1. Provincial Budgets and Expenditure Review: 2003/04 – 2009/10 Chapter 3: Health 17 October 2007

2. 2 Health spending outcome 2006/07

3. 3 Provincial health expenditure and budget trends, 2003/04 to 2009/10

4. 4 By 2009/10, total expenditure to be almost double that of 2003/04 Functional classifications – strong growth in most areas, esp. HIV & Aids Strong growth in hospitals budgets (4% real) Between 2003/04 –2009/10 real growth will exceed 8% annually in NC, MP, NW & LMP

5. 5 Under-spending on Conditional Grants Under-spending on conditional grants 3,5% (pre-audited), compared to provinces overall overspending of -0,7% Under expenditure most prevalent in Forensic Pathology Grant (43,7%) and Hospital Revitalisation Grant (8,1%). Rollover request for R570m received (about 47% for Forensic Pathology) Hospital Revitalisation Task Team in place to strengthen programme and improve performance

6. 6 Primary health care (PHC) per sub- programme  Spending on PHC to grow sharply over next 3 years (real annual growth 8%)  By 2010 expenditure will be double that of 2003/04

7. 7 Primary Health Care (PHC) visits per province  Despite increase in funding, number of visits have leveled off at 102 million over the past 2 years, suggesting that demand may be leveling off  Utilization rate is lowest in GT and KZN and highest in WC  Low supervision rate of nurse-run clinics in WC, NC and MP may be misleading due to incomplete data

8. 8 PHC Expenditure - District

9. 9 Provincial emergency medical services expenditure, 2003/04 to 2009/10  Additional R863m added over next 3 years as part of rolling out new EMS model  Expenditure to grow to R3,2b by 2009/10, almost double that of 2005/06

10. 10 Provincial HIV and Aids expenditure, 2001/02 to 2007/08  Provinces budgeted R2,4 billion in 2006/07 (excluding conditional grant funds) growing to R3,9 billion in 2009/10 (28,8% real annual growth)  Conditional grant funding grows from R416m in 2003/04 to R2,7b in 2009/10 (30,4% real annual growth)  264 423 patients currently on ARV treatment at 313 treatment sites – expect close to 300 000 by end of financial year. Could reach 600 000 by 2009/10

11. 11 HIV & AIDS, TB Performance indicators 2006/07  Progress with HIV & Aids & TB noted, but still much to do  Despite most health centres stocking Nevirapine, only 62,5% of tested patients receive it, with large variations between provinces  TB cure rate very low at 53%, with large variations between provinces

12. 12 Hospital funding 2003/04 – 2009/10  Real growth of 4% from 2003/04 – 2009/10  Spending on TB hospitals grows strongly as sector deals with MDR-TB  Almost all categories show strong real growth, but central hospitals growth remains flat (may be distorted by WC reclassification of expenditure)  Continuous cycle of under budgeting and over expenditure in central hospitals

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14. 14 Trends in scarce health professionals Health sector personnel numbers increased by 31,710 over past 3 years Compensation of employees budget to grow 10,6% annually over next 3 years to 2009/10, allowing sector to fill medical and administrative posts Sector plans to recruit further 30,000 employees over next 5 years

15. 15 Conclusion  2006/07 budget showed 13,9% nominal growth.  Particular strong growth in HIV & Aids & TB, Primary Health Care, Emergency Medical Services and infrastructure Human Resources strategy bearing fruit –gains are visible in increasing numbers of health personnel, numbers of persons on Aids treatment, shorter ambulance response times and many facilities undergoing capital improvements. However, improvement in health outcomes not yet sufficient