ZULULAND
DISTRICT HEALTH PLAN
2018/19 - 2020/21
(KWAZULU-NATAL)
Zululand District Health Plan 2018/19
Page 2 of 96
Contents
1. EXECUTIVE SUMMARY BY THE DISTRICT DIRECTOR .................................................... 3
2. ACKNOWLEDGEMENTS ................................................................................................ 4
3. OFFICIAL SIGN OFF ....................................................................................................... 5
4. EPIDEMIOLOGICAL PROFILE ........................................................................................ 6
5. SERVICE DELIVERY PLATFORM AND MANAGEMENT ............................................... 21
6. QUALITY OF CARE ....................................................................................................... 27
7. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM ........... Error!
Bookmark not defined.31
8. DISTRICT HEALTH EXPENDITURE .................................................................................. 32
9. DISTRICT HEALTH ASPIRATIONS AND INDICATOR TARGETS .................................... 33
10. BOTTLENECKS AND ROOT
CAUSES……………………………………..…………………………………….…………-49
11. KEY INTERVENTION ...................................................................................................... 51
12. INDICTORS FOR MONITORING 2018-2021------------------------------------------------------75
Zululand District Health Plan 2018/19
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1. EXECUTIVE SUMMARY BY THE DISTRICT MANAGER
None provided
Zululand District Health Plan 2018/19
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2. ACKNOWLEDGEMENTS
The District Planning Team would like to acknowledge the important contribution of the
following members and stakeholders in the development of the 2018/19 District Health
Plan (DHP):
Provincial Strategic Planning Unit
Provincial Data Management Unit
District Management Team
District Specialist Team members(DCSTs)
Hospital Senior Management Team
District Supporting Partners –Health Systems Trust and Aurum/Accenture
District Programme Managers
Hospital Programme Managers and M& E Managers
District Data Management Section
Facility Information Officers
District Finance Management Section
District Human Resource Management and Development Section
Special acknowledgement and gratitude is extended to the following primary collators of this
document for their tireless efforts and commitments demonstrated throughout the compilation
process:
Ms. S.M Cebekhulu: Deputy District Manager-Planning, Monitoring & Evaluation
Miss N.S Khambule : District Pharmacist
Mrs. T.W Buthelezi : DCS-PHC
Mrs. T.G Msibi---M&E Manager – UPhongolo sub-district
Mrs. S.E Mlambo – M&E Manager- Abaqulusi sub district
Ms. N. C Mngoma – M&E Manager – eDumbe sub-district
Mrs. C.A Zulu – Assistant Manager : Nursing - Ceza hospital –Ulundi sub-district Team leader
Mrs. N.E Mbatha - – M&E Manager – Nongoma sub-district
Zululand District Health Plan 2018/19
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3. OFFICIAL SIGN OFF
It is hereby certified that this District Health Plan:
Was developed by the district management team of Zululand Health District with the
technical support from the district health services and the strategic planning Units at the
Provincial head office.
Was prepared in line with the current Strategic Plan and Annual Performance Plan of the Kwa
Zulu Natal Province Department of Health.
Zululand District Health Plan 2018/19
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4. LIST OF ACRONYMS
Abbreviations Description
A
AIDS Acquired Immune Deficiency Syndrome
ALOS Average length of stay
ANC Ante Natal Care
ART Anti-Retroviral Therapy
ARV Anti-Retroviral
B
BAS Basic Accounting System
BUR Bed Utilization Rate
C
CARMMA Campaign on Accelerated Reduction of Maternal Mortality in Africa
CEO (s) Chief Executive Officer(s)
CCMDD Central Chronic Medicine Dispensing Decentralisation
CCG (s) Community Care Giver(s)
CDC Communicable Disease Control
CDW Community Development Worker
CHC(s) Community Health Centre(s)
COE Compensation of Employees
D
DCST(s) District Clinical Specialist Team(s)
DHER(s) District Health Expenditure Review(s)
DHIS District Health Information System
DHMT District Health Management Team
DHP(s) District Health Plan(s)
DH(s) District hospital))(s)
DOH Department of Health
DQPR District Quarterly Performance Report
DRTB Drug Resistant Tuberculosis
E
EMTCT Elimination of Mother To Child Transmission
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EMS Emergency Medical Services
ESMOE Essential Steps in the Management of Obstetric Emergencies
EPWP Expanded Works Program
F
FHT(s) Family Health Team(s)
G
G&S
Goods and Services
H
HCT Health Counselling and Testing
HIV Human Immunodeficiency Virus
HR Human Resources
HRM Human Resources Manager
I
ICSM Integrated Clinical Services Management
IEC Information , Education and Communication
ISHS Integrated School Health Services
Abbreviations Description
ILS Intermediate Life Support
IMAM Integrated Management of Malnutrition
INP Integrated Nutrition Program
ISHS Integrated School Health Services
IYCF Infant and Young Child Feeding
IUCD Intra Uterine Contraceptive Device
J
K
KINC Kwa-Zulu Nata Initiative on Neonatal Care
L
M
M&E Monitoring and Evaluation
ME Machinery and Equipment
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MC&WH Maternal Child & Women’s Health
MDG Millennium Development Goals
MDR-TB Multi Drug Resistant Tuberculosis
MMC Medical Male Circumcision
MMR Maternal Mortality Rate/Ratio
MM Medical Manager
MNC&WH Maternal, Neonatal, Child & Women’s Health
MO (s) Medical Officer(s )
MOU Maternity Obstetric Unit
MTEF Medium Term Expenditure Framework
MUAC Mid-Upper Arm Circumference
N
NDOH National Department of Health
NGO(s) Non-Governmental Organization(s)
NIMART Nurse Initiated and Managed Antiretroviral Therapy
NNW National Nutrition Week
NSDA Negotiated Service Delivery Agreement
O
OPD Out-Patients Department
OSD Occupation Specific Dispensation
OSS Operation Sukuma Sakhe
P
PCR Polymerase Chain Reaction
PCV Pneumococcal Vaccine
PDE Patient Day Equivalent
Persal Personnel and Salaries System
PFMA Public Finance Management Act
PHC Primary Health Care
PM&E Planning , Monitoring and Evaluation
PN(s) Professional Nurse
PPSD Provincial Pharmaceutical Supply Depot
Zululand District Health Plan 2018/19
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PTB Pulmonary Tuberculosis
R
RVD Retro Viral Disease
RV Rota Virus Vaccine
S
SCM Supply Chain Management
SLA Service Level Agreement
SMS Small Message System
SRH Sexual and reproductive health services
Stats SA Statistics South Africa
STI(s) Sexually Transmitted Infection(s)
SVS Stock Visibility System
T
TB Tuberculosis
THPs Traditional Health Practitioner(s)
U
UTT Universal Test and Treat
V
VCT Voluntary Counselling and Testing
W
WBOT(s) Ward based Outreach team(s )
WHO World Health Organization
X
XDR-TB Extreme Drug Resistant Tuberculosis
Y and Z
Zululand District Health Plan 2018/19
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4. EPIDEMIOLOGICAL PROFILE
District Map with Population distribution, sub district boundaries, and health facility
locations
Zululand District is situated in the north-eastern part of KwaZulu-Natal Province. It is primarily a
rural district and comprises five health sub-districts, namely Nongoma, Ulundi, eDumbe,
uPhongolo and Abaqulusi. The district has a population of 854 894, with a population density of
Zululand District Health Plan 2018/19
Page 11 of 96
57.8 persons per km2, and falls into socio-economic Quintile 1, among the poorest districts.
Estimated medical scheme coverage is 5.6%.
Population distribution
Figure 1: Population Pyramid District
Source: StatsSA.2011
Graph 1: Population distribution per Municipality 2016/17
Source: web based DHIS 2018
There is a slight increase of the total population from 844 531 in 2015 to 854 893 in 2016 (1.2%)
and is related to the normal population increase per year, of which 93.50% is uninsured.(DHIS
2015))This is a large portion of the total population fully dependent of public health services,
which indicates a very strong need for the district to develop plans to focus on the prevention
60 40 20 0 20 40 60
under 5 years
10-14 years
20-24 years
30-34 years
40-44 years
50-54 years
60-64 years
70-74 years
80 years and older
Population (inThousands)
Female Male
199 367
136 422
87 277 227 068
204 759
Zululand Sub district Population distribution
Ulundi LM
uPhongolo LM
eDumbe LM
Abaqulusi LM
Nongoma LM
Zululand District Health Plan 2018/19
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and management of low socio -economic related diseases strategies and activities like
malnutrition and other related social ills as evidenced by the high rates of malnutrition in children
under 5years at Nongoma, Abaqulusi and uPhongolo sub districts. The high number of
population age group between 15 -19, which is a highly active population (teenage stage),
needing special attention in terms of health and other social issues, is concerning and calls for
the district to pay more focus on the implementation of Youth Friendly Service delivery by
introducing the program to all clinics and increasing the number of facilities accredited and
sustaining the program. The marked decrease in the number of 20years and above as
indicated in the population pyramid is related to the high death rate of this category due to TB
and HIV related illnesses(DHB 2014/15), plans are put in place to address the issue under
interventions.
Social Determinants of Health
Sub-Districts Data Source Abaqulusi
Sub-district
eDumbe
Sub-district
Nongoma
Sub-District
Ulundi Sub-
District
UPhongolo
Sub-district District
Un
em
plo
ym
en
t ra
te
Census 2001 59.5% 57.5% 37.7% 66.7% 48.7% 54.02%
Census 2011 40% 39% 71.7% 54% 51% 51%
C/ S 2007 35.3% 37.7% 63% 49.4% 35.5% 44.18%
C / S 2016 41.1%
Tota
l n
um
be
r
of
ho
use
ho
lds Census 2001 37 064 15 824 32 473 34 856 26 954 147 171
Census 2011 39 866 15 147 35 293 38 513 25 740 154 559
C/ S 2007 43 299 16 138 34 341 35 196 28 772 157 746
C / S 2016 43 299 16 138 34 341 35 198 28 772 178 516
Pe
rce
nta
ge
o
f
po
pu
latio
n
livin
g
be
low
po
ve
rty l
ine
of
R2
83
p
er
mo
nth
Census 2001 68% 72% 81% 68% 72% 72%
Census 2011
C/ S 2007 43.3% 43.3% 43.4% 42.3% 41.9%
C / S 2016
Nu
mb
er
of
ho
use
ho
lds
in
Info
rma
l
dw
elli
ng
Census 2001 1261 310 374 1383 398 3726
Census 2011 2 153 339 507 188 1 614 4 801
C/ S 2007 1 743 570 2127 1038 651 6 129
C / S 2016
Nu
mb
er
of
ho
use
ho
lds
in
form
al
dw
elli
ng
Census 2001 20 043 8 696 11 250 13 916 15 605 69 510
Census 2011 26 070 7 596 7 995 14 341 18 481 74 483
C/ S 2007 33 417 11 529 20 307 22 263 23 790 111 306
C / S 2016
Pe
rce
nta
ge
o
f
Ho
use
ho
l
ds
with
ac
ce
ss
to
san
ita
tio
n Census 2001 36.4% 5.2% 6.0% 20.2% 9.1% 15.38%
Census 2011 79% 95% 54% 71% 83% 76%
C/ S 2007 40.9% 5.5% 4.5% 19.1% 11.4% 16.28%
Zululand District Health Plan 2018/19
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Sub-Districts Data Source Abaqulusi
Sub-district
eDumbe
Sub-district
Nongoma
Sub-District
Ulundi Sub-
District
UPhongolo
Sub-district District
C / S 2016
Ho
use
ho
lds
with
ac
ce
ss t
o
po
tab
le w
ate
r Census 2001 63.5% 62.9% 30.5% 45.8% 60.6% 52.66%
Census 2011 2% 15% 7% 2% 1% 5%
C/ S 2007 38.8% 13.8% 9.6% 22.2% 17.4% 20.36%
C / S 2016
Pe
rce
nta
ge
o
f
Ho
use
ho
lds
with
a
cc
ess
to
ele
ctr
icity
Census 2001 43.2% 31.3% 24.6% 40.2% 53.5% 33.56%
Census 2011 41 % 26% 30% 54% 50% 40%
C/ S 2007 72.1% 62.8% 63.6% 73.4% 73.0% 68.98%
C / S 2016
Ad
ult
lite
rac
y
rate
Census 2001 69.8% 62.3% 54.7% 55% 62.9% 60.94%
Census 2011
C/ S 2007 83.1% 81.7% 79.5% 79.4% 80.1% 80.76%
C / S 2016
Source: StatsSA 2011
The district has a high unemployment rate of 41% as well as a high % of people living below the
poverty line; which is highest at Nongoma sub district and is evidenced there with the highest
rate of malnutrition as well as the death rate of child under-five years from SAM of 13.5 %( DHIS)
2015.This is being addressed through the interdepartmental social cluster (OSS) malnutrition
project that is going to be rolled out to all sub districts. the district has a very high percentage of
the community without access to portable water of 61.2% and is highest at Nongoma at (90.6)
(Stats SA 2011) thus increasing the risk of waterborne diseases within the sub district which
contributes more to childhood diarrhoeal diseases as evidenced by 12.2 (DHIS2015)diarrhoeal
incidence child under five years.
Zululand District Health Plan 2018/19
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Causes of Mortality
SOURCE: DHB 2014/15
113
147
165
185
191
362
543
625
2338
2891
0 500 1000 1500 2000 2500 3000 3500
Nephritis
Cerebro Vascular Diseases
Road Accidents
Endocine Nutritional Disorders
Cervical Cancer
Meningitis Encephalitis
Diarrhoeal Diseases
Lower Respiratory Infections
HIV/AIDs
Tuberculosis
12
34
56
78
91
0
2891
2338
625
543
362
191
185
167
147
113
0 500 1000 1500 2000 2500 3000 3500
Causes of mortality
Tuberculosis
HIV/AIDS
Lower Respiratory Infections
Diarrhoeal Diseases
Meningitis/ Encephalitis
Cervical Cancer
Endocrine Nutritional Disorders
Road Injuries
Cerebro Vasc ular Diseases
Nephritis
Zululand District Health Plan 2018/19
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Baseline data for all Theory of Change (Impact, Outcome, and Output) Indicators for
Maternal and Women’s Health, Child Health, HIV and TB, by sub-District and for the
District.
Women and Maternal Health
Impact Outcome Output
Ma
tern
al
mo
rta
lity
in
fac
ility
ra
tio
(pe
r10
0K
)
An
ten
ata
l c
lie
nt
initia
ted
o
n
AR
T
rate
(%
)
De
liv
ery
in
fa
cility
un
de
r 1
8
ye
ars
rate
(%
)
An
ten
ata
l 1
st v
isit
be
fore
2
0
we
ek
s
rate
(%
)
Ce
rvic
al
ca
nc
er
scre
en
ing
co
ve
rag
e (
%)
Co
up
le
ye
ar
pro
tec
tio
n
rate
(WH
O)
(%)
Mo
the
r p
ost
na
tal
vis
it w
ith
in 6
da
ys
rate
(%
)
2016/17 2016/17 2016/17 2016/17 2016/17 2016/17 2016/17
Abaqulusi SD Indicator 146.6 99.7 11.5 82.4 82.9 73.4 60.2
Numerator 6 793 478 3 458 3 713 46 444 2 496
Denominator 4 094 795 4 145 4 196 53 736 759 594 4 145
eDumbe SD Indicator - 96.7 6.5 71.2 58.6 74.8 158.9
Numerator - 322 46 1 108 971 17 750 1 119
Denominator 703 333 704 1 556 19 898 284 673 704
Nongoma SD Indicator 105.3 110.9 9.3 73.0 89.8 59.0 32.7
Numerator 5 845 443 3 168 3 384 33 867 1 558
Denominator 4 747 762 4 763 4 338 45 233 689 373 4 763
Ulundi SD Indicator 55.9 98.9 8.8 66.1 73.4 68.4 59.5
Numerator 2 831 315 2 885 2 837 39 086 2 136
Denominator 3 580 840 3 592 4 363 46 403 685 572 3 592
uPhongolo SD Indicator 93.7 97.0 10.3 63.8 99.5 83.3 41.8
Numerator 3 623 334 2 036 2 449 31 940 1 349
Denominator 3 203 642 3 230 3 192 29 542 460 101 3 230
Zululand District Indicator 98.0 101.2 9.8 71.7 82.3 70.5 52.7
Numerator 16 3 414 1 616 12 655 13 354 169 087 8 658
Denominator 16 327 3 372 16 434 17 645 194 813 2 879 313 16 434
KwaZulu-Natal Indicator 106.7 97.2 8.5 70.2 85.6 74.8 66.8
South Africa Indicator 116.9 95.1 6.8 65.2 61.5 70.2 70.3
Source: DHIS.
Zululand District Health Plan 2018/19
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Annual trends Child Health
Impact Outc
ome Output
Ch
ild
un
de
r 5
ye
ars
dia
rrh
oe
a
ca
se
fata
lity
rate
(%
)
Ch
ild
un
de
r 5
ye
ars
pn
eu
mo
nia
ca
se
fata
lity
rate
(%
)
Ch
ild
un
de
r 5
ye
ars
se
ve
re
ac
ute
ma
lnu
tritio
n
ca
se
fata
lity
rate
(%
)
Inp
atie
nt
de
ath
u
nd
er
1
ye
ar
rate
(%)
In
pa
tie
nt
de
ath
u
nd
er
5
ye
ar
rate
(%)
In
pa
tie
nt
ea
rly
ne
on
ata
l
de
ath
ra
te
(pe
r1K
)
Inp
atie
nt
ne
on
ata
l
de
ath
ra
te
(pe
r1K
)
Infa
nt
PC
R
test
p
osi
tiv
e
aro
un
d
10
we
ek
s ra
te
(%)
Imm
un
iza
tio
n
co
ve
rag
e
un
de
r 1
ye
ar
(%)
In
fan
t
ex
clu
siv
ely
bre
ast
fed
a
t
DTa
P-I
PV
-
Hib
-HB
V
3rd
do
se r
ate
(%
)
Me
asl
es
2n
d
do
se
co
ve
rag
e
(%)
Sc
ho
ol
Gra
de
1
scre
en
ing
co
ve
rag
e
(%)
Sc
ho
ol
Gra
de
8
scre
en
ing
co
ve
rag
e
(%)
Vita
min
A
do
se
12
-59
mo
nth
s
co
ve
rag
e
(%)
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
201
6/1
7
2016
/17
Abaqulusi
SD
Indicator 1.3 1.2 12.5 3.1 2.6 8.1 9.3 0.5 91.7 50.2 104.
2
36.5 20.9 54.7
Numerator 5 5 8 52 62 33 38 6 4
300
2
117
5
008
2
289
1
069
21
472
Denominat
or
391 402 64 1
663
2
376
4
094
4
094
1
093
56
271
4
220
57
657
6
264
5
104
471
024
eDumbe
SD
Indicator 6.7 - 50.0 6.7 2.2 - - 1.6 74.8 61.3 93.1 10.6 5.3 65.4
Numerator 1 - 1 1 1 - - 6 1
503
933 1
916
306 127 10
991
Denominat
or
15 9 2 15 45 703 703 364 24
114
1
521
24
690
2
876
2
413
201
774
Nongoma
SD
Indicator 6.5 6.4 12.4 19.1 10.7 14.3 16.6 0.9 61.6 51.6 79.5 42.3 23.0 97.2
Numerator 16 12 13 108 123 68 79 7 3
451
2
140
4
329
2
167
1
156
41
099
Denominat
or
246 187 105 566 1
149
4
747
4
747
761 67
176
4
144
65
367
5
128
5
036
507
198
Ulundi SD Indicator 2.1 2.0 15.7 9.6 5.9 10.1 11.7 0.5 81.6 50.4 97.0 31.4 16.9 63.7
Numerator 6 2 8 61 70 36 42 4 3
908
2
050
4
680
2
235
1
060
24
682
Denominat
or
287 102 51 633 1
178
3
580
3
580
820 57
441
4
065
57
897
7
125
6
287
464
802
uPhongol
o SD
Indicator 4.1 6.7 22.1 12.9 8.8 6.6 7.2 1.8 77.1 56.2 100.
6
42.3 15.6 48.5
Numerator 7 7 17 40 55 21 23 11 2
486
1
601
3
249
1
940
678 12
508
Denominat
or
171 105 77 311 625 3
203
3
203
616 3870
9
2
849
3876
0
4
581
4
346
309
558
Zululand
District
Indicator 3.2 3.2 15.7 8.2 5.8 9.7 11.1 0.9 77.0 52.6 94.2 34.4 17.6 68.0
Numerator 35 26 47 262 311 158 182 34 1564
8
8
841
1918
2
8
937
4
090
110
752
Denominat
or
1
110
805 299 3
188
5
373
1632
7
1632
7
3
654
2437
11
1679
9
2443
71
3116
88
2782
32
19543
56
KwaZulu-
Natal
Indicator 2.0 1.8 7.4 6.4 4.5 9.7 12.4 1.0 85.8 53.9 99.8 26.2 16.4 62.1
South
Africa
Indicator 2.0 2.0 8.0 6.3 4.4 9.9 12.4 1.3 82.3 41.6 96.2 33.0 19.8 58.0
Zululand District Health Plan 2018/19
Page 17 of 96
Annual trends HIV
3rd 90-90-90 2n
d
90
-
90
-90
1st 90-90-90
Impact Outco
me
Output
Ad
ult
with
vir
al
loa
d
co
mp
letio
n
rate
a
t
12
m
on
ths
(%)
Ch
ild
w
ith
vir
al
loa
d
co
mp
letio
n
rate
a
t
12
m
on
ths
(%)
Ad
ult
with
vir
al
loa
d
sup
pre
sse
d
rate
1
2
mo
nth
s
(%)
Ch
ild
w
ith
vir
al
loa
d
sup
pre
sse
d
rate
1
2
mo
nth
s
(%)
Ad
ult
pe
rce
nta
g
e
on
A
RT
aft
er
12
mo
nth
s
(%)
Ch
ild
pe
rce
nta
g
e
on
A
RT
aft
er
12
mo
nth
s
(%)
Clie
nts
rem
ain
ing
on
A
RT
rate
(%
)
Fe
ma
le
co
nd
om
dis
trib
utio
n
co
ve
rag
e
(No
)
HIV
te
st
po
sitiv
e
clie
nt
15
ye
ars
a
nd
old
er
rate
(in
clu
din
g
AN
C)
(%)
HIV
te
stin
g
co
ve
rag
e
(in
clu
din
g
AN
C)
(%)
M
ale
co
nd
om
dis
trib
utio
n
co
ve
rag
e
(No
)
Me
dic
al
ma
le
cir
cu
mc
isi
on
ra
te
(pe
r1K
)
2015 2015 2015 2015 2015 2015 2016/
17
2016/
17
201
6/17
2016/
17
2016/17 2016/17
Abaqulusi
SD
Indicator 27.2 29.9 91.3 82.9 74.1 75.0 - 1.1 - 39.9 42.6 26.9
Numerator - 41 - 34 - 138 - 88 897 - 50 746 3 136
992
2 305
Denominator 2
946
137 802 41 4
129
184 - 971
184
- 1 526
511
883 197 1 028
649
eDumbe
SD
Indicator 51.9 32.4 93.5 81.8 83.3 94.4 - 2.1 - 27.9 61.6 28.8
Numerator - 11 - 9 - 34 - 64 927 - 12 856 1 597
860
893
Denominator 684 34 355 11 836 36 - 366
489
- 552
873
311 139 372 339
Nongoma
SD
Indicator 40.5 44.4 93.8 60.4 78.9 79.9 - 1.7 - 41.0 51.7 58.9
Numerator - 48 - 29 - 111 - 125
398
- 42 826 2 817
082
3 966
Denominator 2
317
108 938 48 3
017
139 - 879
909
- 1 253
631
653 529 807 465
Ulundi SD Indicator 35.7 40.9 90.6 72.2 77.8 82.7 - 1.3 - 35.5 62.5 34.2
Numerator - 54 - 39 - 134 - 94 753 - 37 382 3 471
427
2 300
Denominator 2
273
132 812 54 3
033
162 - 873
246
- 12641
52
666 801 807 801
uPhongolo
SD
Indicator 39.6 35.1 87.8 80.0 65.4 74.0 - 2.4 - 29.3 67.2 16.8
Numerator - 20 - 16 - 77 - 112
721
- 22 008 2 806
018
831
Denominator 997 57 395 20 2
093
104 - 572
952
- 901
974
500 733 592 968
Zululand
District
Indicator 58.0 56.8 91.8 68.5 75.9 78.5 61.3 1.5 11.4 42.5 53.9 30.5
Numerator - 174 - 127 - 494 101
471
486
696
16
808
165
818
13 829
379
10 295
Denominator 217 468 3302 174 13
108
625 171
640
3 663
780
178
755
5 499
141
3 015
399
3 609
222
KwaZulu-
Natal
Indicator 58.0 56.8 91.8 68.5 75.9 78.5 61.3 1.5 11.4 42.5 53.9 30.5
South
Africa
Indicator - - - - - - 55.0 1.3 8.2 35.9 47.5 19.0
Zululand District Health Plan 2018/19
Page 18 of 96
4.6.4 TB
Impact Outcome Output Process &
input
TB
de
ath
rate
(ETR
.ne
t)
(%)
TB
DR
clie
nt
de
ath
ra
te
(ED
RW
eb
)
(%)
TB
c
lien
t
lost
to
follo
w
up
rate
(ETR
.Ne
t)
(%)
TB
clie
nt
tre
atm
en
t
suc
ce
ss
rate
(ETR
.ne
t)
(%)
TB D
R c
lien
t
loss
to
follo
w
up
rate
(ED
RW
eb
)
(%)
TB
DR
tre
atm
en
t
suc
ce
ss
rate
(ED
RW
eb
)
(%)
TB
Rifa
mp
icin
resi
sta
nc
e
co
nfirm
ed
clie
nt
rate
(%)
TB
Rifa
mp
icin
resi
sta
nt
clie
nts
tre
atm
en
t
initia
tio
n
rate
(%
)
TB/H
IV
co
-
infe
cte
d
clie
nt
on
AR
T ra
te
(ETR
.Ne
t)
(%)
TB
clie
nt
initia
ted
o
n
tre
atm
en
t
rate
(%
)
TB
sym
pto
m
5
ye
ars
a
nd
old
er
scre
en
ed
in
fac
ility
ra
te
(%
2015 2014 2015 2015 201
4
201
4
2016 2016 2016 2016 2016/17
Abaqulusi
SD
Indicator 7.9 - 2.2 86.7 - - - - 81.9 - 77.3
Numerator 174 - 48 1 914 - - - - 567 - 363 568
Denominat
or
2207 - 2
207
2 207 - - - - 692 - 470 375
eDumbe SD Indicator 7.6 - 0.4 88.0 - - - - 72.5 - 74.4
Numerator 37 - 2 427 - - - - 116 - 146 226
Denominat
or
485 - 485 485 - - - - 160 - 196 587
Nongoma
SD
Indicator 6.1 - 3.4 83.6 - - - - 80.1 - 88.3
Numerator 81 - 46 1 115 - - - - 322 - 329 180
Denominat
or
1334 - 1
334
1 334 - - - - 402 - 372 740
Ulundi SD Indicator 6.7 - 2.6 83.8 - - - - 88.2 - 75.2
Numerator 79 - 30 984 - - - - 402 - 349 030
Denominat
or
1174 - 1
174
1 174 - - - - 456 - 464 337
uPhongolo
SD
Indicator 7.8 - 4.3 83.8 - - - - 91.2 - 86.5
Numerator 76 - 42 820 - - - - 332 - 243 270
Denominat
or
979 - 979 979 - - - - 364 - 281 254
Zululand
District
Indicator 7.2 24.1 2.7 85.1 10.9 59.0 10.3 66.5 83.8 67.0 80.2
Numerator 447 108 168 5 260 49 265 316 210 1 739 2 061 1 431 274
Denominat
or
6
179
449 6
179
6 179 449 449 3
077
316 2 074 3 077 1 785 293
KwaZulu-
Natal
Indicator 5.4 19.0 4.8 82.7 17.2 59.6 7.7 73.8 85.7 62.4 78.3
South Africa Indicator 6.6 23.0 6.4 81.0 17.9 50.5 6.2 68.0 88.3 72.8 51.6
Source: Stats SA 2015; including deaths due to MDR-TB and XDR-TB
Zululand District Health Plan 2018/19
Page 19 of 96
Annual trends Non-communicable diseases
Outcome
Diabetes incidence
per1K)
Hypertension incidence (per1K
2016/17 2016/17
Abaqulusi SD Indicator 0.5 8.6
Numerator 105 380
Denominator 2 735 028 528 357
eDumbe SD Indicator 0.7 7.2
Numerator 59 119
Denominator 1 050 825 196 983
Nongoma SD Indicator 6.5 23.6
Numerator 1 327 842
Denominator 2 463 909 427 848
Ulundi SD Indicator 5.3 18.8
Numerator 1 064 680
Denominator 2 399 952 433 734
uPhongolo SD Indicator 1.1 18.7
Numerator 145 432
Denominator 1 642 605 276 678
Zululand District Indicator 3.1 15.8
Numerator 2 700 2 453
Denominator 10 292 319 1 863 600
KwaZulu-Natal Indicator 2.8 21.7
South Africa Indicator 2.5 18.8
Source: DHIS.
Zululand District Health Plan 2018/19
Page 20 of 96
5. SERVICE DELIVERY PLATFORM AND MANAGEMENT
Number of facilities per sub-district
Sub-Districts Health Posts Mobiles Satellites Clinics Community
Day Centre1
Community
Health
Centres (24
x 7)2
Standalone
MOU3
District
Hospitals
LG P LG P LG P LG P LG P LG P LG P
Abaqulusi 0 3 15 0 1
eDumbe 0 2 6 1 0
Nongoma 1 4 14 0 1
Ulundi 0 6 26 0 2
uPhongolo 0 3 10 0 1
District 1 18 71 1 5
Source: DHIS 2016/17
Abaqulusi Local Municipality experienced an increase in the population to clinics (15) from 14
929 (2015) to 15 137.90 (1.4% increase) and is the highest within the district as compared to other
sub districts with the highest population to mobiles (03) from of 74647 (2015) increasing to 75
689.30; and the second highest head count total of 486403 (DHER 2016) after Ulundi municipality.
This indicates the strain that this sub district is experiencing in the provision of services as
compared to other sub districts. Ulundi Local Municipality has the lowest number of population
to clinics and is due to the highest number of clinics (26) with the highest number of mobiles (06)
as compared to all other sub districts with the highest headcount total of 513201(DHER 2016)
and is only +-27 000 higher than that of Abaqulusi sub district with almost half (15clinics vs
26Ulundi and 3mobiles vs 06 Ulundi the number of PHC facilities compared to Ulundi. Nongoma
Local Municipality has the 2nd highest population to mobiles of 67 544(2015) increasing to 68
253.00 (1% increase) for 14 clinics and only 03 mobiles and one Health post with a headcount
total of 405 736(DHER 2016) including that of the Heath post. Mobiles in this sub-district are
experiencing a strain in case of service delivery and they have a challenge of regular
breakdowns of mobile vehicles due to age. UPhongolo Local Municipality has a total of 10
clinics and 03 mobiles. The current number of clinics may change to 12 once the issue of Fuduka
and Qalukubheka clinics has been finalized as the district map show them to be falling off
Abaqulusi to UPhongolo local municipality.
1 There are no Commlunity Day Centres in KwaZulu-Natal
2 All Community Health Centres (CHC’s) in KwaZulu-Natal do not have MOU’s according to the definitions used in the
DHER 2011/12. All KZN CHC’s operate on a 24 hour, 7 day a week basis.
3 Accordingly to the DHER 2011/12 definitions for Stand Alone MOU’s, there are no Stand Alone MOU’s operational within
KwaZulu-Natal
Zululand District Health Plan 2018/19
Page 21 of 96
5.1 .Human Resources for Health (filled posts)
Co
mm
un
ity
h
ea
lth
wo
rke
r
Nu
rsin
g A
ssis
tan
t
En
rolle
d n
urs
e
Pro
fess
ion
al n
urs
e
Do
cto
r
Ph
arm
ac
ist
De
ntist
Oc
cu
pa
tio
na
l
the
rap
ist
Ph
ysi
oth
era
pis
t
Sp
ee
ch
th
era
pis
t
Au
dio
log
ist
Abaqulusi 234 68 138 268 11 6 2 1 2 0 2
EDumbe 1 12 54 54 4 2 1 0 2 0 0
Nongoma 243 105 173 215 12 3 0 1 1 0 1
Pongola 118 54 110 102 6 3 1 0 2 1 1
Ulundi 353 84 201 269 13 6 1 1 3 1 2
District 949 323 676 908 46 20 5 3 10 2 6
Source: Persal 2016/17
Number of patients to staff type in facilities –Clinics
Organisation
unit Admin Clin. Other Couns. DC GW/C NA PA Basic
PA Post
Basic PN SN Spec.
Ulundi LM 19007.4 18678.5 12830.0 46654.6 18328.6 128300.3
4172.4 7127.8
uPhongolo
LM 36792.0 33919.4 13378.9 32704.0 21024.0 15491.4
5553.5 7547.1
eDumbe LM 132849.0 67489.5 18978.4 18978.4 13284.9 66424.5 66424.5 132849.0 5109.6 4920.3
Abaqulusi LM 28611.9 32232.7 24320.2 121600.8 13146.0 162134.3
48640.3 3986.9 7483.1
Nongoma LM 26657.0 24879.9 9996.4 66642.5 33321.3 22214.2
6151.6 8160.3
Source: DHER 2016
The number of patients to staff type indicates the workload each category of staff experiences
during the day to day service delivery practice, the lower the number of patients to staff type
versus the more the category of personnel indicates less strain that category of staff experiences
at work. The district experienced an increase in the number of patients to PNs from 4 744.4(2015)
to 4994.8 ( 2016);with sub districts having a significantly high number of patients to PNs
increasing from the previous year’s numbers like Nongoma increasing from 5453.1(2015) to
6151.6( 2016); eDumbe increasing from 5399 in 2015 to 5399.2 in 2016 and uPhongolo, increasing
from 4845.6 in 2015 to 5553.5(2016), which indicates a continuously experienced strain by this
category of staff within the district. The moratorium on the filling of posts that came out this year
had a contributing factor in this as people were leaving without any replacements. There are a
Zululand District Health Plan 2018/19
Page 22 of 96
noticeable high number of patients to counsellors especially at Abaqulusi sub district increasing
from 23442.0in 2015 to24320.2 in 2016, This is due to the high number of counsellors released for
further development as nurses; they were not replaced as per H.R policies and the
implementation of the provider initiated; counselling and Testing (PICT) program. The high
number of patients to Pharmacist assistants (PAs) indicates special attention to be paid to it
because they will assist in the implementation of Centralised Chronic Medicine Dispensing and
Distribution(CCMDD) program which is going to be run by PAs at clinics, the and PAs’ availability
will also improve medicine availability thus reducing stock out at PHC facilities. The number of
patients to Data Capturers is decreasing but at a very slow pace except at eDumbe where one
data capturers obtained a higher post and could not be replaced, hence an increase. This has
a negative impact on service delivery especially on capturing of patients on ARTs in the 3Tier
system. This situation is going to change as plans are in place for the Provincial HAST unit to
provide the district with seven data capturers for high volume clinics before the end of this
financial year (2017/18). The high number of patients to GW/Cs is noted throughout the district
and is because there are some clinics like Okhukho, Nhlopheni, Mashona and Nkunzana clinic
that are functioning without cleaners, thus creating challenges in terms of IPC and patient
safety.
Number of patients to staff type in facilities –CHCs
Organisation
unit Admin
Clin.
Other Couns. DC GW/C MO NA
PA
Basic
PA Post
Basic Pharm PN SN Spec.
Ulundi LM
uPhongolo LM
eDumbe LM 3832.4
22994.5 91978.0 10219.8 30659.3 9197.8
30659.3 15329.7 2139.0 3537.6
Abaqulusi LM
Nongoma LM
It is noted that in eDumbe CHC the number of patients to staff type in general has slightly
decreased as compared to the last financial year(2015); however there is still some categories of
staff that are still experiencing strain with the high numbers of patients to attend to like PA Post
Basic at 30659.3, MOs at 30659.3, DCs at 91978.0 and GW/C at 10219.8;the sub district is still
experiencing a challenge of running facilities with grossly short staffing of GW/C as there are
three clinics( Luneburg, Hartland and Ophuzane ) that are without any cleaners at all. The
process of acquiring private services provider for cleaning services at clinics without cleaners
(GW/C) (Outsourcing) could not be implemented due to unavailability of funds.
Zululand District Health Plan 2018/19
Page 23 of 96
Population to Staff [number]
DHER – 2016 Population to Medical Officer (Sub-District)
Organisation unit Uninsured Population Total Population
Ulundi LM
uPhongolo LM
eDumbe LM 27200.7 29092.3
Abaqulusi LM
Nongoma LM
The population to Medical Officer for eDumbe CHC slightly increased from 26 865.7 in 2015 to
27 200.7 in 2016 with a total population to MOs increasing from 28733.3 in 2015 to 29092.3 in 2016
and is due to the decrease in the number of medical officers from 4 in 2015 to 2 in 2016 as they
resigned and could not be replaced due to the moratorium on the filling of posts. The situation is
different now as there are 04 doctors and 02 clinical associates were appointed in 2017/18
DHER – 2016 Population to Professional Nurse (Sub-District) -
Organisation unit Uninsured Population Total population
Ulundi LM 1515.5 1620.9
uPhongolo LM 2406.7 2574.0
eDumbe LM 1182.6 1264.9
Abaqulusi LM 1740.2 1861.2
Nongoma LM 2945.4 3150.1
In general the district experienced an increase in the number of uninsured population to PNs;
from 1768.18 (2015) to 1958.8(2016) the highest number is noted at Nongoma which was at
2595.4 in 2015 to 2945.4 in 2016 and uPhongolo which was at 1999.3 in 2015 and 2406.7 in 2016,
this is due to the utilization of staff loaned from hospital not linked to PHC on Persal especially at
Nongoma. UPhongolo PNs are working under marked strain more especially because there are
no PNs at PHC that are loaned from hospital since the hospital has a BUR above 70% indicating
strain to the hospital nurses too.
Zululand District Health Plan 2018/19
Page 24 of 96
Management and efficiency indicators for the service delivery platform-PHC
(Refer to Annexure C for the templates for the above mentioned).
Sub-
districts
Efficiency Management
Pro
vin
cia
l a
nd
lo
ca
l g
ove
rnm
en
t
dis
tric
t h
ea
lth
se
rvic
es
ex
pe
nd
itu
re p
er
ca
pita
(un
insu
red
po
pu
latio
n)
(Ra
nd
)
Pro
vin
cia
l a
nd
lo
ca
l g
ove
rnm
en
t
prim
ary
he
alth
ca
re e
xp
en
ditu
re
pe
r c
ap
ita
(u
nin
sure
d
po
pu
latio
n)
(Ra
nd
)
Pro
vin
cia
l a
nd
lo
ca
l g
ove
rnm
en
t
ex
pe
nd
itu
re p
er
prim
ary
he
alth
ca
re h
ea
dc
ou
nt
(Ra
nd
)
Pe
rce
nta
ge
of
ass
ess
ed
PH
C
fac
ilitie
s w
ith
90%
of
the
tra
ce
r
me
dic
ine
s a
va
ila
ble
(%
)
Pe
rce
nta
ge
Id
ea
l C
linic
s (%
)
PH
C f
ac
ilitie
s u
sin
g H
ea
lth
Pa
tie
nt
Re
gis
tra
tio
n (
No
)
PH
C U
tilis
atio
n R
ate
(N
o)
PH
C <
5 U
tilis
atio
n R
ate
(N
o)
8 7 6 5 4 3 2 1
Ab
aq
ulu
si Indicator 725.21 725.21 282.26 0% 2.5 3.4
Numerator 159780550 159780550 159780550 0 470375 95695
Denominator 220322 220322 566070 0 205842 28542
eD
um
be
Indicator 1357.02 1357.02 497.32 0 3.2 2.6
Numerator 117213731 117213731 117213731 0 196587 39103
Denominator 86376 86376 235690 0 79,591 12297
No
ng
om
a Indicator 712.09 712.09 279.59 0 3.2 2.4
Numerator 130797179 130797179 130797179 0 372,740 95,073
Denominator 183681 183681 467813 0 165,971 29,433
Ulu
nd
i
Indicator 946.48 946.48 309.83 0 3.9 2.9
Numerator 176034991 176034991 176034991 0 464,337 103,828
Denominator 185989 185989 568165 0 171,138 26,565
UP
ho
ng
ol
o
Indicator 673.79 673.79 262.13 0 3.6 2.5
Numerator 91627458 91627458 91627458 0 281,254 68,300
Denominator 135989 135989 349554 0 125,497 19,171
Zu
lula
nd
Indicator 831.63 831.63 308.81 100% 63% 0 3.2 2.9
Numerator 675459491 675459491 675459491 71 45 0 1 785 293 362 896
Denominator 812208 812208 2187292 71 71 0 748 039 116 008
KwaZulu
-Natal Indicator 1 879 1 213 397
South
Africa Indicator 1 726 1 054 389
Source: DHIS, BAS, Ideal Clinic Information System 2016/17
Zululand District Health Plan 2018/19
Page 25 of 96
The district is experiencing a challenge of a chronically low the PHC utilization rate of 2.5(2016);
dropping from 2.7 in the past three years (2013-2015). A number of clinics and the CHC within
the district have experienced a drastic drop in the PHC head count total this year (2016), the
actual cause of which is not clearly known as the assumption that CCMDD had a contribution
has been dismissed since it has been noted that the clinics doing well in CCMDD are mostly the
ones that has gained a few clients / has minimal decrease in the PHC headcount. Ulundi and
Abaqulusi sub districts are the ones that experienced a significant drop in the utilization rate total
from 2.6(2015) to 2.3 (20160 and 3.0 (2015) to 2.8 (2016) respectively whilst uPhongolo remained
at 2.6 for both 2015 and 2016. It is also related to the long waiting times experienced at clinics
due to high number of resignations experienced towards the end of the financial year where
personnel could not be replaced due to the moratorium on the filling of posts. Poor data quality
due to the lack of proper registers (RORs) at clinics also has an impact
Management and efficiency indicators for the service delivery platform - Hospitals
Hospital
Name
District Hospital
Average
length of stay
(days)
Inpatient bed
utilisation rate
(%)
OPD new
client not
referred rate
(%)
Expenditure
per patient
day
equivalent
(Rand)
Inpatient
Crude Death
Rate (%)
23 22 21 20 19
Abaqulusi
Indicator 5.1 71.1 41.6 2.233 5.3
Numerator 80495 80495 14433 242423913 840
Denominator 15883 113102 34658 108531 15883
eDumbe
Indicator - - - - -
Numerator - - - - -
Denominator - - - - -
Nongoma
Indicator 5.8 45 76.1 2.876 5.3
Numerator 74610 74610 18265 274642780 678
Denominator 12854 165698 23994 95505 12854
Ulundi
Indicator 6 56.7 32 3.006 8.6
Numerator 70735 70735 16751 309220208 1013
Denominator 11832 132144 52333 102868 11832
uPhongolo
Indicator 4.9 76.6 7.5 2.317 5
Numerator 43179 43179 3414 149089119 445
Denominator 8917 56216 45576 64339 8917
District
Indicator 5.45 62.35 49.9 2.608 5.2
Numerator 269019 269019 52863 975376020 2976
Denominator 49486 467160 156561 371243 49486
Zululand District Health Plan 2018/19
Page 26 of 96
The district is experiencing a challenge of a progressively decreasing Bed utilization rate (BUR)
over the years from 66.7% ( 2014), 65.3% (2015) to 59.9% (2016),as compared to the national
target of 75% for district hospitals. It is highest at Itshelejuba hospital at 76.6 %( 2016) and lowest
at Ceza hospital at 43.5 %( 2016).Benedictine hospital is demonstrating a certain degree of
inefficiency looking at its progressively decreasing BUR over the past three years from
63.1%(2014) , 59.4%(2015) to 45% (2016) as compared to Vryheid hospital which is of its same size
in terms of the number of useable beds ,with a BUR from 68.2(2014), 68.2%(2015) to 71.1%
(2016).The challenge at Benedictine has always been explained by the institutional
management as due to hiccups experienced with the retention of doctors; resulting to limited
number of patients seen in OPD, unfortunately the appointment of sessional doctors to remedy
the situation as promised in(2015) does not seem to be having any positive results in solving the
challenge, it has only been able to reduce patient waiting times from 6hours to less than 3hours
thus the reduction of complaints on long waiting times. The progressively increasing high BUR at
Itshelejuba from 77.3 %( 2014); 77.55(2015) to 76.6 %( 2016) over the years is noted with a
concern though because this hospital has a few number of general patient beds which are
always full to capacity with spillages thus compromising the quality of care. In general the district
is progressing towards the national target of the number of days spent by each patient
admitted in hospital as there is a progressive decline in the ALOS over the years from 6.18days
(2014) , 5.9days(2015) to 5.5days (2016)versus the provincial target of 6days(2016).It is noted that
Ceza hospital has the longest average length of stay ranging from 7.2days (2014), 6.4days(2015)
and 6.1 (2016),indicating that the few patients that get admitted at Ceza are kept for a longer
period of time in hospital, may be trying not to have empty wards. Itshelejuba hospital
management is commended for the progressive decrease in the ALOS from 5.1days (2014),
5.2days (2015) to 4.9days (2016), this is due to the implementation of the previous DHER
recommendations on the implementation of the admission and discharge criteria. The highest
expenditure per PDE in Ulundi (R3 006) and Nongoma (R2 876) sub districts indicates that
hospitals are inefficient in the provision of services; they spend more budgets against limited
service delivery output.
6. QUALITY OF CARE
Top 20 worst performing Ideal Clinic (ICRM) elements in PHC facilities Element (2016)
Element # Element % yes scores
155 There is WEB access 9%
41 80% of Professional Nurse have been trained on Basic Life Support 11%
171 EMS respond according to the pre-determined response time 13%
150 The back-up electrical power supply is checked weekly to determine its functionality 20%
161 There is a functional computerized patient information system 21%
149 There is a functional back electrical supply 23%
137 Clinic space accommodates all services and staff 30%
132 There is a standard security guard room 33%
17 The guideline for filling, archiving and disposal of patient records is adhered to 40%
Zululand District Health Plan 2018/19
Page 27 of 96
Element # Element % yes scores
28 Immunization coverage under one year (annualised) is at least 92% or has increased by at
least 5% from the previous year
41%
97 Training records reflect that planned training is conducted as per the district training plan 49%
47 Clinical audit meetings are conducted quarterly in line with the guidelines 53%
124 All toilets are clean, intact and functional 54%
15 Patient record content adheres to ICSM prescripts 54%
16 The provincial/district standard operating procedure/guideline for filling , archiving and
disposal of patient records is available
57%
83 Basic surgical supplies ( consumables) 57%
136 Deficiencies identified during the practice of the emergency evacuation drill are addressed 57%
140 Essential equipment is available and functional in every consulting room 57%
68 The complaints/ compliments /suggestions records show compliance to the National Policy
to manage complaints/ compliments /suggestions
60%
118 Cleaning materials are available 60%
Top 20 worst performance National Core Standards in District Hospitals and PHC clinics
as at [date 2016]
Measure No. Element No scores
3.1.2.1.1.X Tracer medicines as per applicable Essential Drugs List or formulary are available in the
medicine room
5
3.2.1.3.1.E Functional laboratory equipment with appropriate consumables and reagents are
observed
4
3.1.3.5.2.E Physical stock corresponds to the stock reflected in the inventory management system
(as per checklist 31211)
3
3.2.2.8.E There is a recent report (in the last six months) of radiation safety measures showing
actions that have been implemented to limit exposure
2
3.4.1.1.2.E Functional essential equipment as listed in the checklist is available in the Radiology
Department
2
1.8.2.3.1.E Letters to the last five complainants whose cases have been completed are in their files
and include the findings and actions
4
5.2.1.1.2.V
An up-to-date copy of the delegations of authority for the manager of the health
establishment or district details the manager’s authority in terms of financial supply chain
and human resource management
2
5.2.4.1.1.V The health establishment can provide evidence that operational plans are monitored
quarterly against targets and indicators and remedial actions are in place to address
gaps
2
1.1.3.3.1.E Patient satisfaction survey results show that patients are satisfied with linen services of the
health establishment
3
5.2.2.2.2.E The operational plans contain clear service delivery requirements for Finance / HR 4
Zululand District Health Plan 2018/19
Page 28 of 96
Measure No. Element
No scores
/ Operations and clinical service components including targets
5.5.2.1.2.E 11. Results of the staff satisfaction survey conducted in the last 12 months shows that staff
feel motivated and engaged in their work
2
4.1.1.2.5.D
12. Management monitors the presenting complaint/disease being seen at the
establishment and up to date communication strategy is available in the health
establishment which includes formal and informal mechanisms for communicating with
the public and the correct authorisation procedure to follow in line with policy
3
5.6.2.1.1.D
An up to date communication strategy is available in the health establishment which
includes formal and informal mechanisms for communicating with the public and the
correct authorisation procedure to follow in line with policy
2
5.6.2.5.1.V
The health establishment has a policy or protocol for the obtaining of patient consent if
patient identifiable information needs to be communicated to a 3rd party
4
7.1.4.1.1.V Maintenance records show that recommendations of annual management inspection
reports on safety hazards and maintenance needs are implemented
3
4.4.1.3.1.E The establishment has a service level agreement for the safe disposal of toxic chemicals
/ radioactive waste and expired medicines with an accredited service provider and the
service levels are monitored for compliance
3
2.6.3.4.3.X Appropriate isolation accommodation exists for patients with communicable diseases -
as a minimum for viral haemorrhagic disease
7
6.6.3.1.1.E All confidential records are archived in a secure / access controlled environment that is
fire proof
6
2.6.1.6.1. E Evidence that at least 50% of health professionals have been trained in standard
precautions in the previous financial year
2
2.1.1.2.1.V There is evidence that the health establishment participates in monthly maternal and
perinatal morbidity and mortality meetings
1
Top 5 challenges reported by patients in patient surveys, and patient complaints (PHC)
# Total
No scores
1. Long waiting times 115
2. Negative staff attitude 93
3. Safety and Security 83
4. Infection control 80
5. unavailability of medicine 70
Period: 4th Quarter 2016/17
Challenges Planned Interventions
1. Waiting times due to staff
shortages in clinics
Reorganize off duties and leaves for staff
Decentralize more patients on CCMDD
Inform Clients in the Clinic promptly about the envisaged waiting times and how
Zululand District Health Plan 2018/19
Page 29 of 96
Challenges Planned Interventions
long they going to wait.
Implement fast queues-Prioritize clients that need to be seen first.
Implement appointment system, Retrieve client cards 72 Hours before arrival
2. Staff attitudes Have on-going in-service training of staff on Batho Pele
To monitor customer care
3. Infection control Re enforce handwashing in the for health workers.
Have campaigns on hand washing and IPC
Ensure continuous availability of all hand wash facilities at all levels
4. Availability of medicine Improve management and supply of medicines
5. Cleanliness To have checklists monitored and signed hourly
Conduct hourly hygiene rounds
Allocate a dedicated person to monitor cleanliness hour especially at the
ablutions
Provide monthly IPC support at clinics- IPC Manager
Zululand District Health Plan 2018/19
Page 30 of 96
7. ORGANISATIONAL STRUCTURE OF THE DISTRICT MANAGEMENT TEAM
DISTRICT HEALTH
SERVICE DELIVERY P;
M&E
DDM: P; M&E
INTEGRATED DISTRICT PUBLIC
HEALTH SERVICE SYSTEM
DDM: Clinical Programs
VACANT
CORPORATE SERVICES:
OFFICE MANAGER
Vacant
DISTRICT CLINICAL
SPECIALISTS TEAM X 04
District
Director
DISTRICT
PHARMACIST
SECRETARY
CEO CEZA HOSPITAL
CEO
NKONJENI
HOSPITAL
CEO
BENEDICTINE
HOSPITAL
CEO
VRYHEID
HOSPITAL
CEO
ITSHELEJUBA
HOSPITAL
AM OMMUNICATIONS
CEO
eDUMBE CHC
Zululand District Health Plan 2018/19
Page 31 of 96
8. DISTRICT HEALTH EXPENDITURE
Sub-Programme Budget: Adjusted Appropriation Expenditure TOTAL %
Overspent
(Underspent
)
Province Transfer
to LG *
LG
Own
Province Transfer
to LG
LG Own Budget Expenditure
2.1 District Management 19 103 000.00 0.00 0.00 18 549 100.00 0.00 0.00 19 103 000.00 18 549 100.00 (3%)
2.2 Clinics 382 657 000.00 0.00 0.00 394 534 916.00 0.00 0.00 382 657 000.00 394 534 916.00 3%
2.3 Community Health Centres 54 798 000.00 0.00 0.00 55 051 983.00 0.00 0.00 54 798 000.00 55 051 983.00 0%
2.4 Community Services (incl. PAH) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
2.5 Other Community Services 94 728 000.00 0.00 0.00 90 940 322.00 0.00 0.00 94 728 000.00 90 940 322.00 (4%)
2.6 HIV/AIDS 254 099 000.00 0.00 0.00 286 011 738.00 0.00 0.00 254 099 000.00 286 011 738.00 (3%)
2.7 Nutrition 4 200 000.00 0.00 0.00 2 681 911.00 0.00 0.00 4 200 000.00 2 681 911.00 (36%)
2.9 District Hospitals 853 688 000.00 0.00 0.00 827 922 075.00 0.00 0.00 853 688 000.00 827 922 075.00 (3%)
2.12 Other Donor Funding
TOTAL DISTRICT 1 663 273 000 0.00 0.00 1 675 692 045.00 0.00 0.00 1 663 273 000.00 1 675 692 045.00 1%
Source: District Health Expenditure Review (2016/17) or BAS
*LG - Local Government
The District Management budget increased from R12 659 000 (15/16) to R19 103 000 (16/17), which was R6 444 000(50%) increase. The
expenditure has increased from R 12 951 360, (15/16) toR18 549 100 in 16/17 (43%). It has under expenditure of R 553,900 (2.9%).It is
recommended that District Management Expenditure be linked to facility performance to justify over and /or under expenditure to avoid this in
future.
Zululand District Health Plan 2018/19
Page 32 of 96
9. DISTRICT ASPIRATIONS AND INDICATOR TARGETS
List the District aspirations, and map to the Provincial DoH Strategic Plan 2015-2020 goals.
# District Aspiration Provincial Strategic Plan 2015-2020 Goal(s)
1. Improved Child Health Reduce and manage the burden of disease
2. Improved maternal and women’s health Reduce and manage the burden of disease
3. Improved management and control of HIV and TB Reduce and manage the burden of disease
4. Improve quality of health care Improved quality of healthcare
5. Improved management of non-communicable diseases Reduce and manage the burden of disease
6. Strengthen Primary Health Care Services Strengthen health system effectiveness
7. Strengthened Hospital Services Strengthen health system effectiveness
8. Strengthened Health Support Services Strengthen health system effectiveness
Theory of Change (impact, outcome and output) indicators for all District aspirations, to reach health outcomes.
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Dis
tric
t A
spira
tio
n
#0
1:
Im
pro
ve
d
ch
ild h
ea
lth
Type
Imp
ac
t
Child Under 5years mortality rate 7.3 4.4 5.7 5.6% 4% 3% 2%
Inpatient death under 5years 465 272 305 300 210 156 102
Inpatient separations under 5 years 6,380 6,114 5,342 5288 5265 5183 5131
Zululand District Health Plan 2018/19
Page 33 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Child under 5 years diarrhoea case fatality rate 4.7% 3% 3.2% 3.0% 3% 2% 2%
Child under 5years with diarrhoea death 52 34 35 34 34 34 33
Child under 5 years with diarrhoea admitted 1,098 1,124 1,110 1124 1238 1406 1650
Child under 5 pneumonia case fatality rate 4.5% 3.8% 3.2% 3.1% 3% 2% 2%
Child under 5 years with pneumonia death 32 31 26 25 24 23 22
Child under 5 years with pneumonia admitted 705 814 805 814 968 1175 1445
Child under 5 years severe acute malnutrition
case fatality rate
20.3% 7.8% 15.7% 14% 12% 9% 7%
Child under 5 year with severe acute malnutrition
death
47 22 47 44 43 41 39
Child under 5 year with severe acute malnutrition
admitted
231 283 299 310 362 439 536
Imp
ac
t
Death in facility under 1 year rate (annualised 8.3% 5.7% 8.1% 6.1% 6% 4% 2%
Death in facility under 1 year total 357 221 256 259 244 228 213
Inpatient separations under 1 year 4,322 3,886 3,173 4190 4132 5843 9300
Inpatient early neonatal death rate 10.2/1K 7.3/1K 9.9/1K 6.3 5.9 5.5 5.2
Dis
tric
t
Asp
ira
tio
n
#0
1:
Imp
ro
ve
d
ch
ild
he
alth
Imp
ac
t Neonatal death within 7days of birth 169 111 152 100 98 95 90
Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146
Zululand District Health Plan 2018/19
Page 34 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Neonatal death in facility rate 12.2/1K 8.8/1K 11.4/1K 7.1/1K 7.1/1K 6.9/1K 6.7/1K
Neonatal 0-28 days death in facility 203 135 176 113 110 108 104
Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146
Ou
tpu
t
Infant 1st PCR test positive around 10 weeks rate 2.4 1.5 0.93 1.1 % 0.8% 0.8% 0.7%
Infant PCR test positive around 10 weeks 170 58 34 28 36 45 45
Infant PCR test around 10 weeks 7,149 3,781 3,647 2661 4505 5574 6919
Infant exclusively breastfed at HipB3rd dose rate 41.7 34.2 52.7 54% 56% 60% 64%
Infant exclusively breastfed at HipB3rd dose 8,025 6,189 8,841 7492 11825 16085 22217
HipB3rd dose 19,251 9,484 16,778 13873 20988 26694 34494
Immunisation under 1 year coverage (annualised) 87.9 78.1 77.0 78.7% 80% 82% 85%
Immunised fully under 1 year new 18,451 16,111 15,647 15994 16413 17217 18063
Population under 1 year 20,713 20,379 20,126 20327 20529 20939 21358
Measles 2nd dose coverage (annualised) 88.9% 72.6% 94.2% 94.5% 94.7% 95.4% 96%
Measles 2nd dose 18,387 14,899 19 182 19209 19442 19880 20148
Population 1 year 20,559 20,389 20,126 20327 20529 20939 20988
Dis
tri
ct
Asp
i
ratio
n
#
02
:
Imp
r
ov
e
d
ma
t
ern
al
an
d
wo
m
en
’s
he
alt
h
Imp
ac
t
Maternal mortality in facility ratio 55.4
/100K
79/
100K
96.3
/100K
63.7
/100K
53.2/
100K
20.9/
100K
19.3
/100k
Zululand District Health Plan 2018/19
Page 35 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Maternal death in facility 10 13 16 10 9 4 4
Live births in facility 3 16,614 15,465 15,715 15856 16483 17144 17146
Ou
tpu
t
Vitamin A dose 12-59 months coverage
(annualised)
74.0% 72.9%
94.4% 94.6%
95% 95.3% 95.5%
Vitamin A dose 12 - 59 months 84337 84692 110727 114982 113727 115227 116379
Population 12-59 months (multiplied by 2) 113970 116162 117353 1185237 119712 120909 122118
Antenatal client first visit before 20 weeks rate 60.7 67.0 71.7 72% 75.0% 78.6% 82.4%
Number of ANC 1st visit before 20 weeks 11,994 12,180 12,655 13273 14835 15556 17278
Number of ANC 1st visit total 19,772 18,182 17,642 18182 20771 19795 20977
Antenatal client initiated on ART rate 98,1% 99,3% 101.2% 99,5% 98.% 99,4% 99.75
Number of ANC clients started on ART 4682 3827 3414 3835 3950 4704 5596
Number of ANC clients known HIV +ve but not on
ART at 1st visit
4766 3855 3372 3855 3994 4733 5614
Delivery in facility 10-19years rate 10.1% 9.8% 9.9% 8.9% 8.5% 7.4% 6.4%
Number of deliveries in facility 10-19 years 1,686 1,510 1,558 1411 1401 1268 1098
Number of deliveries in facility 16,614 15,465 15,715 15856 16483 17144 17146
Dis
tric
t
Asp
ira
tio
n
#
02
:
Imp
rov
ed
ma
tern
al
an
d
wo
me
n’s
he
alth
Ou
tpu
t
Couple year protection rate (WHO) 43.2 58.0 70.5 73% 73.2% 73.6% 75%
Contraceptive years dispensed 98670 138921 121970 176446 179705 183512 190114
Zululand District Health Plan 2018/19
Page 36 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Population 15-49years- females 234,438 238,741 243,563 241 707 245 499 249 338 253 486
Mother postnatal visit within 6days rate 58.3 59.1 55.1 56.4% 63.4% 78.3% 99.3%
Mother postnatal visit within 6days after delivery 9,684 9,135 8,658 9200 11350 15275 21099
Delivery in facility total 16,614 15,465 15,715 16299 17898 19501 21255
Cervical cancer screening coverage 60.9 80.6 82.3 82.6% 83.8% 87.5% 91.4%
Cervical car screening in women 30years& older 9,319 12,722 13,294 13026 14576 15921 17400
Population 30years and older female/10 15,668 16,110 16,609 15770 17385 18196 19046
Dis
tric
t A
spira
tio
n #
03
: Im
pro
ve
d
ma
na
ge
me
nt
an
d c
on
tro
l o
f H
IV
an
d T
B
Imp
ac
t
TB death rate 6.6% 7.2% 6.8% 4.5 5.9% 5.8% 4.5%
Number of TB client death during treatment 475 447 475 70 455 436 419
Number of TB clients initiated(started) on
treatment
6896 6179 6934 1570 6150 7533 9248
TBDR death rate 24.1% 25% 25% 24 23% 21% 20%
Number of TBDR client death during treatment 108 108 65 63 60 54 50
Number of TBDR clients initiated(started) on
treatment
449 436 283 285 287 290 295
Dis
tric
t
Asp
ira
tio
n
#0
3:
Imp
rov
e
d
ma
na
ge
me
nt
an
d
co
ntr
ol
of
HIV
an
d T
B
TB clients treatment success rate 81.6% 85.1% 85% 90% 86.2% 87.3% 88.5%
Ou
tc
om
e Number of TB clients cured and completed
treatment
5630 5260 5895 1413 6906 7875 9110
Zululand District Health Plan 2018/19
Page 37 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Number of TB clients initiated(started) on
treatment
6896 6179 6934 1570 6150 7533 9248
TBDR clients treatment success rate 81.1% 75.47% 76.38% 77% 78% 93% 94%
Number of TBDR clients cured and completed
treatment
309 160 152 215 210 269 278
Number of TBDR clients initiated(started) on
treatment
449 436 283 285 287 290 295
TB/HIV co-infected client on ART rate 73.7% 67% 67.0% 91% 82% 85.7% 90.7%
Number of registered TB/HIV co-infected clients
started on ART
6628 122 2061 4665 3683 5404 8203
Total number of registered HIV positive TB patients 10916 1802 3077 5123 4497 6305 9046
TB clients loss to follow up rate 4.4% 2.7% 3% 3.3% 2.6% 2.4% 2.3%
Number of TB clients lost to follow up 304 168 88 52 204 218 235
Number of TB clients initiated(started) on
treatment
6896 6179 6934 1570 6150 7533 9248
TB DR clients loss to follow up rate 10.9% 10,3% 9,5% 9% 8.8% 8.5%
Number of TBDR clients initiated(started) on
treatment
449 436 283 285 287 290 295
New smear positive PTB cure rate 83% 81.3% 87,6% 85% 85% 86% 87%
Number of new smear positive pulmonary TB 1079 918 816 1673 1339 1646 1817
Zululand District Health Plan 2018/19
Page 38 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
clients
New smear positive pulmonary TB clients cured 1302 1129 932 1965 1582 1907 2126
Adult with viral load completion rate at 6 months 40.6% 40.4% 43.3% 50% 56% 63% 72%
Adult client viral load done at 6months 4760 4405 6129 6129 7185 8501 10148
ART first line regimen plus ART second line regimen 11963 11110 12349 12349 12925 13538 14192
Adult viral load suppression rate at 6 months 92.4% 92.2% 93% 94% 97% 98% 99%
Adult client viral load 400cps/ml(VLS) at 6 months 4388 3959 5116 5201 6019 7100 8397
ARTM viral load done at 6 months 4760 4405 5905 5607 7068 8511 10310
Adult viral load suppression rate at 12months 91.7% 93.1% 93.5% 94% 9%7 98% 99%
Adult client viral load 400cps/ml(VLS) at 12
months
1628 1497 3088 5275 6019 7110 8397
ARTM viral load done at 6 months 1723 1688 3302 5612 7068 8511 10310
Adult with viral load completion rate at 12 months 48.9% 44.2% 44.4% 50% 56% 63% 72%
Adult client viral load done at 12months 1776 1608 745 6129 7185 8501 10148
ART first line regimen plus ART second line regimen 16997 13894 9217 12349 12925 13538 14192
Child with viral load completion rate at 12 months 44.4% 39.8% 41.7% 55.3% 56% 63% 72%
Child with viral load done at 12 months 4760 4405 6129 6943 7185 8501 10148
Zululand District Health Plan 2018/19
Page 39 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Child with viral load due at 12 months 11963 11110 12349 12567 12925 13538 14192
Dis
tric
t A
spir
atio
n #
03
: Im
pro
ve
d m
an
ag
em
en
t a
nd
co
ntr
ol o
f H
IV a
nd
TB
Ou
tpu
t
Child with viral load suppression at 12 months 66.0% 63.5% 72% 72.3 72.5% 73% 73.5%
Child client viral load done at 12months 107 228 127 128 130 133 137
ART first line regimen plus ART second line regimen 162 359 174 176 178 182 186
ART client remain on ART end of month - total 75,729 85,939 89,698 109540 106888 124910 138839
Adults remaining on ART end of period - Total 71,193 80,997 85,517 103058 105781 116394 128293
Total children(Under 15 years) remaining on ART-
Total
4,536 4,942 5,173 6381 5537 5933 6363
Pro
ce
ss a
nd
In
pu
t
TB symptoms 5 years and older screened in
facility rate
Not
collected
19.0% 80.2% 83% 86% 90% 946%
TB client 5years and older screened in facility Not
collected 349,260 1,431,274 1580989 1604710 1761463 1938317
PHC Headcount Not
collected
1,840,591 1,785,293 1904806 1874125 1965488 2065135
HIV test positive clients 15 years and older rate
(including ANC)
12.2% 11.4% 9.4% 9.2% 7.6% 6.8% 6.1%
Clients 15years and older (including antenatal
)who tested Positive as a proportion of all clients
15years and older ( including antenatal) on
whom an HIV test was done
21,464 17,256 16,808 16447 18064 17134 16268
HI test client 15 years and older ( Incl ANC) 176,090 151,018 178,755 178 770 237661 251035 265227
Zululand District Health Plan 2018/19
Page 40 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
HIV testing coverage (including ANC ) 39.5% 33.1% 39.2% 40.6% 50.4% 52.3% 54.2%
HIV test done total 176,090 151,018 178,755 187693 237661 251040 265227
Denominator 446,073 455,677 455,670 462650 470777 479396 488984
Dis
tric
t A
spira
tio
n
#0
3:
Imp
rov
ed
ma
na
ge
me
nt
an
d
co
ntr
ol
of
HIV
an
d T
B
Ou
tpu
t
Male condom distribution coverage(No) 41.3 72.6 55.0 59.0 61.0 65.0 69.5
Number of condoms distributed 9,943,385 17,852,683 13,829,379 13101915 15150416 16614759 18239567
Population 15-49 years old (males) 211,635 216,936 216,929 219099 214 141 218 514 223 297
Female condom distribution coverage 1.0 2.1 1.6 2.0 1.7 1.8 1.84
Number of Female condom distributed 289,821 644,794 486,696 503486 419535 442883 467981
Population 15-49years- females 234,438 238,741 238,741 241 707 245 499 249 338 253 486
Medical male circumcision performed 8,865 9,827 10,295 9720 11069 11926 12876
Male urethritis syndrome incidence 4.3% 4.0% 2.7% 2.7% 2.6% 2.5% 2.3%
Number of Male urethritis syndrome treatment -
new episode
9,074 8,745 5,883 5824 5613
5355
5064
Dis
tric
t A
spira
tio
n
#0
4:Im
pro
ve
d
ma
na
ge
me
nt
of
no
n-
co
mm
un
ica
ble
dis
ea
ses
Imp
ac
t
Male population 15-49years 211,635 216,936 216,929 219099 214 141 218 514 223 297
Deaths from Malaria 2 0 0 0 1 1 1
Total number of malaria cases reported 14 0 2 2 3 7 7
Ou
tpu
t
Number of new local malaria cases - - - 0 0 0 0
Hypertension incidence 13.9% 14.5% 15.8% 15.3% 16.3% 15.2% 14.2%
Hypertension client treatment new 2,083 2,218 2,453 20824 2311 2184 2065
Population 40years and older 151,987 154,526 155,261 1546813 141844 143635 145451
Dis
tri
ct
Asp
ir
atio
n
#0
4:I
mp
ro
ve
d
ma
n
ag
e
me
nt
of
no
n-
co
m
mu
ni
ca
bl
e
dis
ea
ses
Ou
tp
ut
Diabetes incidence 0.9% 1.9% 3.1% 1.6% 1.4% 1.3% 1.3%
Diabetes client treatment new 749 1,571 2,700 2511 2335 2171 2020
Zululand District Health Plan 2018/19
Page 41 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Population Total 844,526 854,892 853,855 864047 880637 891739 894126
Number of clients 40 years and older screened for
hypertension
Not
collected
Not
collected 222739 238331 424105 968316 2448325
Number of clients 40 years and older screened for
diabetes
Not
collected
Not
collected 160018 192022 367052 930162 2465294
Mental disorders screening rate Not
collected 0.7% 15.8% 1.4% 32.7% 31.2% 36.2%
PHC client screened for mental disorders Not
collected 15,549 345,146 32284 804504 804505 965406
PHC headcount - total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469
Dental extraction to restoration ratio 30.2 54.7 37.3 31.0 22 16 12
Tooth extractions 30,486 30,924 31,419 29210 29091 28800 28512
Tooth restorations 1,010 565 842 943 1345 1798 2448
Cataract surgery rate 267.7/ml 77.9 /ml 0.0/1ml 163/ml 62/1ml 61/ml 60/1ml
Cataract surgery done 224 66 0 132 50 50 50
Population un insured 771627 785752 800112 806642 810611 821 302 832188
Dis
tric
t A
spir
atio
n
#0
5:
Imp
rove
d
qu
alit
y
of
he
alth
ca
re
Ma
na
ge
me
nt
an
d Q
ua
lity
Percentage of fixed PHC facilities scoring
above 70% on the ideal clinic dashboard - 34% 63% 77% 94% 100% 100%
Number of Fixed PHC clinics scoring above 70%
on the ideal clinic dashboard - 24 45 55 67 71 71
Total number of fixed PHC facilities - 71 71 71 71 71 71
Complaints resolution rate ( PHC) 73.1% 72.0% 86.4% 90% 90% 92% 94%
Complaints resolved 422 190 203 295 216 223 234
Complaints received 577 264 235 327 239 242 249
Zululand District Health Plan 2018/19
Page 42 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Complaints resolution rate within 25 working days
rate(PHC)
80.6% 96.3 % 94.6% 96.8% 97% 97% 97%
Complaints resolved within 25 working days 340 183 192 287 232 235 242
Total number of complaints resolved 422 190 203 295 239 242 249
Hospital achieved 75% and more on
National Core Standards self-assessment
rate (District Hospitals)
50% 50% 50% 100% 100% 100% 100%
Number Hospital achieved 75% and more on
National Core Standards self-assessments
2 2 2 5 5 5 5
Number of DHs doing the NCS self-assessments 4 4 4 5 5 5 5
Ma
na
ge
me
nt
an
d
Qu
ality
Complaints resolution rate (DHs) 56.2% 71.1% 85.5% 86% 86% 89% 90%
Complaints resolved 100 150 177 186 268 280 299
Complaints received 178 211 207 216 312 321 332
Complaints resolution rate within 25 working
days rate(DHs) 76.0% 96.7 % 97.2% 97% 98% 98% 98%
Complaints resolved within 25 working days 76 145 172 155 255 275 278
Total number of complaints resolved 100 150 177 160 260 280 283
Dis
tric
t A
spir
atio
n
#
06:S
tre
ng
the
ne
d P
rim
ary
He
alth
Ca
re s
erv
ice
s
O
utp
ut
Ma
na
ge
me
nt
an
d
effic
ien
cy
Effic
ien
cy
PHC utilisation rate -total 2.7 2.6 2.6 2.7 2.8 2.9 3.0
PHC head count total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469
Population total 844,526 854,892 853,855 864047 880637 891739 894126
PHC utilisation rate under 5years 3.9 3.9 4.0 4.0 4.2 4.2 4.3
PHC head count under 5years 399,484 399,164 401,999 403570 415992 428372 439899
Population under 5years 102,144 101,782 100,226 100854 100167 101229 101549
Zululand District Health Plan 2018/19
Page 43 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Expenditure per PHC headcount total 171 195 215 245 246 268 291
Total expenditure PHC( Subprogram 2.2-2.7) 339618750 384698694 422198931 493726362 498713497 501452856 6512396351
PHC head count total 1991311 1976639 1961877 2012126 2027851 2096996 2169513
House hold registration visit coverage 43.9% 27.7% 19.4% 25.7% 32.5% 36.7% 37.4%
Outreach household registration visit 82671 71051 42505 56981 74537 83964 85643
Households in the population 188473 256763 219526 221721 229014 229026 229126
Number of school health teams
(cumulative ) 9 10 11 14 14 14 14
Number of schools accredited as health
promoting ( Cumulative )
31 33 36 46 50 54 60
Number Ward based outreach Teams in 5
most deprived wards(Cumulative) 2 6 10 14
15 16 20
Dis
tric
t A
spira
tio
n
#
07
:Str
en
gth
en
ed
Ho
spita
l Se
rvic
es
School grade 1 screening coverage 29% 51% 24% 59% 30% 37% 45%
School Grade 1 learners screened 7528 13405 82017 14874 2723 3676 4963
School Grade 1 learners – total 26220 26312 2330 25008 8989 9860 10985
School grade 8 screening coverage 6% 9% 25% 27.7% 33% 41% 51%
Ma
na
ge
me
nt
an
d
Eff
icie
nc
y
School Grade 8 learners screened 2672 3875 1709 1926 2478 3593 5210
School Grade 8 learners – Total 44615 44593 6813 6949 7595 8696 10250
Inpatient bed utilisation rate - total 65.3% 62.7% 57.65% 66.7% 67% 67.6% 68%
In-patient days - total 182 101 289969 268916 307286 308 185 309 430 310430
½ Day patients 757 1301 1459 2163 3634 6146 6246
Inpatient bed days available 1235 1235 1235 1235 1235 1235 1235
Zululand District Health Plan 2018/19
Page 44 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
Average length of stay - total 6.3 6.2 5.8 5.6 5.3 5.0 5.0
In-patient days - total 182 101 289969 268916 307286 308 185 309430 310430
½ Day patients 744 853 1459 2163 3634 6146 6246
Inpatient separations 27 977 5049486 49 486 55162 58503 62218 62218
Expenditure per patient day equivalent
(PDE) R3 272 R1 923.27 R2627 R1 922 R1 954 R1 996 R2571
Expenditure total R801,383,0
00
R789,609,2
44
R975 376
020
R919,650,951 R975,727,381 R1,040,376
,666
1397172567
Patient day equivalent 244 941 410 556 478 468 478 468 499 293 521 323 543353
Ou
tpu
t
OPD Head count total 350,940 349,731 295,517 361782 374311 387340 400369
OPD new client not referred rate (%) 38.2% 39.9% 36.9% 23% 16% 15.3% 14.8%
New OPD clients not referred as a proportion of
OPD new clients total 80,174 83,395 61,513
82644
60283 59077 57896
OPD new clients total 209,932 209,262 166,534 361782 374311 387340 391213
Dis
tric
t A
spira
tio
n
#
08:
Imp
rov
ed
h
ea
lth
c
are
su
pp
ort
serv
ice
s
Ma
na
ge
me
nt
an
d e
ffic
ien
cy
Tracer medicine stock -out rate (Hospital) 4.2% 6% 5% 2% 1.9% 1.7% 1.4%
The proportion of all fixed DHs/TBHs/Psych
Hospitals that had stock-out of ANY tracer item
for any period as a proportion of fixed DHs/TBHs
and Psych Hospitals
166 176 134 56 55 50 40
Fixed DHs/TBHs and Psych Hospitals s 3951 2892 2952 2952 2952 2952 2952
Tracer medicine stock -out rate (Fixed PHC clinic,
Gateway & Mobile base) 1% 3% 2%
1%
0.5% 0.5% 0.4%
The proportion of all fixed ,CHCs and CDCs that
had stock-out of ANY tracer item for any period
as a proportion of fixed clinics plus fixed
150 725 428
145 140 135 120
Zululand District Health Plan 2018/19
Page 45 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
CHCS/CDCs
Fixed clinics plus fixed CHCs/CDCs 29016 26 726 26676 26676 26676 26676 26676
Percentage of expired stock (DHs) 0.64% 0.4% 0.4% <1% <1% <1% <1%
Value expired medicines stock R 514 284 R 303 835 R 265 636 268292.36 270975.28 273685.03 276421.88
Value of total stock in the medicine store room
R 80 354
833
R85 247
911
R 59 386
645 599805511.45 60580316.56 61186119.73 61797980.92
Ma
na
ge
me
nt
an
d E
ffic
ien
cy
Percentage of expired stock (PHC) 0.13% 0.3% 0.04% <1% <1% <1% <1%
Total expired medicines stock R85 522 R 293 541 R 45 045 R40 000 R39 600 R38 800 R37000
Total stock in the medicine store room R 68 410
092
R 107 063
131
R 102 198
224
R 103 220
2016.24
R104 252 408
.30
R105 294 932
.38
R106 347 881
.70
Pharmacies graded A or B 100% 87.5% 87.5% 100% 100% 100% 100%
Pharmacies with A or B Grading 8 7 7 8 8 8 8
Total number of pharmacies 8 8 8 8 8 8 8
Percentage of hospitals with functional PTCs 50% 50% 37.5% 62.5% 100% 100% 100%
Number of hospitals with functional PTCs 4 4 3 5 8 8 8
Total number of hospitals 8 8 8 8 8 8 8
Percentage over/under expenditure per quarter 1% -1% -2% 8% 0% 0% 0%
Total expenditure per quarter (accumulative?) 1740355991 1866535045 195369947
8
1895236708 2212259000 2367118000 2532817000
Total Budget 1722432000 1823049590 191527000
0
2063279500 2212259000 2367118000 2532817000
Percentage maintenance and repairs budget
spent
100% 124% 145% 96% 100% 100% 100%
maintenance and repairs budget spent R6 684 040 R6 247 018 R 12 871 R6 779 534 7591000 8123000 8692000
Zululand District Health Plan 2018/19
Page 46 of 96
District
Aspiration
Indicator
Audited
performan
ce 2014/15
Audited
performan
ce 2015/16
Audited
performan
ce 2016/17
Estimated
performance
2017/18
Target
2018/19
Target
2019/20
Target
2020/21
059
Total maintenance and repairs budget R6 679 000 R5 036 000 R 8 907 000 R7 094 000 7591000 8123000 8692000
Number of Hospital Managers who have signed
Performance Agreements (PA’s 5 5 5 5 5 5 5
Number of District Managers who have signed
PA’s
1 1 1 1 1 1 1
Number of ethics workshops conducted 0 0 0 1 1 1 1
10. BOTTLENECKS AND ROOT CAUSES
Bottlenecks / Challenges Root Causes District
Aspiration #
District
Aspiration
1. High child under 5 years deaths due to
diarrhoea
2. Poor implementation of IMCI guidelines in
children.
3. Poor initiation of children under 5years on
ARTs
Poor triaging of babies in OPD
Limited skill in the management of children according to
IMCI at hospitals.
Inadequate Mentorship on ART initiation in children.
Lack of accountability on mentoring NIMART trained nurses.
Poor growth monitoring of children less than 5 years.
Lack of confidence of NIMART trained nurse to initiate
children under 5years on ARTs
Improved child health
Zululand District Health Plan 2018/19
Page 47 of 96
Bottlenecks / Challenges Root Causes District
Aspiration #
District
Aspiration
4. Low immunization coverage in children
under 1 year.
No standardized system in place for tracking and tracking
children for immunization
Poor implementation of the RED strategy
Lack of integration of services for outreach teams.
Poor data quality
01.
5. Use of alternative medicines.
Cultural believes used in the community in treatment of
childhood illnesses.
Limited involvement of community stakeholders e.g. THP’s
6. Lack of surgical and anaesthetic skills for
newly qualified medical officers.
Lack of mentoring and support for junior medical doctors 01. Improved maternal and
women’s health
Poor support of newly qualified medical officers on
anaesthesia and surgery
7. High number of Teenage pregnancies Poor implementation of Youth friendly services policy in
facilities.
Poor marketing of Long Acting Reversible
Contraceptives(LARCs)
Improved maternal and
women’s health
8. Low number of mothers turning up for
post-natal care .at clinics
Poor linkage of post-delivery women to PHC from hospitals
Lack of tracking and tracing of mothers post-delivery by
facilities.
9. Poor implementation of BANC Plus Poor screening and identification of high risk patients.
Late initiation of HIV positive pregnant women.
02 Improved maternal and
women’s health
10. High number of HIV and TB related illnesses
Deaths in ages 15-24 years females due to
Poor implementation of Integrated HIV /TB
guidelines
Late initiation of ART in co-infected patients
High risk behavior due to peer pressure
Engagement in older Sugar daddy relationships.
03. Improved management and
control of HIV and TB
Zululand District Health Plan 2018/19
Page 48 of 96
Bottlenecks / Challenges Root Causes District
Aspiration #
District
Aspiration
11. Poor implementation of the National Core
Standards (NCS) findings and QIPs
Lack of buy in into the program by institutional top
management leading to very slow/ non-implementation of
the QIPs
04
Improved quality of health care
12. Poor implementation of the PSSS QIPs Lack of accountability and commitment
13. Poor management of non-communicable
diseases new clients at Clinics
Poor understanding of data elements by PNs leading to
poor data quality.
Poor support of the program at both district and sub-district
levels.
Poor utilization of the policy NCD guidelines at all levels
05 Improved management and
control of non-communicable
diseases (NCDs).
14. Poor access to PHC services leading to:
low PHC utilization rates and High number
of new patients not referred at OPDs(
Benedictine and Vryheid Hospitals)
Poor community mobilization and marketing of health
services
Poor access to health care services at Hard to reach areas
Multiple Headcount collection points at clinics
No gateway clinics at both institutions
06 Strengthened Primary
health care services
15. Poor implementation and monitoring of
Ideal Clinic and Realization and
Maintenance program (ICRM)
Poor support of the program by institutional management 06 Strengthened Primary
health care services
16. Shortage of essential equipment
Budgetary constraints
06 Strengthened Primary
health care services
17. Dilapidated infrastructure 06 Strengthened Primary
health care services
18. Low bed utilization rate at DHs (Benedictine
(45%), Nkonjeni and Ceza (53.5%)
Patients needing admission are not admitted until they are
seriously ill.
07 Strengthened Hospital
Services
Zululand District Health Plan 2018/19
Page 49 of 96
Bottlenecks / Challenges Root Causes District
Aspiration #
District
Aspiration
19. Long average length of stay at DHs ( Ceza,
Nkonjeni and Benedictine )
Delayed admission of patients visiting OPD until they are
seriously ill at home
No ward rounds taken over weekends and holidays thus
long ALOS
Non implementation of the antibiotic use policy resulting to
patients staying longer.
07 20. High expenditure Per PDE ( DHs)
21. Poor Medicine Supply Management Poor functionality of pharmaceutical governance structures
Poor monitoring of open stock at all levels
Poor supervision and support to PHC facilities
08
Strengthen health systems
effectiveness
22. High tracer medicine stock out Inadequate management of stock at facilities 07 Strengthen health systems
effectiveness
23. Poor decanting of patients to external pick
up points
Insufficient number of clubs and external pick up points 07 Strengthen health systems
effectiveness
Zululand District Health Plan 2018/19
Page 50 of 96
11. KEY INTERVENTIONS
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
01
Impro
ved
child
health
<5yea
rs
Children
under 5
years
Nongoma
,
uPhongol
o,
eDumbe
All Ensure management of fast queues for
children under 5years
Conduct integrated quarterly community
health awareness campaigns per sub district
on water prevention and management of
diarrhoea at home
Poor triaging of children
under 5 years in OPDs
Hospitals
&Clinics
<5yea
rs
Children
under 5
years
Nongoma
,
uPhongol
o,
eDumbe
All Conduct community component IMCI for
CCGs and other key stake holders
Train MCWH nurses 2 per facility on IMCI
guidelines.
Conduct refresher course for previously IMCI
trained nurses.
Monitor implementation of IMCI guideline
monthly at each facility.
Train Paeds, OPD and Nursery doctors in IMCI
Provide mentorship and couching of IMCI
trained clinicians
Limited skill in management
of children according to IMCI
Clinics
WBOTs
Community
IMCI trained
clinicians
All All Conduct at least 2 mentorship and couching
support visits per month to all newly trained
IMCI clinicians per month
Inadequate supervision and
mentoring of newly trained
clinicians on IMCI.
Clinics
Include NIMART Support and couching in the
PAs of PHC trainers
Zululand District Health Plan 2018/19
Page 51 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
Children
under 5
years
All All Conduct RTHB audit to determine if MUAC,
weight and plotting of graph is done on each
child’s visit to health care facility.
Poor growth recording
monitoring in children less
than 5 years.
Clinics
01
Improv
ed
child
health
<5yea
rs
Children
under 5
years
All All Design a standardized tracking and tracing
register utilizing the vaccinators’ manual
specimen.
No standardized tracking
system
WBOTs
Clinics
Conduct door to door EPI catch up
campaigns targeting the hard to reach areas.
Conduct monthly Monitoring of the
implementation of the RED Strategy
Poor implementation of RED
strategy
All Include case finding on EPI, SAM, TB and HIV in
the package of services provided by the
outreach teams.
Include child health (EPI) in the Pas for WBOTs
Lack of integrated service
delivery for outreach teams
(WBOTs) to provide less 5 year
old services.
Sub districts
WBOTs
Conduct Data verification on weekly basis at
all facilities.
Ensure implementation of the EPI schedule as
per the new RTHCB
Poor data quality
Marketing of the services for “PHILA
MNTWANA” centres.
Poor utilization of PHILA
MNTWANA CENTRES
- THPs- All Convene Meeting with THP to discuss health
related issues involving children.
Poor involvement of
community stakeholders e.g.
Community
Zululand District Health Plan 2018/19
Page 52 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
Conduct community dialogues to discuss
negative impact of on alternative medicine
use in children.
THP’s
Cultural believes used in the
community in treating
childhood illnesses.
Adults - Conduct onsite mentoring of NIMART trained
nurses during doctor’s visits to clinics,
Lack of accountability on
mentoring NIMART trained
nurses.
Clinics
02
Improve
d
materna
l and
women’
s health
10 – 49
years
Women of
child
bearing
age
All Monitor Implementation of safe Caesarean
Section principles
Poor support of newly
qualified medical officers on
anaesthesia and surgery
DHs
All Release newly qualifies doctors for supportive
training on anaesthesia and surgery at Queen
Nandi Mother and Child Regional hospital
Conduct onsite mentoring and couching of
newly qualified doctors on anesthesia and
surgery at all district hospitals.
10-18
years
Adolescent
and youth
All Monitor implementation of the six standards of
Adolescent and Youth Friendly Services (AYFS)
policy in all facilities.
Poor implementation of Youth
friendly services policy in
facilities.
Clinics
Train all sexual and reproductive health
(SRH)services champions per facility on the
current guidelines
Identify SRH Champions for
marketing and
implementation of the
program
Zululand District Health Plan 2018/19
Page 53 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
10 – 49
years
Women of
child
bearing
age
All Track and trace post-delivery mothers using
the linking list twice a week.
Conduct weekly meetings to review tracked
and traced clients.
Lack of tracking/ tracing of
mothers post-delivery by
facilities
Clinics
Keep updated record of outcomes of all
clients traced back to care.
Poor linkage of post-delivery
women to PHC from hospitals
Community
Monitor implementation of BANC plus at all
facilities
Conduct continuous in-service updates of PNs
on BANC Plus
Late initiation of HIV positive
pregnant women on ARTs
Sub district
Clinic
03
Improve
d
manag
ement
and
control
of HIV
and TB
15-
24year
s
Women
All All Capacitate OMNs (PHC) on supervision
strategies / activities with specific focus to
HAST program
Lack of skills and competency
(OM and PHCC) to supervise
(facility and WBOT)
Sub district
Clinics
All All All All Capacitate on the optimal use of Tier system
to fast track HAST performance
Inefficient utilization of Tier
system to fast track the HAST
performance
District
Conduct advocacy and monitoring of
national guidelines implementation at all
levels to improve clinical management of
clients
Provide VL services after hours, weekends and
Poor implementation of the
HIV guidelines
Sub district
Clinics
Community
Zululand District Health Plan 2018/19
Page 54 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
holidays to ensure coverage
Strengthen the use of the standardized
linkage, tracing, and tracking system
Inadequate use of
standardized linkage,
tracing, and tracking system
(ART and TB)
Facilitate signing off of 40 remaining on TB,HTS
modules (THIS)
Align decanted clients (CCMDD Adherence
clubs )with scripts renewal dates as groups
Facilitate (Reach out to all ) targeted HIV/TB
/STI screening and prevention strategies to all
through National Screening Campaigns
(#THUMAMINA) as per the national health
calendar
Poor case identification and
early diagnosis identification
0-
14year
s
Children All All Monitor the implementation of the Unfinished
Business program
Poor management
of HIV and AIDS among
children
Sub district
Clinics
All All All Revive morbidity and mortality meetings to
discuss each and every client’s management
and draw QIPs.
Non functionality of the
morbidity and mortality
meetings at hospitals
Sub districts
All All All Improve infection prevention and control (IPC)
health education of patients with TB
Inadequate IPC health
education given to TB
patients by health workers
Sub district
Clinics
04
Improve
All all Include ICRM in the PAs for senior managers
Identify elements that can be quickly archived
needing no funds and develop the
Poor support of the
program by institutional
management
Sub districts
Zululand District Health Plan 2018/19
Page 55 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
d
quality
of
health
care
implementation plan.
Identify and list all the necessary equipment
for procurement
Include equipment the 2018/19 procurement
plan
Place orders at the beginning of the financial
year ( preferably during the 1st quarter)
Poor implementation of the
procurement plan
Monitor progress on implementation of QIPs
Conduct weekly monitoring of the program
progress at EXCO and Cash flow meetings
Implement consequent management for
unexplained poor performance
Non/Poor implementation
of QIPs
Lack of management
accountability and
commitment
Sub districts
Clinics
04
Improve
d
quality
of
health
All All Include PEC surveys monitoring in the PAs for
all CEO’s
Conduct monthly program monitoring and
support
Poor implementation of IPC
guidelines at all levels of
care
Poor support to PHC
facilities by mother hospital
in the provision of supplies
Sub-districts
Zululand District Health Plan 2018/19
Page 56 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
care(Co
nt)
(hand wash facilities)
All All Create community awareness on the
complaints/ compliments and suggestions
procedure
Monitor functionality of the sub-district
Complaints/compliments and suggestions
Management Committees
Poor marketing of
complaints management
services service at all levels
In consistency in the sitting
of Complaints/compliments
Management Committees
Hospitals
Clinics
Include management of PHC facilities
complaints/ compliments and suggestions
management in the PAs of all PROs with a
higher than 20% score rating
Poor support of PHC
facilities by Institutional
PRO’s in the management
of complaints/compliments
/ suggestions
District
Sub districts
Clinics
05
Improve
d
manag
ement
and
control
of non-
commu
nicable
diseases
40year
s and
above
Males and
females
Ulundi –
Nkonjeni
ALL Coordinate preparations for the
implementation of the cataract surgery
program
Non availability of an
Ophthalmologists to
cataract surgery within the
district
All ALL
Capacitation OMNs on data quality
management
Incorporate NCD data into the weekly nerve
centre data elements for close monitoring
Poor data quality
management
Clinics
All ALL
Train al operational managers on early malaria
identification and detection
Ensure availability of rapid malaria test strips
rips at all clinics
Poor malaria management
at all levels
Clinics
All All
Conduct training of PNs on Adult Primary
health care guidelines
Poor program support at all
levels
Clinics
Zululand District Health Plan 2018/19
Page 57 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
Guidelines
All Male
Females All All
Revive specific program clinics (Chronic
diseases clinics) at all District hospitals
District
Sub district
All All All All
Create community awareness of
communicable diseases through community
dialogues
Promote healthy life style practices at
community level
Community
All All All All
Procure assistive devices during the first quarter
of the financial year
Keep as a standing item in the cash flow
meetings until finalised
Long supply chain
management process for
the procurement of assistive
devices
Include program management as KRA in the
PA s of Medical Managers
Monitor dental fillings versus extraction’s
weekly at hospital
Poor implementation and
monitoring of the program
(oral and Dental health
services )
06
Strength
ened
Primary
Health
Care
Services
All All Ulundi -
Ceza
eDumbe
UPhongol
o
Identify under-utilized staff and use them to
develop at least one new WBOT per sub
district
Allocate one pool vehicle to WBOTs on daily
basis
Conduct monthly WBOTs performance reviews
Poor community mobilization and marketing of
health services
Poor access to health care
services at Hard to reach
areas
Sub districts
Ensure there is only one headcount collection
point at each facility
Monitor implementation of the Health Patient
Multiple Headcount
collection points at clinics
Sub districts
Zululand District Health Plan 2018/19
Page 58 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
Registration System(HPRS)
Nongoma
Abaqulusi
Implement integrated clinical Care management
system (ICSM)(Three streams )at ARV clinics
No gateway clinics at
Benedictine and Vryheid
hospitals
Clinics
06
Strength
ened
Primary
Health
Care
Services
(Cont)
All All All All Conduct quarterly community mobilization to
Market services. PHC
Poor community
mobilization and marketing
of PHC services
Community
Conduct quarterly integrated health
screening campaigns to increase access
focusing on hard to reach areas and pension
pay points
Clinics
Implement consequence management for
facilities who do not implement strategies to
increase PHC utilization rate
Poor support by Sub district
management to PHC
services
Sub district
Conduct quarterly community mobilization to
Market services,
Poor community
mobilisation and marketing
of services
Clinics
All All Draw a list /plan of the quick win ICRM
elements needing no budget to implement
from the top 20 list.
Budgetary constraints Sub district
Clinics
All All Monitor implementation of the plan until all
issues are resolved
All All Include essential equipment needs in the next
three year plan per priority of importance
Budgetary constraints Sub district
Clinics
All All Initiate equipment procurement during the 1st Clinics
Zululand District Health Plan 2018/19
Page 59 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
quarter of the financial year to avoid
unnecessary delays
06
Strength
ened
Primary
Health
Care
Services
(Cont)
All All Monitor progress through weekly cash flow
meetings until all items are received
Hospital
All All Include clinics’ refurbishment in the sub district
annual infrastructure maintenance plan
Hospital
All All Monitor monthly progress on the maintenance
of facilities through weekly executive
management meetings until resolved.
Hospital
# 07
Strength
en
hospital
services
In
&out
patien
ts
All All Conduct ward rounds daily, over weekends
and holidays and discharge suitable patients.
Monitor implementation of the antibiotic
policy-no unnecessary IVs, Switch IV antibiotics
to orally on day 3 and discharge patients..
Identify cost drivers
Delayed admission of sick
patients from OPD until they
are very sick.
Poor implementation of the
antibiotic policy
Wards rounds not
conducted daily, over
weekends and holidays
Poor monitoring of
expenditure
Hospitals
All All Improve the quality of cash flow meetings to
monitor expenditure against norms/targets.
Poor monitoring Sub districts
In and
outpatients
All All Revive morbidity and mortality meetings to
monitor patient management trends from OPD
until final outcomes
Poor implementation of the
admission and discharge
criteria
08
Strength
Pharmacists
,
All Conduct quarterly sub-district medicine audits Inadequate management
of stock at facilities
Clinics
Zululand District Health Plan 2018/19
Page 60 of 96
District
Aspirati
on #
Population Geography Public Health Intervention Costing
Life
Cours
e
Group
Key
Population
**
(Sub-
district)**
Ward
**
Key Intervention Root Cause** Service
Delivery
Platform*
Amou
nt
Fundin
g
Sourc
e
ened
health
support
services
Nurses, PAs
Doctors, PAs
and Nurses
All Conduct quarterly Pharmacy and
Therapeutic Committee meetings
Inadequate management
of stock at facilities
Sub districts
Patients All Develop adherence and outreach clubs Insufficient number of clubs
and external pick up points
Community
CCMDD
champion,
CCGs& and
WBOT
All Market CCMDD program and pick up points Insufficient number of
adherence clubs and
external pick up points
Clinics
Community
Describe and unpack shortlisted Public Health Interventions into three dimensions
District Aspiration Provincial District Sub-district Facility
District aspiration 1:
Strategy: Reducing child under 5 years mortality from 5.8(31/5373)(2016) to [ 4.0/1K(291/250870by March 2019
Clinical Monitor implementation of
IMCI guideline monthly at
each facility.
Provide mentorship and couching of IMCI
trained clinicians
Monitor implementation of IMCI guideline
monthly at each facility.
Train MCWH nurses 2 per facility on IMCI
guidelines
Conduct monthly Monitoring
of the implementation of the
RED Strategy
Conduct weekly Monitoring of the
implementation of the RED Strategy
Implement the Reach Every Child in the
District ( RED )Strategy
Zululand District Health Plan 2018/19
Page 61 of 96
District Aspiration Provincial District Sub-district Facility
Include case finding on EPI SAM, TB and HIV
in the package of services provided by the
outreach teams.
Conduct RTHB audit to determine if MUAC,
weight and plotting of graph is done on
each child’s visit to health care.
Conduct RTHB audit to determine if
MUAC, weight and plotting of graph is
done on each child’s visit to health care
Conduct community component IMCI
training for CCGs and other key stake
holders
Conduct community component IMCI
training for CCGs and other key stake
holders
Clinical
Conduct community mapping in grey areas
to access children.
Conduct door to door EPI catch up
campaigns targeting the hard to reach
areas
Coordinate the conduction of door to door
EPI catch up campaigns targeting the hard
to reach areas
Convene quarterly Meetings with THP to
discuss health related issues including child
health children.
Convene monthly Meetings with THP to
discuss health related issues including
child health
Conduct community dialogues to discuss
negative impact on the use of alternative
medicine
Conduct community dialogues to discuss
negative impact on the use of alternative
medicine
Community Provide intra-campaign
support
Market health care services for “PHILA
MNTWANA” centres through community
structures and OSS
Market health care services for “PHILA
MNTWANA” centres through community
structures and OSS
District Aspiration 02: Improved maternal and women’s health
Strategy : 01 Sustaining maternal mortality rate of below 100 /100K population by March 2019
Zululand District Health Plan 2018/19
Page 62 of 96
District Aspiration Provincial District Sub-district Facility
Clinical Monitor Implementation of
safe Caesarean Section
principles
Release newly qualifies M.Os for supportive
clinical exposure on at Queen Nandi
Hospital
Conduct continuous onsite mentoring and
couching of newly qualified doctors on
anesthesia and surgery at all district
hospitals – District Family Physician
Monitor Implementation of safe Caesarean
Section principles
Implement safe Caesarean Section
principles
Conduct ESMOE drill on the management
of labor and puerperium
Conduct ESMOE drill on the
management intrapartum care
Community
Systems Utilize tracking and tracing systems at
facility levels.
Conduct weekly meetings to review
tracked and traced clients
Keep updated record of outcomes of
all clients traced back to care
Province District Sub district Facility
District Aspiration 02: Improved maternal and women’s health
Strategy:
01
Reducing teenage pregnancy
Clinical Train all sexual and reproductive health
(SRH)services champions per facility on the
current guidelines
Identify SRH Champions for marketing and
implementation of the program
Monitor implementation of
the six standards of
Adolescent and Youth
Monitor implementation of the six standards
of Adolescent and Youth Friendly Services
(AYFS) policy in all facilities
Monitor implementation of the six
standards of Adolescent and Youth
Friendly Services (AYFS) policy in all
Zululand District Health Plan 2018/19
Page 63 of 96
Province District Sub district Facility
District Aspiration 02: Improved maternal and women’s health
Friendly Services (AYFS)
policy in all facilities
facilities
Monitor implementation of
the plans
Ensure Marketing long-term contraceptive
methods
Conduct community awarenesses to
Market long term contraceptives
methods
Community Provide support to facilities s in the
conduction of community dialogues on
teenage pregnancy
Conduct one community dialogue per
quarter on teenage pregnancy
System
Strategy 03 Increasing post-natal care clinic attendance within 6days
Clinical Track and trace post-delivery mothers using
the linking list twice a week
Community Conduct weekly meetings to review tracked
and traced clients
System Monitor implementation of the tracking system
Keep updated record of all tracked patients’
outcomes
Strategy 03 Improving implementation of BANC Plus
Monitor implementation of
BANC Plus at all facilities
Monitor implementation of BANC Plus at all
facilities
Conduct continuous in-service updates of PNs
on BANC Plus
District Aspiration 03: Improved management and control of HIV and TB
Strategy:
1. Improving PMTCT program performance
Clinical Coordinate training of
OMNs on Basic supervision
strategies
Train OMNs on basic supervision focusing
on HAST program
Zululand District Health Plan 2018/19
Page 64 of 96
Province District Sub district Facility
District Aspiration 02: Improved maternal and women’s health
Coordinate OMNs
capacitation workshop on
the use of the 3Tier system
Ensure optimal capacity of PMNs on the
3Tier system to fast track HAST monitoring
and performance
Ensure optimal capacity of OMNs on the
3Tier system to fast track HAST monitoring
and performance
Coordinate signing off of
40 remaining on TB,HTS
modules (THIS)
Facilitate signing off of 40 remaining on TB,HTS
modules (THIS)
Facilitate signing off of 40 remaining on
TB,HTS modules (THIS)
Monitor the advocacy of
the integrated HIV and
AIDS guidelines
Conduct advocacy of the integrated HIV
and AIDS guidelines at all levels to improve
clinical management of clients
Conduct advocacy of the integrated HIV
and AIDS guidelines at all levels to
improve clinical management of clients
Systems Monitor provision of VL
services after hours,
weekends and holidays to
ensure coverage
Monitor provision of VL services after hours,
weekends and holidays to ensure coverage
Provide VL services after hours, weekends
and holidays to ensure coverage
Monitor implementation of
the unfinished business
program
Monitor implementation of the unfinished
business program
Implement the unfinished business
program
Community Strengthen the use of standardized linkage,
tracing and tracking system.
Track and trace post-delivery mothers
using the linking list twice a week.
Monitor Alignment
decanted clients (CCMDD
Adherence clubs) with
scripts renewal dates as
groups
Monitor Alignment decanted clients
(CCMDD Adherence clubs) with scripts
renewal dates as groups
Align decanted clients (CCMDD
Adherence clubs) with scripts renewal
dates as groups
District
Aspiration
3:
Improved management and control of HIV and TB
Provincial District Sub-district Facility
Monitor the implementation of
(Reach out to all ) targeted
HIV/TB /STI screening and
Facilitate implementation of (Reach out to
all ) targeted HIV/TB /STI screening and
prevention strategies to all through
Implement the (Reach out to all )
targeted HIV/TB /STI screening and
prevention strategies to all through
Zululand District Health Plan 2018/19
Page 65 of 96
Province District Sub district Facility
District Aspiration 02: Improved maternal and women’s health
prevention strategies to all
through National Screening
Campaigns (#THUMAMINA) as
per the national health
calendar
National Screening Campaigns
(#THUMAMINA) as per the national health
calendar
National Screening Campaigns
(#THUMAMINA) as per the national health
calendar
District Aspiration 4: Improved Quality of Health Care
Strategy:
01
Improve performance on the top 20 worst performing ICRM and NCS elements
Clinical
Systems Include ICRM in
the PAs for all
District Directors
Include ICRM in the PAs for
all CEOs
Include ICRM in the PAs for all DMNs,
Finance, PHC and Systems Mangers
Include ICRM in the PAs for all OMNs
Implement consequent
management for
unexplained poor
performance
Identify and implement elements that can
be quickly achieved needing no funds to
implement
Identify elements that can be quickly
archived needing no funds and
implement
Conduct weekly monitoring of the program
progress at EXCO and Cash flow meetings
Implement consequent management for
unexplained poor performance
Include equipment the 2018/19
procurement plan
Place orders at the beginning of the
financial year ( preferably during the 1st
quarter)
Strategy :
02
Improving management of complaints/compliment and suggestions
Community Conduct community awareness on the flow
and management complaints
Conduct community awareness on the flow
and management complaints
District Improved management and control of non- communicable diseases
Zululand District Health Plan 2018/19
Page 66 of 96
Aspiration#:
05 Provincial District Sub district Facility
Systems
Monitor functionality
of the sub-district
complaints/
compliments and
suggestions
committees.
Convene weekly complaints/ compliments and
suggestions committee meetings
Convene weekly complaints/ compliments
and suggestions committee meetings
Strategy :
01 Fast tracking the implementing cataract surgery program within the district
Clinical Monitor finalization of the
preparations for the
implementation of the
cataract surgery program
Coordinate preparations for the
implementation of the cataract
surgery program
Finalize preparations for the implementation
of the cataract surgery program
Train nurses on cataract identification
Screen and refer clients for cataract surgery
Community
Systems
Strategy :
02
Improving management of diabetes and hypertension program
Clinical Conduct personnel training on Primary
health care guidelines (diabetes / HPT
)management guideline s
Capacitation OMNs on data quality
management
Monitor data quality -understanding of all
indicators/data elements on HPT and
diabetes
Ensure proper screening for all non-
communicable diseases
Ensure proper screening for all non-
communicable diseases
Community Create community awareness of
communicable diseases through community
dialogues
Promote healthy life style
Conduct community dialogues to promote
healthy life style practices and create
awareness on NCDs
District
Aspiration
Improved management and control of non- communicable diseases
Provincial District Sub district Facility
Zululand District Health Plan 2018/19
Page 67 of 96
05 :
Strategy :
03
Improving management and control of malaria
Clinical Train al operational managers on early
malaria identification and detection
Train al operational managers on early
malaria identification and detection
Ensure continuous availability of rapid
malaria test strips at all clinics
Ensure continuous availability of rapid
malaria test strips rips at all clinics
Community Integrate malaria awareness in the
community dialogues for NCDs
Systems
Strategy :
04
Increasing access to Rehabilitations services (wheelchairs)
Community
Systems Initiate procurement/wheelchairs of assistive
devices during the first quarter of the
financial year to give allowance for un
foreseen delays
Conduct continuous follow up in the cash
flow meetings until item delivered
Zululand District Health Plan 2018/19
Page 68 of 96
District Aspiration
6 :
Strengthened PHC services
Provincial District Sub district Facility
Strategy: 1. Increasing access to health care services in hard to reach areas
Clinical Conduct monthly WBOTs performance
reviews.
Conduct Integrated health screening
campaigns
Conduct weekly performance reviews
against allocated targets
Conduct Community mobilization to
create awareness of WBOTs program
Community
Systems Monitor WBOTs performance on
monthly basis
Conduct close monitoring and support to
WBOTs
Conduct monthly WBOTs performance
reviews Identify under-utilized staff and use
them to develop new WBOTs
Allocate pool vehicles on daily basis for
WBOTs,
Ensure there is only one headcount collection
point at each facility
Monitor implementation of the Health Patient
Registration System(HPRS)
Provision of resources for outreach
teams like stationery and other
supplies
District Aspiration 6 : Strengthened Primary Health Care services
Provincial District Sub-district Facility
Strategy : 01 Strengthen implementation of Ideal Clinic Realization and Maintenance program
Clinical
Zululand District Health Plan 2018/19
Page 69 of 96
District Aspiration 6 : Strengthened Primary Health Care services
Provincial District Sub-district Facility
Community
Systems Monitor implementation of the identified
equipment list
Keep a list /plan of identified quick win
essential equipment
Monitor implementation of the plan at monthly
cash flow meetings until resolved
Include essential equipment in the next
three years procurement plan per
priority
Include clinics for refurbishment in the 2018/19
sub-district maintenance plan
District Aspiration
7 :
Strengthened hospital services
Provincial District Sub-district Facility
Strategy : 01 Increasing he inpatient Bed utilization rate from 58% to 67% by March 2019
Clinical Ensure that patients are admitted and
discharged as per stipulated criteria
Implement the patient admission and discharge
criteria
Systems
Strategy : 02 Reducing the average length of stay from 5.4 to 5.3 by March 2019
Clinical Monitor proper implementation of the
antibiotic policy
Ensure continuous availability of a medical
officer over weekends and holidays to conduct
rounds
Monitor implementation of the
antibiotic Standard operation
procedure(SOP)
Implement the antibiotic Standard operation
procedure
Strategy : 03 Reduce Expenditure Per Patient Day Equivalent from – to by March 2019
Clinical
Community
Zululand District Health Plan 2018/19
Page 70 of 96
District Aspiration
7 :
Strengthened hospital services
Provincial District Sub-district Facility
Systems Conduct monthly monitoring of
expenditure on identified cost drivers
Identify cost driver
Monitor expenditure on cost driver
through weekly cash flow meeting and
monthly expenditure reports
Strategy : 04 Reducing OPD new clients not referred
Clinical
Community
Systems Monitor implementation if the three
streams of care at all institutions
Ensure implementation of integrated clinical
Care management system (ICSM)(Three streams
of care )at all previous ARV /TB clinics
District
Aspiration 8 :
Improved health care support services
Provincial District Sub-district Facility
Strategy: 1 Improving medicine supply and management at all levels of care
Clinical Monitor functionality of the sub district
Pharmacy and Therapeutic
Committees
Conduct quarterly Pharmacy and Therapeutic
Committee meetings
Community
Systems Monitor Conduction of quarterly sub-
district medicine management and
control through audits
Conduct quarterly medicine stock management
and control through audits
Conduct quarterly sub-district medicine sock
taking
Conduct monthly medicine stock counts
Strategy: 2 Increasing access to pharmaceutical services
Clinical Coordinate development of adherence and Develop adherence and outreach clubs
Zululand District Health Plan 2018/19
Page 71 of 96
District
Aspiration 8 :
Improved health care support services
Provincial District Sub-district Facility
outreach clubs
Community Market CCMDD program and pick up
points
Systems Provide monthly monitoring and
support of the CCMDD program
Conduct weekly CCMDD program performance
review
Zululand District Health Plan 2018/19
Page 72 of 96
ANNEXURE A: Indicators for monitoring 2018/19-2020/2021
Zululand Health District
(Administration)
Strategic Objective Statement Indicators Audited/ Actual Performance
Estimated
Performanc
e
Medium Term Targets
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
1.2.1) Annual unqualified audit opinion
for financial statements and
performance information from 2015/16
onwards
1. Audit opinion from Auditor-General
1.4.1) Connectivity established at 90%
public health facilities by March 2020
2. Percentage of hospitals with
broadband access
Total number of hospitals with minimum 2
Mbps connectivity
Total number of public hospitals 8 8 8 8 8 8 8
3. Percentage of fixed PHC facilities with
broadband access
Not
collected
Not
collected
Not
collected
0% 100% 100% 100%
Number of PHC facilities that have
access to at least 1Mbps connectivity
Not
collected
Not
collected
Not
collected
0 71 71 71
Total number of fixed PHC facilities 71 71 71 71 71 71 71
1.3.1) Costed annual Procurement Plan
for minor and major assets by the end of
April in each reporting year
4. Approved annual procurement plan 1 1 1 1 1 1 1
4.1.2) Review and approve macro and
micro structures aligned to function
5. Number of organizational structures
reviewed & submitted for approval
N/A N/A N/A N/A N/A N/A N/A
Zululand District Health Plan 2018/19
Page 73 of 96
Strategic Objective Statement Indicators Audited/ Actual Performance
Estimated
Performanc
e
Medium Term Targets
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
4.1.3) Implement the Community Based
Training in a PHC Model in collaboration
with UKZN with Phase 1 pilot
commencing in 2016/17
6. Implement the Community Based
Training in a PHC Model
Draft
Business
Plan
Approve
d Business
Plan
Impleme
nt Model
Implement
Model
Implemen
t Model
4.1.9) Provide sufficient staff with
appropriate skills per occupational group
within the framework of Provincial staffing
norms by March 2020
7. Medical Officers per 100 000 peopled
Number of Medical Officers posts filled
Total population 844,526 854,892 853,855 864047 880637 891739 894126
8. Professional Nurses per 100 000 people
Number of Professional Nurses posts filled
Total population 844,526 854,892 853,855 864047 880637 891739 894126
9. Pharmacists per 100 000 people
Number of Pharmacists posts filled
Total population 844,526 854,892 853,855 864047 880637 891739 894126
4.2.1) All personnel comply with
performance management requirements
from March 2016 onwards
10. Number of Hospital Managers who
have signed Performance
Agreements (PA’s)
5 5 5 5 5 5 5
11. Number of District Managers who
have signed PA’s
1 1 1 1 1 1 1
12. Percentage of Head Office
Managers (Level 13 and above)
who have signed PA’s
N/A N/A N/A N/A N/A N/A N/A
Head Office Managers (level 13 and
above) who signed PA’s in the reporting
cycle
N/A N/A N/A N/A N/A N/A N/A
d Indicators 8, 9 and 10: Minimal increase in the number of staff projected based on the funding envelope – change in estimated populations for 2017/18 MTEF affect value per 100 000
Zululand District Health Plan 2018/19
Page 74 of 96
Strategic Objective Statement Indicators Audited/ Actual Performance
Estimated
Performanc
e
Medium Term Targets
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
Number of Head Office Managers (level
13 and above)
N/A N/A N/A N/A N/A N/A N/A
1.1.1) 2017 – 2027 Strategic Position
Statement approved by June 2017 and
Long Term Plan approved by March 2018
13. Approved 2017-2027 Long Term Plan N/A N/A N/A N/A N/A N/A N/A
1.7.2) Hospital Rationalisation Plan
approved by June 2017
14. Approved Hospital Rationalization
Plane
Not
reported
No Hospital
Rationalis
ation Plan
in draft
Not
finalised
Impleme
nt
approve
d plan
Implement
approved
plan
Implemen
t
approved
plan
5.2.5) 100% Public health hospitals score
more than 75% on the Food Service
Monitoring Standards Grading System
(FSMSGS) by March 2020
15. Percentage of public health
hospitals that scored more than 75%
on the Food Service Monitoring
Standards Grading System
Not
reported
Not
reported
25% 25% 50% 62.5% 100%
Public health hospitals that score more
than 75% on the FSMSGS
Not
reported
Not
reported
2 2 4 5 8
Number of public health hospitals
assessed
8 8 8 8 8 8 8
4.1.11) Appoint an average of 10 000
CCGs per annum on contract
16. Number of Community Care Givers
appointed on contract
1039 1039 1039 1041 1041 1041 1041
5.2.6) Conduct at least 40 ethics
workshops per annum from 2017/18
onwards
17. Number of ethics workshops
conducted
Not
reported
Not
reported
Not
reported
1 1 1 1
1.2.3) Monthly submission of disclosures of
donations, sponsorships, and gifts as per
Circular G15/2016
18. Number of complete submissions of
disclosures of donations, sponsorships
and gifts submitted to Finance
Not
reported
Not
reported
Not
reported
8 8 8 8
e The Plan will be incorporated in the Long Term Plan and Turn-Around Plan (not stand-alone)
Zululand District Health Plan 2018/19
Page 75 of 96
PHC
Strategic Objective Statement Indicator
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
1.6.1) 100% Provincial fixed PHC facilities
score above 70% on the Ideal Clinic
Dashboard by March 2020
1. Ideal clinic status rate - 34% 63% 77% 94% 100% 100%
Ideal clinic status - 24 45 55 67 71 71
Fixed clinics plus fixed CHCs/CDCs - 71 71 71 71 71 71
1.5.3: PHC utilisation rate of at least 2.7
visits per person per year by march
2020
2. PHC utilization rate - total
(Annualised) 2.7 2.6 2.6 2.7 2.8 2.9 3.0
PHC headcount total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469
Population total 844,526 854,892 853,855 864047 880637 891739 894126
5.1.7) Sustain a 95% (or more)
complaint resolution within 25 working
days rate in all public health facilities
from March 2020 onwards
3. Complaint resolution within 25
working days rate (PHC) 73.1% 72.0% 86.4% 90% 90% 92% 94%
Complaint resolved within 25
working days 340 183 192 287 232 235 242
Complaint resolved 422 190 203 295 239 242 249
5.1.6) Sustain a complaint resolution
rate of 95% (or more) in all public
health facilities from March 2020
onwards
4. Complaint resolution rate (PHC) 80.6% 96.3 % 94.6% 96.8% 97% 97% 97%
Complaint resolved 422 190 203 295 216 223 234
Complaint received 577 264 235 327 239 242 249
2.1.1) Increase the total life
expectancy to 60.5 years by March
2020
5. Life expectancy at birth - Total
N/A N/A N/A N/A N/A N/A N/A
2.1.2) Increase the life expectancy of
males to 58.4 years by March 2020 6. Life expectancy at birth - Male
N/A N/A N/A N/A N/A N/A N/A
2.1.3) Increase the life expectancy of
females to 62.7 years by March 2020 7. Life expectancy at birth - Female
N/A N/A N/A N/A N/A N/A N/A
Zululand District Health Plan 2018/19
Page 76 of 96
Strategic Objective Statement Indicator
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
1.5.4) Under 5 utilisation rate of at least
4.2 visits per child per year
8. PHC utilization rate under 5 years
(Annualised) 3.9 3.9 4.0 4.0 4.2 4.2 4.3
PHC headcount under 5 years 399,484 399,164 401,999 403570 415992 428372 439899
Population under 5 years 102,144 101,782 100,226 100854 100167 101229 101549
1.5.6) Increase the expenditure per
PHC headcount to R 471 by March
2020
9. Expenditure per PHC headcount 171 195 226 232 246 268 291
Total expenditure PHC (Sub-
Programmes 2.2-2.7) 339618750 384698694 922198931 598035993 498713497
56145285
6 632396351
PHC headcount total 1991311 1976639 1961877 2582629 2027851 2096996 2169513
1.5.7) Increase School Health Teams to
245 by March 2020
10. Number of school health teams
(cumulative) 9 10 11 14 14 14 14
1.5.2: Increase the number of ward
based outreach teams to 190 by
March 2020
2 6 10 12 14 15 16 20
1.5.8) Increase the accredited Health
Promoting Schools to 335 by March
2020
31 33 36 46 50 54 60
District Hospitals
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performan
ce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Zululand District Health Plan 2018/19
Page 77 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performan
ce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
5.1.2) 60% (or more) public health
hospitals achieved 75% and more on
the National Core Standards self-
assessment rate by March 2020
1. Hospital achieved 75% and
more on National Core
Standards self-assessment rate
(District Hospitals)
50% 50% 50% 100% 100% 100% 100%
Hospital achieved 75% and more
on National Core Standards self-
assessment
2 2 2 5 5 5 5
National Core Standards self-
assessment 4 4 4 5 5 5 5
1.7.3) Improve hospital efficiencies by
reducing the average length of stay
to at least 5.5 days (District), 5.3
(Regional), 15 days (TB), 286.5 days
(Psych), 28.5 days (Chronic), 9 days
(Tertiary), and 8.6 days (Central) by
March 2020
2. Average length of stay - total 80% 80% 100% 80% 80% 100% 80%
In-patient days - total 4 4 5 4 4 5 4
½ Day patients 5 5 5 5 5 5 5
Inpatient separations N/I N/I N/I N/I N/I N/I N/I
1.7.1) Maintain a bed utilisation rate of
75% (or more) by March 2021
3. Inpatient bed utilization rate -
total 60.8% 54.8% 51.8%
66.7%
67% 67.6% 68%
In-patient days - total 354,696 333,392 314,124 307286 308 185 309 430 310430
½ Day patients 744 853 1459 2163 3634 6146 6246
Inpatient bed days available 1235 1235 1235 1235 1235 1235 1235
1.7.4) Maintain expenditure per PDE
within the provincial norms
4. Expenditure per patient day
equivalent (PDE)
R3 272 R1 923.27 R2627 R1 922 R1 954 R1 996 R2571
Expenditure total R801,383,00
0
R789,609,2
44
R975 376
020
R919,650,9
51
R975,727,3
81
R1,040,376
,666
1397172567
Patient day equivalent 244 941 410 556 478 468 478 468 499 293 521 323 543353
Zululand District Health Plan 2018/19
Page 78 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performan
ce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
5. Complaint resolution within 25
working days rate 100 150 177 100 150 177 100
Complaints resolved within 25
working days 178 211 207 178 211 207 178
Complaints resolved 76.0% 96.7 % 97.2% 76.0% 96.7 % 97.2% 76.0%
5.1.6) Sustain a complaint resolution
rate of 95% (or more) in all public
health facilities from March 2020
onwards
6. Complaints resolution rate 73.1% 72.0% 86.4% 90% 90% 92% 94%
Complaints resolved 422 190 203 295 216 223 234
Complaints received 577 264 235 327 239 242 249
2.7.2) Reduce the caesarean section
rate to 26% (District), 37% (Regional),
60% (Tertiary), and 67% or less
(Central) by March 2020
7. Delivery by caesarean section
rate 21.9% 23% 22.0% 22% 22% 21% 20%
Delivery by caesarean section 1902 3411 3 470 3411 3420 3438 3291
Delivery in facility total 8700 14743 15 715 15282 15850 16448 16451
1.7.5) Reduce the un referred
outpatient department (OPD)
headcounts with at least 7% per
annum
8. OPD headcount- total 350,940 349,731 295,517 361782 374311 387340 400369
9. OPD headcount not referred
new
80,174 83,395 61,513 82644 82986 84486 82796
Zululand District Health Plan 2018/19
Page 79 of 96
HIV, AIDS, STI & TB
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.3.1) Increase the number of patients
on ART to at least 1.5 million by March
2020 (cumulative)
1. ART client remain on ART end of
month - total 75,729 85,939 89,698 109540
106888
(G)
124910 138839
2. TB/ HIV co-infected clients on
ART rate 73.7% 67% 67.0% 91% 82% 85.7% 90.7%
TB/HIV co-infected clients on ART 6628 122 2061 4665 3683 5404 8203
HIV positive TB client 10916 1802 3077 5123 4497 6305 9046
2.2.2) Test at least 16.5 million people
for HIV by March 2020 (cumulative) 3. HIV test done - total 176,090 151,018 178,755 187693 237661 251040 265227
2.2.3) Increase the male condom
distribution to 220 million by March
2019
4. Male condoms distributed 9,943,385 17,852,683 13,829,379 13101915 15150416 16614759 18239567
2.2.4) Increase number of female
condoms distributed from 489931 to
419535
5. Number of female condoms
distributed 289,821 644,794 486,696 503486 419535 442883 467981
2.2.4) Increase the medical male
circumcisions to 1.1 million by March
2020 (cumulative)
6. Medical male circumcision –
total 8,865 9,827 10,295 9720 11069 11926 12876
2.4.5) Increase the TB clients 5 years
and older start on treatment to 99% by
March 2020
7. TB symptom 5 years and older
start on treatment rate
Not
collected 19.0% 80.2% 83% 86% 90% 946%
TB client 5 years and older start on
treatment
Not
collected 349,260 1,431,274 1580989 1604710 1761463 1938317
TB symptomatic client 5 years and
older tested positive
Not
collected 1,840,591 1,785,293 1904806 1874125 1965488 2065135
Zululand District Health Plan 2018/19
Page 80 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.4.1) Increase the TB client treatment
success rate to 90% (or more) by
March 2020
8. TB client treatment success rate Not
collected 19.0% 80.2% 83% 86% 90% 946%
TB client successfully completed
treatment
Not
collected 349,260 1,431,274 1580989 1604710 1761463 1938317
TB client start on treatment Not
collected 1,840,591 1,785,293 1904806 1874125 1965488 2065135
2.4.6) Decrease the TB client lost to
follow up to 2.6% (or less) by March
2020
9. TB client lost to follow up rate 4.4% 2.7% 3% 3.3% 2.6% 2.4% 2.3%
TB client on treatment lost to follow
up 304 168 88 52 204 218 235
TB client start on treatment 6896 6179 6934 1570 6150 7533 9248
TB DR clients loss to follow up rate 10.9% 10,3% 9,5% 9% 8.8% 8.5%
Number of TBDR clients lost to follow
up 49 45 28 25 20 15
Number of TBDR clients
initiated(started) on treatment 449 436 283 285 287 290 295
2.4.3) Decrease the TB death rate to
2% by March 2020
10. TB client death rate 6.6% 7.2% 6.8% 4.5 5.9% 5.8% 4.5%
TB client death during treatment 475 447 475 70 455 436 419
TB client start on treatment 6896 6179 6934 1570 6150 7533 9248
2.4.4) Increase the MDR-TB treatment
success rate to 75% (or more) by
March 2020
11. TB MDR treatment success rate 81.1% 75.47% 76.38% 77% 78% 93% 94%
TB MDR client successfully
completing treatment 309 160 152 215 210 269 278
TB MDR confirmed client start on
treatment
449 436 283 285 287 290 295
2.4.2) Reduce the TB incidence to 400
(or less) per 100 000 by March 2020
12. TB incidence 981 912 716 715 694 684 682
New confirmed TB cases 8461 6243 6120 6181 6110 6100 6090
Zululand District Health Plan 2018/19
Page 81 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Total population in Zululand 828143 844531 853,855 864047 880637 891739 894126
2.4.7) Improve Drug Resistant TB
outcomes by ensuring that 90% (or
more) diagnosed MDR/XDR-TB patients
are initiated on treatment by March
2020
13. TB XDR confirmed client start on
treatment N/A N/A N/A N/A N/A N/A N/A
2.4.11) Maintain new smear positive PTB
cure rate of 85% or more from March
2017 onwards
14. New smear positive PTB cure
rate 83% 81.3% 87,6% 85% 85% 86% 87%
New smear positive pulmonary TB
client cured 1079 918 816 1673 1339 1646 1817
New smear positive pulmonary TB
client start on treatment 1302 1129 932 1965 1582 1907 2126
2.2.1) Reduce the HIV incidence to 1%
(or less) by March 2020 (ASSA2008
estimates)
15. HIV incidence 1.2% 1.3% 1.4% 1.2% 1.1% 1% <1%
2.2.5) Decrease male urethritis
syndrome to at least 3% by March 2020
16. Male urethritis syndrome
incidence 4.3% 4.0% 2.7% 2.7% 2.6% 2.5% 2.3%
Male urethritis syndrome treated –
new episodes 9,074 8,745 5,883 5824
5613
5355
5064
Male population 15-49 years 211,635 216,936 216,929 219099 214 141 218 514 223 297
2.3.1) Increase the number of patients
on ART to at least 1.5 million by March
2020 (cumulative)
17. ART adult remain on ART end of
period
71,193
80,997 85,517 103058 105781 116394 128293
18. ART child under 15 years remain
on ART end of period 4,536 4,942 5,173 6381 5537 5933 6363
Zululand District Health Plan 2018/19
Page 82 of 96
MNC&WH & NUTRITION
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.7.3) Increase the antenatal 1st visit
before 20 weeks rate to 70% (or more)
by March 2020
1. Antenatal 1st visit before 20 weeks rate 59.8% 67% 72% 73% 75% 79% 82%
Antenatal 1st visit before 20 weeks 5959 12180 12655 13010 14023 15556 17277
Antenatal 1st visit total 9962 18182 17645 17822 18686 19796 20978
2.7.4) Increase the postnatal visit within
6 days rate to 70% (or more) by March
2020
2. Mother postnatal visit within 6 days rate 58.3 59.1 55.1 56.4% 63.4% 78.3% 99.3%
Mother postnatal visit within 6 days after delivery 9,684 9,135 8,658 9200 11350 15275 21099
Delivery in facility total 16,614 15,465 15,715 16299 17898 19501 21255
2.5.2) Reduce the mother to child
transmission of HIV to less than 0.5% by
March 2020
3. Infant 1st PCR test positive around 10 weeks
rate - - 0.8% 1 % 0.8% 0.8% 0.7%
Infant PCR test positive around 10 weeks - - 43 28 36 45 45
Infant PCR test around 10 weeks - 5197 2561 4505 5574 6919
2.6.3) Increase immunisation coverage
to 88% or more by March 2020
4. Immunization under 1 year coverage
(Annualised) 87.9 78.1 77.0 78.7% 80% 82% 85%
Immunised fully under 1 year new 18,451 16,111 15,647 15994 16413 17217 18063
Population under 1 year 20,713 20,379 20,126 20327 20529 20939 21358
2.6.4) Maintain the measles 2nd dose
coverage of 90% (or more) from March
2017 onwards
5. Measles 2nd dose coverage (Annualised) 88.9% 72.6% 94.2% 94.5% 94.7% 95.4% 96%
Measles 2nd dose 18,387 14,899 19 182 19209 19442 19880 20148
Population 1 year 20,559 20,389 20,126 20327 20529 20939 20988
2.6.6) Reduce the under-5 diarrhoea
case fatality rate to 2% (or less) by
March 2020
6. Diarrhoea case fatality under 5 years rate 4.7% 3% 3.2% 3.0% 3% 2% 2%
Diarrhoea death under 5 years 52 34 35 34 34 34 33
Diarrhoea separation under 5 years 1,098 1,124 1,110 1124 1238 1406 1650
Zululand District Health Plan 2018/19
Page 83 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.6.7) Reduce the under-5 pneumonia
case fatality rate to 2.1% (or less) by
March 2020
8. Pneumonia case fatality under 5 years rate 4.5% 3.8% 3.2% 3.1% 3% 2% 2%
Pneumonia death under 5 years 32 31 26 25 24 23 22
Pneumonia separation under 5 years 705 814 805 814 968 1175 1445
2.6.8) Reduce the under-5 severe
acute malnutrition case fatality rate to
6.5% by March 2020
9. Severe acute malnutrition case fatality under
5 years rate 20.3% 7.8% 15.7% 14% 12% 9% 7%
Severe acute malnutrition death in facility under
5 years 47 22 47 44 43 41 39
Severe acute malnutrition separation under 5
years 231 283 299 310 362 439 536
1.5.9) Increase the number of learners
screened with at least 5% per annum
10. School Grade 1 screening coverage 29% 51% 24% 59% 30% 37% 45%
School Grade 1 learners screened 7528 13405 82017 14874 2723 3676 4963
School Grade 1 learner - total 26220 26312 2330 25008 8989 9860 10985
11. School Grade 8 screening coverage 6% 9% 25% 27.7% 33% 41% 51%
School Grade 1 learners screened 2672 3875 1709 1926 2478 3593 5210
School Grade 1 learner - total 44615 44593 6813 6949 7595 8696 10250
2.7.6) Reduce deliveries under 19 years
to 8.5% or less by March 2020
12. Delivery in 10 to 19 years in facility rate 10.1% 9.8% 9.9% 8.9% 8.5% 7.4% 6.4%
Delivery 10 to 19 years in facility 1,686 1,510 1,558 1411 1401 1268 1098
Delivery in facility - total 16,614 15,465 15,715 15856 16483 17144 17146
2.8.1) Increase the couple year
protection rate to 73.2% by March 2020
13. Couple year protection rate (international) 43.2 58.0 70.5 73% 73.2% 73.6% 75%
Couple year protection 98670 138921 121970 176446 179705 183512 190114
Population 15-49 years females 234,438 238,741 243,563 241 707 245 499 249 338 253 486
Zululand District Health Plan 2018/19
Page 84 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.8.2) Maintain the cervical cancer
screening coverage of 75% (or more)
14. Cervical cancer screening coverage 30
years and olderf 60.9 80.6 82.3 82.6% 83.8% 87.5% 91.4%
Cervical cancer screening in woman 30 years
and older 9,319 12,722 13,294 13026 14576 15921 17400
Population 30 years and older female/10 15,668 16,110 16,609 15770 17385 18196 19046
2.7.5) Initiate 99% eligible antenatal
clients on ART by March 2020
16. Antenatal client start on ART rate 98,1% 99,3% 101.2% 99,5% 98.% 99,4% 99.75
Antenatal client start on ART 4682 3827 3414 3835 3950 4704 5596
Antenatal client known HIV positive but not on
ART at 1st visit 4766 3855 3372 3855 3994 4733 5614
2.8.3) Maintain programme to target 9
year old girls with HPV vaccine 1st and
2nd dose as part of cervical cancer
prevention programme
17. Human papilloma virus (HPV) 1st dose 87% 55% 71% 73% 77% 83% 90%
Girl 9 years and older that received HPV 1st dose 12870 9256 7497 8030 9973 13365 18054
Grade 4 girl learners > 9 years 14780 16951 10577 11000 12988 16089 20122
17. HPV 2nd dose 79% 89% 91% 92% 93% 94% 96%
Girl 9 years and older received HPV 2nd dose 8128 11191 10167 10120 12942 16673 21733
Grade 4 girl learners > 9 years 10280 12605 11187 11000 13989 17682 22590
2.7.1) Reduce the maternal mortality in
facility ratio to 100 (or less) per 100 000
live births by March 2020
19. Maternal mortality in facility ratio
(Annualised)
55.4
79 96.3
63.7
53.2 20.9 19.3
Maternal death in facility 10 13 16 10 9 4 4
Live birth in facility plus Born alive before arrival
at facility 16,614 15,465 15,715 15856 16483 17144 17146
2.5.3) Reduce the neonatal death in
facility rate to at least 11.1/1000 by
20. Neonatal death in facility rate 12.2 8.8 11.4 7.1 7.1 6.9 6.7
Neonatal 0-28 days death in facility 203 135 176 113 110 108 104
f Replaced the approved customised indicator “Cervical cancer screening coverage 20 years and older” as per communicate from the Director General Health dates 09 February 2017
Zululand District Health Plan 2018/19
Page 85 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
March 2020 Live birth in facility 16,592 15,262 15,399 15856 16483 17144 17146
2.5.1) Reduce the infant mortality rate
to 29 per 1000 live births by March 2020
21. Infant mortality rate 8.3 5.7 8.1 6.1 6 4 2
Death in facility under 1 year total 357 221 256 259 244 228 213
Inpatient separations under 1 year 4,322 3,886 3,173 4190 4132 5843 9300
2.6.1) Reduce the under 5 mortality
rate to 40 per 1000 live births by March
2020
22. Under 5 mortality rate 7.3 4.4 5.7 5.6% 4% 3% 2%
Inpatient death under 5years 465 272 305 300 210 156 102
Inpatient separations under 5 years 6,380 6,114 5,342 5288 5265 5183 5131
2.6.10) Reduce under-5 diarrhoea with
dehydration incidence to 10 (or less)
per 1000 by March 2020
23. Diarrhoea with dehydration in child under 5
years incidence (Annualised) 11 9 16 14 13 12 11
Diarrhoea with dehydration new in child under 5
years 1178 1000 1744 1596 1462 1340 1178
Population under 5 years 111379 110953 110213 110777 111347 111922 111379
2.6.11) Reduce the under-5
pneumonia incidence to 63 (or less)
per 1000 by March 2020
24. Pneumonia in child under 5 years incidence
(Annualised) 51.7 52 30 28.3 27 25 22
Pneumonia new in child under 5 years 5296 5296 3305 3126 3003 2729 2481
Population under 5 years 102426 102323 110213 110312 110777 111347 111922
2.6.2) Reduce severe acute
malnutrition incidence under 5 years to
4.6 per 1000 by March 2020
25. Child under 5 years severe acute
malnutrition incidence (Annualised) 4.0 5.0 3.9 3.0 2.9 2.8 2.7
Child under 5 years with severe acute
malnutrition new 374 543 397 332 318 311 301
Population under 5 years 102426 102323 102386 110312 110777 111347 111922
2.6.9) Increase the Vitamin A dose 12-
59 months coverage to 64% or more by
March 2020
26. Vitamin A dose 12-59 months coverage
(Annualised) 86.9% 97.0% 118% 98% 98.5% 98.6% 98.8%
Vitamin A dose 12 - 59 months 80428 90822 110752 92263 92436 92468 93495
Zululand District Health Plan 2018/19
Page 86 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Population 12-59 months (multiplied by 2) 92525 93656 94097 94145 93843 93781 94630
2.6.12) Reduce the death in facility
under 1 year rate to 5.5% or less by
March 2020
27. Death in facility under 1 year rate
(Annualised) 8.3% 5.7% 8.1% 6.1% 6% 4% 2%
Death in facility under 1 year total 357 221 256 259 244 228 213
Inpatient separations under 1 year 4,322 3,886 3,173 4190 4132 5843 9300
2.6.13) Reduce the death in facility
under 5 years rate to 5.0% (or less) by
March 2020
28. Death in facility under 5 years rate 8 4 6 4% 4 3 2
Death in facility under 5 years total 822 258 311 291 291 272 255
Inpatient separations under 5 years 10649 6073 5373 6833 6833 9462 14667
Disease Prevention and Control (DPC)
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2.9.6) Increase the cataract surgery
rate to at least 850 per 1 mil uninsured
population by March 2020
1. Cataract surgery rate (Annualised) 267.7/ml 77.9 /ml 0.0/1ml 163/ml 62/1ml 61/ml 60/1ml
Total number of cataract surgeries completed 224 66 0 132 50 50 50
Population uninsured 771627 785752 800112 806642 810611 821 302 832188
2.10.2) Reduce the malaria case
fatality rate to less than 0.5% by March
2020
2. Malaria case fatality rate 14% 0% 0 0% 0% 0% 0
Deaths from malaria 2 0 0 0 1 1 1
Total number of Malaria cases reported 14 0 2 2 3 7 7
2.10.1) Zero new local malaria cases
by March 2020
3. Malaria incidence per 1000 population at
risk
- - - 0.2 0.3 0.7 0.9
Number of malaria cases (new) 0 0 0 2 3 7 9
Zululand District Health Plan 2018/19
Page 87 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Population Zululand
844,526 854,892 853,855 864047 880637 891739 894126
2.9.3) Screen at least 2.5 million people
(40 years and older) per annum for
hypertension y March 2020
4. Clients 40 years and older screened for
hypertension
Not
Monitore
d
Not
Monitore
d
222739 238331 240 000 256800 274776
2.9.1) Hypertension incidence of 24.6
per 1000 population by March 2020
5. Hypertension incidence (Annualised) 13.9% 14.5% 15.8% 15.3% 16.3% 15.2% 14.2%
Hypertension client treatment new 2,083 2,218 2,453 20824 2311 2184 2065
Population 40 years and older 151,987 154,526 155,261 1546813 141844 143635 145451
2.9.4) Screen at least 2.5 million people
(40 years and older) per annum for
diabetes by March 2020
6. Clients 40 years and older screened for
diabetes
Not
collected
Not
collected 160018 192022 367052 930162 2465294
2.9.2) Diabetes incidence of 3.1 per
1000 population by March 2020
7. Diabetes incidence (Annualised) 0.9% 1.9% 3.1% 1.6% 1.4% 1.3% 1.3%
Diabetes client treatment new 749 1,571 2,700 2511 2335 2171 2020
Population total 844,526 854,892 853,855 864047 880637 891739 894126
2.9.5) Screen at least 1.5 million people
for mental disorders at PHC services by
March 2020
8. Mental disorders screening rate
Not
collect
ed
0.7% 15.8% 20% 33% 35% 38%
PHC client screened for mental disorders
Not
collect
ed
15,549 345,146 469687 804504 902921 1014398
PHC headcount - total 2,268,261 2,239,755 2,187,292 2348437 2462632 2582629 2669469
2.9.7) Improve the number of
wheelchairs issued to 4 200 by March
2020
9. Wheelchairs issued
Not
collect
ed
Not
collect
ed
Not
collect
ed
250 256 269 283
5.2.7) Improve the restoration to
extraction ratio to 18:1 or less by March
10. Dental extraction to restoration ratio 30.2 54.7 37.3 31.0 22 16 12
Tooth extraction 30,486 30,924 31,419 29210 29091 28800 28512
Zululand District Health Plan 2018/19
Page 88 of 96
Strategic Objective Statement Performance Indicators
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
2020 Tooth restoration 1,010 565 842 943 1345 1798 2448
Emergency Medical Services (EMS)
Strategic Objective Statement Performance Indicators Audited/ Actual Performance
Estimated
Performa
nce
Medium Term Targets
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
1.8.4) Improve P1 urban response times
of under 15 minutes to 20% by March
2020
1. EMS P1 urban response under 15 minutes
rate 55.2% 51.7% 41.9% 36.7%
EMS P1 urban response under 15 minutes 16 853 10 298 3 729 4 334
EMS P1 urban calls 43 280 37 390 10 788 5 071
1.8.5) Improve P1 rural response times of
under 40 minutes to 40% by March 2020
2. EMS P1 rural response under 40 minutes
rate
EMS P1 rural response under 40 minutes
EMS P1 rural calls
1.8.6) Increase the inter-facility transfer
rate to 50% by March 2020
3. EMS inter-facility transfer rate
EMS inter-facility transfer
EMS clients total
1.8.1) EMS Turn-Around Strategy
approved by June 2017
4. Approved EMS Turn-Around Strategy
Zululand District Health Plan 2018/19
Page 89 of 96
Strategic Objective Statement Performance Indicators Audited/ Actual Performance
Estimated
Performa
nce
Medium Term Targets
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
1.8.2) Increase the average number of
daily operational ambulances to 220 by
March 2020
5. Average number of daily operational
ambulancesg
1.8.7) Increase number bases with
network access to 50 by March 2020
6. Number of bases with access to intranet/
Specialized Psychiatric Hospitals
Strategic Objective Statement Performance Indicator
Audited /Actual Performance
Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
5.1.2) 60% (or more) public health hospitals
achieved 75% or more on National Core Standards
self-assessment rate by March 2020
1. Hospital achieved 75% and
more on National Core
Standards self-assessment rate
0% 0% 0% 0% 0% 0% 100%
Hospital achieved 75% and more on
National Core Standards self-
assessment
0 0 0 0 0 0 0
Hospitals conducted National Core
Standards self-assessment
1 1 0 0 1 1 1
5.1.7) Sustain a 95% (or more) complaint resolution
within 25 working days rate in all public health
facilities by March 2020 onwards
2. Complaint resolution within 25
working days rate
0 0 100 100 100 100 100
Complaint resolved within 25 days 0 0 1 1 1 1 1
g This will include improved fleet management, maintenance, purchase/allocation of new ambulances and appointment of staff
Zululand District Health Plan 2018/19
Page 90 of 96
Strategic Objective Statement Performance Indicator
Audited /Actual Performance
Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Complaint resolved 0 0 1 1 1 1 1
1.7.3) Improve hospital efficiencies by reducing the
average length of stay to at least 5.5 days (District),
5.3 (Regional), 15 days (TB), 286.5 days (Psych), 25.8
days (Chronic), 9 days (Tertiary), and 8.6 days
(Central) by March 2020
3. Average length of stay – total 12 16 11
Inpatient days-total 6729 6929 7177
½ Day Patients 1.0 0 2
Inpatient separations total 548 542 412
1.7.1) Maintain a bed utilisation rate of 75% (or
more)by March 2020
4. Inpatient bed utilization rate –
total
17.6% 18.1% 18.7% 20% 21% 22%
Inpatient days-total 6729 6929 7177 7535.85 7913 8308.
½ Day Patients 1.0 0 2 2 2 2
Inpatient bed days available 38329 38329 38329 38329 38329 38329
1.7.4) Maintain expenditure per PDE within the
provincial norms
Expenditure per PDE 5214.27 4956.38 4936.97
Total expenditure Psychiatric
Hospitals
43664310.
42
43338588.
66
42354351.
34
Patient day equivalents 8374 8744 8579
1.7.5) Reduce the un referred OPD headcounts
with at least 7% per annum
OPD headcount – total 4896 5,444 3,716
OPD headcount new case not
referred 856 1,450 941
Zululand District Health Plan 2018/19
Page 91 of 96
Specialized TB Hospitals
Strategic Objective Statement Performance Indicator
Audited /Actual Performance
Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
5.1.2) 60% (or more) public health hospitals
achieved 75% or more on National Core Standards
self-assessment rate by March 2020
1. Hospital achieved 75% and
more on National Core
Standards self-assessment rate
0% 0% 0%
Hospital achieved 75% and more on
National Core Standards self-
assessment
0 0 0
Hospitals conducted National Core
Standards self-assessment
0 0 0
5.1.7) Sustain a 95% (or more) complaint resolution
within 25 working days rate in all public health
facilities by March 2020 onwards
2. Complaint resolution within 25
working days rate
100% 0% 0%
Complaint resolved within 25 working
days
1 0 0
Complaint resolved 1 0 0
1.7.3) Improve hospital efficiencies by reducing the
average length of stay to at least 5.5 days (District), 5.3
(Regional), 15 days (TB), 286.5 days (Psych), 25.8 days
(Chronic), 9 days (Tertiary), and 8.6 days (Central) by
March 2020
3. Average length of stay – total 38 64 56
Inpatient days-total 13260 9834 11417
½ Day Patients 0 0 0
Inpatient separations total 342 152 201
1.7.1) Maintain a bed utilisation rate of 75% (or
more) by March 2020
4. Inpatient bed utilization rate –
total
38% 44.9% 52.1% 55 57 60
Inpatient days-total 8312 9834 11417 11988 12587 13217
½ Day Patients 0 0 0 0 0 0
Inpatient bed days available 21902 21902 21902 21902 21902 21902
Zululand District Health Plan 2018/19
Page 92 of 96
Strategic Objective Statement Performance Indicator
Audited /Actual Performance
Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
1.7.4) Maintain expenditure per PDE within the
provincial norms
5. Expenditure per PDE h 2570.97 3697.04 3408.85
Total expenditure TB Hospitals 36908968.
65
40327323.
98
39276871.
69
Patient day equivalents 14359 10908 11522
1.7.5) Reduce the un referred OPD headcounts with
at least 7% per annum
6. OPD headcount – total 3298 3221 3141
7. OPD headcount new case not
referred
164 436 423
Health Sciences & Training
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
4.1.4) Allocate 197 bursaries for first year medicine
students between 2015/16 and 2019/20
1. Number of bursaries awarded for
first year medicine students
4.1.5) Allocate 1 000 bursaries for 1st year nursing
students between 2015/16 and 2019/20
2. Number of bursaries awarded for
first year nursing students
4.3.1) KZNCN accredited as IHE by March 2017 3. KZNCN accredited as Institution of
Higher Education
4.1.9) Increase enrolment of Advanced Midwives
by at least 10% per annumi
4. Number of Advanced Midwifes
graduating per annum
h For planning purposes, NHLS costs for GeneXpert and NPI’s have been included in the projected budget figures i Due to budget constraints the intended 10% increase per annum will be reconsidered year on year in line with the available funding envelope and provision for absorption
Zululand District Health Plan 2018/19
Page 93 of 96
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performa
nce
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
4.1.8) Increase the number of MOP’s who
successfully completed the degree course at DUT
to 61 (cumulative) by March 2020
5. Number of MOP’s that successfully
completed the degree course at
DUT
4.1.6) Increase intake of Mid-Level Workers with at
least 10% per annum (pending availability of
budget)
6. Number of new Pharmacy
Assistants enrolled in training
courses
4.1.7) Increase the EMS skills pool by increasing the
number ILS student intakes to 300 by March 2020
7. Number of Intermediate Life
Support graduates per annum
(Health Care Support)
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
1.9.2) Decrease and maintain zero
clean linen stock outs in facilities from
March 2020 onwards
1. Percentage of facilities reporting
clean linen stock outs
14% 18% 13% 12.5% 12.5% 12.5% 12.5%
Number of facilities reporting clean linen
stock out
1 1 1 1 1 1 1
Facilities total 8 8 8 8 8 8 8
1.9.5) Implement the approved
Forensic Pathology Rationalisation
Plan by March 2017
2. Forensic Pathology rationalization
Plan
N/A N/A N/A N/A N/A N/A N/A
1.9.1) Increase the number of
operational Orthotic Centres to 4 by
March 2020
3. Number of operational Orthotic
Centres - cumulative
N/A N/A N/A N/A N/A N/A N/A
Zululand District Health Plan 2018/19
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Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
5.2.1) Increase the percentage
pharmacies that comply with the SA
Pharmacy Council Standards (A or B
grading) to 100% by March 2020
4. Percentage of Pharmacies that
obtained A and B grading on
inspection
100% 87.5% 87.5% 100%
100% 100% 100%
Pharmacies with A or B Grading 8 7 7 8 8 8 8
Number of pharmacies 8 8 8 8 8 8 8
5.2.3) Decrease medicine stock-out
rates to less than 1% in all health
facilities and PPSD by March 2020
5. Tracer medicine stock-out rate (PPSD) N/A N/A N/A N/A N/A N/A N/A
Number of tracer medicine out of stock N/A N/A N/A N/A N/A N/A N/A
Total number of tracer medicine
expected to be in stock
N/A N/A N/A N/A N/A N/A N/A
5.2.4) improve pharmaceutical
procurement and distribution reforms
6. Tracer medicine stock-out rate
(Institutions)
11% 31% 21% 1% 1% 1% 1%
Number of tracer medicines stock out in
bulk store
316 901 562 201 195 185 160
Number of tracer medicines expected to
be stocked in the bulk store
32967 29618 29628 29628 29628 29628 29628
7. Percentage facilities on Direct
Delivery Model for Procurement and
Distribution of Pharmaceuticals
Not
monitored
Not
monitored
100% 100% 100% 100% 100%
Number of facilities on Direct Delivery
Model
Not
monitored
Not
monitored
8 8 8 8 8
Total number of facilities eligible for Direct
Delivery Model
Not
monitored
Not
monitored
8 8 8 8 8
8. Percentage facilities on Cross-
Docking Model for Procurement and
Distribution of Pharmaceuticals
N/A N/A N/A N/A N/A N/A N/A
Number of facilities on Cross-Docking
Model
N/A N/A N/A N/A N/A N/A N/A
Zululand District Health Plan 2018/19
Page 95 of 96
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performanc
e
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
Total number of facilities eligible for Cross-
Docking Model
N/A N/A N/A N/A N/A N/A N/A
9. Percentage of items on Direct
Delivery and Cross Docking Model
N/A N/A N/A N/A N/A N/A N/A
Number of items on Direct Delivery and
Cross Docking Model
N/A N/A N/A N/A N/A N/A N/A
Total number of items in the Provincial
Essential Medicines Catalogue
N/A N/A N/A N/A N/A N/A N/A
10. Number of facilities implementing the
CCMDD Programme
Not
monitored
Not
monitored
68 101 101 102 102
11. Number of patients enrolled on
CCMDD programme (cumulative)
Not
monitored
Not
monitored
39894 64830 71391 78531 86384
12. Number of pick-up points linked to
CCMDD
Not
monitored
Not
monitored
179 274 274 274 274
(Health Facilities Management)
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performance
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
3.3.4) Major and minor refurbishment
completed as per approved
Infrastructure Plan
1. Number of health facilities that
have undergone major and minor
refurbishment in NHI Pilot District
0 0 0 0 0 0 0
2. Number of health facilities that
have undergone major and minor
refurbishment outside NHI Pilot
District (excluding facilities in NHI
Pilot Districts).
0 1 1 1 1 2 3
Zululand District Health Plan 2018/19
Page 96 of 96
Strategic Objective Statement Performance Indicator
Audited/ Actual Performance Estimated
Performance
2017/18
Medium Term Targets
2014/15 2015/16 2016/17 2018/19 2019/20 2020/21
3.2.1) Create 11,800 jobs through the
Expanded Public Works Programme
(EPWP) by March 2020 (cumulative)
3. Number of jobs created through
the EPWP
105 130 142 197 201 220 240
3.3.1) Complete 40 new and replaced
projects by March 2020
4. Number of new and replacement
projects completed
6 5 3 0 1 5 0
3.3.2) Complete 47 upgrade and
addition projects by March 2020
5. Number of upgrade and addition
projects completed
1 1 2
2 1 3 4
3.3.3) Complete 24 renovation and
refurbishment projects by March 2020
6. Number of renovation and
refurbishment projects completed
1 1 2 2 1 3 4
3.3.5) 100% of maintenance budget
spent annually
7. Percentage of maintenance and
repairs budget spent
100%
124%
145%
96%
100% 100% 100%
Maintenance budget expenditure R6 684 040
R6 247 018
R 12 871
059
R6 779 534 7591000 8123000 8692000
Total maintenance budget R6 679 000 R5 036 000 R 8 907 000 R7 094 000 7591000 8123000 8692000