sahr2001 - Health Systems Trust

Health Services Indicators
Health Facilities
The number and type of health facilities in the country is undergoing constant
change. However, additional data have become available in the National
Health Accounts projects and are reflected in the Intergovernmental Fiscal
Review. One particular area of continued confusion is the number of beds in
each category in the public sector. While hospitals have generally been
designated as either district, regional or central in nature, they may include
‘beds’ of a combination of types. For instance, a regional hospital may continue
to provide some district-level services and have wards allocated accordingly.
The only source for the private sector remains the Hospital Association of
South Africa (HASA) [Health Annals 2001]. Since virtually all private sector
hospitals with inpatient facilities are members of HASA, their figures are
taken as a reasonably accurate reflection of the sector. However, not all day
clinics and stand-alone operating facilities may be included.
While the number of facilities and their distribution are an indicator of access,
their level of equipment is an indicator of quality. Clearly, much more data
will be needed in the future to allow comparisons between districts and to
track progress towards equity.
Utilisation may depend on many things like accessibility, acceptability and
appropriateness of services, as well as the legacy of apartheid with its gross
inequity in resources and personnel. National PHC models generally calculate
a need for 3-3.5 visits per capita per year. The DHIS figure is therefore roughly
half the expected value for the full range of PHC services. Some inaccuracy
may result from confusion about the definition of headcount and procedures
for calculating it, especially in provinces that use multiple categories to
determine headcount (such as age breakdown, gender breakdown).
At the primary level, the results of the biennial Facilities Survey remain the
major source of data. The Eastern Cape have also produced a useful collation
of primary health care data, although most of the data are organised by old
health districts and regions, so were not included in this chapter [PHC in EC
1997-2000].
Definitions:
Utilisation Rate PHC: Number of visits per person to PHC health facilities
per year. Calculated from PHC headcount divided by total population [Census
96 population estimates for the appropriate year].
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