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Table 1 Country indicators and data sources for subnational UHC index

From: Is South Africa closing the health gaps between districts? Monitoring progress towards universal health service coverage with routine facility data

Tracer Area Index indicator (WHO) Index indicator, definition and transformations (South Africa) Source
Reproductive, maternal, newborn and child health (RMNCH)
 UHC1: Family planning Demand satisfied with modern methods in women aged 15–49 years who are married or in a union (%) Couple year protection rate
Women protected against pregnancy by using modern contraceptive methods, including sterilisation, as a proportion of female population 15–49 years.
 UHC2: Pregnancy and delivery care Four or more visits to antenatal care (ANC) (%) Antenatal 1st visit coverage before 20 weeks
Number of ANC 1st visits before 20 weeks of gestation divided by the estimated number of pregnant women, for which the proxy is the population under 1 year multiplied by a factor of 1.15.
 UHC3: Child immunisation Children aged 1 year who have received three doses of a diphtheria, tetanus, and pertussis (DTP) vaccine (%) Immunisation under 1 year coverage
Children under 1 year who completed their primary course of immunisation as a proportion of population under 1 year.
 UHC4: Child treatment Care-seeking behaviour for children with suspected pneumonia (%) Pneumonia case fatality under 5 years rate (smoothed and rescaled)
Pneumonia deaths in children under 5 years as a proportion of pneumonia separations (inpatient deaths + inpatient discharges + inpatient transfers out) in health facilities.
Smoothed rates rescaled according to the maximum observed value:
\( index=\frac{maximum- original\ value}{maximum- minimum} \bullet 100 \)
DHIS (modelled)
Infectious diseases
 UHC5: Tuberculosis (TB) treatment TB effective treatment coverage (%) TB effective treatment coverage
Treatment success (drug-sensitive) multiplied by the national WHO estimate of the case detection rate. (electronic HIV and TB register data as exported to DHIS)
 UHC6: HIV treatment People living with HIV (PLHIV) receiving antiretroviral therapy (%) Antiretroviral effective coverage
Total number of PLHIV, on treatment, with viral load suppressed at 12 months divided by the total number of PLHIV.
PLHIV estimates were derived by a modelling and triangulation method, incorporated in DHIS.
 UHC8: Water and sanitation Households with access to at least basic sanitation (%) Percentage of households with access to improved sanitation
Proportion of households with access to flush toilets connected to a public sewerage system or a septic tank, or to a pit toilet with a ventilation pipe.
Census and Community Survey
Non-communicable diseases (NCD)
 UHC9: Prevention of cardio-vascular disease Prevalence of non-raised blood pressure regardless of treatment status (%) Age-standardised prevalence of non-raised blood pressure (rescaled)
Proportion of population 15 years and older with systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Age-standardised using population estimates from Census 2011 and rescaled to obtain finer resolution across districts:
\( index=\frac{original\ value- minimum}{100- minimum}\bullet 100 \)
 UHC10: Management of diabetes Age-standardized mean fasting plasma glucose for adults aged 25 years and older Diabetes treatment coverage
Ratio between the population proportion of treated cases and diabetes prevalence.
NiDS, modelled using predictor information of diabetes prevalence from SADHS
 UHC11: Cancer detection Cervical cancer screening in women aged 30–49 years (%) Cervical cancer screening coverage
Cervical smears in women 30 years and older as a proportion of one-tenth of the female population 30 years and older.
 UHC12: Tobacco control Adults aged at least 15 years who had not smoked tobacco in the previous 30 days (%) Tobacco non-smoking prevalence
Adults aged at least 15 years who had not smoked tobacco in the previous 30 days.
Service capacity and access
 UHC13: Facility access Number of hospital beds per person Hospital beds per 10,000 target population (rescaled)
Total number of public sector hospital beds per 10,000 uninsured population, rescaled using the target of 18 beds per 10,000 population.
\( index=\frac{original\ value}{18}\bullet 100 \)
Modelled estimates of the uninsured population from Census, Community Survey, General Household Survey and Council for Medical Schemes data.
 UHC14: Health worker density Number of health professionals per person: comprising physicians, psychiatrists, and surgeons Health worker density (rescaled)
Geometric mean of the scaled scores for medical practitioners (mp), professional nurses (pn) and pharmacists (ph) employed in the public sector, using thresholds of 30 physicians, 100 nurses, and 5 pharmacists per 10,000 uninsured population.
\( index=\sqrt[3]{\frac{mp}{30}\bullet \frac{pn}{100}\bullet \frac{ph}{5}}\bullet 100 \)
Modelled estimates of the uninsured population.
 UHC15: Access to essential medicines Proportion of health facilities with availability of the WHO-recommended core list of essential medicines Proportion of primary health facilities with essential medicines
100 minus the tracer items stock-out rate in fixed primary care facilities.
 UHC16: Health security International Health Regulations core capacity index Environmental health services compliance rate
Based on national environmental health norms and standards which municipalities should adhere to, assessed by means of an audit tool.
National Department of Health audit tool