Select Committee on Finance National Council of Provinces National Treasury September 2008

1. Provincial Health Budgets and Expenditureas at 30 June 2008(2008/09 Financial Year)[Section 32 of PFMA] Select Committee on Finance National Council of Provinces National Treasury September 2008

2. Health Provincial forecasting trends: 2004/05 - 2008/09

3. Health (1) • Spending at R17.1bn or 24.7% against R69.4bn main budget • 8 provinces projecting to overspend their main budgets • GP – R1.8bn, KZN – R1.6bn • WC – R81.8m underspending • Increase of R4bn or 30% compared to the previous year • Low rate of health spending in GP (21.8%) and WC (22.1%) • EC (28.8%) and FS (28%) reflects the highest rate of spending in health • Health Personnel spending at R10.2bn or 26.6% (R38.4bn main budget) • NPNC spending at R5.7bn or 23.8% of R24.1bn budget • Projected overspending of R645.2m in 5 provinces • GP – R189.7m, EC – R175.6m • Capital spending at R1.2bn or 17% of R7bn budget • Increase of 11.8% compared to pre-audited spending last year • Low rate of capital spending in NC (11.5%) and MP (12.3%) • FS (27%) and NW (22%) reflects the highest rate of capital spending in health

4. Health spending by province

5. Health: Programme Analyses • Programme 2: Provincial District Health Services • Spending at R7.2bn or 25.4% of R28.2bn main budget • Lowest rate of spending in WC (21.9%) and GP (22.1%) • Highest in EC (31.3%) and FS (26.9%) • Programme 4: Provincial Hospital Services • Spending at R4.2bn or 26.9% of R15.8bn main budget • Lowest rate of spending in WC (18.2%) and MP (20.2%) • Highest in KZN (31.2%) and NC (30.9%) • Programme 5: Central Hospital Services • Spending at R2.4bn or 26.6% of R9.2bn main budget • Projected over-expenditure of R1.1bn in 3 provinces • GP – R907m, KZN – R136.7m, FS – R60.6m • Lowest rate of spending in NW (12.1%) and LP (21.4%) • Highest in WC (32%) and KZN (29.8%)

6. Health: District Services

7. Health: Hospital Services

8. Health: Central Hospital Services

9. Health: Personnel

10. Health: Non-personnel Non-capital

11. Health: Capital

12. Health Grants (1)Comprehensive HIV and Aids Grant • Objective (Schedule 5 Grant): • To enable the health sector to develop an effective response to HIV and Aids • Support implementation of the National Operational Plan for Comprehensive HIV and Aids Treatment and Care

13. Health Grants (2)Forensic Pathology Services Grant • Objective (Schedule 5 Grant): – To continue the development and provision of a comprehensive Forensic Pathology Service following the shift of this function to the health sector from the SAPS

14. Health Grants (4)Hospital Revitalisation Grant • Objective (Schedule 5 Grant): – To provide funding to enable provinces to plan, manage, modernise, rationalise and transform the infrastructure, health technology, monitoring and evaluation of hospitals; and to • transform hospital management and improve quality of care in line with national policy objectives.

15. Health Grants (5)National Tertiary Services Grant • Objective (Schedule 4 Grant): • To compensate provinces for the supra-provincial nature of tertiary services provision and spill over effects • To provide strategic funding to enable provinces to plan. modernise. rationalise and transform the tertiary hospital service delivery platform in line with national policy objectives including improving access and equity.

16. Health Grants (3)Health Professions Training and Development Grant

17. Conclusion • Concern around large over-spending projection • Low spending on capital and conditional grants • Interventions by Provincial DOHs and PTs required