IGFR 2001 - Health Presentation to NCOP October 2001

Outline Public Health in Context Expenditure & budget trends Interprovincial comparisons (Equity & composition of expenditure) Inputs and service delivery Conditional grants Sector issues

Public health in context Large private sector: 1.2 times the budget, serve less than a quarter of the patients 84% of population not covered by medical schemes underlines key role of public sector

Public health in context (See Table 4.1)

Trends in health expenditure 1

Expenditure outcomes & projections (See Tables 4.3 & 4.4)

Expenditure and projections Decline by about 1,0% p.a. 97/98 to 00/01 Corrective to unsustainable real growth in 95/96 and 96/97 Range of pressures in sector: wages settlements, increased demand, policy shifts, fiscal Shifts to greater inter-provincial equity slowed Restructuring in hospital sector Real growth of 1,7% p.a. over MTEF 2000/01 see return to real growth in health spending Real growth in 7 out of 9 provinces

Inter-provincial comparisons Composition of expenditure Health share increases between 97/98 & 99/00; drops back slightly over MTEF Share ranges between 15,9% in Mpumalanga to 32,7% in Gauteng - partly because of central hospitals Personnel increasing to as high as 64% in 98/99 (wage settlements & slow budget growth) Personnel share declining to below 60% by 2003/04

Inter-provincial comparisons Per capita expenditure (Tables 4.7 & 4.8) Large differentials, even excluding central hospital spending Spending per person without medical aid in Gauteng twice that in Mpumalanga, 1,6 times that in Northern Province Implies large differences in access, quality of services Inequalities also reflected in other inputs hospital admissions hospital beds Spending by programme (Table 4.9) District health services grew strongly between 97/98 & 00/01, compared to provincial and academic health services But district health services projected to fall back in relative terms over MTEF

Inequities 1

Expenditure per capita 1

Inputs and service delivery Primary care Notable progress towards equity availability of ante-natal care, turnaround times for test, DOTS implementation, doctor availability, availability of drugs & supplies Remaining problems with service access & infrastructure test availability, emergency transport, essential equipment, communications, key drugs Hospitals Decentralisation of hospital management & information Reduction in hospital beds, except for Mpumalanga, Northern Province and North West Inefficiencies HIV/Aids National Planning Framework

Personnel vs. Non-personnel expenditure 1

Inputs and service delivery Personnel & training Cost pressures as a result of broad-banding, rank & leg Substantial reduction in numbers since 98/99: nearly 15 000 or more than 6% Differential access to scarce skills: Gauteng 30,9 specialists per 100 000 against 2,3 in Northern Province Large differentials wrt dentists, pharmacists Need for integrated human resource planning

Inputs and service delivery Infrastructure 1996 Audit found 1/3 of facilities by value require replacement or major repair Levels of spending and maintenance insufficient Resulted in further worsening in situation Health infrastructure grants Hospital construction grants for Pretoria and Nkosi Albert Luthuli Academic hospitals Hospital Rehabilitation grant National planning framework Provincial plans Shift to Revitilisation program Spending doubled but still under-spending (R77m) Allocation from provincial infrastructure grant (about 13%)

Expenditure on conditional grants 1

Conditional grants Review of tertiary services grants Health administers major grants in the system - > 40% of total grants Tertiary & training grants - >70% of health grants Central hospital Redistribution of specialised services Health Professionals Training and Research grant Review of tertiary services grants Third of tertiary services occur outside the 10 central hosp. Inequity in funding and access of tertiary services eg Eastern Cape R81m expenditure and R13m grant. Need for a new funding framework to redress inequities Phase 2 to determine optimal future configuration

Conditional grants Integrated Nutrition Programme spending on grant improved in 2000/01 under-spending at provincial level Recommendations: standardised menus, feeding days, cost per feed; role of school governing boards; create subprogram to improve monitoring

HIV/AIDS A number of funding channels for HIV/AIDS Provincial health budgets ( R4 billion) Government Aids Action plan - ( R190 million) Conditional grant: Integrated strategy (R75 million 99/00 to R300m 01/02) Spending by individual departments Developed strategy for enhanced response for: prevention treatment, care and support

Conclusion/Sector issues Resumption of growth trend in health expenditure Inequities remain Conditional grant reconfiguration HIV/Aids - a major fiscal challenge Hospital revitilisation linked to National Planning Framework and provincial plans Need to enhance hospital efficiency & quality of services and decentralisation

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