Abstract
BackgroundSouth Africa is committed to advancing universal health coverage (UHC). The usefulness and potential of using routine health facility data for monitoring progress towards UHC, in the form of the 16-tracer WHO service coverage index (SCI), was assessed.MethodsAlternative approaches to calculating the WHO SCI from routine data, allowing for disaggregation to district level, were explored. Data extraction, coding, transformation and modelling processes were applied to generate time series for these alternatives. Equity was assessed using socio-economic quintiles by district.ResultsThe UHC SCI at a national level was 46.1 in 2007–2008 and 56.9 in 2016–2017. Only for the latter period, could the index be calculated for all indicators at a district level. Alternative indicators were formulated for 9 of 16 tracers in the index. Routine or repeated survey data could be used for 14 tracers. Apart from the NCD indicators, a gradient of poorer performance in the most deprived districts was evident in 2016–2017.ConclusionsIt is possible to construct the UHC SCI for South Africa from predominantly routine data sources. Overall, there is evidence from district level data of a trend towards reduced inequity in relation to specific categories (notably RMNCH). Progress towards UHC has the potential to overcome fragmentation and enable harmonisation and interoperability of information systems. Private sector reporting of data into routine information systems should be encouraged.
Highlights
South Africa is committed to advancing universal health coverage (UHC)
We focused on health service coverage (SDG 3.8.1) and not financial protection (SDG 3.8.2)
The greatest progress was made in the RMNCH category, which increased by 49%, from 47.9 to 71.5
Summary
South Africa is committed to advancing universal health coverage (UHC). The usefulness and potential of using routine health facility data for monitoring progress towards UHC, in the form of the 16-tracer WHO service coverage index (SCI), was assessed. Achieving universal health coverage (UHC) requires the whole population to receive essential effective health services, without financial hardship. Global efforts to monitor progress in relation to the health-related target on universal health coverage, as part of the Sustainable Development Goal (SDG 3.8), have largely relied on survey data for between-country comparisons, in the form of the UHC service coverage index (SCI) [5, 6]. To be more useful for regular subnational monitoring, alternative indicators based on routine or health facility data will need to be considered [10]. There is a need to monitor progress at the local (district, or even sub-district) level, to track implementation more frequently and to incorporate a quality of care component in the coverage measures where feasible
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
