The Agincourt Health and Socio-Demographic Surveillance System (HDSS), located in rural northeast South Africa close to the Mozambique border, provides the foundation for the Rural Public Health and Health Transitions Research Unit of the Medical Research Council (MRC) and University of the Witwatersrand, South Africa (the MRC/Wits-Agincourt Unit). Its origins lie in the university’s ‘Health Systems Development Unit’ that in the early 1990s focused on district health systems development, sub-district health centre networks and referral systems and training of clinically oriented primary health care nurses.
The Agincourt HDSS was a founding member of the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) (http://www.indepth-network.org/) and provides leadership to INDEPTH multi-centre initiatives in adult health and ageing3 and migration and health
Location of Agincourt HDSS research site in South Africa
Agincourt Health and Socio-Demographic Surveillance System (Agincourt HDSS)
The Agincourt Health and Socio-Demographic Surveillance System (HDSS) provides the foundation for the MRC/Wits-Agincourt Unit. An HDSS is a longitudinal population registration system that monitors demographic dynamics in a geographically defined population.
In 1992, a baseline census was conducted in 20 contiguous villages chosen for their rural living conditions, limited access to public sector services, underperforming primary care clinics and communities of Mozambican refugees displaced by the civil war.3,4 Three phases followed the baseline census.
Extending a portfolio of intervention research (2004 onwards): An established university and MRC-linked field research and training programme supporting multiple investigations into the causes and consequences of critical findings from the HDSS. Ongoing trials target critical problems affecting the health and well-being of children and adolescents.
Decentralised Health Systems Development: Decentralised health systems development (1992-96)1-6 was closely aligned with, and contributed to, national and provincial Department of Health (DOH) strategies. These sought to establish primary health care oriented district-based health systems as the basis for an equity-sensitive national public health system. Demographic surveillance, conducted approximately annually, was introduced in Agincourt through a baseline census in 1992 (pop. 58,000), just prior to South Africa’s first democratic election in 1994. Working closely with district and provincial services, research and development efforts addressed planning and operational challenges in district systems development, quality of care, decentralised laboratory development, and evaluation of community programmes. Work also contributed to WHO efforts to strengthen district systems.
Deepening observational work:6,7,8 Several cohorts are nested within the population under surveillance and generally focus on subgroups at different stages along the life course. The Agincourt HDSS contributes to evaluation of national policy at population, household and individual levels. Examples include the following:
i) introduction of the Rotarix and pneumococcal conjugate vaccines into the Expanded Programme on Immunization,
ii) impact of social support grants (old age pension and child support grant) on the health and well-being of grant recipients and other household members, and
iii) the population impact of decentralized delivery of highly active anti-retroviral therapy (HAART) through public and private health systems.
In addition, a portfolio of work examines household responses to shocks and stresses and the resulting pathways influencing child and adult health and well-being. This includes the care and support roles of older women, intra- and inter-household social connections, use of natural resources, and diverse migration and livelihood strategies