what we know about the impact of hiv/aids on teachers: a gerneral overview

What we know about the Impact of HIV/AIDS on Teachers: a gerneral

overviewFrom Peter Badcock-Walters, Christopher Desmond, Daniel Wilson

& Wendy Heard

4 June 2003

Study Objective • Benchmark the mortality rate amongst in-

service educators in KZN by age and gender

to inform future educator demand and supply

planning and modelling.

Method• Analysis of Annual School Survey data

• 100-school random sample survey to

investigate non-reporting by 90% schools

• Analysis of PERSAL records

• Reconciliation/analysis of trends & outcomes

Education & HIV Context • Largest provincial system with 2,6 million

learners & 76000 educators, in 6000 schools;

• Demand: Enrolment in Grade 1 shows only

1,9% growth over 5 years, 1998 - 2002;

• Supply: Educator attrition (all causes) greater

than decline in demand – 6,8% in 1999 of

which 0,64% estimated to be AIDS mortality;

• Educators vulnerable to high rates of HIV

prevalence (35%+) over several years;

• Growing mortality in Private Sector increasing

recruitment of educators from the system.

Prevalence rates

Ante Natal Clinics

Schools

HIV Prev. as %

Data: Annual School Survey

Change in Grade 1 enrolment

0

50000

100000

150000

200000

250000

300000

350000

400000

1997 1998 1999 2000 2001 2002Years

Gra

de 1

enr

olm

ent

+3%

-12%

-24%

+20%

+27%

Study Method • Identification of available KZNDEC data;

• Analysis of Annual School Survey, capturing

educator & learner mortality since 1999;

• Commissioning/analysis of 100-school

random sample survey to check undercount/

non-reporting by 90% of schools;

• Analysis of Personnel Salary (PERSAL) system

data from 1996;

• Reconciliation and analysis of observed

contradictions, trends and likely impact.

Age Distribution of Educators Age distribution of Educators, 2000 - All schools

0

2000

4000

6000

8000

10000

12000

14000

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Agenot

StatedAge Group

Educ

ator

s

Female Male

Analysis: Annual School Survey

• Only 8% schools in 1999 reported educator mortality – 92% balance unknown;

• Reported 509 deaths (424/83% due to illness) in cohort of 68 615 publicly-paid educators = gross mortality rate of 0,74%;

• 11% of schools in 2000 reported 650 deaths (580/ 89% due to illness) in cohort of 67 958 educators = gross mortality rate of 0,96%;

• Mortality rate for male educators higher in 1999 (1,12% vs 0,56%) and in 2000 (1,4% vs 0,76%) than for females;

• 68% of educators female, average age 37,4.

AS Data: Mortality due to Illness

Educator Mortality due to illness, 1999 - 2000

0

20

40

60

80

100

120

140

160

180

20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55+

Age Group

Educ

ator

s

1999 2000

AS Data: Mortality by Gender

* Female mortality in age band 30-34 rose by 70% 1999 to 2000, and by 30% for those 35-40;

* Gross number of female deaths rose from 327 to 354 (+8%) versus 253 to 300 (+19%) for males;

* Percentage females dying from illness grew from 89% to 92% versus 78% to 84% for males.

Female mortality due to illness

0

20

40

60

80

100

120

20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55+

Age Group

1999 2000

Male mortality due to iIlness

0

20

40

60

80

100

120

20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55+

Age group

1999 2000

Analysis: Personnel Salary Records

• PERSAL apparently most reliable data but suffers average reporting lag of 4,3 months;

• 1998-2001 shows 84% to 87% deaths due to illness/natural causes;

• 1998: mortality rate for males peaked at 1,2% 35-39, averaging 0,9%, while female rate peaked at 0,8% 30-34, averaging 0,5%. Total mortality rate for 1998 = 0,6%

• 1998 PERSAL total deaths 493, 70% in age group 25-39;

• Average age of educators at death 36,6.

Analysis: PERSAL 1999• 1999: PERSAL shows 530 deaths in cohort of

71084 vs 509 in 1999 Annual Survey data;

• 1999 mortality rate for males peaked at 1,3% 35-

39, averaging 1,1%, while females peaked at

0,7% 30-34 averaging 0,6%. Total rate = 0,7%;

• 68% deaths 25-39; average age at death 36,5. Educator Mortality, PERSAL 1999

0

10

20

30

40

50

60

70

80

90

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+

Age Group

Ed

ucato

rs

Female Males


68615 vs 654 in 2000 Annual Survey data;





0

20

40

60

80

100

120

140

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+

Age Group

Ed

ucato

rs

Female Males


67958; there is no Annual Survey data as yet;





0

10

20

30

40

50

60

70

80

90

100

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+

Age Group

Ed

ucato

rs

Female Males

Analysis: Sample Survey 1999

• Initiated 100-school random sample survey to explain/resolve 90% non-reporting issue;

• Shows only 24% schools kept viable records;

• Raises doubts about school data quality;

• 1999: Showed 4 extra deaths and 1 duplication vs 12 captured via AS and PERSAL; of actual total 16, sample school principals ‘neglected’ to report 12 deaths but analysis also shows AS undercount of 8;

• Sample educator cohort of 1843 suggests gross mortality rate of 0,87% for 1999.

Analysis: Sample Survey 2000

• 2000: Showed 3 extra deaths and 9

duplications vs 15 captured via AS and

PERSAL; of actual total 18, sample school

principals only ‘neglected’ to report 6 deaths

but again also shows AS undercount of 7;

• Sample educator cohort of 1903 in 2000

suggests mortality rate of 0,94%;

• Direct consequence of survey evidence of

record keeping failure may be introduction of

monthly data capture via the DEMMIS system

piloted in 200 schools over 24 months.

Outcomes: Mortality Trends

• 90%-93% all educator deaths 1998-2001 <49;

• 2124 educators of 2313 dying 1998-2001 <49;

• 80%+ of this <49 group (1700) died of illness;

• Mortality 3-times higher than without AIDS.

Total Mortality by Age Group - KwaZulu-Natal 1998 - 2001

0

20

40

60

80

100

120

140

160

180

200

220

240

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+Age Group

Tota

l

1998 Total 1999 Total

2000 Total 2001 Total

Outcomes: Convergent Trends

• The three data sets show fairly convergent trends and patterns in 1999, with real convergence in 2000;

• In 1999, the Annual Survey suggests a gross mortality rate of 0,66%, PERSAL 0,88% and the sample survey 0,89%;

• In 2000, the Annual Survey suggests a gross mortality rate of 0,96%, PERSAL 1,0% and the sample survey 0,94%;

• Additional data for 2001 from PERSAL suggests a slight drop back to 0,9%.

Outcomes: Post-Service Mortality?

• Mortality rates used are for in-service educators only;

• Studies of SA corporate sector suggest up to 50% of employees die after leaving service;

• Further PERSAL analysis suggests that large numbers of educators (average age 47) are indeed leaving on medical grounds;

• Must assume that in-service mortality is only a portion of the real rate, and undercounts real number of educators dying;

• Research will continue to attempt to establish this position.

Lessons and Conclusions

• Establishing rates of mortality should not require this volume of research and analysis, and suggests the lack/failure of MIS;

• The complexity of PERSAL attrition data requires extensive further analysis

• There can no longer be any doubt that AIDS is impacting educators, who are dying at 3-4,5 times the expected rate without AIDS;

• HIV/AIDS are adding to existing levels of attrition and dysfunction and impacting on teaching, learning, quality and outcomes – impacts that must be adequately measured.

Educator Mortality in KwaZulu Natal

A Consolidated Study of In-Service Impact and Trends

Thank You for your Attentionenquiries: [email protected]

what we know about the impact of hiv/aids on teachers: a gerneral overview

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