1. NATIONAL DEPARTMENT OF HEALTH
Inter Governmental Fiscal Review
Presentation to the Select Committee on Finance
17 October2007
2018/09/22
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2. NATIONAL DEPARTMENT OF HEALTH
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Introduction – General Comments
The base document for the presentation is Chapter 3 of the 2007 IGFR
The Public Health Sector does not contest the data contained in the document
The Public Health Sector has a different interpretation of the data.
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3. NATIONAL DEPARTMENT OF HEALTH
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4. NATIONAL DEPARTMENT OF HEALTH
Discussion on health spending as a proportion of GDP
Additional funding over and above the baseline allocation needs to fund –
An increased demand for health services which emanates from a larger burden of disease which in turn originates from the HIV and AIDS epidemic and the TB crisis in the country
Increased cost of health services due to inflation
A catch-up programme to provide more of the correct health facilities at the correct places in all provinces but particularly the disadvantaged provinces
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5. NATIONAL DEPARTMENT OF HEALTH
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6. NATIONAL DEPARTMENT OF HEALTH
Discussion on health funding comparisons with middle income countries
The table lists 21 middle income countries and SA is ranked 10th in terms of Government expenditure on health as a percentage of GDP
When total expenditure on health is ranked as a percentage of GDP, SA ranks 3rd
This “improvement” arises from the inequity in spending on health in the public(3.5% for 37m people) and (5% for 7m people) in private spending
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7. NATIONAL DEPARTMENT OF HEALTH
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8. NATIONAL DEPARTMENT OF HEALTH
Discussion on Provincial Health expenditure
Table reports over run by 4 provinces. This is artificial because provinces “engineer” expenditure by carrying it forward because of the draconian clauses in the PFMA
Gross over run of R 736 m versus nett over run of R 369m
Uneven provincial growth rates – makes policy implementation difficult
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9. NATIONAL DEPARTMENT OF HEALTH
Discussion on Provincial Health expenditure
Reason for over expenditure –
Demand for health services outstrips availability of function particularly in Gauteng and Free State where allocations have grown slowly.
Reason for under expenditure –
Rural provinces inability to fill vacant posts
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10. NATIONAL DEPARTMENT OF HEALTH
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11. NATIONAL DEPARTMENT OF HEALTH
Discussion on conditional grant spending
Spending pattern improves in areas of operational spending , i.e. NTSG, HPT&D and the Comprehensive HIV and AIDS Plan
Spending of capex , i.e. hospital Revitalization and Forensic Pathology Services is slow
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13. NATIONAL DEPARTMENT OF HEALTH
Discussion on provincial expenditure and budget trends
Growth 2003/04 to 2006/07 – Sector 13.2%
Concerns for Free State & Gauteng – low overruns
Concerns for Limpopo, Mpumalanga, Northern Cape and North West – capacity to spend
Growth 2007/08 – 2009/10 – Sector 9.6% growth slows down
Growth is choppy – planning is difficult
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15. NATIONAL DEPARTMENT OF HEALTH
Discussion on trends in health professional numbers
Role of community services
Role of foreign doctors
Growth in numbers recruited of 20% over period, spending increases by 27% over the same period
Although personnel numbers are up, provinces report vacancy rates of up to 40% in certain categories
The availability of trained health staff in rural areas remains a problem
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16. NATIONAL DEPARTMENT OF HEALTH
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17. NATIONAL DEPARTMENT OF HEALTH
Discussion on provincial health expenditure by functional classification
Large growth sectors
HIV and AIDS % , burden of disease
Health facilities 13.8%, catch up of backlog
Areas of low growth
Hospitals 4%, Administration 3.7%, Health Care support 2.7%, Nutrition 4.4%
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18. NATIONAL DEPARTMENT OF HEALTH
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19. NATIONAL DEPARTMENT OF HEALTH
Discussion on hospital admissions
Hospital admissions peaked at 3.7m in 2001/02, dropped to 3.5m in 2006/07
This is contrary to experience in hospitals as hospitals are overloaded
Patients in hospitals are generally requiring more and a higher level of care
Problem – Health Information System - requested funding for Health Information System in 2008 MTEC
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20. NATIONAL DEPARTMENT OF HEALTH
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21. NATIONAL DEPARTMENT OF HEALTH
Discussion on Comprehensive HIV and AIDS programme expenditure
Burden of disease plays a role in the allocation of funds
The comprehensive plan consists of a number of elements such as –
ART related interventions
Home and community base care and support
High transmission interventions
Sexual assault interventions
Prevention of mother-to-child transmission
Programme management and capacity building
Step down and chronic care facilities
Voluntary counselling and testing
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22. NATIONAL DEPARTMENT OF HEALTH
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23. NATIONAL DEPARTMENT OF HEALTH
Discussion on Mortality rates
The items which impact on mortality rates are –
Communicable diseases such as malaria, TB and HIV and AIDS
Non-communicable diseases such as hypertension and cancer
Trauma and violence
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25. NATIONAL DEPARTMENT OF HEALTH
Discussion on Medical Emergency Services budget
Key programme for Health for 2010
Good growth in most provinces where EMS Services were poorly funded
Next phase is to ensure hospitals can handle EMS patients when they arrive at the hospital
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26. NATIONAL DEPARTMENT OF HEALTH
Discussions on Hospital Revitalization
Currently funding has a time horizon of 20 years
There is a need to shorten this period
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28. NATIONAL DEPARTMENT OF HEALTH
Discussion on per capita health funding trends per province
National figure 5.3%
Provinces with low growth – Free State & Gauteng %
Middle of the range – Eastern Cape & Northern Cape %, Western Cape %
High growth provinces – KZN, Limpopo, Mpumalanga and North West
Provinces where tertiary services are provided in low and medium growth areas
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29. NATIONAL DEPARTMENT OF HEALTH
Concerns from a national perspective
Difficulty to provide a seamless national health service
Inequity in funding between provinces
Uneven growth in provincial allocations
Allocations dropping below inflation and population growth
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30. NATIONAL DEPARTMENT OF HEALTH
General concerns from a national perspective
Internal population migrations
External population migrations
Crisis as a result of disease such as MDR / XDR TB
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