1. What we know about the Impact of HIV/AIDS on Teachers: a gerneral overview From Peter Badcock-Walters, Christopher Desmond, Daniel Wilson & Wendy Heard 4 June 2003

2. Study Objective Benchmark the mortality rate amongst in- service educators in KZN by age and gender to inform future educator demand and supply planning and modelling. Method Analysis of Annual School Survey data 100-school random sample survey to investigate non-reporting by 90% schools Analysis of PERSAL records Reconciliation/analysis of trends & outcomes

3. Education & HIV Context Largest provincial system with 2,6 million learners & 76000 educators, in 6000 schools; Demand: Enrolment in Grade 1 shows only 1,9% growth over 5 years, 1998 - 2002; Supply: Educator attrition (all causes) greater than decline in demand – 6,8% in 1999 of which 0,64% estimated to be AIDS mortality; Educators vulnerable to high rates of HIV prevalence (35%+) over several years; Growing mortality in Private Sector increasing recruitment of educators from the system.

4. Prevalence rates Ante Natal Clinics Schools HIV Prev. as %

5. Data: Annual School Survey +3% -12% -24% +20% +27%

6. Study Method Identification of available KZNDEC data; Analysis of Annual School Survey, capturing educator & learner mortality since 1999; Commissioning/analysis of 100-school random sample survey to check undercount/ non-reporting by 90% of schools; Analysis of Personnel Salary (PERSAL) system data from 1996; Reconciliation and analysis of observed contradictions, trends and likely impact.

7. Age Distribution of Educators

8. Analysis: Annual School Survey Only 8% schools in 1999 reported educator mortality – 92% balance unknown; Reported 509 deaths (424/83% due to illness) in cohort of 68 615 publicly-paid educators = gross mortality rate of 0,74%; 11% of schools in 2000 reported 650 deaths (580/ 89% due to illness) in cohort of 67 958 educators = gross mortality rate of 0,96%; Mortality rate for male educators higher in 1999 (1,12% vs 0,56%) and in 2000 (1,4% vs 0,76%) than for females; 68% of educators female, average age 37,4.

9. AS Data: Mortality due to Illness

10. AS Data: Mortality by Gender *Female mortality in age band 30-34 rose by 70% 1999 to 2000, and by 30% for those 35-40; *Gross number of female deaths rose from 327 to 354 (+8%) versus 253 to 300 (+19%) for males; *Percentage females dying from illness grew from 89% to 92% versus 78% to 84% for males.

11. Analysis: Personnel Salary Records PERSAL apparently most reliable data but suffers average reporting lag of 4,3 months; 1998-2001 shows 84% to 87% deaths due to illness/natural causes; 1998: mortality rate for males peaked at 1,2% 35-39, averaging 0,9%, while female rate peaked at 0,8% 30-34, averaging 0,5%. Total mortality rate for 1998 = 0,6% 1998 PERSAL total deaths 493, 70% in age group 25-39; Average age of educators at death 36,6.

12. Analysis: PERSAL 1999 1999: PERSAL shows 530 deaths in cohort of 71084 vs 509 in 1999 Annual Survey data; 1999 mortality rate for males peaked at 1,3% 35-39, averaging 1,1%, while females peaked at 0,7% 30-34 averaging 0,6%. Total rate = 0,7%; 68% deaths 25-39; average age at death 36,5.

13. Analysis: PERSAL 2000 2000: PERSAL shows 681 deaths in cohort of 68615 vs 654 in 2000 Annual Survey data; 2000 mortality rate for males peaked at 1,6% 30-34, averaging 1,5%, while females peaked at 1,1% 30-34 averaging 0,8%. Total rate = 1,0%; 67% deaths 25-39; average age at death 36,9.

14. Analysis: PERSAL 2001 2001: PERSAL shows 609 deaths in cohort of 67958; there is no Annual Survey data as yet; 2001 mortality rate for males peaked at 1,8% 50-54, averaging 1,3%, while females peaked at 0,8% 30-39 averaging 0,7%. Total rate = 0,9%; 64% deaths 25-39; average age at death 37,8.

15. Analysis: Sample Survey 1999 Initiated 100-school random sample survey to explain/resolve 90% non-reporting issue; Shows only 24% schools kept viable records; Raises doubts about school data quality; 1999: Showed 4 extra deaths and 1 duplication vs 12 captured via AS and PERSAL; of actual total 16, sample school principals ‘neglected’ to report 12 deaths but analysis also shows AS undercount of 8; Sample educator cohort of 1843 suggests gross mortality rate of 0,87% for 1999.

16. Analysis: Sample Survey 2000 2000: Showed 3 extra deaths and 9 duplications vs 15 captured via AS and PERSAL; of actual total 18, sample school principals only ‘neglected’ to report 6 deaths but again also shows AS undercount of 7; Sample educator cohort of 1903 in 2000 suggests mortality rate of 0,94%; Direct consequence of survey evidence of record keeping failure may be introduction of monthly data capture via the DEMMIS system piloted in 200 schools over 24 months.

17. Outcomes: Mortality Trends 90%-93% all educator deaths 1998-2001 <49; 2124 educators of 2313 dying 1998-2001 <49; 80%+ of this <49 group (1700) died of illness; Mortality 3-times higher than without AIDS.

18. Outcomes: Convergent Trends The three data sets show fairly convergent trends and patterns in 1999, with real convergence in 2000; In 1999, the Annual Survey suggests a gross mortality rate of 0,66%, PERSAL 0,88% and the sample survey 0,89%; In 2000, the Annual Survey suggests a gross mortality rate of 0,96%, PERSAL 1,0% and the sample survey 0,94%; Additional data for 2001 from PERSAL suggests a slight drop back to 0,9%.

19. Outcomes: Post-Service Mortality? Mortality rates used are for in-service educators only; Studies of SA corporate sector suggest up to 50% of employees die after leaving service; Further PERSAL analysis suggests that large numbers of educators (average age 47) are indeed leaving on medical grounds; Must assume that in-service mortality is only a portion of the real rate, and undercounts real number of educators dying; Research will continue to attempt to establish this position.

20. Lessons and Conclusions Establishing rates of mortality should not require this volume of research and analysis, and suggests the lack/failure of MIS; The complexity of PERSAL attrition data requires extensive further analysis There can no longer be any doubt that AIDS is impacting educators, who are dying at 3- 4,5 times the expected rate without AIDS; HIV/AIDS are adding to existing levels of attrition and dysfunction and impacting on teaching, learning, quality and outcomes – impacts that must be adequately measured.

21. Educator Mortality in KwaZulu Natal A Consolidated Study of In-Service Impact and Trends Thank You for your Attention enquiries: peterbw@eastcoast.co.za