The Eastern Cape’€™s OR Tambo district in the old Transkei is officially the most miserable, socially deprived area in the country.

This is according to the District Health Barometer, which ranked the country’€™s 53 health districts by comparing factors such as unemployment and access to clean water and electricity.

OR Tambo, where only a quarter of people have access to clean water, turned up worst. It was followed closely by its neighbour in the old Transkei, Alfred Nzo district.

In contrast, the five districts with the least social deprivation are all from the Western Cape, with the living being easiest in the West Coast, followed by Overberg and the Cape Winelands.

All Gauteng’€™s districts are in the top one-third.  

By comparing health statistics from the 53 districts for 2005/6, the Barometer provides the most up-to-date and comprehensive snapshot of our nation’€™s health.

‘€œThe Barometer is a tool for district health managers to pick up weaknesses in their areas so that they can prioritise and plan to address these,’€ says co-editor Fiorenza Monticelli, from Health Systems Trust.

Unfortunately, one of the weaknesses is that some of the data ‘€“ three-quarters of which comes from the Department of Health ‘€“ is inaccurate.

‘€œThere are some inaccuracies because of weaknesses in data collection in the districts,’€ says Monticelli. ‘€œBut we estimate that about 80% of the information is true.’€

Besides, she says, by highlighting the data irregularities, the Barometer also forces managers to confront skills weaknesses in their districts.

Monticelli praised the Department of Health for ‘€œopening up and providing us with real data’€, saying that the information would help to ensure better and more equal service delivery.

Through a series of graphs and tables, it is easy to see at a glance where poverty is at its worst and which districts have poor management systems and health services.

The poorest one-third of the districts is made up almost entirely by those from the Eastern Cape, KwaZulu-Natal and Limpopo ‘€“ with the addition of the Northern Cape’€™s Kgalagadi district.

Interestingly, some of these poorer districts ‘€“ particularly those in KwaZulu ‘€“ spend a fair bit on health per person yet this expenditure does not translate into better health outcomes.

For example, KwaZulu’€™s Umkhanyakude forks as much per person as West Coast, the richest district in the country (over R300 per person) ‘€“ yet it is the fourth poorest district in the country.

North West’€™s Bophirima spends the most per capita on health in the country ‘€“ R416 ‘€“ yet its TB cure rate has plummeted by 10% in the space of a year.

But Limpopo’€™s Greater Sekhukhune spends the least per capita (a mere R115) and has poor health indicators to match.

Some of the indicators are shocking. If you have TB, for example, steer well clear of Mpumalanga’€™s Nkangala, where the cure rate is a pitiful 12%.

Nkangala also distributed the lowest number of male condoms in the year under review ‘€“ with every man getting an annual allotment of half a condom.

Pregnant women could also do well to avoid Zululand, where there are 64 stillbirths per 1000 babies born. The country average is 25.

The stillbirth rate is usually a good indicator of the quality of care during labour and the health and nutritional status of the mother.

The incidence of diarrhoea in children under five was extremely high in virtually all health districts in KwaZulu-Natal and Limpopo ‘€“ probably highlighting a lack of access to clean water and poor sanitation. Data from many Eastern Cape districts was, however, missing.

The cases of diarrhoea in Ethekwini (Durban) were almost double that of the national average, with every second child in the metro reported to have suffered from the disease.

A shocking eight out of 10 kids in Kgalagadi in the Northern Cape had diarrhoea.

The Barometer also picked up serious weaknesses in the country’€™s programme aimed at preventing HIV positive mothers from passing the virus on to their babies ‘€“ the prevention of mother-to-child prevention programme (PMTCT).

In six entire provinces, less than half of all pregnant women were tested for HIV. Mpumalanga was the worst, with less than one in three women being tested. Only half of the Mpumalanga women who were HIV positive took the antiretroviral drug, nevirapine, to cut the risk of HIV transmission to their babies.

Mpumalanga and KwaZulu-Natal have some of the highest HIV rates in the country, yet neither provinces were able to say how many babies born to HIV positive mothers were given nevirapine.

The levels of HIV positive pregnant women taking nevirapine were unimpressively low in all provinces except the Western Cape (almost 70%) and indicates that the PMTCT programme is not been promoted actively enough.

The Barometer was presented to a meeting of provincial health officials yesterday (Thursday 8 February).

Other Provinces:

Limpopo
Northern Cape
North West Province
Free State
Eastern Cape
Western Cape
Gauteng
Mpumalanga
KwaZulu Natal