NATIONAL DEPARTMENT OF HEALTH

NATIONAL DEPARTMENT OF HEALTH Inter Governmental Fiscal Review Presentation to the Select Committee on Finance 17 October2007 IGFR - 17-10-2007

NATIONAL DEPARTMENT OF HEALTH IGFR 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. IGFR - 17-10-2007

NATIONAL DEPARTMENT OF HEALTH IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

NATIONAL DEPARTMENT OF HEALTH Discussion on provincial health expenditure by functional classification • Large growth sectors • HIV and AIDS - 29.7% , 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% IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

NATIONAL DEPARTMENT OF HEALTH Discussion on per capita health funding trends per province • National figure 5.3% • Provinces with low growth – Free State & Gauteng - 3.5% • Middle of the range – Eastern Cape & Northern Cape - 4.6%, Western Cape - 4.3% • High growth provinces – KZN, Limpopo, Mpumalanga and North West • Provinces where tertiary services are provided in low and medium growth areas IGFR - 17-10-2007

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 IGFR - 17-10-2007

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 IGFR - 17-10-2007

NATIONAL DEPARTMENT OF HEALTH