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HEALTH AND HIV FUNDING

This forum discusses the state of health and HIV funding, budget monitoring, and the challenges faced. Topics include mortality rates, AIDS treatment numbers, primary care visits, national service delivery agreement, middle-income health financing, health spending, and public-private health spending.

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HEALTH AND HIV FUNDING

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  1. HEALTH AND HIV FUNDING Budget Monitoring Forum Presenter: Mark Blecher | National Treasury | November 2011

  2. Mortality beginning to drop

  3. Numbers on AIDS treatment

  4. Health personnel

  5. Primary care visits

  6. National service delivery agreement

  7. Middle income health financing

  8. Health spending

  9. Public and private health spending (real)

  10. Hospital workloads

  11. Health infrastructure • Total R10b pa • Improve delivery capacity • R134m for NDOH 11/12 • Partnerships with DBSA, CSIR • Managing engineers • Project monitoring tools • Project intervention teams • 5 large PPPs • New Health Infrastructure grant (R1.7b rising to R1.9b)

  12. Budget 2012 • Difficult fiscal position • Holding budget – no increase in deficit • Only contingency reserve available for allocation • Function committee approach • Reprioritisation • Non-discretionary areas • Policy priorities (minimal fiscal space) • Savings (partly to fund economic stimulus package, enterprise support, EPWP type jobs, NHI pilots)

  13. Budget 2012 • Difficult fiscal position • Holding budget – no increase in deficit • Only contingency reserve available for allocation • Function committee approach • Reprioritisation • Non-discretionary areas • Policy priorities (minimal fiscal space) • Savings (partly to fund economic stimulus package, enterprise support, EPWP type jobs, NHI pilots)

  14. Fiscal position

  15. Government borrowing

  16. Health and social protection diagram

  17. Health Baseline

  18. Reprioritisation • Very difficult fiscal climate requires reprioritisation • Focus on efficiency, improving value for money • Wider call to restructure expenditure • Huge variability in unit costs across hospitals of similar type, districts, economic classification • Was supposed to be first step of budget process • Not much progress made in Function group in this area • Only significant proposal was to top-slice R200m from HIG and HRG for nursing college upgrading • Some potential within goods and services area (procurement, arv prices, fraud, collusion leading to higher prices, improved controls, protocols); inefficiencies in capital projects • More reprioritisation is required given fiscal position, personnel pressures, cuts exercise and improving efficiency • Each province will need to look at this in finalising budget for 2012/13

  19. Budget bids – NHI Pilots • Various aspects of NHI need to be tested and piloted • PHC reforms: • Family health teams: ward based teams set up to improve primary health care delivery • District specialist support teams: Aims to strengthen district health services • School health services: Package of health services (e.g. testing, prevention, deworming) offered at schools • Contracting with private providers: review legal aspects of contracting with private GPs, determine how these contracts can be designed, measured and monitored, and experimentation with reimbursement mechanisms (e.g. capitation) • Costing still in progress: Initial rec xxx

  20. Non-discretionary areas Certain pressures are effectively non-discretionary • ICS (6.8% vs 5.5% carry-through) • ARV uptake increases (approximately 400 000 pa) • Possibly rising PHC visits (4-5m pa average over past decade)

  21. HIV and AIDS • ART Programme: new cd4 350 threshold generalised • Need to make provision for at least 400 000 growth pa • Unit cost R4300-R4900 per capita • Analysis suggests baselines largely sufficient (R1.8b growth pa) except outer year • Recommendation xxx • New NSP development – implications for other sectors

  22. Primary health care and volume adjustment: Rising PHC visits PHC visits rising by 4 mil pa Possible volume adjustment for outer year as non-discretionary baseline adjustment Transfer as part of new NHI conditional grant Links to PHC policies of family health teams, ward based community teams, district support teams and school health services

  23. Policy priorities • NHI pilots • Nursing college upgrading • Office of Standards compliance • Planning large PPPs and infrastructure support • HR strategy

  24. NHI • Key theme for Budget 2012/13 • Release of Green paper, public announcements by Ministers, wide media coverage and public interest • Need to chart practical way forward • DG Health requested NHI pilots as key priority for Budget 2012/13 • Need to accept that NHI will entail greater national control over sectoral funding • Need to establish functioning interim mechanism prior to NHI Fund • Probable establishment of new transitional NHI grant – need to finalise funding mechanism • Two other cgs (NTSG, HIV) potential slight renaming to indicate longer term shift into NHI

  25. Infrastructure • Ministers driving new approach to health infrastructure with larger direct role for National Department and DBSA • Nursing colleges upgrading and recapitalisation is immediate focus – • Large PPPs in planning (but feasibility studies not yet complete) • New Schedule 7 (in-kind) grant is proposed as option / test case on nursing colleges upgrading • Preconditions: i) Provincial sign-off ii) Signed agreements • Reprioritisation: Nursing college upgrading to be funded initially through top-slicing of HIG/HRP • DBSA and CSIR IUSS support interventions • Efficiency of infrastructure delivery: AG Report and Scopa hearing

  26. HR Strategy and ICS for health • Development and implementation of the new HR strategy for health • 100 page document, draft policy and models released • Large focus on filling posts and increasing supply • Partly via NHI pilots • ICS increase 1.3% estimated to cost R800m pa • Over-spending on health personnel >R1bil pa for several years • Over-spending projection on personnel going forward

  27. Provincial Health budget baselines

  28. HIV conditional grant health baseline Rmil

  29. HIV/AIDS subprogramme Health (Health)

  30. Provincial IYM Sept 11 (6 months of 11/12)

  31. Estimate of national HIV spend

  32. NASA draft: Total Funding & Sources for HIV/AIDS/TB in SA (2007/08-2009/10) (incl % of the Child Support Grant)

  33. Conclusion • Budget 2012/13 is being formulated in very tough fiscal climate • Budgets going forward will not be as strong as growth over past three years • Very small number of additional allocations from contingency reserve • NHI pilots will be important going forward and plans will need to become very practical in year ahead • Need to finalise whether will or will not have two new conditional grants • NHI • S7 nursing colleges grant • Provinces will need to focus substantially on reprioritisation • Control of personnel spending will be nb noting projected shortfall • Increasing efficiency and delivery on capital expenditure

  34. NASA draft: Total SA HIV/AIDS Spending Activities (2007/08-2009/10) .

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