District Health Barometer lays bare disparities in SA healthcare

Women in Eastern Cape are twice as likely to die during pregnancy or childbirth than women in Western Cape, according to the latest edition of the District Health Barometer.

Western Cape recorded 62 maternal deaths per 100,000 live births in 2022/23 and is the only province that has met the UN Sustainable Development Goal (SDG) target of reducing maternal mortality to below 70 maternal deaths per 100,000 live births by 2030. The figure was 124.3 maternal deaths per 100,000 live births in Eastern Cape and 101.0 for SA overall in 2022/23.

The data on SA’s maternal mortality indicated its chance of achieving the SDG this indicator was “uncertain”, said health director-general Sandile Buthelezi at the launch of the 2022/23 edition as he sought to highlight improvements in care over the past five years.

The gap between the worst and best performing health districts had narrowed and SA was “definitely making strides in reducing maternal mortality”, he said.

The health department has set a target of less than 100 maternal deaths per 100,000 live births by 2024/25.

Between 2021/22 and 2022/23, the maternal mortality rate declined in 33 districts, an improvement on the 27 districts that recorded better results in 2021/22 compared with the year before, the barometer showed.

The District Health Barometer is used by the health department and policymakers to track resource allocation and health outcomes across SA’s 52 districts.

It lays bare the disparities in the health of patients in different parts of the country, revealing that the worst place in which to be pregnant or give birth is Limpopo’s Capricorn district which had a maternal mortality rate of 198.3 per 100,000 live births. This was an improvement on the maternal mortality rate recorded in Capricorn the year before when it stood at 277.4 per 100,000 live births.

The barometer shows tuberculosis patients with drug-susceptible infection were five times more likely to die in Capricorn than Cape Town, which had death rates of 16.7% and 3.0%, respectively.

Buthelezi said the report had highlighted a concerning decline over the past five years in the “couple year protection rate”, which measures the proportion of women aged between 15 and 49 who are provided with modern contraception methods. It fell from 60.7% in 2018/19 to 45% in 2022/23. “This reduction is not isolated but widespread, with every province experiencing a decline except Mpumalanga. This trend is alarming, and it necessitates collective efforts to understand and address the underlying factors contributing to this significant decline,” he said.

Cervical cancer screening rates are also far from optimal, with none of SA’s health districts close to reaching the World Health Organisation’s recommended target of screening 70% of women by the age of 35 and again before they turn 45 by 2030. The national average was 21.4%, a sharp decline on the 46.8% recorded in 2019/20. The best performing district was uThukela in KwaZulu-Natal (59.4%) and the worst was Namaqua in Northern Cape (5.3%).

SA’s low cervical cancer screening rate is a significant contributor to its high cervical cancer death rate as the disease is generally treatable if caught early.

It is the second most common cancer diagnosed in women SA, but the leading cause of cancer deaths.

kahnt@businesslive.co.za