1. 1 Provincial Budgets and Expenditure 07/08 as at 31 December 2007 SCOF (NCOP) Hearings-Health National Treasury February 2008

2. 2 Health: summary Dec 07 – 9 months of financial year; benchmark 75% spending Spending at R45.3bn or 74.4% against R60.8bn adjusted budget –Seven provinces projecting to overspend by R1.8bn (KZN, GP, LP, EC, WC, NC, FS) while MP and NW projecting to underspend by R282.4m –Q2 Sept showed R1.4b over-spend proj before –Increase of R6.6bn or 17.0% compared to the previous year –Low rate of health spending in NW (66.8%) and MP (68.0%) –KZN (79.7%) and LP (78.2%) reflects the highest rate of spending in health Health personnel spending at R25.2bn or 76.1% (R33.1bn adjusted budget) –Six provinces projecting to overspend by R1.1bn (KZN, EC, LP, GP, WC, FS) –Three provinces projecting to underspend by R64.1m NPNC spending at R16.4bn or 75.8% of R21.6bn adjusted budget

3. 3 Adjustment budget

4. 4 Health

5. 5 Health Personnel

6. 6 Health Non-Personnel, Non-Capital

7. 7 Capital Assets

8. 8 Health capital spending at R3.7bn or 60.6% –Increase of 14.4% compared to spending for the same period last year –Three provinces projecting to overspend by R127.2m while the remaining provinces projecting under expenditure of R257.7m –Low rate of health capital spending in MP (37.1%) and NC (45.0%) –EC (75.0%) and FS (69.6%) reflects the highest rate of capital spending in health

9. 9 Health (3) Programme Analyses Prog 2: Provincial District Health Services –Spending at R18.7bn or 75.0% of R25.0bn adjusted budget –Lowest rate of spending in NW (64.9%) and GP (69.1%) and highest in KZN (83.2%) and LP (78.0%) Prog 4: Provincial Hospital Services –Spending at R10.9bn or 75.0% of R14.5bn adjusted budget –Lowest rate of spending in MP (68.2%) and NW (68.5%) and highest in LP (83.5%) and NC (79.6%) Prog 5: Central Hospital Services –Spending at R7.0bn or 77.7% of R9.0bn adjusted budget –Lowest rate of spending in NW (61.7%) and MP (73.7%) and highest in KZN (84.8%) and FS (79.6%)

10. 10 Health (4) District health services

11. 11 Health (5) Hospital services

12. 12 Health (6) Central hospital services

13. 13 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 First Nine Months Expenditure: –Health spent R1.6bn or 77.6% of the R2.0bn adjusted allocation –Highest spending: NC 89.8% and KZN 87.8% –Lowest spending: FS 66.1% and WC 67.5% Service Delivery Outcome: –Department / Sector to respond

14. 14 HIV and AIDS grant (Dec07)

15. 15 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 in line with national policy objectives First Nine Months Expenditure: –Health spent R1.3bn or 59.5% of the R2.2bn adjusted allocation –66.8% of national allocation transferred –Highest spending: WC 85.7% and NW 74.0% –Lowest spending: MP 29.0% and KZN 42.5% –Forecasted under-expenditure of R90 million, MP R11.7 million, NC R78 million Service Delivery Outcome: –Department / Sector to respond

16. 16 Hospital Revitalisation

17. 17 Health Grants (2) Forensic 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 First Nine Months Expenditure: –Health spent R370.8m or 45.9% of the R808.3m adjusted allocation –Only 60.9% of national allocation transferred –Highest spending: FS 84.8% and NC 73.4% –Lowest spending: MP 29.1% and KZN 32.2% Service Delivery Outcome: –Department / Sector to respond

18. 18 Forensic pathology

19. 19 National Tertiary Services grant

20. 20 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 First Nine Months Expenditure: –Spending of this grants is subsumed in the spending of a range of programmes and therefore no reporting is required –However, spent R3.9bn or 73.2% of the R5.3bn allocation –Transfers received amounted to 75.0% of national allocation –Highest spending: KZN 83.6% and FS 81.7% –Lowest spending: NC 0.7% and MP 50.7% Service Delivery Outcome: –Department / Sector to respond

21. 21 Health Grants (3) Health Professions Training and Development Grant Objective (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 First Nine Months Expenditure: –Spending of this grants is subsumed in the spending of a range of programmes and therefore no reporting is required –However, spent R1.2bn or 72.6% of the R1.6bn allocation –Transfers received amounted to 75.0% of national allocation –Highest spending: FS 96.6% and KZN 77.7% –Lowest spending: NC 3.5% and EC 59.1% Service Delivery Outcome: –Department / Sector to respond

22. 22 Conclusion Over-spending (KZN, NC,Lim) and under- spending provinces (NW, Mpum) R1.7 b over-exp projection end Dec Under-spending on Hospital Revit (NC, KZN) and forensic pathology (KZN, MP) grants NC: Problem journalising NTSG,HPTD Capital under-spending already projected in 5 provinces