Health services in this flat, often bleak, central province are better than many of the other provinces despite a lack of expertise and massive health challenges, many of which are the legacy of the mining industry that dominates the province.
One of the keys to the Free State’s ability to provide stable care lies in the fact that it has built its health system from the primary level upwards.
Increased expenditure on PHC has contributed towards improved tuberculosis cure rates, a decline in the number of sexually transmitted infections, a decline in the stillbirth and perinatal mortality rates and a well functioning immunisation programme.
Other indicators such as average length patients’ stay in a hospital and bed utilisation rate point to relatively well-managed district hospitals.
Data indicates that the province’s prevention of mother-to-child transmission of HIV programme is poor with few pregnant women tested and a negligible number accessing nevirapine.
Less than half of pregnant women were tested for HIV, the second lowest rate in South Africa.
Of the women who tested, a quarter was found to be HIV positive. All their babies received nevirapine to prevent mother-to-child transmission of HIV, but only 3 out of 10 mothers took treatment.
‘This is the lowest rate in South Africa and is not the response one would expect from the priority health programme,’ researchers commented.
Fezile Dabi district in the north of the province has a population of just of over half a million people with almost all households accessing piped water. Despite this, the number of new cases of children with diarrhoea has risen to nearly one in four. There is also a relatively high percentage of children under five not gaining weight.
Fezile Dabi also has the highest nurse clinical workload in the Free State with each nurse seeing around 36 patients per day.
Lejweleputsa, with five district hospitals, has doubled the amount spent per capita on non-hospital primary health care since 2001.
The district has achieved high cure rates for tuberculosis and is one of only 10 districts in South Africa with a cure rate of over 70 percent.
But it was ranked fifth lowest of all districts in the proportion of pregnant women tested for HIV. It also has the second lowest nevirapine uptake among pregnant women in the country.