Summary

1. Summary Health Review: 2005/2006 This Chapter: • Provides an overview of health funding in the public sector context. • Reviews key policy & sectoral developments. • Examines overall expenditure trends. • Focuses on expenditure & service delivery trends in key service delivery areas. • Focuses briefly on aspects of personnel in the sector.

2. Key trends • Real budget growth exceeds 4% per annum • Improving equity • Primary health care, emergency ambulance and HIV and AIDS programme funding growing strongly • Capital and NPNC expenditure significant real growth • Under-spending on capital and conditional grants • Professional personnel increased by 2605 after scarce skills and rural allowance • Weaknesses in sectoral non-financial information

3. The Public Sector Context: Total Health Funding in South Africa • There are large differentials between private and public spending. • Nearly 60% of health funding goes towards funding private health care, while only the wealthiest 15% are insured. • Only 40% of health funding goes towards the majority of the population

5. Public Health Sector Funding in Middle Income Countries • South Africa’s total health expenditure as a proportion of GDP is relatively high • Public sector funding at 3.4% of GDP compares favourably • Influenced by large private health sector, escalating wage costs and the growing burden associated with HIV / Aids

6. Health funding flows 2004/05

7. Provincial health expenditure, 2001/02 to 2007/08

8. Provincial health expenditure, 2001/02 to 2007/08 • Between 2001/02 –2004/05 growth exceeded 15% annually in Northern Cape, Mpumalanga, North West & Limpopo, implying that basic health services were significantly strengthened. • The medium term sees growth in all provinces, with growth above 11% in KZN, Eastern Cape & Northern Cape. • KZN now has the largest provincial health budget. • The 20.3% per capita increase in Limpopo’s budgets in 2005/06 helps to close the spending gap.

9. Under-spending on Conditional Grants • Under-spending on conditional grants 4.8%, compared to overall 1.3% • Most prevalent in Hospital Revitalisation Grant (24.9%) and Integrated Nutrition Programme Grant (22.6%). • From 2006/07, the integrated nutrition grant will be phased into the provincial equitable share • Various interventions being put into place to strengthen Hospital Revitalisation programme

10. Primary health care per capita spending trends • Substantive increase in PHC from 2001/02 (R121) to 2005/06 (R207) reflects national policy of improving access and support lower levels of care. • Significant expenditure growth, though large disparities still exist. • Department of Health has set PHC utilisation target at 3.85 visits per year for uninsured persons.

11. PHC visits per capita

12. Provincial emergency medical services expenditure, 2001/02 to 2007/08 • Funding for EMS grows strongly to R1.7billion in 2005/06. • Unit costs vary significantly among provinces due to problems in information systems, population density, distances and variations in staffing models.

13. Provincial HIV and Aids expenditure, 2001/02 to 2007/08 • Provinces have budgeted R1.7 billion in 2005/06 for specific interventions. • AIDS treatment programmes have been initiated in all 53 health districts, 42 367 people on treatment by December 2004 • Widespread rollout of voluntary counseling and testing (427 sites in 2002 to 3369 in 2004) and Mother-child prevention programmes. Male condoms distributed increased from 150 million in 1998 to 360 million in 2004

14. Revitalisation hospitals close to completion • Need higher quality project business & implementation plans. • Strengthening national programme unit & provincial departments through the infrastructure development improvement programme.

15. Trends in scarce health professionals

16. Personnel per 100 000 population

17. Trends in scarce health professionals • Professional personnel numbers rose (2605 employees), suggesting improving stability • Increases noted in pharmacists (27.9%), dieticians (15.1%), speech therapists (18.6%) & physiotherapists (9.1%). • While number of doctors did not increase, redistribution noted among provinces, following rural allowance strategy. • While progress is noted, the lack of skilled personnel in rural areas remains a problem. • Access to personnel varies considerably across provinces.

19. Conclusion • 2005 / 2006 budget showed 8.6% real growth. • Key emphasis on strengthening primary health care and implementing the district health system, expanding programmes to counter HIV / AIDS, and revitalising health infrastructure. Ambulance budget & goods and services (NPNC) continue to improve. • Greater attention to hospital budgets, Modernisation of Tertiary services and improving staffing levels required in future budgets • Publishing and disseminating health information needs to be improved.

20. Questions • Do we have sectoral information we need for planning and evaluation • How do we increase health professional personnel • How to speed up capital spending and revitalisation • Are we getting value for money • Are we improving quality of care • Are we focusing enough on prevention and outcomes