BUDGET PRESENTATION

NATIONAL DEPARTMENT OF HEALTH

PRESENTATION TO THE SELECT COMMITTEE ON SOCIAL SERVICES

24 May 2002

BUDGET PRESENTATION

Budget Supplem. Total Actual *Adj. Bud. Budget Expenditure Balance

2001/2002 2001/2002 2001/2002 2001/2002 2001/2002R'000 R'000 R'000 R'000 R'000

Programme1: Administration

Minister, Management, Corporate Services 71,467 4,951 76,418 74,944 1,474Fixed Capital (land, buildings, infrastructure) 16,200 22,001 38,201 35,639 2,562Total: Programme 1 87,667 26,952 114,619 110,583 4,036

Programme 2:Strategic Health Programmes

District Health Systems 1,947 0 1,947 2,487 -540International Health Liaison 34,561 0 34,561 35,213 -652South Africa Development Community 1,987 0 1,987 1,977 10Health Monitoring and Evaluation 15,419 1,985 17,404 18,135 -731Maternal Child & Women's Health 17,714 11,124 28,838 26,266 2,572Medicines Regulatory Affairs 18,503 0 18,503 15,842 2,661Mental Health and Substance Abuse 4,700 831 5,531 6,032 -501HIV/AIDS and STD's 61,744 38,306 100,050 96,320 3,730Government AIDs Action Plan (GAAP) 111,430 -4,939 106,491 112,102 -5,611Tuberculosis 4,953 0 4,953 2,996 1,957Pharmaceutical Policy and Planning 9,723 37,439 47,162 49,181 -2,019Medical Schemes 2,585 0 2,585 2,585 0Total: Programme 2 285,266 84,746 370,012 369,136 876

* Expenditure as at 24 April 2002 but before closure of books

EXPENDITURE PER SUB PROGRAMME

BUDGET PRESENTATION

Budget Supplem. Total Actual *Adj. Bud. Budget Expenditure Balance

2001/2002 2001/2002 2001/2002 2001/2002 2001/2002R'000 R'000 R'000 R'000 R'000

Programme 3: Health Service Delivery

Disease Prevention and Control 60,193 5,030 65,223 58,333 6,890Hospital Services 12,565 1,990 14,555 13,140 1,415Human Resources 6,239 3,382 9,621 10,003 -382Non-Personal Health Services 58,122 0 58,122 53,174 4,948Health and Welfare Sector Negotiations 2,563 0 2,563 1,981 582Total: Programme 3 139,682 10,402 150,084 136,631 13,453

Specified items:

Medical Research Council 127,221 0 127,221 127,221 0Vaccine production 4,052 0 4,052 4,052 0Poverty relief 10,000 0 10,000 3,487 6,513Total: Specified items 141,273 0 141,273 134,760 6,513

Sub Total : NDOH (exclud. Conditional Grants) 653,888 122,100 775,988 751,110 24,878

* Expenditure as at 24 April 2002 but before closure of books

EXPENDITURE PER SUB PROGRAMME

BUDGET PRESENTATION

2001/2002 2001/2002 2001/2002 2001/2002 2001/2002R'000 R'000 R'000 R'000 R'000

Conditional grants:

National Tertiary Grant 3,453,080 6,514 3,459,594 3,459,594 0Health Professional Training and Research 1,234,090 0 1,234,090 1,234,090 0Hospital Rehabilitation 500,000 0 500,000 500,000 0Durban Academic Hospital 103,800 0 103,800 103,800 0Pretoria Academic Hospital 50,000 0 50,000 50,000 0Primary School Nutrition Program 582,411 0 582,411 582,411 0HIV/AIDS 34,100 20,298 54,398 54,398 0Total: Conditional grants 5,957,481 26,812 5,984,293 5,984,293 0

Total: National Department of Health 6,611,369 * 148,912 6,760,281 6,735,403 24,878* Roll-over funds 146,912* Additional funds 2,000* Funds suspended (Poverty Relief) 0

148,912

EXPENDITURE PER SUB PROGRAMME

BUDGET PRESENTATION

Budget Budget MTEF MTEF2001/2002 2002/2003 2003/2004 2004/2005

R'000 R'000 R'000 R'000

Programme1: AdministrationMinister, Management and Corporate Services 71,467 81,921 86,151 91,809 Fixed capital (land, buildings, infrastructure) 16,200 5,279 - -

Total: Programme 1 87,667 87,200 86,151 91,809

Programme 2:Strategic Health ProgrammesDistrict Health Systems 1,947 2,039 2,130 2,258 International Health Liaison 34,561 35,970 37,608 39,115 South African Development Community 1,987 2,056 2,129 2,257 Health Monitoring and Evaluation 15,419 18,285 19,573 20,463 Maternal, Child and Women's Health 17,714 20,129 20,911 22,143 Medicines Regulatory Affairs 18,503 19,693 21,822 23,071 Mental Health and Substance Abuse 4,700 6,016 6,185 6,889 HIV/AIDS and STDs 178,127 250,996 277,458 309,023 Government AIDS Action PlanTuberculosisPharmaceutical Policy and Planning 9,723 11,748 12,453 13,266 Medical Schemes 2,585 2,673 2,673 2,833

Total: Programme 2 285,266 369,605 402,942 441,318

BUDGET 2002 - 2005

BUDGET PRESENTATION

Programme 3: Health Service DeliveryDisease Prevention and Control 60,193 88,810 108,929 146,238 Hospital Services 12,565 13,432 14,053 14,895 Human Resources 6,239 6,441 6,703 7,105 Non-Personal Health Services 58,122 60,051 63,261 67,061

Health and Welfare Bargaining Sector Negotiations 2,563 2,383 2,489 2,642

Total: Programme 3 139,682 171,117 195,435 237,941

Specified items:Medical Research Council 127,221 145,498 152,270 158,406 Vaccine production 4,052 - - - Poverty relief 10,000 12,000 15,000 -

Total: Specified items 141,273 157,498 167,270 158,406

Conditional grants:Integrated Nutrition Programme 582,411 582,411 582,411 617,356 HIV/AIDS 34,100 157,209 266,575 380,480 National Tertiary Grant 3,453,080 3,666,842 3,892,849 4,151,542 Health Professional Training and Research 1,234,090 1,279,248 1,299,475 1,393,366 Hospital Rehabilitation 500,000 520,000 543,400 576,004 Durban Academic Hospital 103,800 - - - Pretoria Academic Hospital 50,000 70,000 90,000 - Hospital Management Grant - 124,000 130,000 137,800

Total: Conditional grants 5,957,481 6,399,710 6,804,710 7,256,548

Total: National Department of Health 6,611,369 7,185,130 7,656,508 8,186,022

BUDGET PRESENTATION

Brief Explantion of the New Grant Framework for Tertiary Services

and the Health Professionals Training and Development

Thabo Sibeko

Chief Director

Hospital Services

BUDGET PRESENTATION

Need for Change

• Central Hospitals and Health Professionals Training and Research Grant Frameworks flawed

• Redistributive Grant inadequate

• Review undertaken to examine the location, and volume of Tertiary Services provided in SA (all nine provinces)

BUDGET PRESENTATION

Data

• 529 specialised service units

• 62 hospitals in all 9 provinces

• Major effort by provinces to complete additional data collection yielded significant benefits

BUDGET PRESENTATION

Proportion of Specialised Service Activity per Province

0%

5%

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15%

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30%

35%

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Eastern

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rovin

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West

ern

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Admissions

Day Cases

OP Visits

BUDGET PRESENTATION

Proportion of Provincial Own Revenue Health Budget Spent on Tertiary Care

-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

Eastern Cape Free State Gauteng Kw aZuluNatal

Mpumalanga North West NorthernCape

NorthernProvince

WesternCape

BUDGET PRESENTATION

Expenditure and CHG

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1600

1800

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Central Hospitals Non-Central Hospitals Central Hospitals Grant

BUDGET PRESENTATION

National Tertiary Services

• Based on the review of HSS the following policy findings were observed:– All provinces provide a significant level of Tertiary

Services, however:• Some provinces have low provision, low access and low funding

requirements (Mpu, NW and NP)• Some provinces provide significant level of Tertiary services but

receive no funding (EC, NC)• Some provinces provide significant level of Tertiary services but

receive less funding than is required to deliver these services (KZN, FS)

• Some provinces provide significant level of Tertiary services but receive more funding than is required to provide these services (GP, WC)

BUDGET PRESENTATION

National Tertiary Services• New framework funds all provinces for the tertiary

services they provide based on the volume of services they provide and the costs incurred in providing these services– attempts to address the policy findings mentioned earlier

• The NTS grant replaces the CHG, RTS and HPTR grants– Full costs of NTS exceed the envelope of what was

allocated for the CHG and RTS by R280m– Hence, drew down from HPTR grant.

BUDGET PRESENTATION

National Tertiary Services

PURPOSE

• To fund national tertiary services

• To ensure equitable access by all South Africans to basic tertiary health care

• To ensure nationally coordinated planning for tertiary services

BUDGET PRESENTATION

HPTD

• R280m less in value (to fund NTS)• Original HPTR allocations and criteria retained

but proportionately reduced for all provinces• Development funds added (R227m over 5 years),

– which seeks to strengthen Level II services in Provinces without medical schools by funding additional registrar and medical specialist posts to bring all provices up to the national per capita level

BUDGET PRESENTATION

CONDITIONAL GRANTS (HOSPITAL GRANTS)

BUDGET PRESENTATION

LIST OF OLD & NEW GRANTSLIST OF OLD & NEW GRANTS

Hospital Mx & Quality Improvement

Hospital RevitalizationHospital reconstruction & rehabilitation

Pretoria AcademicPretoria Academic

Health professional training & development

Health professional training & research

National tertiary servicesCentral hospitals and RHSS

NewOld

BUDGET PRESENTATION

Notes

• Service Agreements for NTSG and HPTD prepared• Business plans for other grants are developed and

approved• Expenditure according to business plan /service

agreements• Progress against action plan• List of indicators pertaining to expenditure vs cash

flow• RDP and INP indicators

BUDGET PRESENTATION

Notes (Cont…)

• Provincial heads of health submit monthly and quarterly financial reports

• Certificates signed by Provincial Accounting Officer at the end of the financial year.

• Provincial liaison and technical support visits• Regular meetings per financial year between

national and provinces

BUDGET PRESENTATION

Payment Schedule

• National Tertiary Services and HPT &D-monthly transfers

• Hospital revitalization ,Pretoria Academic- quarterly advances

• and Hosp Mx & Quality Improvement- 3 advance installments

BUDGET PRESENTATION

Payment Schedule

• National Tertiary Services and HPT &D-monthly transfers

• Hospital revitalization ,Pretoria Academic- quarterly advances

• and Hosp Mx & Quality Improvement- 3 advance installments

BUDGET PRESENTATION

NTSGNational Tertiary Services Grant

2001/02 2002/03 2003/04 2004/05

Eastern Cape 62,373,000 123,745,712 190,515,662 264,302,908

Free State 249,813,000 287,424,364 327,914,879 373,244,863

Gauteng 1,568,945,000 1,602,980,656 1,636,902,408 1,678,624,532

KwaZulu Natal 427,525,000 480,679,209 537,751,559 601,853,012

Mpumalanga 37,588,000 38,413,546 39,237,276 40,249,016

Northern Cape 16,700,000 24,061,862 32,052,475 40,908,318

Limpopo 44,500,000 44,837,816 45,115,924 45,545,146

North West 34,200,000 34,188,519 34,106,749 34,110,821

Western Cape 1,011,436,000 1,030,509,944 1,049,252,386 1,072,702,974

Total 3,453,080,000 3,666,841,629 3,892,849,318 4,151,541,591

BUDGET PRESENTATION

Hospital Mx & Quality Improvement

Province 2001/2 2002/3 2003/4 2004/5Eastern Cape 2,000,000 9,000,000 14,000,000 14,840,000Free State 6,000,000 11,000,000 11,000,000 11,660,000Gauteng 32,000,000 34,000,000 28,000,000 29,680,000KZN 16,000,000 19,000,000 17,000,000 18,020,000Mpumalanga 2,000,000 8,000,000 12,000,000 12,720,000North West 2,000,000 8,000,000 11,000,000 11,660,000Northern Cape 1,000,000 7,000,000 8,000,000 8,480,000Limpopo 2,000,000 9,000,000 12,000,000 12,720,000W.Cape 16,000,000 19,000,000 17,000,000 18,020,000Total 79,000,000 124,000,000 130,000,000 137,800,000

BUDGET PRESENTATION

HPT & D2001/02 2002/03 2003/04 2004/05

Eastern Cape 55,865,000 70,269,977 77,834,957 106,977,629

Free State 88,367,000 88,163,715 87,763,191 87,565,065

Gauteng 529,186,000 527,968,627 525,570,088 524,383,610

KwaZulu Natal 154,388,000 160,499,027 163,277,703 175,953,336

Mpumalanga 24,377,000 30,388,910 33,542,652 45,707,869

Northern Cape 24,377,000 27,591,948 29,241,084 35,773,708

Limpopo 24,377,000 34,186,066 39,382,461 59,194,491

North West 24,377,000 32,114,430 36,196,403 51,836,519

Western Cape 308,776,000 308,065,672 306,666,143 305,973,842

Total 1,234,090,000 1,279,248,371 1,299,474,682 1,393,366,069

BUDGET PRESENTATION

Hospital Revitalization

PROVINCE 2001/2 2002/3 2003/4 2004/5

Eastern Cape 69,000,000 81,000,000 84,645,000 89,724,000

Free State 16,000,000 17,000,000 17,765,000 18,831,000

Gauteng 102,000,000 105,000,000 109,725,000 116,308,000

KwaZulu-Natal 87,000,000 90,000,000 94,050,000 99,693,000

Mpumalanga 43,000,000 45,000,000 47,025,000 49,847,000

Northern Cape 10,000,000 10,000,000 10,450,000 11,077,000

Limpopo 88,000,000 92,000,000 96,140,000 101,908,000

North West 56,000,000 50,000,000 52,250,000 55,385,000

Western Cape 29,000,000 30,000,000 31,350,000 33,231,000

TOTALS 500,000,000 520,000,000 543,400,000 576,004,000

BUDGET PRESENTATION

PROVINCIAL HEALTH BUDGETS 2002/03

Portfolio Committee on Health24 May 2002

BUDGET PRESENTATION

Expenditure 2001/02Province 2001/02 Revised Budget Expenditure (Excluded

Suspense Accounts)% Actual vs Budget (Over)/Under Expenditure

Total Personnel Total Personnel Total Personnel Total PersonnelR'000 R'000 R'000 R'000 % % R'000 R'000

EasternCape

4,223,812 2,427,611 3,882,342 2,426,320 91.92% 99.95% 341,470 1,291

Free State 1,970,475 1,241,218 2,035,028 1,263,066 103.28% 101.76% (64,553) (21,848)Gauteng 6,771,374 3,604,800 6,805,610 3,659,869 100.51% 101.53% (34,236) (55,069)KwaZulu-Natal

6,743,729 4,062,032 7,033,460 4,238,651 104.30% 104.35% (289,731) (176,619)

Limpopo 2,718,901 1,698,969 2,674,094 1,736,681 98.35% 102.22% 44,807 (37,712)Mpumalanga 1,517,016 823,145 1,457,670 811,430 96.09% 98.58% 59,346 11,715NorthernCape

508,956 327,873 517,492 323,404 101.68% 98.64% (8,536) 4,469

North West 1,734,817 1,145,442 1,698,934 1,159,341 97.93% 101.21% 35,883 (13,899)WesternCape

3,578,767 2,262,958 3,559,666 2,245,637 99.47% 99.23% 19,101 17,321

Total 29,767,847 17,594,048 29,664,296 17,864,399 99.65% 101.54% 103,551 (270,351)

BUDGET PRESENTATION

Expenditure on conditional grants

Budget*2001/02

Expenditure2001/02

% spent

Health Central Hospitals 3 270 920 3 270 014 99.97% HIV/AIDS 54 398 50 209 92.30% Hospital Rehabilitation 500 000 550 408 110.08% Integrated Nutrition Programme 582 411 511 113 87.76% Nkosi Albert Luthuli AcademicHospital

103 800 392 368 378.00%

Pretoria Academic 50 000 50 188 100.38% Redistribution of SpecialisedHealth Services

188 674 178 124 94.41%

Professional Training andResearch

1 234 090 1 239 906 100.47%

*Excluding rollovers

BUDGET PRESENTATION

Table 1. Provincial expenditure on health by year (R mil)Actual Projected MTEF2000/01 2001/02 2002/03 2003/04 2004/05

Eastern Cape 3,790 3,882 3,917 4,429 4,575Free State 1,777 2,035 2,053 2,176 2,335Gauteng 5,942 6,806 7,213 7,739 8,129KwaZulu-Natal 5,776 7,033 6,996 7,352 7,855Mpumalanga 1,117 1,458 1,657 1,888 2,037Northern Cape 468 517 563 624 675NorthernProvince

2,566 2,674 2,913 3,109 3,394

North West 1,561 1,699 1,920 2,057 2,203Western Cape 3,367 3,560 3,741 3,957 4,157Total 26,364 29,664 30,972 33,332 35,361

BUDGET PRESENTATION

Table 4. Year on year changes

1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2 yr to02/03

EasternCape

0.6% 14.7% 8.4% 2.4% 0.9% 13.1% 3.3% 1.7%

Free State 2.0% -6.1% 11.8% 14.5% 0.9% 6.0% 7.3% 7.5%Gauteng 3.4% 2.3% 6.0% 14.5% 6.0% 7.3% 5.0% 10.2%KwaZulu-Natal

2.0% 4.3% 13.0% 21.8% -0.5% 5.1% 6.8% 10.1%

Mpumalanga

1.1% 8.4% -2.6% 30.5% 13.6% 14.0% 7.9% 21.8%

NorthernCape

4.2% 10.5% 8.1% 10.6% 8.7% 10.9% 8.1% 9.6%

NorthernProvince

6.5% 6.7% 15.6% 4.2% 8.9% 6.7% 9.2% 6.6%

NorthWest

-2.4% 3.1% 12.8% 8.8% 13.0% 7.2% 7.1% 10.9%

WesternCape

3.3% 2.5% 8.4% 5.7% 5.1% 5.8% 5.1% 5.4%

Total 2.4% 4.6% 9.4% 12.5% 4.4% 7.6% 6.1% 8.4%

BUDGET PRESENTATION

Table 5. Funding per capita public sector population1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05Actual Actual Actual Estimated

R millionEastern Cape 516 509 572 606 608 601 666 673Free State 755 754 711 782 885 881 922 978Gauteng 1,189 1,203 1,203 1,279 1,443 1,506 1,592 1,646KwaZulu-Natal 648 647 660 751 902 886 918 968Mpumalanga 427 421 445 433 554 618 691 732Northern Cape 559 574 624 680 745 803 882 945NorthernProvince

421 436 451 506 513 543 562 597

North West 467 446 449 511 548 611 646 682Western Cape 1,025 1,039 1,043 1,128 1,176 1,218 1,270 1,315Total 671 672 688 748 827 849 897 935

BUDGET PRESENTATION

% above per capita mean1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05Actual Actual Actual Estimated

Eastern Cape 77% 76% 83% 81% 74% 71% 74% 72%Free State 112% 112% 103% 105% 107% 104% 103% 105%Gauteng 177% 179% 175% 171% 174% 177% 177% 176%KwaZulu-Natal 97% 96% 96% 100% 109% 104% 102% 103%Mpumalanga 64% 63% 65% 58% 67% 73% 77% 78%Northern Cape 83% 85% 91% 91% 90% 95% 98% 101%NorthernProvince

63% 65% 66% 68% 62% 64% 63% 64%

North West 70% 66% 65% 68% 66% 72% 72% 73%Western Cape 153% 155% 152% 151% 142% 144% 142% 141%

BUDGET PRESENTATION

PROVINCIAL PER CAPITA SPENDING (excl CGs)

0

200

400

600

800

1000

1200

1400

1600

Eastern Cape Free State Gauteng KwaZulu-Natal

Mpumalanga NorthernCape

NorthernProvince

North West WesternCape

Total

Series1

Series2