SAHR 2007 - Health Systems Trust

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Health and Related Indicators 15 Indicator Definitions Indicator Definitions Type Indicator Definition Demographic Population Distribution Socio-Economic Education Average household size Crude death rate Total fertility rate Annual population growth rate Population Population % by province Population % by ethnic group Population % composition Public sector dependent population Area (square km) Area as a % of total area of South Africa Population density (people per km 2 ) Rural (non-urban) percentage Urban percentage GDP per capita (PPP US$) Human development index Human development index rank Poverty prevalence Education level Average number of people living in each household where household is defined as a person, or a group of persons, who occupy a common dwelling (or part of it) for at least four days a week and who provide themselves jointly with food and other essentials for living. In other words, they live together as a unit. People who occupy the same dwelling, but who do not share food or other essentials, are enumerated as separate households. Number of deaths in a year per 1 000 population. The average number of children that a woman gives birth to in her lifetime, assuming that the prevailing rates remain unchanged. The rate at which the population is increasing or decreasing in a given year expressed as a percentage of the base population size. It takes into consideration all the components of population growth, namely births, deaths and migration. Total number of people. Projected population figures are based on various projection models attempting to quantify the expected effects of HIV and AIDS on population growth. Proportion of South African population in each province (calculated from population per province and population for whole of South Africa). Proportion of South African population in each ethnic group (calculated from population per ethnic group and population for whole of South Africa). Percentage of the population by various categories. e.g. Percentage of South African population under age of 15 years Percentage of South African population over age of 60 years Percentage of South African population female. This is an adjustment of the total population to the number assumed to be dependent on services in the public health sector based on medical scheme (health insurance) coverage. It is calculated by subtracting the number of people with medical scheme cover (determined from medical scheme membership reports, or surveys indicating percentage of population on medical schemes) from the total population. Land area covered by geographic entity. Area of province divided by total area of country (South Africa). Number of people per square kilometre. Proportion of population living in a non-urban environment. Non-urban, or rural areas include commercial farms, small settlements, rural villages and other areas which are further away from towns and cities. The definition includes semi-urban areas which are not part of a legally proclaimed urban area, but adjoin it. Proportion of population living in urban environment. An urban area is one which has been legally proclaimed as being urban e.g. towns, cities and metropolitan areas. Gross Domestic Product (GDP) - the total output of goods and services for final use produced by an economy, by both residents and nonresidents, regardless of the allocation to domestic and foreign claims. It does not include deductions for depreciation of physical capital or depletion and degradation of natural resources. Purchasing Power Parity (PPP) - A rate of exchange that accounts for price differences across countries allowing international comparisons of real output and incomes. At the PPP US$ rate, PPP US$1 has the same purchasing power in the domestic economy as $1 has in the United States. The HDI is a summary measure of human development. It measures the average achievements in a country in three basic dimensions of human development: ✧ A long and healthy life, as measured by life expectancy at birth ✧ Knowledge, as measured by the adult literacy rate (with two-thirds weight) and the combined primary, secondary and tertiary gross enrolment ratio (with one-third weight) ✧ A decent standard of living, as measured by GDP per capita (PPP US$). Caution: Calculation of HDI is an evolving methodology, and comparisons should not be made between years (when methods might have varied) but can be made between countries, as issued by the same source. A high value for the HDI represents better human development. Rank from 1 to end given to each country according to value of HDI. (Value of 1 represents the best (highest) human development index.) Proportion of people / households living in poverty. Depending on the poverty line and the methodology used there are various estimates of the extent of poverty, therefore caution should be observed in comparing estimates from different sources, and comparative reliability can be assessed from the rank order correlation between different sets of estimates. Percentage of people in a given age group who have received a particular level of education. In this chapter, data are presented for the percentage of population aged 20 years and above with no schooling. Employment Age dependency ratio Unemployment rate (official definition) The ratio of the combined child population (0-14 years) and the aged population (65 years and over) - persons in the dependent ages - to every 100 people of the intermediate age population (15-65 years) - economically active ages. Where more detailed data are lacking, the age-dependency ratio is often used as an indicator of the economic burden the productive portion of a population must carry - even though some persons defined as dependent are producers and some persons in the productive ages are economically dependent. The official definition of the unemployed is that they are those people within the economically active population who (a) did not work during the 7 days prior to the interview, (b) want to work and are available to work within a week of the interview, and (c) have taken active steps to look for work or to start some form of self-employment in the 4 weeks prior to the interview. Note that the census produces lower estimates of labour force participation because there are less prompts to identify employed people, and the Labour Force Survey provides the official labour market statistics. 331
Type Indicator Definition Household Facilities Mortality Percentage of households by type of housing Percentage of households using electricity for cooking Percentage of households with access to piped water Percentage of households with no toilet Percentage of households with telephone Proportion of people with access to improved sanitation Proportion of population with sustainable access to an improved water source Adult mortality (45q15) Life expectancy at birth Percentage of households that are categorised as formal, informal, traditional or other. Percentage of households using electricity as their main energy source for cooking. Includes households with piped water in dwelling, piped water inside yard or piped water on a community stand (< 200m away or further). Percentage of households that have no toilet of any kind. Percentage of households with a telephone in the dwelling or a cellular telephone. Percentage of the population using improved sanitation facilities (including flush to piped sewer system, flush to septic tank, flush / pour flush to pit, flush / pour flush to elsewhere). ‘Improved’ water supply technologies are: household connection, public standpipe, borehole, protected dug well, protected spring, rainwater collection. ‘Not improved’ are: unprotected well, unprotected spring, vendor-provided water, bottled water (based on concerns about the quantity of supplied water, not concerns over the water quality), tanker truck provided water. It is assumed that if the user has access to an ‘improved source’ then such source would be likely to provide 20 litres per capita per day at a distance no longer than 1 000 metres. The probability of dying between the ages of 15 and 60 years of age (percentage of 15 year olds who die before 60th birthday). The average number of additional years a person could expect to live if current mortality trends were to continue for the rest of that person’s life. (Most commonly cited as life expectancy at birth.) Disability Infectious Disease Cataract surgery rate Prevalence of disability (%) Syphilis prevalence rate (%) (antenatal) Number of cataract surgeries done per year per 1 million public sector dependent population. Percentage of people reporting moderate to severe disability in a survey where disability is defined as a limitation in one or more activities of daily living (seeing, hearing, communication, moving, getting around, daily life activities, learning, intellectual and emotional). In Census 2001, disability is defined as a physical or mental handicap which has lasted for six months or more, or is expected to last at least six months, which prevents the person from carrying out daily activities independently, or from participating fully in educational, economic or social activities. The definition of disability used in Census 2001 is not comparable with that used in Census 1996. Percentage of women surveyed testing positive for syphilis. Tuberculosis (TB) Malaria Bacteriological coverage rate Cure rate (new Sm+ cases) DOTS population coverage (%) Incidence of TB (all types) (per 100 000) Incidence of TB (PTB new Sm+) (per 100 000) Interruption rate (new Sm+ cases) Reported cases of TB (new Sm+) Reported cases of TB (PTB) Retreatment ratio Smear conversion rate (new Sm+ cases) Smear positivity (percentage of new PTB cases which are Sm+) Successful completion rate (new Sm+) Tuberculosis death rate per 100 000 Tuberculosis prevalence rate per 100 000 population Tuberculosis, DOTS detection rate (%) Tuberculosis, DOTS treatment success, (%) The bacteriological coverage rate reflects the percentage of cases of PTB for which sputum microscopy results were available. As such, it reflects both the availability of laboratory services and compliance with the national TB guidelines which stress the use of sputum microscopy in the diagnosis of PTB. Percentage of patients who are proven to be cured using smear microscopy at the end of treatment. The cure rate for new smear positive patients is regarded as the key indicator in high-burden countries. South Africa is working towards achieving the accepted WHO target of an 85% cure rate for new smear positive cases. Percentage of population falling within administrative areas where the DOTS TB control strategy is used. Number of cases of tuberculosis (all types) reported to the Department of Health per 100 000 population (for the year). Note that reporting rates in some areas are far from complete and this may influence the values quite significantly. Number of cases of tuberculosis (pulmonary TB, new smear positive cases) reported to the Department of Health per 100 000 population (for the year). Note that reporting rates in some areas are far from complete and this may influence the values quite significantly. % of patients who do not complete their course of treatment (of new smear positive patients). Also called percentage of patients who defaulted treatment. Number of cases of tuberculosis (new smear positive) reported to the DoH for the year. Number of cases of tuberculosis (Pulmonary TB) reported to the DoH for the year. Number of Sm+ retreatment cases divided by the number of Sm+ cases (new + retreatment) expressed as a percentage. High interruption rates contribute to high retreatment ratios. Percentage of new smear positive PTB cases who are smear negative after two months of anti-TB treatment and are therefore no longer infectious. Numerator: Number of new PTB cases who were Sm+ before starting treatment but show a Sm- after 2 months treatment. Denominator: Total number of new Sm+ cases registered during specified time. Number of new smear positive PTB cases divided by number of new PTB cases. % of patients who are cured plus those who complete treatment but without laboratory proof of cure, of new smear positive patients. Number of deaths due to tuberculosis (all types) reported per 100 000 population (for the year). Number of people with TB (all types) per 100 000 population. Percentage of TB cases detected under DOTS. Percentage of TB cases cured under DOTS. Case fatality rate: malaria Number of deaths divided by number of cases expressed as a percentage. The national target is to maintain a CFR below 0.5%. Reported cases of malaria (per 100 000) The number of cases of malaria reported to the Department of Health per 100 000 population (for the relevant year). Also known as incidence of malaria. 332
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South African Health Review 2007 LI
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Foreword The 12th edition of South
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12 Traditional and Complementary Me
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Other Funders for the Health System
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This response raises a number of qu
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ucts are currently sold without reg
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The authors conclude that mandatory
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servicing and inappropriate hospita
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systems is also critical; worrying
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Authors: Laetitia Rispel i Geoffrey
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Stewardship: Protecting the Public
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Introduction The importance of the
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diseases such as tuberculosis and t
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17 of 2002). This Act entirely repl
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(d) and any other matter relating t
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Year Act No. Title Objects 1997 90
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References 1 Department of Health.
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Purchasing of Health Care 33Pooling
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Introduction This chapter presents
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Medical schemes are the largest fin
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per person dependent on the public
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An increase in hospital expenditure
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private pharmacy do so for self-tre
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References 1 McIntyre D, Thiede M,
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Policy and legislative framework In
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Medical schemes and revenue collect
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There is evidence that when faced w
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are thus contributing factors to th
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Figure 2: Historic membership of me
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Solvency of the risk pools has beco
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Figure 4: 100 Proportion of risk be
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will retain that benefit for their
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There is a general sense (but often
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and towards competition based on ef
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37 Du Preez L. Registrar wants cura
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Introduction There has long been co
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an element of cream-skimming which
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Table 1: Distribution of health car
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isk equalisation mechanism were imp
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once the cost spiral in medical sch
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Revenue collection: Collecting orga
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Current debates A key area of ongoi
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References 1 Gluckman H. The Provis
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Authors: Patrick Matshidze i Lyn Ha
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Health Information Systems in the P
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Authors: Shahieda Adams i Reno Mora
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Health and Health Care in the Workp
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Author: Bettina Taylor i 8 Rationin
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Rationing of Medicines and Health C
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Health Care Delivery 139
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Authors: Haroon Wadee i Farzana Kha
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Human Resources for Health 9 Table
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Human Resources for Health 9 Table
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Human Resources for Health 9 source
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Human Resources for Health 9 Refere
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Authors: Shadrack Shuping i Sipho K
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Public-Private Partnerships 10 Alth
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Public-Private Partnerships 10 Tabl
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Public-Private Partnerships 10 Conc
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Authors: Thulani Matsebula i Michae
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Private Hospitals 11 Table 1: Priva
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Private Hospitals 11 Table 3: Distr
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Private Hospitals 11 Human resource
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Private Hospitals 11 Figure 3: 16 T
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Private Hospitals 11 Figure 4: 2 50
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Private Hospitals 11 Monitoring qua
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Private Hospitals 11 Recommendation
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Authors: Nceba Gqaleni i Indres Moo
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Traditional and Complementary Medic
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Authors: Myles Mander i Lungile Ntu
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Economics of the Traditional Medici
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Authors: Marion Stevens i Edina Sin
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HIV and AIDS, STI and TB in the Pri
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Indicators 213
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Authors: Candy Day i Andy Gray ii 1
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Page 364 and 365: Glossary AFA AIDS ALP AMA ANC ART A
Page 366 and 367: Glossary KZN LFS LIMS LP LPP MAR MC
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Page 370 and 371: Index A Acts (Legislation and Bills
Page 372 and 373: Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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