1. 30th Alma Ata Celebration The South Africa National Conference on Primary Health Care, 10 -11 April 2008 Alma Ata and Primary Health Care Where are we now? Monitoring progress Fiorenza Monticelli, Health Systems Trust

2. Alma Ata and Primary Health Care Where are we now? Monitoring progress Information and health systems research are key tools required for: –monitoring progress in the achievement of PHC goals –assisting with decision making –ensuring that managerial decisions are based on objective and high quality evidence. Data collated from the DHIS and StatsSA and other primary sources, are made available through the District Health Barometer (DHB) in a cohesive, easily understandable and accessible way to aid management decisions and monitoring.

3. Alma Ata and Primary Health Care Using information to monitor progress Using information from the DHB, this presentation demonstrates progress made in selected key components of PHC. To illustrate this, a number of examples which include some of the most important elements of PHC, have been selected. These examples are:  Adequate supply of safe water and basic sanitation (social determinants of health)  Maternal and child health  Control of local endemic diseases (e.g. TB & HIV)  Equity (in resource allocation)

4. Alma Ata and Primary Health Care The Social Determinants of Health % Households with access to piped water in SA 200184.5% 200585.8% Adequate supply of safe water and basic sanitation YET: still more than a 30% point difference exists between the highest and lowest province % Households with access to piped water by province Eastern CapeLimpopoWestern Cape 200162.4%78.0%98.3% 200567.4%75.8%98.9%

5. Alma Ata and Primary Health Care The Social Determinants of Health % Household access to piped water by district 2001: 71.3% point difference between the highest and lowest district –Central Karoo 98.9% –O R Tambo 27.6% 2005: 55.7% point difference between highest and lowest district –City of Cape Town 99.2% –O R Tambo 43.5%

6. Alma Ata and Primary Health Care The Social Determinants of Health Basic sanitation % Households with no toilet in SA 200112.4% 20069.5% % Households with no toilet by province Eastern CapeGautengFree State 199629.1%2.5%8.8% 200624.3%4.4%3.2% A 21.1% point difference between the highest and lowest province in 2006 vs 26.6% point difference in 2001 - Equity is improving at both provincial and national level

7. Alma Ata and Primary Health Care Maternal and Child Health Perinatal mortality rate* in facilities in rural and metro districts 2003/04 – 2006/07 2003/042004/052005/062006/07 South Africa37.037.934.533.8 ISRDP average43.956.644.740.1 Metro average34.931.534.130.1 Whilst the rate is declining the ISRDP districts are not improving relative to the rest.* Stillbirths and neonatal deaths < 8 days old per 1000 births in a facility 18.6% 33%

8. Alma Ata and Primary Health Care Control of Local Endemic Diseases Proportion of Antenatal Clients Tested for HIV 2003/4 -2006/07

9. Alma Ata and Primary Health Care Control of Local Endemic Diseases Despite falling well below the WHO target for TB cure rate in developing countries (85%), most provinces are improving slowly; although much more needs to be done, especially in the North West, KwaZulu-Natal and Northern Cape

10. 55.6% 31.4% 83.6% TB Cure Rate by District 2005

11. Alma Ata and Primary Health Care Control of Local Endemic Diseases Both the values of the highest and lowest cure rates improved as well as the gap between them, but values are still far from the 85% WHO target 54.2% points difference in 2003 vs 52.2% points in 2005

12. Alma Ata and Primary Health Care Control of Local Endemic Diseases TB Smear Conversion Rate

13. Alma Ata and Primary Health Care Equity in resource allocation Allocation of PHC spend per province and districts Non- hospital Per Capita Expenditure on Primary Health Care (2006/07 prices) 2001/022005/062006/07 South AfricaR222R243R256 Provinces: 2001/02 a 4.4 fold difference between highest and lowest Western Cape – R418 and R95 in Mpumalanga 2006/07 a 1.9 fold difference between highest and lowest Western Cape - R354 and R189 in Mpumalanga

14. Alma Ata and Primary Health Care Equity in resource allocation Districts : An improved equity in per capita expenditure on non- hospital PHC between districts from 2001/02 to 2006/07 2001/02 9.3 fold difference Ekurhuleni (GP) – R418 and R55 Gert Sibande (MP) 2006/07 3.3 fold difference Namakwa (NC) – R497 and R151 Siyanda (NC) (most inequitable province in 2006/07) Equity between district spending within most provinces has improved in 2006/07 eg: Mpumalanga: less than 10% difference between the highest and lowest spending district in 2006/07 vs a 3 fold difference in 2001/02

15. Non-hospital PHC Per Capita Expenditure ISRDP nodes 2001/02 – 2006/07 The difference between the highest and the lowest values moved from a 6.8 fold difference in 2001/02 to a 1.9 fold difference in 2006/07

16. Alma Ata and Primary Health Care Where are we now? Monitoring progress Conclusions: Universal access to care and equity is one of the principles of PHC as set out in the Alma Ata declaration. From the data presented it can be seen that equity has improved in many areas, but quality of care needs attention. One of the essential components of PHC is functional information management and technology – It is therefore of great importance to have the highest quality of data to monitor progress and make management decisions – if inconsistent or of low quality, then it becomes impossible to measure or effect change in a positive way.