Big spender Ekurhuleni fails to deliver
Ekurhuleni Metro on Gauteng’s East Rand spends more per person on primary healthcare services than other health district in the country, but this does not translate into better services for its residents.
While Ekurhuleni spent R389 per person, the Gert Sibande (Ermelo) district in Mpumalanga spent a mere R42 per person on primary health care, according to figures for 2001 (the latest year that these statistics are available).
Despite being a big spender, Ekurhuleni scores consistently low in key service provision areas.
Only 15% of women attending antenatal clinics in Ekurhuleni in 2004 were tested for HIV. This contrasts sharply with the Western Cape and KwaZulu-Natal, where most health districts test over 80% of pregnant women
Ekurhuleni also had the lowest Caesarean rate of the metros (13.9%), two points lower than the internationally recommended rate of 16%.
The most Caesareans were performed in KwaZulu’s eThekwini metro (27.2%), a number that is problematically high but could be related to the HIV epidemic in the province. Caesareans decrease the likelihood of mother passing HIV to their babies.
‘All the rural districts in the Eastern Cape and Limpopo have low caesarean section rates of close to 10% or below. This is likely to reflect a poor quality of maternity services in these districts,’ according to the District Health Barometer.
The Barometer was complied by the Health Systems Trust, based on statistics supplied by the districts themselves. But HST researchers caution that not all the figures are reliable as some districts are not yet keeping accurate records.
Another good indicator of maternal services is the stillbirth rate, or the number of full-term babies per 1000 that are born dead. Developed countries have a stillbirth rate of about 10 per 1000 births (1%).
As the district figures are only of women giving birth at clinics, it excludes the more tricky pregnancies that are referred to hospitals. But some districts report shockingly high stillbirth rates, and the worst in urban areas.
Worst in the country is the West Rand in Gauteng, where 68 babies per 1000 were born dead in 2004.
Two poorly resourced areas in Limpopo, Vhembe and Mopani, have the lowest stillbirth rate. But HST researchers believe that the rate is likely to have been pushed down by ‘significant home deliveries in these two districts’.
Of the metros, Johannesburg and Ekurhuleni have the worst stillbirth rate (35), followed by Tshwane (34). Cape Town has the best rate (21).
While Gauteng districts have consistently high stillbirth rates, this could be because women from neighbouring provinces choose to deliver in Gauteng, complicated pregnancies are referred there and the recording of stillbirths may be more accurate, say the researchers.
The most overworked nurses in the country are in the Southern district (Klerkdorp-Potchefstroom-Ventersdorp) of the North West, where clinics reported that their professional nurses saw an average of 92 patients a day.
The recommended average is 35 patients per day.
Nurses in the Northern Cape’s Kgalagadi district were the most overworked of all rural districts, seeing 63 patients each every day. Nurses in Chris Hani district in the Eastern Cape saw the least patients, around 21 per day.
In the metros, Cape Town nurses were busiest, seeing 54 patients. eThekwini followed close behind with 50 patients. These nurses had more than double the workload of Johannesburg metro nurses, who saw 21 patients in a day.
Five of the Eastern Cape’s seven districts had workloads below the national target.
‘In most of the provinces there were wide variations in this workload indicator and this points to either inequities in staff distribution or differences in efficiency. This applies particularly to KwaZulu-Natal, the Western Cape and Limpopo provinces,’ according to the Barometer.
Tuberculosis is one of the country’s most common infectious diseases, yet in many districts the cure rates are abysmal. The cure rate is defined as people who test negative for TB after six months of treatment, with the country’s average cure rate sitting at 56%, and covers people hospitalized as well as attending clinics.
The worst performing district is Sisonke (Kokstad area) in KwaZulu-Natal, which cures less than a quarter of its patients (23.7%).
Eden district (Mossel Bay to Knysna) in the Western Cape performed best with over three-quarters of its TB patients (77.9%) being cured after six months.
The Western Cape, which has one of the country’s highest TB rates, is the best performer and the Cape Town metro is the best performing metro (70%).
Six of the ten worst performing districts are in KwaZulu-Natal, and the eThekwini metro is the worst performing metro, curing less than a third of its patients (30.1%). The HIV epidemic in the province is a likely complicating factor as TB is the most common opportunistic infection to prey on people with HIV.
Mpumalanga and the Eastern Cape districts also have low cure rates.
But, says the Barometer: ‘These low rates demonstrate a lack of commitment to the TB control programme in populations where this should be a priority.’
A high rate of diarrhoea usually means that people do not have access to clean water. This is evidently the case in Mopani in Limpopo (Phalaborwa-Tzaneen) where close to 400 children under five per 1000 were treated for diarrhoea.
The 10 districts with the highest incidence of diarrhoea were all in rural areas, the majority in KwaZulu-Natal and Limpopo.
The eThekweni metro also had an exceptionally high rate of 270 cases of diarrhoea per 1000 children, double that of the next highest metro.
With the exception of eThekwini, urban areas score best. The 10 districts with the lowest incidence of diarrhoea include all six districts of Gauteng, three Western Cape districts and the Nelson Mandela metro.
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