DHB 2006/07 - Health Systems Trust

Section B: District and Province Profiles
Free State
Ross Haynes
The Free State, with almost three million people contains
6.2% of the SA population. The province is not considered
to be poor, as all but one of its districts are in the 3 rd and
4 th highest socio-economic quintiles and an average of
95.3% of households have access to piped water. On the
other hand, 48% of households lived on less than R800
per month in 2005. In 2006/07, R237 per capita was spent
on primary health care services, a significant increase from
R131 per capita in 2001. The utilisation rate of PHC
facilities has declined slowly over the past three years to
two visits per person per year, which is well below the
target set by the national Department of Health of 3.5
visits. The clinical workload of nurses has increased over
the past three years to the current number of 36.3 patients
per nurse per day.
The TB cure rate improved marginally to 67.5% in 2005.
There was a steady improvement in the smear conversion
rate from 58.5% in 2004 to 67.2% in 2006. There was a
big increase in the proportion of ANC clients tested for
HIV to 66.9% in 2006/07. Unfortunately the data linked
to nevirapine uptake by HIV +ve mothers and their babies
has fluctuated so much that it is not possible to interpret
these data. More attention needs to be given to this in
all districts.
The incidence of STIs improved steadily from 4.5% in
2003/04 to 3.7% in 2006/07. During the same time period
the condom distribution rate remained fairly constant at
around 7 condoms per man per year. This is indicative of
a lack of prioritisation of this important preventive activity.
The delivery rate in facilities dropped marginally in the
past year to 80% in 2006/07, but remained higher than
the national average. Of these deliveries in district hospitals,
11.6% resulted in Caesarean sections.
Although the stillbirth rate and the perinatal mortality
rates have again declined to 28.3 and 38.1 per 1000 births
respectively, the stillbirth rate was still the 2 nd highest in
SA in 2006/07. The proportion of children under five who
are not gaining weight increased slightly to 3.6% in 2006/07
and remained the highest rate in SA.
The immunisation coverage improved steadily over the
past three years to 88.3% in 2006/07. The marked
improvement in the drop out rate in 2005/06 was not
maintained in 2006/07, suggesting a data error in 2005/06.
The overall pattern of improvement since 2003/04 had
nevertheless been maintained.
For the district hospitals, the indicators show that for the
last four years the average length of stay was steady at
around thee days, which is amongst the lowest in the
country. The bed utilisation rate in the district hospitals
decreased from 71.1% to 67.3% in 2006/07, the lowest
level in the past four years, but still 3 rd best in the country.
Both these indicators point to relatively well-managed
district hospitals.
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