1. IGFR Health
Presentation to NCOP
October 2001

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

3. 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

4. Public health in context (See Table 4.1)

5. Trends in health expenditure1

6. Expenditure outcomes & projections (See Tables 4.3 & 4.4)

7. 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

8. 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

9. 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

10. Inequities 1

11. Expenditure per capita1

12. 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

13. Personnel vs. Non-personnel expenditure1

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

15. 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%)

16. Expenditure on conditional grants1

17. 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

18. 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

19. 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

20. 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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