time within 60 minutes Percentage of all call outs with response times within 60min Monitor Response times EMS Information Systems Numerator: No of calls where Response times within 60min Denominator: All Call outs Accuracy dependant on quality of data from reporting EMS station Quality Percentage Quarterly No Higher percentage indicate better response times EMS Manager
44 AND 46 PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR EMS Number of stations established Percentage of P1 call outs to rural locations with response times within national rural target (40 mins) Monitor Response times within national rural target EMS Systems Numerator: No priority 1 rural calls where Response times within national rural target All priority 1 rural Call outs Accuracy dependant on quality of data from reporting EMS station Quality No Higher indicate better response times in the rural areas EMS Manager Number of emergency care practitioners providing Number of all operational EMS Stations (46) Improve response times in all areas of operations EMS Plan (52) Numerator: Total number of rostered ambulances per station Denominator: Total number of rostered ambulances per district Reliance on accuracy of population estimates by stats SA Quality Sum no Reporting of improved response times may lead to improved EMS service delivery EMS Manager Number of ECPs providing EMS Number of available practitioners (1505) Improve Emergency Medical Services response times EMS Plan (3200) Numerator: Total number of available Operational staff Denominator: Total number of all calls serviced Reliance on accuracy of population estimates by stats SA Quality Sum no Higher number of recruited staff may lead to improved response times and EMS services EMS Manager
Number of planned patients transported All patients transported from one facility to the other Monitoring total number of patients moved from facility to facility EMS system Numerator: No of patients transported Accuracy dependant on quality of data from reporting EMS station Quality Number New Reduced number of patients EMS Manager SUB PROGRAMME: REGIONAL HOSPITALS: TABLE 51 AND 53: NATIONAL PERFORMANCE INDICATORS FOR REGIONAL HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Caesarean section rate in regional hospitals Caesarean section deliveries in hospitals expressed as a percentage of all deliveries in hospitals. Track the performance of obstetric care of the regional hospitals DHIS Numerator: Number of Caesarean sections performed Denominator: Total number of deliveries in regional hospitals Accuracy dependant on quality of data from reporting facility Output Percentage Quarterly No Higher percentage of Caesarean section indicates higher burden of disease, and/or poorer quality of antenatal care. Hospital
Total Separations in regional hospitals Recorded completion of treatment and/or the accommodation of a patient in district hospitals. Separations include inpatients who were discharged, transferred out to other hospitals or who died and includes Day Patients. Monitoring the service volumes DHIS Sum of: Inpatient deaths Inpatient Inpatient transfer out Day patient Accuracy dependant on quality of data from reporting facility Output Cumulative totals Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Hospital Services
OPD Headcount in Regional hospitals A headcount of all outpatients attending an outpatient clinic. Monitoring the service volumes DHIS Sum of: OPD specialist clinic OPD general clinic Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Hospital Services Average length of stay in Regional Hospitals Average number of patient days that an admitted patient in the regional hospital before separation. To monitor the efficiency of the district hospital DHIS Numerator: Inpatient days + 1/2 Day patients Denominator: Separations Sum of: Inpatient deaths Inpatient Inpatient transfer out Day patient Accuracy dependant on quality of data from reporting facility Efficiency Ratio Quarterly No A low average length of stay reflects high levels of efficiency. But these high efficiency levels might also compromise quality of hospital care Hospital Services
Bed utilisation rate (based on usable beds) in Regional Hospitals Patient days during the reporting period, expressed as a percentage of the sum of the daily number of usable beds in regional hospitals Track the over/under utilisation of regional hospital beds DHIS Numerator: Inpatient days + 1/2 Day patients Denominator: Number of usable bed days Accurate reporting sum of daily usable beds Efficiency Percentage Quarterly No Higher bed utilisation indicates efficient use of bed utilisation and/or higher burden of disease and/or better service levels Hospital Services Expenditure per patient day equivalent (PDE) in Regional Hospitals Expenditure per patient day which is a weighted combination of inpatient days, day patient days, and OPD/Emergency total headcount, with inpatient days multiplied by a factor of 1, day patient multiplied by a factor of 0.5 and OPD/Emergency total headcount multiplied by a factor of 0.33. All hospital activity expressed as a equivalent to one inpatient day Track the expenditure per PDE in regional hospitals in the province BAS / DHIS Numerator: Total Expenditure in district hospitals Denominator: Patient Day Equivalent (PDE)* Efficiency Rate Quarterly No Lower rate indicating efficient use of financial resources. Hospital Services.
Regional hospitals with monthly Maternal Mortality and Morbidity Meetings Percentage of Regional hospitals having monthly Maternal Mortality and Morbidity Meetings (3 per quarter) To monitor the quality of hospital services, as reflected in levels of diseases adverse events; and proportion of deaths Quality Assurance (QA) Numerator: Number of Regional hospitals having Maternal Mortality and Morbidity every month Denominator: Total number of Regional hospitals Accuracy dependant on quality of data from reporting facility Quality Percentage Quarterly No Higher percentage suggests better clinical governance Quality Assurance (QA) Percentage of complaints of users of Regional Hospital Services resolved within 25 days Percentage of complaints of users of Regional Hospital Services resolved within 60 days To monitor the management of the complaints in Regional Hospitals Quality Assurance Numerator: Total number of complaints resolved within 25 days during the quarter Denominator: Total number of complaints during the quarter Accuracy of information is dependent on the accuracy of time stamp for each complaint Quality Percentage Quarterly Yes Higher percentage suggest better management of complaints in Regional Hospitals Quality Assurance
Regional Hospital Patient Satisfaction rate The percentage of users that participated in the Regional Hospital Services survey that were satisfied with the services Tracks the service satisfaction of the Regional Hospital users QA Numerator: Total number of users that were satisfied with the services rendered in Regional Hospitals Denominator: Total number of users that participated in the Client Satisfaction Survey (in Regional Hospitals) Generalizability depends on the number of users participating in the survey. Output Percentage Annual Yes Higher percentage indicates better levels of satisfaction in Regional Hospital services Quality Assurance Percentage of Regional and specialist Hospitals assessed for compliance against 6 priority areas of the core standards Percentage of Regional and specialised Hospitals assessed for compliance against the core standards Tracks the levels of compliance against the 6 priority areas of the core standards QA Numerator: Total number of Regional and specialised hospitals assessed against the core standards. Denominator: Total number of Regional and specialised hospitals in the province Process Sum Annual Yes Higher number indicates better compliance with the core standards in Regional Hospitals Quality Assurance
50 AND 52: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR REGIONAL HOSPITALS Percentage reduction in referrals to tertiary level Reduction in number of patients transferred from facilities to tertiary To improve access to tertiary services Numerator Number of patients transferred Denominator Total number of patients admitted Reliability No To improve access to tertiary services Hospital Service Number of hospitals conducting outreach programs weekly Number of hospitals and disciplines that provide visits for teaching and patient care support to other hospitals To strengthen Clinical care services at district level Sum of Programmes submitted Reliability Process Number quarterly No To strengthen tertiary services Hospital Service Number of health facilities implementing 75% of the basic nursing care package Essential nursing service package that should be provided to every individual in need of patient care To monitor of the Basic Nursing Care Package by all the health care facilities in Limpopo Legally mandated by the Nursing Act No 33 of 2005 and Regulation 2598 as amended Number of health facilities implementing 90% of the Basic Nursing Care Package quality of nursing care Number Yes All 40 hospitals and 416 PHC facilities must provide quality care by implement 90% and more of the Basic Nursing Care Package Nursing Services Directorate
SUB PROGRAMME: SPECIALISED HOSPITALS: TABLE 54 AND 55: NATIONAL PERFORMANCE INDICATORS FOR SPECIALISED HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Cycle New Desired Performance Indicator Average length of stay in specialised hospitals (acute) Average number of acute patient days that an admitted patient in this hospital spends in hospital before separation. To monitor the efficiency of the district hospital DHIS Numerator: Acute Inpatient days + 1/2 Day patients Denominator: Separations Sum of: Acute Inpatient deaths Acute Inpatient Acute Inpatient transfer out Day patient) Accuracy dependant on quality of data from reporting facility Ratio Quarterly No A low average length of stay reflects high levels of efficiency. But these high efficiency levels might also compromise quality of hospital care Hospital Services Average length of stay in specialised hospitals (sub-acute) Average number of patient days that an admitted patient in this hospital spends in hospital before separation. To monitor the efficiency of the district hospital DHIS Numerator: Sub-acute Inpatient days + 1/2 Day patients Accuracy dependant on quality of data from reporting facility Ratio Quarterly No A low average length of stay reflects high levels of efficiency. But these high efficiency levels might also Hospital Services
Denominator: Separations Sum of: Sub-acute Inpatient deaths Sub-acute Inpatient Sub-acute Inpatient transfer out Day patient) compromise quality of hospital care Bed utilisation rate (based on usable beds) in specialised hospitals Patient days during the reporting period, expressed as a percentage of the sum of the daily number of usable beds in specialised hospitals Track the over/under utilisation of specialised hospitals beds DHIS Numerator: Inpatient days + 1/2 Day patients Denominator: Number of usable bed days Accurate reporting sum of daily usable beds Percentage Quarterly No Higher bed utilisation indicates efficient use of bed utilisation and/or higher burden of disease and/or better service levels Hospital Services Percentage of mental Health Care users (MHCU) on leave of absence Mental Health Care users (MHCU) on leave of absence expressed as percentage of all mental health care users in hospital Track the ability of the mental health care users to adapt to community environment and their readiness to be integrated Hospital records Numerator: Number of mental health care users on leave of absence in specialised hospitals Accuracy dependant on quality of data from reporting facility Output Percentage Quarterly No Higher number of mental health care users rehabilitated Hospital services
Denominator: Total number of mental health care users in specialised hospitals Percentage of specialised hospitals assessed for compliance against 6 priority areas of the core standards Percentage of specialised hospitals assessed for compliance against the core standards Tracks the levels of compliance against the 6 priority areas of the core standards QA Numerator: Total number of specialised hospitals assessed against the core standards. Denominator: Total number of specialised hospitals in the province Process Sum Annual Yes Higher number indicates better compliance with the core standards specialised hospitals Quality Assurance
PROGRAMME 5: CENTRAL/TERTIARY HOSPITALS TABLE AND 61: NATIONAL PERFORMANCE INDICATORS FOR TERTIARY HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Caesarean section rate for Central / Tertiary hospitals Caesarean section deliveries in hospitals expressed as a percentage of all deliveries in central and tertiary hospitals Track the performance of obstetric care of the central and tertiary hospitals DHIS Numerator: Number of Caesarean sections performed in central and tertiary hospitals Denominator: Total number of deliveries in central and tertiary hospitals Accuracy dependant on quality of data from reporting facility Output Percentage Quarterly No Higher percentage of Caesarean section indicates higher burden of disease, and/or poorer quality of antenatal care. Hospital Total Separations in Central/Tertiary Hospitals Recorded completion of treatment and/or the accommodation of a patient in district hospitals. Separations include inpatients who were discharged, transferred out to other hospitals or who died and includes Day Patients. (in central and tertiary Monitoring the service volumes DHIS Sum of: Inpatient deaths Inpatient Inpatient transfer out Day patient (All above in central and tertiary hospitals) Accuracy dependant on quality of data from reporting facility Output Cumulative totals Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Hospital Services
hospitals) Patient Day Equivalent in Central/Tertiary Hospitals Patient day equivalent is weighted combination of inpatient days, day patient days, and OPD/Emergency total headcount, with inpatient days multiplied by a factor of 1, day patient multiplied by a factor of 0.5 and OPD/Emergency total headcount multiplied by a factor of 0.33. All hospital activity expressed as a equivalent to one inpatient day Monitoring the service volumes DHIS Sum of: Inpatient days 1/2 Day patients 1/3 OPD -total 1/3 OPD Headcount total = sum of: OPD specialist clinic + OPD general clinic + Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Hospital Services
OPD Headcount in Central/Tertiary hospitals A headcount of all outpatients attending an outpatient clinic. Monitoring the service volumes DHIS Sum of: OPD specialist clinic OPD general clinic Accuracy dependant on quality of data from reporting facility Output Sum Quarterly No Higher levels of uptake may indicate an increased burden of disease, or greater reliance on public health system Hospital Services Average length of stay in central and tertiary hospitals Average number of patient days that an admitted patient in this hospital spends in hospital before separation. To monitor the efficiency of the district hospital DHIS Numerator: Inpatient days + 1/2 Day patients Denominator: Separations Sum of: Inpatient deaths Inpatient Inpatient transfer out Day patient) Accuracy dependant on quality of data from reporting facility Efficiency Ratio Quarterly No A low average length of stay reflects high levels of efficiency. But these high efficiency levels might also compromise quality of hospital care Hospital Services
Central Tertiary hospitals with monthly Maternal Mortality and Morbidity Meetings Percentage of Central / Tertiary hospitals having monthly Maternal Mortality and Morbidity Meetings (3 per quarter) To monitor the quality of hospital services, as reflected in levels of diseases adverse events; and proportion of deaths Quality Assurance (QA) Numerator: Number of Central / Tertiary hospitals having Maternal Mortality and Morbidity every month Denominator: Total number of Central / Tertiary hospitals Accuracy dependant on quality of data from reporting facility Quality Percentage Quarterly No Higher percentage suggests better clinical governance Quality Assurance (QA) Percentage of complaints of users of Central / Tertiary Hospital Services resolved within 25 days Percentage of complaints of users of Central / Tertiary Hospital Services resolved within 25 days To monitor the management of the complaints in Central / Tertiary Hospitals Quality Assurance Numerator: Total number of complaints resolved within 60 days during the quarter Denominator: Total number of complaints during the quarter Accuracy of information is dependent on the accuracy of time stamp for each complaint Quality Percentage Quarterly Yes Higher percentage suggest better management of complaints in Central / Tertiary Hospitals Quality Assurance
Central and Tertiary Hospital Patient Satisfaction rate The percentage of users that participated in the Central and Tertiary Hospital Services survey that were satisfied with the services Tracks the service satisfaction of the Regional Hospital users QA Numerator: Total number of users that were satisfied with the services rendered in Central and Tertiary Hospital Denominator: Total number of users that participated in the Client Satisfaction Survey (in Central and Tertiary Hospitals) Generalizability depends on the number of users participating in the survey. Output Percentage Annual Yes Higher percentage indicates better levels of satisfaction in Central and Tertiary Hospital services Quality Assurance Percentage of Central and Tertiary Hospitals assessed for compliance against 6 priority areas of the core standards Percentage of Central and Tertiary Hospital assessed for compliance against the core standards Tracks the levels of compliance against the 6 priority areas of the core standards QA Numerator: Total number of Central and Tertiary Hospitals assessed against the core standards. Denominator: Total number of Central and Tertiary Hospitals in the province Process Sum Annual Yes Higher number indicates better compliance with the core standards in Central and Tertiary Hospitals Quality Assurance
58 AND 60: PROVINCIAL STRATEGIC OBJECTIVES AND ANNUAL TARGETS FOR TERTIARY HOSPITALS Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Type Cycle New Indicator Desired Indicator Number of tertiary services provided Number of tertiary services provided according to Modernisation of Tertiary Services To improve access to Tertiary services Information DHIS Sum of Tertiary services Inaccuracies Reliability Output Number Quarterly No To improve access to tertiary services Hospital Service Number of disciplines conducting outreach programmes Number of Clinical disciplines that conduct visits for teaching and patient care support to other hospitals To strengthen Tertiary services at Regional and district level Information Sum of Programmes submitted yearly Inaccuracies Reliability Process Number Quarterly No To strengthen tertiary services Hospital Service Percentage referrals outside of province (reduction) Reduction in number of patients transferred outside of Province To improve access to Tertiary services Information DHIS Numerator Number of patients transferred Denominator Total number of patients admitted Inaccuracies Reliability Outcome Quarterly No To Provide tertiary services Hospital Service Number of institutions using Number of institutions using Tele-medicine to access tertiary care and capacitate health workers in peripheral facilities To improve access to Tertiary services Clinical Records Sum of institutions using tele-medicine Reliability Process Number Quarterly Yes To improve access to tertiary services Hospital Service Number of registrars appointed Number of registrars in training for various specialities To increase training of specialists to provide tertiary services HR Records Sum of registrars appointed Inaccuracies Reliability Output Number Quarterly Yes To strengthen tertiary services Hospital Service
PPROGRAMME 6: HEALTH SCIENCES AND TRAINING TABLE 64-69 AND 73: PROVINCIAL PERFORMANCE INDICATORS HEALTH SCIENCES AND TRAINING Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Type Cycle New Desired Performance Indicator Number of new bursaries awarded Financial assistance to students pursuing Health Science Related qualifications To increase the production of Health professional for effective and efficient Health Care Service Delivery HRP and HRD strategy Population size of the district X Total Number of grants per field ------------------ Total population of the province Data reliability depends on the availability of automated system Output Sum Total Quarterly No Bridging of the skills shortages within the department Human Resource Development and Training Number of new participants appointed in the internship programme Workplace Experiential Learning Empower youth to gain experience of work and prepare them to contribute to the economy Human Resource PLAN and HRD strategy Percentage of total staff establishment Budget constraints Output Quarterly No Experienced and appointable graduates Human Resource Development and Training Number of new participants appointed in the learnership programme Workplace Learning Empower the youth to Acquire a registered qualification on the National Qualification framework and prepare them to contribute to the economy Human Resource PLAN Percentage of total staff establishment Budget constraints Output Quarterly No Qualified learners on NQF Level qualification Human Resource Development and Training Number of post basic nurse trained Number of professional nurses trained on post-basic nursing programmes Professional nurses trained for development of all levels of care Human Resource No of post basic nurses trained Dependent on study leave and availability of posts output Sum total Annual No Desired pass rate on all programmes Nursing Education
70: NATIONAL PERFORMANCE INDICATORS HEALTH SCIENCES AND TRAINING Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Intake of nurse students Number of nurses entering the first year of nursing college Tracks the training of nurses Human Resources Development No denominator Data quality depends on good record keeping by both the Provincial DoH and nursing colleges Input Sum total Annual No Higher levels of intake are desired, to increase the availability of nurses in future Human Resources Development Programme Students with bursaries from the province Number of students provided with bursaries by the provincial department of health Tracks the numbers of health science students sponsored by the Province to undergo training as future health care providers Human Resources Development No denominator Data quality depends on good record keeping by both the Provincial DoH and Health Science Training institutions Input Sum total Annual No Higher numbers of students provided with bursaries are desired, as this has the potential to increase future health care providers Human Resources Development Basic nurse students graduating Number of students who graduate from the basic nursing course Tracks the production of nurses Human Resources Development No denominator Data quality depends on good record keeping by both the Provincial DoH and nursing colleges Output Sum total Annual No Desired performance level is that higher numbers of nursing students should be graduating Programme
PROGRAMME 7: HEALTH CARE SUPPORT SERVICES TABLE 73 AND 74 PROVINCIAL PERFORMANCE INDICATORS FOR HEALTH CARE SUPPORT SERVICES Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Percentage availability of essential medicines This is the percentage of essential medicines and surgical sundries monitored at the depot, hospitals and clinics To ensure that essential medicines and surgical sundries are available at the depot, hospitals and clinics PDSX information system, hospital and clinic data collection tool. Numerator: Totals number of medicines available at depot, Hospitals and clinics. Denominator: Total number of medicines to be monitored. Total for Depot= 683 Hospitals= 101 Clinics= 273 Data quality from hospitals and clinics depend on good record keeping by hospital Pharmacies. Outcome Percentage Quarterly No High percentage indicates the availability of ordered medicines and surgical sundries from the suppliers Pharmaceutical services Number of Hospitals with full complement of clinical health support services The hospital should have all eight Clinical health support disciplines To provide access to services Hospitals Number hospitals with full complement over the total number of hospitals High turnover of Personnel Input Numerical Quarterly No When all hospitals are covered access to services is increased Clinical Health support Manager and Hospital CEOs Number of Forensic Pathology Services (FPS) facilities completed FPS facilities that have been built to completion Tracks the number of FPS facilities that have been built to completion Health Facilities Management Programme Numerator Number of FPS facilities completed during reporting period Denominator Total number of FPS facilities targeted for completion during reporting period Whether completion is defined as practical completion or final handover Completed within or above the contractual period (time and value) Output Sum total Annual No Higher numbers reflect progress with completion and provision of FPS facilities Health Facilities Management Programme
PROGRAMME 8; HEALTH FACILITIES MANAGEMENT TABLE 77 AND 78 NATIONAL PERFORMANCE INDICATORS FOR HEALTH FACILITIES MANGEMENT Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Type Cycle New Desired Indicator Equitable share capital programme as % of total health expenditure Expenditure on buildings and equipment from the provincial equitable share allocation (I.e. excluding conditional grants) as a percentage of total provincial health expenditure Tracks expenditure on health and equipment Health Facility Maintenance Programme BAS Numerator Expenditure on buildings upgrade renovation and construction Denominator Total Expenditure by provincial DoH (equitable share) Data quality is reliant on accurate costing and assessment of the condition of health facilities Quality in Rands Annual No Higher average backlog of service platform reflects poor condition of health facilities. In some instances, it might even be more cost-effective to replace than to repair the facility Health Facility Maintenance Programme Number of Hospitals funded from the revitalisation programme Number of hospitals with funding from the Grant from 2003 Tracks progress with the revitalisation of hospitals to improve service delivery Health Facility Maintenance Programme No Denominator Focus should be on hospitals that have been actually funded for planning or or both, but not on approved business cases that have not been funded Input Sum Annual No Higher percentages of hospitals funded reflect progress with the revitalisation of hospitals Health Facility Maintenance Programme
Level 1 beds per 1000 uninsured population Level 1 beds in all hospitals per 1,000 uninsured population Tracks the provision and availability of Level 1 beds in the Province Integrated Health Planning Framework Provincial Service Transformation Plan Service Plan Numerator: Level 1 beds in all hospitals Total uninsured population x 1000 Depends on accuracy of population data Outcome Number per 1000 Annual No Higher numbers of Level 1 beds suggest that the need for Level 1 beds is being met. But bed occupancy rates must also be assessed to develop an informed judgement Health Facility Maintenance Programme Level 2 beds per 1000 uninsured population Level 2 beds in all hospitals per 1,000 uninsured population Tracks the provision and availability of Level 2 beds in the Province Integrated Health Planning Framework Provincial Service Transformation Plan Service Plan Numerator: Level 2 beds in all hospitals Total uninsured population x 1000 Depends on accuracy of population data Outcome Number per 1000 Annual No Higher numbers of Level 2 beds suggest that the need for Level 2 beds is being met. But bed occupancy rates must also be assessed to develop an informed judgement Health Facility Maintenance Programme
TABLES 80 AND 81 PROVINCIAL PERFORMANCE INDICATORS FOR HEALTH FACILITIES MANAGEMENT Indicator Title Short Definition Purpose/ Importance Source Method of Calculation Data Limitations Type of Indicator Calculation Type Reporting Cycle New Indicator Desired Performance Indicator Responsibility Number of Primary Health Care (PHC) facilities completed Fixed PHC facilities that have been built to completion Tracks the number of PHC facilities that have been built to completion Health Facilities Management Programme Numerator Number of Fixed PHC facilities completed during reporting period Denominator Total number of fixed PHC facilities targeted for completion during reporting period Whether completion is defined as practical completion or final handover Completed within or above the contractual period (time and value) Output Sum total Annual No Higher numbers reflect progress with completion and provision of PHC facilities Health Facilities Management Programme Number of new Emergency Medical Services (EMS) facilities completed Fixed new EMS facilities that have been built to completion Tracks the number of new EMS facilities that have been built to completion Health Facilities Management Programme Numerator Number of EMS facilities completed during reporting period Denominator Total number of EMS facilities targeted for completion during reporting period Whether completion is defined as practical completion or final handover Completed within or above the contractual period (time and value) Output Sum total Annual No Higher numbers reflect progress with completion and provision of EMS facilities Health Facilities Management Programme
Number of hospitals on revitalisation on preplanning Hospitals that are taken from the priority list to start with revitalization programme Track hospital hospitals that are revitalized Provincial Hospital Revitalization Priority list NPHF Model Revised annual using indicators provided in the Project Implementation Manual from National Department of health output NPHF Model Quarterly No Approved Business cases Health Facilities Management Programme Number of hospitals on revitalization completed Hospitals on revitalization wherein all construction projects have been completed Tracks the number of hospitals on revitalization which have been upgraded / built to completion Health Facilities Management Programme Numerator Number of hospitals on revitalization program completed during reporting period Denominator Total number of hospitals on revitalization program targeted for completion during reporting period Whether completion is defined as practical completion or final handover Completed within or above the contractual period (time and value) Output Sum total Annual No Higher numbers reflect progress with completion of hospital on revitalization program Health Facilities Management Programme Number of Forensic Pathology Services (FPS) facilities completed FPS facilities that have been built to completion Tracks the number of FPS facilities that have been built to completion Health Facilities Management Programme Numerator Number of FPS facilities completed during reporting period Whether completion is defined as practical completion or final handover Output Sum total Annual No Higher numbers reflect progress with completion and provision of FPS facilities Health Facilities Management Programme
Number of health facilities provided with own source of water Health facilities that have access to own source of water Tracks the provision of own source of water services to health facilities Health Facilities Management Programme Numerator Health facilities provided with access to own source of water during reporting period Denominator Total number of health facilities targeted to be provided with own water during reporting period Dependent on availability of underground water and boreholes drying up Output Sum total Annual No Higher numbers reflect progress with provision of own source of water to health facilities Health Facilities Management Programme Number of health facilities provided with pollution free sanitation units PHC facilities with access to pollution free sanitation units Tracks the provision of pollution free sanitation services to PHC facilities Health Facilities Management Programme Numerator Fixed PHC facilities provided with access to pollution free sanitation units during reporting period Denominator Total number of fixed PHC facilities targeted to be provided with pollution free sanitation services during reporting period Whether completion is defined as practical completion or final handover Completed within or above the contractual period (time and value) Output Sum total Annual No Higher numbers reflect progress with provision of pollution free sanitation services to PHC facilities Health Facilities Management Programme
Number of health facilities with upgraded electrical supply Health facilities that have access to electricity as per required quantity Tracks the provision of electricity services as per required quantity to health facilities Health Facilities Management Programme Numerator Health facilities with upgraded electrical supply during reporting period Denominator Total number of health facilities targeted for electrical upgrading during reporting period Completed within or above the contractual period (time and value) Output Sum total Quarterly No Higher numbers reflect progress with provision of upgraded electricity supply to health facilities Health Facilities Management Programme Percentage of health facilities complying with maintenance contracts Compliance of health facilities with maintenance term contracts available Tracks compliance of maintenance term contracts within the Health Department Health Facilities Management Programme & hospitals Numerator Number of health facilities complying with maintenance term contracts during reporting period Denominator Total number of health facilities during reporting period availability of norms and standards for maintenance term contracts Output Sum total Quarterly Yes Higher numbers progress towards compliance Health Facilities Management Programme