1
District Clinical Specialist Team
Situation Analysis: Maternal, Newborn and Child Health
Province
Mpulimteng
District
Fictitia
Date
January 2013
Report prepared by:
Sihle Siyabe (DCST paediatric specialist)
Peter Majole (DCST advanced midwife)
Replace with your own a picture here
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Contents
1.
EXECUTIVE SUMMARY .......................................................................................................................... 5
2.
DESCRIPTION OF THE HEALTH DISTRICT ............................................................................................... 6
3.
2.1
Geography ..................................................................................................................................... 6
2.2
Map ............................................................................................................................................... 7
2.3
Demography.................................................................................................................................. 8
2.4
Socio-economic conditions ......................................................................................................... 10
THE HEALTH SERVICE .......................................................................................................................... 12
3.1
Public Health Sector .................................................................................................................... 12
3.1.1
Facilities.............................................................................................................................. 12
3.1.2 Community care ......................................................................................................................... 15
3.1.3 Referral Systems ........................................................................................................................ 16
3.2 Other Health Care providers ............................................................................................................. 16
3.2.1 The private medical sector......................................................................................................... 16
3.2.2 The traditional health sector ..................................................................................................... 16
3.2.3 The NGO sector .......................................................................................................................... 17
4.
HEALTH STATUS AND HEALTH INDICATORS ....................................................................................... 18
4.1 Vital Statistics .................................................................................................................................... 18
4.2 Mortality ........................................................................................................................................... 18
4.2.1 Mortality rates ........................................................................................................................... 18
4.2.2 Causes leading to death ................................................................................................................. 19
4.2.3 Place of death ................................................................................................................................ 20
5.
ASSESSMENT OF KEY HEALTH SERVICES AND PROGRAMMES ........................................................... 22
5.1 Antenatal services ............................................................................................................................. 22
5.2 Delivery and intrapartum services .................................................................................................... 22
5.3 Postnatal services ............................................................................................................................. 23
5.4 HIV and PMTCT ................................................................................................................................. 23
5.4 Family planning ................................................................................................................................. 24
5.5 Sexually transmitted infections (STDs) ............................................................................................. 24
5.7 Neonatal health ................................................................................................................................ 24
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5.7 Neonatal care .................................................................................................................................... 25
5.8 Child Health services ......................................................................................................................... 25
5.9 Integrated Management of Childhood Illness (IMCI) ....................................................................... 26
5.10 Immunisation .................................................................................................................................. 26
5.11 Nutrition and Growth Monitoring .................................................................................................. 27
5.12 Infectious diseases .......................................................................................................................... 27
5.13 School Health Services .................................................................................................................... 28
5.14 Infection control and cleanliness .................................................................................................... 29
5.15 Other services ................................................................................................................................. 29
6. MANAGEMENT OF SUPPORT SERVICES .................................................................................................. 30
6.1 Human Resources ............................................................................................................................. 30
6.1.1 Staff availability and skills .......................................................................................................... 30
6.1.2 Staff training (development)...................................................................................................... 31
6.1.3 Patient and personnel safety ..................................................................................................... 31
6.2 Transport........................................................................................................................................... 31
6.3 Drug and vaccine supply, distribution and control ........................................................................... 32
6.4 Laboratory services ........................................................................................................................... 32
6.5 Communication ................................................................................................................................. 33
6.6 Health Information............................................................................................................................ 33
6.7 Monitoring and evaluation ............................................................................................................... 33
6.8 Quality Improvement ........................................................................................................................ 34
6.9 Governance ....................................................................................................................................... 34
6.10 Financial Management.................................................................................................................... 34
7.
PROGRESS TOWARDS THE IMPLEMENTATION OF A DISTRICT HEALTH SERVICE ............................... 35
8.
OTHER SECTORS WHICH IMPACT ON HEALTH .................................................................................... 36
8.1
Social Development .................................................................................................................... 36
8.2
Education .................................................................................................................................... 36
8.3
Home Affairs ............................................................................................................................... 36
8.4
Safety and Security ..................................................................................................................... 36
8.5
Correctional Services .................................................................................................................. 37
8.6
Agriculture .................................................................................................................................. 37
8.7
Water Affairs ............................................................................................................................... 37
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8.8. Other ................................................................................................................................................ 37
9.
SUMMARY OF KEY HEALTH PROBLEMS AND CONCLUSION ............................................................... 38
10.
REFERENCES .................................................................................................................................... 39
11.
APPENDICES .................................................................................................................................... 40
Appendix 1: Names and contact details of key district health personnel .............................................. 40
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1.
EXECUTIVE SUMMARY
This is the most important page of the report. Try to keep it to a page.
Present the key facts from the situation analysis on this page.

You may want to bullet some points (as shown in this example).
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2.
DESCRIPTION OF THE HEALTH DISTRICT
2.1 Geography
This section should include a description of the chief physical features of the area. An
example is shown below:
The Fictitia District is one of the six districts of …(province). The Fictitia District covers an
area of 50 015 km2, which is 13% of the total area of … (province). The area is semidesert and covered with scrub. The annual rainfall is only 350 mm/yr. There are no
perennial rivers and the only major permanent sources of fresh water in the region are…
Other important geographic features that have an impact on health and health care
delivery should also be described. For example, the state of roads in a district.
The poor condition of roads is one of the major problems facing the district. Nine roads
require urgent upgrading and maintenance, and ten new roads have been requested.
The only tarred roads are the national roads R617 and R612. Driving to other subdistricts and health facilities is quite a problem particularly in the rainy season.
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2.2 Map
A simplified map, or a few maps, of the district can be pasted so that most of the
following features can be shown:
 Town/villages/informal settlements
 Major roads
 Health facilities and mobile clinic points
 Schools (primary and secondary)
 Creches and Early Child Development Centres
 Location of NGO/CBO projects
 Location of local authority offices
 Other important features
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2.3 Demography
Demography is concerned with the size, composition and location of human
populations and how these factors impact on health service planning and delivery.
This information will help to ensure that you can plan to improve access to health
services.
Data for Fictitia was obtained from the 2011 Census. Details about the population of the
district is shown in table 1 below. In summary, ….
Table 1. Demography of Province and Fictitia District – based on census data, 2011
Province District SubDistrict1
Population (no.)
Population growth rate, 2001-11
(%)
Sex ratio (male:female)
Racial distribution (%)
-
Black African
Coloured
Indian or Asian
White
Dependency ratio
Marital status (%)
-
Married/living together
Never married
Widow/Widower
Separated/Divorced
Highest level of education (%)
-
No schooling
Some primary
Completed primary
Some secondary
SD2
SD3
SD4
SD5
SD6
9
-
12/Matric
Higher
School attendance
-
Total
Male
Female
Unemployment rate (%)
Figure 1. Distribution of population by age and sex – Fictitia, 1996, 2001, 2011
Source: Census 2011
Table 2. Distribution of the population by age, Fictitia District, 2011
Age (years)
0-4
5-9
10-14
15-19
20-29
30-39
40-49
≥50
Sub-district
1
Sub-district
2
Sub-district
3
Sub-district
4
Sub-district
5
Sub-district
6
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2.4 Socio-economic conditions
Information about the socio-economic conditions of the district include:
 the main economic activities in the district;
 household income eg. average household income, and percentage of families living below
the poverty line;
 employment and unemployment figures;
 communities or groups who are particularly vulnerable;
 housing conditions;
 the provision of basic services: water, electricity, sewage and sanitation;
 telecommunications in the district eg. how many households have telephones, the reliability
of the postal service, and plans for the improvement of telecommunications.
This is summarised in Table 3.
From the environmental health point of view, it is important to know which parts of
the district predominantly consist of households without access to clean water and
adequate sanitation, for example.
Housing: All houses within the municipal area have access to a tap (on-site) and refuse is
collected regularly. Most houses are supplied with electricity and sanitation is provided
via waterborne sewerage or, in some cases, the bucket system.
Economy: Agriculture is the major economic activity in the area. The main produce are
grapes and sun-dried fruits. The October Household Survey of 2012 estimated that
32.5% of an estimated 278 743 economically active people were unemployed.
Poverty: Although there are no accurate figures, there is no doubt that a sizable
proportion of the population live in poverty. In comparison to other regions in the
province, more people live in rural areas with poorer access to basic services.
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Table 3. Household details for Province and Fictitia District – based on Census data, 2011
Provin
ce
Population (no.)
Households (%)
Average household size
Main dwelling (%)
- Formal
- Traditional
- Informal
Households (%) with:
- Radio
- Television
- Refrigerator
- Computer
- Cell phone
- Telephone/Landline
- Internet
Electricity use (%) for:
- Lighting
- Cooking
- Heating
Access to piped water (%):
- Inside dwelling/yard
- Communal
- No access
Refuse removal (%)
- Local authority/
private
- Communal/ own
- None
Access to toilet (%):
- Flush/ chemical
- Pit latrines
- Bucket
- None
Average household income
(rand)
Female headed household
(%)
Child headed household (%)
Distric
t
Subdistric
t1
Subdis
trict 2
Subdistric
t3
Subdistric
t4
Subdistric
t5
Subdistric
t6
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3.
THE HEALTH SERVICE
3.1 Public Health Sector
3.1.1 Facilities
Brief summary of hospitals, clinics and community care in district.
A summary of all facilities in the district is provided in table 4.
Table 4. Summary of all facilities in district
Sub-district
Population
Hospital(s)
Community
centre(s)
1
2
3
4
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3.1.1.1 Hospitals
Brief summary of all hospitals in the district.
Hospital 1
- Type of hospital (category)
- Location
- Hospitals/Clinics served
- Outreach/mobile services
- Hospital it refers patients to
- Facilities and physical layout
- Beds and distribution of beds
Clinics
MOUs
Mobile
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-
Human resources (related to MCH) – medical, nursing, administrative
Public/private mix
Basic hospital statistics (summarised in table 5)
Major constraints
Hospital 2
- Type of hospital (category)
- Location
- Hospitals/Clinics served
- Outreach/mobile services
- Hospital it refers patients to
- Facilities and physical layout
- Beds and distribution of beds
- Human resources (related to MCH) – medical, nursing, administrative
- Public/private mix
- Basic hospital statistics (summarised in table 5)
- Major constraints
Hospital 3
-
Type of hospital (category)
Location
Hospitals/Clinics served
Outreach/mobile services
Hospital it refers patients to
Facilities and physical layout
Beds and distribution of beds
Human resources (related to MCH) – medical, nursing, administrative
Public/private mix
Basic hospital statistics (summarised in table 5)
Major constraints
Table 5. Basic annual hospital statistics, 2012
Hospital
name 1
Type of hospital
No. of beds
No of paediatric beds
No of maternity beds
Average number of paediatric OPD
visits per month
Average number of antenatal clinic
visits per month
Hospital
name 2
Hospital
name 3
Hospital
name 4
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Total paediatric admissions
Total births
Number of full-time doctors
Number of full-time nurses
Number of Caesarian sections per
month
3.1.1.2 Clinics, Community health centres and Midwife obstetric units
Brief summary
Sub-district 1
- Number
- Infrastructure (consulting rooms, space, triage area, separate child area, security [fence],
electricity, water, toilets, communication [phone],
- Services offered
- Outreach/mobile services
- Operational hours
- Hospital(s) it refers patients to
- Facilities and physical layout
- Tools and equipment for case management
- Organisation of case management tasks
- Human resources (related to MCH) – medical, nursing, administrative
- Community involvement
- Basic statistics (summarised in table 6)
- Major constraints
Sub-district 2
- Number
- Infrastructure (consulting rooms, space, triage area, separate child area, security [fence],
electricity, water, toilets, communication [phone],
- Services offered
- Outreach/mobile services
- Operational hours
- Hospital(s) it refers patients to
- Facilities and physical layout
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-
Tools and equipment for case management
Organisation of case management tasks
Human resources (related to MCH) – medical, nursing, administrative
Community involvement
Basic statistics (summarised in table 6)
Major constraints
Sub-district 3
- Number
- Infrastructure (consulting rooms, space, triage area, separate child area, security [fence],
electricity, water, toilets, communication [phone],
- Services offered
- Outreach/mobile services
- Operational hours
- Hospital(s) it refers patients to
- Facilities and physical layout
- Tools and equipment for case management
- Organisation of case management tasks
- Human resources (related to MCH) – medical, nursing, administrative
- Community involvement
- Basic statistics (summarised in table 6)
- Major constraints
Table 6. Basic annual clinic statistics, 2012
Subdistrict1 SD2 SD3 SD4 SD5 SD6
3.1.2 Community care
Community health agents
Summary
Number present
Ratio of households to community agent
Proportion of district covered
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Community care groups
Summary
3.1.3 Referral Systems
Is there a clear and documented referral policy for patients?
Do staff receive adequate feedback regarding their referrals?
Is the referral system working well?
Are patients being referred appropriately?
Are patients referred directly from the clinics or health centres to the regional or central
hospital?
Is their feedback to local centre from referral facility?
What are the major problems regarding the referral of patients?
Can add a Diagram here of organisation of health services in district
3.2 Other Health Care providers
3.2.1 The private medical sector
Number of private clinics and their location
Number of family practitioners (GPs)
Number of paediatricians and their location
Number of midwives
Who (population) served?
Average consultation rates
3.2.2 The traditional health sector
Number of registered traditional healers
Number of traditional birth attendants
Who (organisation) affiliated with?
Who (population) served?
Relationship (links) with formal health sector
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3.2.3 The NGO sector
Briefly summarise organisation and activities (if possible), and links to health sector
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4.
HEALTH STATUS AND HEALTH INDICATORS
4.1 Vital Statistics
Table 7. Basic maternal and child health vital statistics, Fictitia District, Jan-Dec 2012
District SubDistrict1
Total deliveries (no.)
Live Births (no.)
Stillbirths (no.)
Maternal deaths (no.)
Neonatal deaths* (no.)
Early neonatal deaths (0-7
days of life)* (no.)
Late neonatal deaths (8-28
days of life)*(no.)
Low birth weight
(<2500g)(no.)
Caesarian section (no.)
Assisted delivery (no.)
* Include all babies > 500g
4.2 Mortality
4.2.1 Mortality rates
Summary:
Maternal mortality rate
Perinatal mortality rate
Neonatal mortality
Under 5 mortality rate
SD2
SD3
SD4
SD5
SD6
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Table 8. Calculated maternal and child health mortality indicators, Fictitia District, Jan-Dec
2012
District SubDistrict1
SD2
SD3
Maternal mortality rate
Stillbirth rate
Early neonatal mortality
rate
Perinatal mortality rate
Neonatal mortality rate
Under 5 mortality rate
4.2.2 Causes leading to death
Summary
Maternal
Newborn
Child
Table 9. Maternal causes of death
Cause of death
HIV
APH
PPH
Severe pre-eclampsia
Severe eclampsia
Severe pregnancy related sepsis
Other
Unknown
Total number of deaths
Table 10. Neonatal causes of death
Number
%
SD4
SD5
SD6
20
Category Total
Hospital
Cause of death
Preterm birth
Perinatal asphyxia
Infections
Congenital
Other
Unknown
Total number of deaths
MOU
Number
Clinic
%
Table 11. Child (1 month to 5 years) causes of death
Cause of death
HIV
Diarrhoea
Pneumonia
Accidents and injuries
TB
Malnutrition
Other
Total number of deaths
4.2.3 Place of death
Summary
Maternal
Newborn
Child
Number
%
Home
Other
Unknown
21
Maternal
Neonatal
Child
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5.
ASSESSMENT OF KEY HEALTH SERVICES AND PROGRAMMES
Where possible, for each programme or health service, provide some information on the
following:
 the aims, objectives and targets of the services and programmes;
 the current set of activities and services;
 the person or people responsible for managing and supervising these activities;
 the personnel available to work in the programme;
 the quality of care provided;
 the problems and constraints involved with the implementation of the required
activities;
 how the activities relate to other services provided in the district;
 the problems that need to be solved in order to improve the effectiveness and efficiency
of the activities.
A critical assessment of how the programme or service is contributing to meeting the overall
needs of the district should also be included. Below is a list of these programmes and some
suggestions about the types of activities which could be described.
5.1 Antenatal services
Summary:
No. ANC first visits
ANC coverage
% ANC 1st visit under 13 weeks
% ANC visits under 20 weeks
5.2 Delivery and intrapartum services
Summary:
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Number of deliveries
Number of unbooked cases
Number of patients with
emergency obstetric
complications
Number of Caesarian sections
5.3 Postnatal services
Summary:
No attending Postnatal within
6 days
5.4 HIV and PMTCT
Summary:
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HIV prevalence in ANC
% ANC patients tested for HIV
No. of women ARV prophylaxis
No of women initiated on ARV
treatment
% eligible on HAART
NVP dose to newborn
PCR testing 6 weeks (infants)
Infants tested PCR positive
Children initiated on HAART < 1 year
Children initiated on HAART > 1 year
% children initiated on HAART
5.4 Family planning
Number treated
Methods prescribed – injections, oral
5.5 Sexually transmitted infections (STDs)
Number treated, ages,
Diagnosis
Management
5.7 Neonatal health
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5.7 Neonatal care
Number of births
Number of low birth weight (<2500 g)
Care of preterms – e.g. Kangaroo mother care
Proportion of hospitals that conform to the Baby Friendly Hospital Initiative
5.8 Child Health services
Integration of preventive and curative child care.
In-patient paediatric care and access to specialist services.
Services for children with disabilities and special needs.
PHC U5 utilization rate
Weighing coverage U5
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5.9 Integrated Management of Childhood Illness (IMCI)
Summary:
5.10 Immunisation
Summary:
Immunization coverage by one year
Drop out rate (Measles 1-2)
Pneumococcal vaccine
Functioning refrigerator
Adequate vaccine conditions
All vaccines available and viable
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5.11 Nutrition and Growth Monitoring
Breastfeeding practices- e.g. exclusive breastfeeding rates
Growth monitoring and promotion activities
Availability of food supplementation for children “failing to thrive”
Vitamin A supplementation
Identification and management of severe malnutrition
Community Based Nutrition Programmes.
The Primary School Nutrition Programme.
Nutrition education and health promotion.
Inter-sectoral collaboration.
Not gaining weight
Incidence of severe malnutrition
No admitted for severe
malnutrition
No deaths due to severe
malnutrition
Case fatality rate
Vitamin A
DHIS
DHIS
DHIS
Vitamin A coverage 6 - 11 months
Vitamin A coverage 12 - 59 months
5.12 Infectious diseases
Summary of notified diseases
Maternal
Newborn
Child
DHIS
DHIS
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Diarrhoeal disease (DD)
incidence
dhis - PHC
Diarrhoea with dehydration
(DDD)
dhis - PHC
Total DD + DDD
Calc
DHIS
DD admitted U5
Hosp
DHIS
DD deaths U5
Hosp
DHIS
DD CFR U5
Hosp
Incidence of pneumonia
Pneumonia Deaths U5
DHIS PHC
DHIS
Hosp
DHIS
Hosp
Pneumonia CFR U5
DHIS
Hosp
Pneumonia admitted U5
5.13 School Health Services
The number of schools in the district.
School health promotion.
Health education in the school curriculum.
Special schools.
Inter-sectoral collaboration between the health and education sectors.
School health teams:
- Personnel
- Services rendered
- Problems encountered
District
How many schools?
How many 1st quintile
schools?
Sub-District1
SD2
SD3
SD4
SD 5
SD6
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How many dedicated
school teams?
5.14 Infection control and cleanliness
Summary
5.15 Other services
Summary
Tuberculosis
Environmental Health
Oral Health
Mental Health
Rehabilitation and disability services
Chronic diseases
Other
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6. MANAGEMENT OF SUPPORT SERVICES
6.1 Human Resources
6.1.1 Staff availability and skills
Number of
Registered
Nurses (RN)
Number of
Paediatric
Nurses
Number of
Advanced
midwives
Number of
RNs PHC
trained
Number of RNs
NIMART
trained
Number of RNs
District
Hospital
CHC 5
CHC 4
CHC 3
CHC 2
CHC 1
PHC 10
PHC 9
PHC 8
PHC 7
PHC 6
PHC 5
PHC 4
PHC 3
PHC 2
PHC 1
Number of Obstetricians
Number of Paediatricians
Number of Family Physicians
Number of Anaesthetists
31
IMCI trained
Number of
Health care
staff ESMOE
trained
Number of
Health care
staff BANC
trained
6.1.2 Staff training (development)
Courses offered
In-service training
Support mechanisms
Evaluation of impact
6.1.3 Patient and personnel safety
Summary
6.2 Transport
How accessible are services to the community?
Who is responsible for co-ordinating transport?
How is transport organised?
What resources are available, particularly for MCH? E.g., vehicles, staff,
Mobile service vehicles available for MCH?
EMS response time
Use of private vehicles?
Are vehicles serviced? Equipment availability?
Which MCH services and programmes are limited because of inadequate transport?
32
6.3 Drug and vaccine supply, distribution and control
Who is responsible for procurement?
Who is responsible for distribution?
Who pays for drugs?
Adequacy of drug supply? (see below)
Storage facilities
Prescribing practices
Problems
Drug management adequate
All critical IMCI drugs available.
All PMTCT drugs and supplies available
All Essential IMCI drugs available
All drugs and supplies for TB care in children
All ARV drugs for children (pg 45 and 46)
Adequate tools / equipment for IMCI
Latest IMCI chart booklet in every consulting room
6.4 Laboratory services
Describe availability of laboratory services related to Maternal Child Health within
the district.
33
6.5 Communication
Availability of communication devices: telephone, fax, computers, internet, email
How is communication between province, district, hospital and clinics conducted (e.g.
meetings, memos)?
Maintenance of lines of communications.
Punctuality of meetings
Task completion
Needs and skill audit
6.6 Health Information
Flow of information from clinic onwards
Feedback of analysis to clinics.
State of District Health Information System (DHIS)
Community health information projects
6.7 Monitoring and evaluation
Core Standards monitoring
34
6.8 Quality Improvement
Implementation of clinic supervision manual
Quality Improvement projects
Patient satisfaction
Waiting times
6.9 Governance
Clinic committees
Complaints mechanism
Service delivery improvement plans
Availability of Policies and Protocols
6.10 Financial Management
Description of both the process of allocation and the amounts allocated to the district.
Where does district budget come from?
Who pays for primary health care services?
What is the district budget?
What is the per capita budget?
How much of budget is spent on capital expenses, personnel, etc.?
What are the individual hospital budgets?
How much is spent on MCH?
35
7. PROGRESS TOWARDS THE IMPLEMENTATION OF A DISTRICT
HEALTH SERVICE
The factors facilitating or hindering progress should be presented, and it should also include a
description of:
 provincial and regional structures, and how they relate to the district;
 how the fragmentation of the old health system is being integrated into a district health
system;
 the proposed organogram for the district (where appointments have been made the
names of responsible people should be included);
 the progress made in establishing the District Management Team;
 the governance of the health district; and community involvement in health.
There are also a number of important administrative factors that help to improve the
effectiveness and efficiency of a district health management team. These include:
 proper offices and office space;
 good communication assisted by a working telephone and a fax machine;
 reliable clerical and secretarial support;
 a photocopier; and
 computers and printers.
Historical background
District co-ordinating team
- Composition
- Functioning and responsibilities of district office
District development
Community involvement
36
8.
OTHER SECTORS WHICH IMPACT ON HEALTH
8.1 Social Development
Grant provision
Orphans and vulnerable children
Child Abuse
8.2 Education
Role in school health services
Immunisation campaigns
8.3 Home Affairs
Registration of births and deaths at health facility level.
8.4 Safety and Security
Satellite stations at hospitals
Security provided
Assistance with transport
Assistance with patient/family contact
Family violence, spousal abuse
Handling of violent/psychiatric mothers
Child protection
37
8.5 Correctional Services
No of pregnant women and children in prison
Services offered to this population
8.6 Agriculture
Role in communal gardens
8.7 Water Affairs
Water and sanitation provision activities
8.8. Other
38
9. SUMMARY OF KEY HEALTH PROBLEMS AND CONCLUSION
Important areas of progress and development in the district over the previous year.
The most important and urgent health problems of the district.
An indication of how these priority problems will be addressed.
Key problems facing the district – can consider presenting a summary of root cause analysis
Main factors impacting on delivery of services – can considering presenting a summary of a
SWOT analysis
Factors that lie outside of the district which may hamper continued progress and development.
39
10. REFERENCES
40
11. APPENDICES
Appendix 1: Names and contact details of key district health personnel
Post
Name and surname
Contact number
Email address
Name and surname
Contact number
Email address
District executive manager
Senior Manager Health
Special Programme
Senior Manager Primary
Health Care
Senior Manager Hospital
Services
Manager MCWH
Manager HAST
Deputy Manager Maternal
Health
Deputy Manager Child Health
District information officer
District Pharmacist
Other:
Post
EMRS Manager
NHLS Manager
Other:
Other:
Other: