SAHR 2007 - Health Systems Trust

Health and Related Indicators 15
➤ Be sceptical about ‘examplar-based estimates’ and
insist they be put in an appropriate context.
➤ Question every change (whether point or trend) to
determine how much might be due to changes in
methods or data inputs.
➤ Demand information on uncertainty, and use it to determine
whether reported differences are meaningful in
public-health terms.”
Global comparisons of health statistics have often been
controversial, but remain key to strategic decision making at
a global level. AbouZahr and colleagues [Lancet 369(1039-
46)], in the final part of the Lancet series, made the following
good practice recommendations:
➤ “Reconcile data from different sources rather than
relying on only one source of information. Dependence
on single sources increases risk of making decisions
based on statistics that are incomplete or biased.
➤ Foster transparency in the way data are obtained,
analysed, and presented, and make effective use of
the media for dissemination of information.
➤ Promote country ownership of statistics and reduce
disputes between national authorities and global
agencies.
➤ Explicitly recognise and address conflicts of interest of
stakeholders, especially of those responsible for advocacy
and fundraising for specific health initiatives and
those in charge of overall health policy.”
The same points could be applied in the way data from
different districts and provinces, and from the public and
private sectors, are combined and serve as “evidence” to
guide decision making.
The data provided in this chapter are only a subset
of those available. More data, particularly that
showing trends over time, are stored in the Health
Statistics Database, which can be accessed on the
Health Systems Trust web site (www.hst.org.za/healthstats/).
In addition, a substantial set of district-level
data are presented in the District Health Barometer
reports, which can also be accessed from the HST
web site.
Data sources and collection
Available routine data for this chapter are largely determined
by the application of South Africa’s National Indicator
Data Set (NIDS). The list of indicators and their definitions
was included in the 2005 Review [SAHR 2005 Ch17]. As in
previous years, the variety and depth of data sources available
continue to improve.
Reference sources in the text are indicated by the use
of a short name for the reference, enclosed in square
brackets e.g. [StatsSA Mid-year Estimates]. For the
data tables, the short name of the reference / source
is given in the footnotes to each table, together with
any specific notes about the section of the reference
used or the data itself. At the end of the chapter, full
details of each reference are provided, ordered by
the short names used. Where possible, the means
to access the complete data electronically are
provided. Specific Universal Resource Locators (URLs)
are not always available for a single document. In
such cases, the location of the issuing authority’s
web site has been provided (e.g. Statistics SA can be
accessed at http://www.statssa.gov.za).
Largely, this chapter has sought to provide data disaggregated
by province and ethnic group. Providing data by health
district is still complicated by the as-yet unresolved issues of
some cross-boundary districts. However this year the data
have been presented according to the new demarcation,
and any data being reported for cross-boundary districts
have been aggregated and included in the province that
the district is located in according to the latest boundaries
from the Municipal Demarcation Board.
Reported health statistics should form the basis for comparison
with norms and targets, set nationally and globally.
For example, the National Department of Health’s Annual
National Health Plan 2006/07 contains the following targets
in relation to human resources:
➤
“fully mapped distribution of all staff and agreement on
appropriate baseline level of staffing by discipline for
tertiary and level 2 services”
This would require that the national Department provide
“target minimum staff levels and activity thresholds by
speciality and hospital type”, whereafter each provincial
Department would have to “map current and required staff
against delivery points, levels of care and outreach services”.
The private sector is not forgotten, with the target set
of “Service Level Agreements with GPs and other specialists
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