Comments from Health on the MTBPS

General comments

• Medium term expenditure framework

• Adjustment appropriation 2003/04

• Direct benefit to public health

• Indirect benefit to public health

• Concerns to public health

Health Financing & Economics 3

General Comments (2)

• Health Acknowledges the key initiatives i.e:– The expanded public works programme– The social security programmes to support

the most vulnerable– Black Economic Empowerment – Strengthened partnerships and local

development initiatives.


Concerns of the National Department of Health

• Indirect concerns– The social sector consists of three main players i.e.

• Health• Social Development• Education

– A certain “competition” exist between these players.– In terms of the allocation to Social Development –

child support and disability grants and the allocations made available to Education, the previous balance between the Social Sector partners are disturbed.


Figure 1 Consolidated public health expenditure per uninsured person in 2002 prices (R)

800

850

900

950

1,000

1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06


Comparison between SectorsFigure 2 Sectoral breakdown of government expenditure (%)

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00% Debt Interest/Payments as% of govt spending

Health as % of GovtSpending

Education as % of GovtSpending

Social development as % ofGovt Spending

Defence as % of GovtSpending

Police as % of GovtSpending

Correctional Services as %of Govt Spending


% of GDPFigure 3 Consolidated public health expenditure as % GDP

2.70%

2.78%

2.85%

2.93%

3.00%

3.08%

3.15%

3.23%

3.30%

3.38%

3.45%


Sector ComparisonFigure 4 Consolidated health, education and social development

expenditure as % GDP

0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%5.00%5.50%6.00%6.50%7.00%

1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

Health as % of GDP

Education as % of GDP

Social Development as % of GDP


Increased service workload

• 700+ clinics built serving 7m people

• 60%+ clinics provide PHC package

• per capita PHC visits:- '92/93 1.8 per year (incl. OPD)- '01/02 2.3 per year (excl. OPD)

• annual admissions up 100,000 since '94inpatients more gravely ill


Figure: Ratios of health expenditure per uninsured person of provinces to lowest spending province (100)

-

50

100

150

200

250

300

350

400

450

1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

Eastern Cape

Free State

Gauteng

Kw aZulu Natal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

Total


Figure: PHC expenditure by health district relative to a district deprivation score 2001/02

0.00

50.00

100.00

150.00

200.00

250.00

300.00

350.00

R pe

r cap

ita

-10

-8

-6

-4

-2

0

2

4

6

8

DIS

R pc

DIS

Linear (DIS)


Conclusion

• Whilst the budgetary increases seem rosy for the health sector

• Upon closer reflection and in the greater context of challenges that are being experienced by Health,– Insufficient resources being allocated

Comments from Health on the MTBPS

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