sahr2001 - Health Systems Trust

Goals, Indicators and Targets
The development of district based health status indicators is a slow and
difficult process. Health status indicators b are conceptually difficult to
understand. Difficulty experienced in developing relevant district level
indicators is exacerbated by both the lack of clearly formulated health status
indicators at provincial and national levels and the lack of accurate facility
and district level catchment population denominator data.
The measure of improved coverage and quality of health services is determined
by its impact on health outcomes and health status. The traditional assessment
of coverage provides information on the people who attend health services –
utilisation rates. True coverage should determine to what extent health services
are meeting the needs of the whole community – catchment population.
Census data have been made available to all provinces in various age, gender,
race and socio-demographic permutations from the national Department of
Health. Provincial offices further distributed these data. However, these data
are seldom available in a format that is easily accessible and usable for
operational management at district level. The Municipal Demarcation Board
provided population figures for local municipalities. These figures are not
age cohort appropriate for use within the health sector.
Using the growth estimate formula provided by Statistics South Africa, it is
possible to make annual mid-year adjustments of the population figures.
The potential exists to break down these catchment populations into
appropriate gender and age cohorts for use in monitoring coverage and quality
of health services at both district and facility levels.
Numeracy skill among health workers is generally weak. A review of data
reflects a lack of understanding of basic epidemiological principles. The
concept of rates as per 100, 1000 or 10 000 is poorly understood as
demonstrated by the submission of data in excess of 100%. The lack of
access to and understanding of population-based denominator data has
resulted in headcount being commonly used to evaluate aspects of service
delivery and activity. This is aggravated by the demand from service and
programme managers for raw data rather than indicator based data. This
makes meaningful comparisons between facilities, districts, regions and
provinces difficult.
b Health status indicators provide both direct and indirect measures of coverage and
quality of health service delivery and serve as a valuable tool in the management and
planning of health services at both local and national levels. Service and programme
managers at both provincial and national levels have initiated mechanisms to explore
development of appropriate indicators. The challenge lies in balancing local initiative
with the need for standardisation that will facilitate inter-provincial as well as national
and international comparison.
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