2014 HEALTH BUDGET 2 JULY 2014

POLICY PRIORITIES 2

STATE OF THE NATION ADDRESS JUNE 2014 The President highlighted the following health-related priorities : Improved access to primary health care (PHC); Increasing life expectancy at birth from 60 years in 2012 to 63 years in 2019; Continue to invest in education and skills development including doctors; Reducing child and maternal mortality ratios; Implementation of the National Health Insurance; Improve the quality of care in the public sector; and HIV and AIDS treatment and support programme by expanding mass HIV prevention communication campaigns. 3

POLICY PRIORITIES NATIONAL DEVELOPMENT PLAN Nine goals for health have been identified in the NDP: Average male and female life expectancy at birth increased to 70 years; Tuberculosis (TB) prevention and cure progressively improved; Maternal, infant and child mortality reduced; Significantly reduced prevalence of non-communicable chronic diseases; Injury, accidents and violence reduced by 50 per cent from 2010 levels; Health system reforms completed; Primary health care teams deployed to provide care to families and communities; Universal health coverage achieved; and Health posts filled with skilled, committed and competent individuals. 4

POLICY PRIORITIES NATIONAL DEPARTMENT OF HEALTH (DOH) STRATEGIC PLAN The Department’s strategic goals are to: Prevent disease and reduce its burden and promote health; Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of the health facilities for its implementation; Re-engineer primary healthcare; Improve health facility planning by implementing norms and standards; Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms; Develop an efficient health management information system for improved decision making; Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; and Improve human resources for health by ensuring adequate training and accountability measures. 5

BUDGET ANALYSIS 6

HEALTH BUDGET FOR 2014/15 7

BUDGET ANALYSIS HEALTH BUDGET FOR 2014/15 8

BUDGET ANALYSIS HEALTH BUDGET FOR 2014/15 Highlights The Department receives R33.9 billion for 2014/15, up 11.2% from R30.5 billion in the previous financial year. The two largest programmes namely Programme 5: Hospitals, Tertiary Services and Human Resource Development and Programme 3: HIV and AIDS, TB, Maternal and Child Health jointly constitutes almost 94% of the total budget. The allocation for Programme 4: Primary Health Care Services again declines (-8.87 %) in 2014/15. Less than one per cent (0.28 per cent) is allocated to this programme (R93.5 million). 9

BUDGET ANALYSIS PROGRAMME 1: ADMINISTRATION 10

BUDGET ANALYSIS PROGRAMME 1: ADMINISTRATION KEY POINTS The purpose of the Administration Programme is overall management of the Department and providing centralised support services. The Programme budget decreases by 1.5 % from R405.7 million in 2013/14 to R399.7 million in 2014/15. Office Accommodation receives 26.5 % of the Programme budget, and is the only sub-programme allocation to increase, from R97.5 million in 2013/14 to R105.8 million. 11

BUDGET ANALYSIS PROGRAMME 2: NATIONAL HEALTH INSURANCE, HEALTH PLANNING AND SYSTEMS ENABLEMENT 12

BUDGET ANALYSIS PROGRAMME 2: NATIONAL HEALTH INSURANCE, HEALTH PLANNING AND SYSTEMS ENABLEMENT KEY POINTS The purpose of the Programme is to improve access to quality health services through planning, integration of health systems, reporting, monitoring and evaluation, and research. The Programme budget increases by 26.3% from R491.8 million in 2013/14 to R621.3 million in 2014/15. The NHI sub-programme receives the largest portion of the Programme’s budget, at 78.4 % (R487.2 million) The 31.6% increase in this sub-programme is to ensure that General Practitioners (GPs) are contracted for the NHI. 13

BUDGET ANALYSIS PROGRAMME 3: HIV AND AIDS, TB, MATERNAL AND CHILD HEALTH 14

BUDGET ANALYSIS PROGRAMME 3: HIV AND AIDS, TB, MATERNAL AND CHILD HEALTH KEY POINTS The aim of this programme is to coordinate, manage and fund HIV and AIDS, Tuberculosis (TB) and maternal and child health sub- programmes. 98% of this programme’s budget is allocated to the HIV and AIDS sub-programme, amounting to R12.8 billion. This represents a nominal increase of 16.4 % from R10.9 billion in the previous year. The four remaining sub-programmes combined receive less than 2.0 per cent of the programme’s budget. TB sub-programme increases slightly from R25.8 million to R26.4 million, which means it declines 3.65% in real terms. 15

BUDGET ANALYSIS PROGRAMME 3: HIV AND AIDS, TB, MATERNAL AND CHILD HEALTH KEY POINTS The Women’s Maternal and Reproductive Health sub- programme is responsible for amongst other interventions, deploying obstetric ambulances, establishing Kangaroo Mother Care facilities, midwifery education and training, and strengthening infant feeding practices. This sub-programme increased by only R as it received R17.1 million which is less than 1% (0.13%) of the programme budget. 16

BUDGET ANALYSIS PROGRAMME 3: HIV AND AIDS, TB, MATERNAL AND CHILD HEALTH KEY POINTS The Child, Youth and School Health sub-programme develops and monitors policies and guidelines, and sets norms and standards for child health. The budget increases from R17 million to R218.4 million. This is mainly due to roll-out of the Human Papilloma Virus (HPV) Vaccine which prevents cervical cancer, to be provided to Grade 4 girls. Over the medium term, key initiatives will be the continued rollout of the integrated school health programme to cover all learning phases, and strengthening the immunisation programme. Empirical evidence shows that South Africa has managed to reduce child mortality in the last five years. This is a positive outcome emanating from the scale-up of prevention of mother to child transmission of HIV, the rollout of antiretroviral therapy, new child vaccines (pneumococcus and rotavirus) and other child survival programmes. 17

BUDGET ANALYSIS PROGRAMME 4: PRIMARY HEALTH CARE SERVICES 18

BUDGET ANALYSIS PROGRAMME 4: PRIMARY HEALTH CARE SERVICES KEY POINTS The Primary Health Care Services programme aims to develop and implement a uniform district health system and to develop policy for district health services. The budget decreased by 8.9%. This is despite the Department’s stated aim of providing health services based on the primary health care approach. The Non- Communicable Diseases sub-programme assists provinces in implementing and monitoring chronic diseases, disability, elderly people, oral health, mental health and substance abuse. Its allocation decreases from R25.9 million to R25.7 million. 19

BUDGET ANALYSIS PROGRAMME 5: HOSPITALS, TERTIARY HEALTH SERVICES AND HUMAN RESOURCES DEVELOPMENT 20

BUDGET ANALYSIS PROGRAMME 5: HOSPITALS, TERTIARY HEALTH SERVICES AND HUMAN RESOURCES DEVELOPMENT KEY POINTS The aim of the Hospitals, Tertiary Health Services and Human Resources Development Programme is to accelerate the delivery of health infrastructure and strengthen human resource capacity in the health sector. The budget for this programme has increased by 6.8% (nominal). The Forensic Chemistry Laboratories sub-programme allocation increases by 55.8% from R78.9 million to R122.9 million. The Hospital Management sub-programme allocation declined in by 1.8%. Similarly in 2014/15, the Nursing sub-programme allocation declined by 34.2% from R3.8 million to R2.5 million. 21

BUDGET ANALYSIS PROGRAMME 6: HEALTH REGULATION AND COMPLIANCE MANAGEMENT 22

BUDGET ANALYSIS PROGRAMME 6: HEALTH REGULATION AND COMPLIANCE MANAGEMENT KEY POINTS The Health Regulation and Compliance Management programme aims to reduce the time taken for medicines to reach the market, establish the Office of Health Standards Compliance and establish a National Public Health Institute. The programme budget has increased by 13.3 % from R763.7 million in 2013/14 to R865.3 million in 2014/15. Most of the funds (68.5 per cent) that is R592.5 million of this programme budget is allocated to the Public Entities Management sub-programme. The Office for Health Standards Compliance sub-programme increases by 87.4 % to employ additional staff to establish itself and build its inspectorate function. The Compensation Commissioner for Occupational Diseases, has still not tabled an Annual Report for last year. 23

ISSUES FOR CONSIDERATION 24

ISSUES FOR CONSIDERATION KEY ISSUES FOR CONSIDERATION BY PARLIAMENT Maternal Mortality: why no significant increase in this sub- programme’s budget, given the challenges? Primary Health Care is given as the department’s approach to health care yet this programme does not receive budgetary priority. Non-communicable diseases (NCDs) also don’t get a significant increase despite being highlighted as important. NHI: Slow spending on conditional grants need to be addressed. TB programme budget not increasing significantly, despite SA having high rate of TB. Why is this? 25

Thank you! 26