select committee on finance national council of provinces presented by: national treasury

1

Health services: Preliminary Outcome of Conditional Grants & Capital

Expenditure as at 31 March 2007

(2006/07 Financial Year)

Select Committee on Finance

National Council of Provinces

Presented by:

National Treasury11 May 2007

2

Key priorities for 2006 MTEF

Health– Hospital Revitalisation

– Forensic pathology

– Recruit health professionals (including CHWs);

– Expand Emergency Medical Services, implement new national ambulance service model;

– Primary health care,

– Modernise tertiary services.

3

Health (1)

• Spending at R53,6bn or 100,6% against R53,3bn adjusted budget– Four provinces (FS, GP, LP and NC) overspent their adj budgets– Preliminary overspending of R328,2m (GP – R372,2m)– Increase of R6,6bn or 14,0% compared to the previous year – Low rate of health spending in NW (96,2%) and EC (98,2%) – NC (107,0%) and LP (104,8%) reflects the highest rate of

spending in health• Health Personnel spending at R28,8bn or 99,5%

(R28,9bn adjusted budget)• NPNC spending at R20,2bn or 104,2% of R19,4bn

adjusted budget– Preliminary overspending of R806,3m (GP – R329,7m)

• Capital spending at R4,7bn or 93,1% – Increase of 21,4% compared to audited spending – Low rate of capital spending in KZN (84,6%) and NC (85,2%) – LP (111,8%) and FS (104,2%) reflects the highest rate of capital

spending in health

4

Health (2)

Table: Provincial Health Expenditure as at 31 March 2007

Eastern Cape 7 336 999 7 204 681 98.2% – 132 318 1.8% 26.8% 34.6% 6 120 970 17.7%

Free State 3 369 410 3 475 010 103.1% -105 600 – -3.1% 28.2% 37.5% 3 121 275 11.3%

Gauteng 10 748 498 11 120 685 103.5% -372 187 – -3.5% 32.1% 46.8% 9 974 183 11.5%

Kw aZulu-Natal 11 819 251 11 671 677 98.8% – 147 574 1.2% 31.5% 40.4% 10 555 752 10.6%

Limpopo 5 554 259 5 819 070 104.8% -264 811 – -4.8% 24.4% 33.2% 4 788 257 21.5%

Mpumalanga 3 032 242 3 008 386 99.2% – 23 856 0.8% 24.0% 31.9% 2 663 694 12.9%

Northern Cape 1 316 370 1 408 429 107.0% -92 059 – -7.0% 30.8% 43.1% 1 096 575 28.4%

North West 3 615 906 3 478 848 96.2% – 137 058 3.8% 23.2% 33.0% 2 968 159 17.2%

Western Cape 6 476 348 6 410 685 99.0% – 65 663 1.0% 34.0% 45.7% 5 718 812 12.1%

Total 53 269 283 53 597 471 100.6% -834 657 506 469 -0.6% 28.9% 39.0% 47 007 677 14.0%

Net -328 188

% share of Health to

total provincial

expenditure

% share of Health to

total Social serv

expenditure

2005/06: Audited outcome

Year-on-year

growth

Preliminary outcome as

% of adjusted budget

(Over) Under

% (Over) / under of adjusted budget

R thousand

Adjusted budget

Preliminary outcome as at 31 March

2007

5

Health: Programme Analyses

• Programme 2: Provincial District Health Services– Spending at R21,1bn or 99,0% of R21,3bn adjusted budget– Lowest rate of spending in NW (94,7%) and WC (96,6%)– Highest in LP (105,3%) and NC (101,3%)

• Programme 4: Provincial Hospital Services– Spending at R13,0bn or 102,1% of R12,8bn adjusted budget– Lowest rate of spending in LP (98,1%) and MP (98,8%) – Highest in NC (111,0%) and FS (110,1%)

• Programme 5: Central Hospital Services– Spending at R8,7bn or 106,4% of R8,2bn adjusted budget– Preliminary over-expenditure of R522,9m (GP – R412,9m)– Lowest rate of spending in NW (99,5%) and WC (100,2%) – Highest in GP (112,2%) and FS (106,2%)

6

Health: District Services

Table: Provincial District Health Services Expenditure (Programme 2) as at 31 March 2007

Eastern Cape 3 314 391 3 210 685 96.9% – 103 706 3.1% 12.0% 44.6% 2 812 011 14.2%

Free State 1 309 177 1 289 967 98.5% – 19 210 1.5% 10.5% 37.1% 1 137 573 13.4%

Gauteng 2 492 773 2 467 148 99.0% – 25 625 1.0% 7.1% 22.2% 2 152 883 14.6%

Kw aZulu-Natal 5 390 094 5 377 370 99.8% – 12 724 0.2% 14.5% 46.1% 4 924 947 9.2%

Limpopo 2 800 173 2 947 850 105.3% -147 677 – -5.3% 12.4% 50.7% 2 366 331 24.6%

Mpumalanga 1 587 572 1 558 280 98.2% – 29 292 1.8% 12.4% 51.8% 1 358 797 14.7%

Northern Cape 510 966 517 766 101.3% -6 800 – -1.3% 11.3% 36.8% 421 305 22.9%

North West 1 894 386 1 793 804 94.7% – 100 582 5.3% 12.0% 51.6% 1 585 270 13.2%

Western Cape 1 996 771 1 928 496 96.6% – 68 275 3.4% 10.2% 30.1% 1 629 951 18.3%

Total 21 296 303 21 091 366 99.0% -154 477 359 414 1.0% 11.4% 39.4% 18 389 068 14.7%

Net 204 937

% share of DHS to total provincial

expenditure

% share of DHS to total

Health expenditure


Year-on-year

growth



(Over) Under


R thousand

Adjusted budget


2007

7

Health: Hospital Services

Table: Provincial Hospital Services Expenditure (Programme 4) as at 31 March 2007

Eastern Cape 2 269 097 2 281 081 100.5% -11 984 – -0.5% 8.5% 31.7% 2 043 109 11.6%

Free State 867 048 954 517 110.1% -87 469 – -10.1% 7.8% 27.5% 856 209 11.5%

Gauteng 2 824 831 2 944 113 104.2% -119 282 – -4.2% 8.5% 26.5% 2 645 825 11.3%

Kw aZulu-Natal 3 163 833 3 135 343 99.1% – 28 490 0.9% 8.5% 26.9% 2 796 081 12.1%

Limpopo 722 984 709 196 98.1% – 13 788 1.9% 3.0% 12.2% 620 139 14.4%

Mpumalanga 435 347 430 256 98.8% – 5 091 1.2% 3.4% 14.3% 399 450 7.7%

Northern Cape 307 834 341 793 111.0% -33 959 – -11.0% 7.5% 24.3% 295 230 15.8%

North West 830 666 838 459 100.9% -7 793 – -0.9% 5.6% 24.1% 815 128 2.9%

Western Cape 1 349 533 1 400 071 103.7% -50 538 – -3.7% 7.4% 21.8% 1 295 905 8.0%

Total 12 771 173 13 034 829 102.1% -311 025 47 369 -2.1% 7.0% 24.3% 11 767 076 10.8%

Net -263 656

% share of PHS to total provincial

expenditure

% share of PHS to total

Health expenditure


Year-on-year

growth



(Over) Under


R thousand

Adjusted budget


2007

8

Health: Central Hospital Services

Table: Central Hospital Services Expenditure (Programme 5) as at 31 March 2007

Free State 576 169 612 141 612 141 106,2% -35 972 – -6,2% 5,0% 17,6% 543 235 12,7%

Gauteng 3 386 868 3 799 787 3 799 787 112,2% -412 919 – -12,2% 11,0% 34,2% 3 656 071 3,9%

Kw aZulu-Natal 1 168 164 1 196 563 1 196 563 102,4% -28 399 – -2,4% 3,2% 10,3% 1 068 606 12,0%

Limpopo 480 238 497 016 497 016 103,5% -16 778 – -3,5% 2,1% 8,5% 431 189 15,3%

Mpumalanga 417 534 442 282 442 282 105,9% -24 748 – -5,9% 3,5% 14,7% 382 724 0,0%

North West 69 380 69 010 69 010 99,5% – 370 0,5% 0,5% 2,0% –

Western Cape 2 122 767 2 126 853 2 126 853 100,2% -4 086 – -0,2% 11,3% 33,2% 1 980 705 7,4%

Total 8 221 120 8 743 652 8 743 652 106,4% -522 902 370 -6,4% 4,7% 16,3% 8 062 530 8,4%

Net -522 532

R thousand

Adjusted budget

Preliminary outcome


2007



(Over) Under


% share of CHS to total provincial

expenditure

% share of CHS to total

Health expenditure


Year-on-year

growth

9

Health: Personnel

Table: Provincial Personnel Expenditure: Health as at 31 March 2007

Eastern Cape 3 979 988 3 865 447 97.1% – 114 541 2.9% 23.4% 53.7% 3 445 574 12.2%

Free State 2 002 525 2 012 269 100.5% -9 744 – -0.5% 27.9% 57.9% 1 849 533 8.8%

Gauteng 5 179 398 5 347 780 103.3% -168 382 – -3.3% 33.8% 48.1% 4 688 666 14.1%

Kw aZulu-Natal 6 723 759 6 629 171 98.6% – 94 588 1.4% 30.6% 56.8% 5 866 764 13.0%

Limpopo 3 239 490 3 332 512 102.9% -93 022 – -2.9% 22.5% 57.3% 2 854 775 16.7%

Mpumalanga 1 678 923 1 638 222 97.6% – 40 701 2.4% 22.4% 54.5% 1 449 633 13.0%

Northern Cape 590 828 621 051 105.1% -30 223 – -5.1% 25.8% 44.1% 522 587 18.8%

North West 1 972 888 1 913 299 97.0% – 59 589 3.0% 22.3% 55.0% 1 764 998 8.4%

Western Cape 3 543 036 3 416 364 96.4% – 126 672 3.6% 35.1% 53.3% 2 976 610 14.8%

Total 28 910 835 28 776 115 99.5% -301 371 436 091 0.5% 27.7% 53.7% 25 419 140 13.2%

Net 134 720

% share of Health

Personnel to total

personnel expenditure

% share of Health

personnel to total Health

expenditure


Year-on-year

growth



(Over) Under


R thousand

Adjusted budget


2007

10

Health: Capital

Table: Provincial Capital Expenditure: Health as at 31 March 2007

Eastern Cape 573 037 561 835 98.0% – 11 202 2.0% 30.1% 7.8% 358 224 56.8%

Free State 236 498 246 283 104.1% -9 785 – -4.1% 22.4% 7.1% 228 838 7.6%

Gauteng 1 070 332 944 409 88.2% – 125 923 11.8% 37.6% 8.5% 969 241 -2.6%

Kw aZulu-Natal 1 109 560 938 213 84.6% – 171 347 15.4% 26.7% 8.0% 943 133 -0.5%

Limpopo 662 625 740 634 111.8% -78 009 – -11.8% 39.9% 12.7% 391 344 89.3%

Mpumalanga 269 899 244 875 90.7% – 25 024 9.3% 22.9% 8.1% 256 111 -4.4%

Northern Cape 281 861 240 173 85.2% – 41 688 14.8% 46.8% 17.1% 169 843 41.4%

North West 342 286 321 710 94.0% – 20 576 6.0% 21.5% 9.2% 170 624 88.5%

Western Cape 449 160 413 723 92.1% – 35 437 7.9% 24.2% 6.5% 345 201 19.8%

Total 4 995 258 4 651 855 93.1% -87 794 431 197 6.9% 29.8% 8.7% 3 832 559 21.4%

Net 343 403

R thousand

Adjusted budget


2007



(Over) Under


% share of Health

Capital to total

Capital expenditure

% share of Capital to

total Health expenditure


Year-on-year growth

11

Health: Non-personnel Non-capital

Table: Provincial Non-Personnel, Non-Capital Expenditure: Health as at 31 March 2007

Eastern Cape 2 783 974 2 777 399 99.8% – 6 575 0.2% 10.3% 38.5% 2 317 172 19.9%

Free State 1 130 387 1 216 458 107.6% -86 071 – -7.6% 9.9% 35.0% 1 042 904 16.6%

Gauteng 4 498 768 4 828 496 107.3% -329 728 – -7.3% 13.9% 43.4% 4 316 276 11.9%

Kw aZulu-Natal 3 985 932 4 104 293 103.0% -118 361 – -3.0% 11.1% 35.2% 3 745 855 9.6%

Limpopo 1 652 144 1 745 924 105.7% -93 780 – -5.7% 7.3% 30.0% 1 542 138 13.2%

Mpumalanga 1 083 420 1 125 289 103.9% -41 869 – -3.9% 9.0% 37.4% 957 950 17.5%

Northern Cape 443 681 547 205 123.3% -103 524 – -23.3% 12.0% 38.9% 404 145 35.4%

North West 1 300 732 1 243 839 95.6% – 56 893 4.4% 8.3% 35.8% 1 032 537 20.5%

Western Cape 2 484 152 2 580 598 103.9% -96 446 – -3.9% 13.7% 40.3% 2 397 001 7.7%

Total 19 363 190 20 169 501 104.2% -869 779 63 468 -4.2% 10.9% 37.6% 17 755 978 13.6%

Net -806 311

% share of NPNC to

total provincial

expenditure

% share of NPNC to



Year-on-year

growth



(Over) Under


R thousand

Adjusted budget


2007

12

• Health capital spending at R4,7bn or 93,1% – Increase of 21,4% compared to audited

outcome ast year

– Preliminary underspending of R343,4m– Low rate of health capital spending in KZN

(84,6%) and NC (85,2%)

– LP (111,8%) and FS (104,1%) reflects the highest rate of capital spending in health

Payments for Capital Assets (Health)

13

Health: Capital

Table: Provincial Capital Expenditure: Health as at 31 March 2007

Eastern Cape 573 037 561 835 98.0% – 11 202 2.0% 30.1% 7.8% 358 224 56.8%

Free State 236 498 246 283 104.1% -9 785 – -4.1% 22.4% 7.1% 228 838 7.6%

Gauteng 1 070 332 944 409 88.2% – 125 923 11.8% 37.6% 8.5% 969 241 -2.6%

Kw aZulu-Natal 1 109 560 938 213 84.6% – 171 347 15.4% 26.7% 8.0% 943 133 -0.5%

Limpopo 662 625 740 634 111.8% -78 009 – -11.8% 39.9% 12.7% 391 344 89.3%

Mpumalanga 269 899 244 875 90.7% – 25 024 9.3% 22.9% 8.1% 256 111 -4.4%

Northern Cape 281 861 240 173 85.2% – 41 688 14.8% 46.8% 17.1% 169 843 41.4%

North West 342 286 321 710 94.0% – 20 576 6.0% 21.5% 9.2% 170 624 88.5%

Western Cape 449 160 413 723 92.1% – 35 437 7.9% 24.2% 6.5% 345 201 19.8%

Total 4 995 258 4 651 855 93.1% -87 794 431 197 6.9% 29.8% 8.7% 3 832 559 21.4%

Net 343 403

% share of Health

Capital to total

Capital expenditure

% share of Capital to



Year-on-year growth



(Over) Under


R thousand

Adjusted budget


2007

14

Monthly Expenditure: Payments for Capital Assets

MONTHLY EXPENDITURE ON PAYMENTS FOR CAPITAL ASSETS FOR 2006/07

-

200 000

400 000

600 000

800 000

1 000 000

1 200 000

1 400 000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Public Works,Roads andTransport

Health

Education

PRELIMINARY OUTCOME AS AT 31 MARCH 2007

15

Proposed Dates for CG QPRs

• National departments administering conditional grants are required to table QPRs (including both financial and non-financial information) with the SCOF in the NCOP at the end of each quarter in line with the requirements of the DoRA, Grant Frameworks and Treasury Regulation 5.3

• Departments are required to provide the NT with copies of the reports tabled at SCOF in NCOP

• The quarterly reports for each quarter should be submitted to the NT by the dates provided

16

Health GrantsComprehensive 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

• 4th Quarter Expenditure:– Health spent R1,7bn or 103,1% of the R1,7bn adjusted

allocation (includes provincial roll-overs) – Transfers received amounted to 100,0% of national allocation– Highest spending: EC (121,0%) and LP (112,9%)– Lowest spending: NC (91,3%) and NW (96,0%)

• Service Delivery Outcome:– Department / Sector to respond

17

CG: performance (non-financial) reporting

Quarterly Health Conditional Grant reports submitted for 2006/07

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Comprehensive HIV & AIDS 22-Aug-06 04-Dec-06

National Tertiary Services Grant 22-Aug-06 27-Nov-06

Health Prof Training & Dev

Hospital Revitalisation Submitted 04-Dec-06 13-Mar-07

Forensic Pathology Services 22-Aug-06

18

HIV/AIDS

COMPREHENSIVE HIV AND AIDS

Province

R thousandEastern Cape 232,021 280,810 121.0% (48,789) Free State 142,265 138,418 97.3% 3,847 Gauteng 270,195 270,643 100.2% (448) KwaZulu-Natal 344,304 344,304 100.0% - Limpopo 175,861 198,536 112.9% (22,675) Mpumalanga 110,962 107,594 97.0% 3,368 Northern Cape 72,682 66,345 91.3% 6,337 North West 148,316 142,316 96.0% 6,000 Western Cape 133,170 132,016 99.1% 1,154 Total 1,629,776 1,680,982 103.1% (51,206)

Preliminary (over)/under

Total availableProvincial

actual payments

% Actual payments of

total available

19

Health GrantsHospital 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 in line with national policy objectives

– To transform hospital management and improve quality of care in line with national policy

• 4th Quarter Expenditure:– Health spent R1,6bn or 88,7% of the R1,8bn adjusted

allocation (including provincial roll-overs)– Transfers received amounted to 100,0% of national allocation– Highest spending: LP (346,2%) and EC (108,1%)– Lowest spending: KZN (69,9%) and NC (72,2%)


20

Hospital Revitalisation

Province

R thousandEastern Cape 125,071 135,174 108.1% (10,103) Free State 59,598 59,598 100.0% - Gauteng 415,201 323,806 78.0% 91,395 KwaZulu-Natal 321,553 224,823 69.9% 96,730 Limpopo 48,247 167,029 346.2% (118,782) Mpumalanga 72,896 53,449 73.3% 19,447 Northern Cape 315,132 227,487 72.2% 87,645 North West 223,588 191,366 85.6% 32,222 Western Cape 178,256 177,652 99.7% 604 Total 1,759,542 1,560,384 88.7% 199,158


total available


Provincial actual

paymentsTotal available

21

Health GrantsForensic Pathology Services Grant

• Objective (Schedule 5 Grant):– To provide for the transitional activities required to transfer the

Medico-Legal Mortuaries from SAPS to Health– To initiate the development and provision of a comprehensive

Forensic Pathology Service to ensure impartial professional evidence for the criminal justice system concerning death due to unnatural causes

• 4th Quarter Expenditure:– Health spent R342,0m or 55,4% of the R616,9m adjusted

allocation (including provincial roll-overs) – Transfers received amounted to 100,0% of national allocation– Highest spending: LP (108,6%) and GP (78,7%)– Lowest spending: KZN (39,8%) and NW (41,7%)


22

Forensic pathology

Province

R thousandEastern Cape 91,867 38,677 42.1% 53,190 Free State 46,883 35,294 75.3% 11,589 Gauteng 82,020 64,550 78.7% 17,470 KwaZulu-Natal 160,360 63,884 39.8% 96,476 Limpopo 38,585 41,894 108.6% (3,309) Mpumalanga 43,591 24,487 56.2% 19,104 Northern Cape 27,718 12,303 44.4% 15,415 North West 40,106 16,721 41.7% 23,385 Western Cape 85,734 44,168 51.5% 41,566 Total 616,864 341,978 55.4% 274,886


total available



actual payments

23

Health GrantsNational 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

• 4th Quarter Expenditure:– Spending of this grants is subsumed in the spending of a

range of programmes and therefore no reporting is required– However, spent R5,0bn or 99,4% of the R5,0bn adjusted

allocation (including provincial roll-overs)– Transfers received amounted to 100,0% of national allocation– Highest spending: LP (100,2%)– Lowest spending: EC (92,2%) and MP (98,2%)


24

National tertiary services grant

Province

R thousandEastern Cape 374,203 345,172 92.2% 29,031 Free State 458,043 458,043 100.0% - Gauteng 1,866,094 1,866,094 100.0% - KwaZulu-Natal 732,167 732,167 100.0% - Limpopo 71,579 71,701 100.2% (122) Mpumalanga 45,571 44,758 98.2% 813 Northern Cape 92,286 92,286 100.0% - North West 69,380 69,377 100.0% 3 Western Cape 1,272,640 1,272,640 100.0% - Total 4,981,963 4,952,238 99.4% 29,725


total available



actual payments

25

Health GrantsHealth Professions Training and Development Grant

• Objectives (Schedule 4 Grant):– Support provinces to fund costs associated with training of

health professionals– Development and recruitment of medical specialists in under-

served provinces– Support and strengthen undergraduate and post graduate

teaching and training processes in health facilities– Enable shifting of teaching activities from central hospital to

regional and district hospitals

• 4th Quarter Expenditure:– Spending of this grants is subsumed in the spending of a range

of programmes and therefore no reporting is required– However, spent R1,5bn or 100,2% of the R1,5bn adjusted

allocation (including provincial roll-overs)– Transfers received amounted to 100,0% of national allocation– Highest spending: LP (104,5%) and EC (100,9%)– Lowest spending: MP (96,2%)

Service Delivery Outcome:– Department / Sector to respond

26

Health professions training grant

Province

R thousandEastern Cape 133,482 134,744 100.9% (1,262) Free State 92,517 92,517 100.0% - Gauteng 554,039 554,039 100.0% - KwaZulu-Natal 204,659 204,659 100.0% - Limpopo 72,411 75,641 104.5% (3,230) Mpumalanga 54,363 52,284 96.2% 2,079 Northern Cape 41,069 41,069 100.0% - North West 62,564 62,560 100.0% 4 Western Cape 323,278 323,278 100.0% - Total 1,538,382 1,540,791 100.2% (2,409)


total available



actual payments

select committee on finance national council of provinces presented by: national treasury

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