HEALTH BUDGETS 2003/04 AND INTERGOVERNMENTALFISCAL REVIEW 2003

Portfolio Committee on Health14 April 2003

Table 5.2 Additional funds added to baseline health budgetsR million 2003/04 2004/05Eastern Cape 689 1,136 Free State 299 384 Gauteng 373 551 Kw aZulu-Natal 703 822 Limpopo 356 450 Mpumalanga 214 278 Northern Cape 113 135 North West 300 400 Western Cape 385 400 Total 3,432 4,558 Comparing to 2003/04 and 2004/05 allocations stated in 2002 budget statements.

Table 5.1 Health expenditure by province1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R millionActual Actual Actual Estimated

actual Medium-term estimates

Eastern Cape 3,496 3,790 3,892 4,377 5,118 5,711 6,314 Free State 1,589 1,777 1,954 2,242 2,475 2,720 2,935 Gauteng 5,605 5,942 6,838 7,675 8,112 8,681 9,121 Kw aZulu-Natal 5,110 5,772 7,030 7,534 8,056 8,677 9,208 Limpopo 2,221 2,524 2,664 3,180 3,466 3,845 4,167 Mpumalanga 1,147 1,117 1,457 1,712 2,102 2,315 2,503 Northern Cape 433 468 517 604 737 810 890 North West 1,384 1,561 1,699 1,949 2,357 2,604 2,963 Western Cape 3,125 3,451 3,706 3,964 4,430 4,653 4,841 Total 24,110 26,403 29,757 33,238 36,852 40,014 42,942

Table 5.1 Health expenditure by province1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R millionActual Actual Actual Estimated

actual Medium-term estimates

Percentage growthEastern Cape 8.4% 2.7% 12.4% 16.9% 11.6% 10.6%Free State 11.8% 9.9% 14.8% 10.4% 9.9% 7.9%Gauteng 6.0% 15.1% 12.2% 5.7% 7.0% 5.1%Kw aZulu-Natal 12.9% 21.8% 7.2% 6.9% 7.7% 6.1%Limpopo 13.7% 5.5% 19.4% 9.0% 10.9% 8.4%Mpumalanga -2.6% 30.4% 17.6% 22.7% 10.1% 8.1%Northern Cape 8.1% 10.6% 16.7% 22.1% 9.8% 9.9%North West 12.8% 8.8% 14.7% 20.9% 10.5% 13.8%Western Cape 10.4% 7.4% 7.0% 11.7% 5.0% 4.0%Total 9.5% 12.7% 11.7% 10.9% 8.6% 7.3%Western Cape includes capital works i.r.o Health on voted on Public Works.

Health budgets Substantial funding increases in previously

disadvantaged provinces: Mpumalanga (22,7%), Northern Cape (22,1%), North West (20,9%) and Eastern Cape 16,9%

R500 million rising to R1 billion additional funding annually for a new system of rural incentives and a scarce-skills strategy for the health sector

Large increases in the Hospital Revitalisation Programme. Capex expenditure has tripled from R1 bil to R3 bil

NPNC, including medicines, increases from 23,6% to 28,4% over the period

Health budgets continued Out of hospital Primary health care expenditure, rises to

R7 billion by outer year

Increases for the Integrated Nutrition Programme

Further strengthening of the Enhanced Response to HIV/Aids Strategy

New budget programme and subprogramme structure and formats for strategic plans

Table 5.4 Expenditure by economic classification 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R millionActual Actual Actual Estimated

actualMedium-term estimates

Current 23,103 25,088 27,505 30,807 33,823 36,894 39,523 Personnel expenditure 15,472 16,408 17,773 19,320 21,226 22,699 24,206 Transfer payments 1,932 2,193 2,046 2,315 2,680 2,910 3,120 Other current expenditure 5,699 6,487 7,686 9,172 9,918 11,286 12,197

Capital 1,007 1,315 2,251 2,431 3,029 3,120 3,419 Total 24,110 26,403 29,757 33,238 36,852 40,014 42,942 Percentage of total Current 95.8% 95.0% 92.4% 92.7% 91.8% 92.2% 92.0%

Personnel expenditure 64.2% 62.1% 59.7% 58.1% 57.6% 56.7% 56.4% Transfer payments 8.0% 8.3% 6.9% 7.0% 7.3% 7.3% 7.3% Other current expenditure 23.6% 24.6% 25.8% 27.6% 26.9% 28.2% 28.4%

Capital 4.2% 5.0% 7.6% 7.3% 8.2% 7.8% 8.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Health personnel financing

• IGFR shows inequities and areas of scarcity and where retention is a problem

• R500 million rising to R1 billion annually for 2 key strategies

• Rural allowance to be significantly increased and wider range of health professionals

• Scarce skills funding to encourage recruitment and retention of professional groups with low staffing

Table 5.6 Population served per public sector health worker: February 2003 Doctor (non-

specialist)

Medical specialist

Profes-sionalnurse

Dentist Pharma-cist

Physio-therapist

Occupa-tional

therapist

Speech therapist

Dietician Radio-grapher

Eastern Cape 8,825 47,529 1,278 190,117 53,662 237,646 554,507 950,583 475,292 26,616 Free State 422 11,342 786 71,491 31,881 45,369 3,932 157,279 65,533 14,212 Gauteng 273 3,398 606 25,458 18,994 29,117 31,575 79,714 54,635 8,104 Kw aZulu-Natal 4,362 15,641 901 145,607 27,239 43,289 79,291 170,391 148,304 21,528 Limpopo 8,544 92,129 1,001 141,736 48,067 106,302 76,774 197,418 110,554 60,084 Mpumalanga 5,772 143,698 1,124 54,605 35,003 75,841 65,006 151,681 60,672 5,056 Northern Cape 823 6,635 1,079 74,066 47,535 86,076 99,526 244,986 109,821 49,763 North West 3,352 39,296 776 64,303 32,151 5,441 101,047 235,777 70,733 24,391 Western Cape 2,979 2,746 796 28,074 13,789 32,126 33,152 135,489 61,103 691 Total 4,829 10,403 910 65,406 29,578 55,698 64,722 172,793 98,282 17,878 Ratio of highest to low est

3.2 52.3 2.1 7.5 3.9 8.2 16.7 7.0 8.7 8.7

Table 5.7 Trends in number of health professionals in provincial health departments

Dec 2001 Feb 2003 Change Community service

posts filled2003

Ratio of filled posts

to community

service posts

Professional nurse 41,063 40,846 -217 – – Medical practitioners 7,363 7,694 331 1,072 7.2 Medical specialists and registrars 3,807 3,571 -236 – – Radiographer 2,058 2,078 20 214 9.7 Pharmacists 1,239 1,256 17 344 3.7 Dental practitioners 625 568 -57 164 3.5 Dental specialists 44 63 19 – – Physiotherapists 455 667 212 290 2.3 Occupational therapist 399 574 175 192 3.0 Psychologists 259 -259 116 – Dieticians 250 378 128 147 2.6 Speech therapist 118 215 97 123 1.7 * Some of the decreases are due to establishment of NHLS (111 specialists and 47 medical practitioners).

Table 5.8 Non-personnel current expenditure excluding transfers (Rand per capita) 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 Average annual

growth

R/capitaActual Actual Actual Estimated

actualMedium-term estimates 1999/00 -

2002/03 2002/03 - 2005/06

Eastern Cape 103 123 138 140 132 184 207 10.8% 13.9%Free State 168 201 241 305 332 361 386 22.0% 8.2%Gauteng 354 378 458 516 522 580 588 13.4% 4.5%Kw aZulu-Natal 147 194 219 240 254 269 279 17.8% 5.1%Limpopo 78 114 117 167 171 192 205 28.9% 7.1%Mpumalanga 136 50 208 245 292 320 342 21.7% 11.8%Northern Cape 180 204 205 257 282 336 399 12.6% 15.8%North West 105 111 125 183 200 236 288 20.3% 16.3%Western Cape 243 272 291 347 381 387 398 12.6% 4.7%Total 163 184 219 257 269 301 319 16.4% 7.5%

Hospital Revitalisation

• Grant rises to R1,27 billion by outer year• Health capex expenditure rises to R3,4 billion

annually by outer year• Funds for an additional 18 hospitals for complete

upgrading or replacement• 429 smaller projects already complete and 9 large

projects started in 2002/03

Table 5.9 Capital expenditure trends 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R millionActual Actual Actual Estimated

actualMedium-term estimates

Eastern Cape 72 158 232 382 500 462 538 Free State 32 53 98 116 128 136 144 Gauteng 231 254 530 470 624 539 583 Kw aZulu-Natal 343 383 784 819 816 924 967 Limpopo 218 226 225 297 285 309 336 Mpumalanga 30 25 48 86 171 195 233 Northern Cape 13 10 34 32 80 82 87 North West 17 76 112 107 187 210 265 Western Cape 50 130 189 121 238 262 266 Total 1,007 1,315 2,251 2,431 3,029 3,120 3,419 Expenditure on Hospital Revitilisation grant

140 323 550 695 718 912 1,027 Western Cape includes capital works i.r.o Health on voted on Public Works.

HIV/AIDS financing

• Enhanced Response financing strategy started in 2002/03 budget

• 2002/03 budget increased financing from R345m in 01/02 to R1 bil in 02/03 rising to R1,8 bil in outer year

• Lifeskills, VCT, Condoms, SAAVI, STIs, PMTCT, oveLife, NGOs and others

• 2003/04 budgets adds R3,3 billion over 3 years to speed up PMTCT and PEP rollout and strengthen care and treatment initiatives over the medium term

HIV/AIDS interventions

• Since IGFR 2001 - widespread rollout of HIV/AIDS programme beyond piloting into national programme

• Lifeskills mainstreamed as compulsory school subject• Availability of HIV testing in majority of clinics and more widespread

counselling• Majority of pregnant women tested and PMCT widely rolling out• Extension of social security grants from 2.5mil to 8m beneficiaries • 450 mil condoms, wider distribution• Widespread mass media - eg Love Life • Health service training and specific medications much more widespread

(Fluconazole, opportunistic infections) • Strengthening STD programmes with decreases STI rates• Teenage pregnancy rates and HIV infection rates declining

Integrated Nutrition Programme

• Grant increases to over R1 bil per year in outer year• Step up anti-poverty strategy• Address food inflation• Include additional learners and schools and grade Rs• Feed a minimum of 156 days per year• Standardise menus

Table 5.12 Selected primary health care expenditure and budgets1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 Average annual

growth

R millionActual Actual Actual Estimated

actualMedium-term estimates 1999/00 -

2002/03 2002/03 - 2005/06

2.1 District Management 612 672 730 552 608 660 691 -3.4% 7.8%2.2. Clinics 1,700 1,719 2,261 2,709 2,779 3,382 3,669 16.8% 10.6%2.3 Community Health Centres 817 982 896 1,395 1,595 1,682 1,845 19.5% 9.8%2.4 Community Based Services 283 365 296 488 685 490 532 19.9% 2.9%2.5 Other Community Services 268 274 383 255 288 297 306 -1.6% 6.3%Total 3,680 4,012 4,566 5,399 5,955 6,511 7,043 13.6% 9.3%Total rand per capita 105 114 127 148 160 172 183 Excludes HIV/AIDS, nutrition and district hospital subprogrammes.

Table 5.13 Primary health care expenditure2002/03 2003/04

R millionEstimated

actual Rand per

capita Budget Rand per

capita Eastern Cape 592 91 703 106 Free State 425 183 396 168 Gauteng 1,138 238 1,183 243 Kw aZulu-Natal 1,288 163 1,392 174 Limpopo 378 70 417 75 Mpumalanga 328 122 405 148 Northern Cape 139 199 174 246 North West 456 145 548 172 Western Cape 654 213 738 237 Total 5,398 148 5,955 160

Table 5.17 Hospital expenditure and budgets 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 Average annual

growth

R millionActual Actual Actual Estimated

actual Medium-term estimates 1999/00 -

2002/03 2002/03 - 2005/06

District 5,690 6,421 6,815 6,233 7,076 7,678 8,241 3.1% 9.8%General (regional) 5,159 5,731 6,261 6,734 7,394 8,146 8,740 9.3% 9.1%Provincial tertiary 591 760 685 800 879 926 993 10.6% 7.5%Central 3,687 4,061 4,337 4,443 4,826 5,066 5,340 6.4% 6.3%Psychiatric and mental handicap

924 1,039 1,094 1,236 1,338 1,468 1,624 10.2% 9.5%

TB 162 186 205 425 474 503 533 37.9% 7.8%Chronic/subacute 46 50 57 189 203 218 230 60.2% 6.8%Dental 129 139 155 175 191 203 212 10.7% 6.6%Other specialised 87 100 101 195 224 239 256 30.9% 9.5%Total 16,475 18,487 19,710 20,430 22,605 24,447 26,169 7.4% 8.6%

Table 5.18 Number of public hospital and semi-private beds Number

of hospitals

Average beds per hospital

Number of beds by type of hospital Beds per 1000

public users

District Regional Tertiary Central Specialised Total Eastern Cape 91 194 7,754 4,600 5,331 17,685 2.8 Free State 33 153 1,695 1,895 438 152 864 5,044 2.2 Gauteng 30 546 1,836 5,483 6,346 2,719 16,384 3.5 Kw aZulu-Natal 73 373 11,239 6,356 456 2,533 6,671 27,255 3.5 Limpopo 43 251 6,282 1,879 882 1,771 10,814 2.1 Mpumalanga 29 143 2,040 1,164 326 620 4,150 1.6 Northern Cape 26 74 757 543 321 1,621 2.4 North-West 22 208 2,226 1,711 1,465 5,402 1.8 Western Cape 55 185 1,559 2,039 2,626 3,966 10,190 3.4 Total 402 245 35,388 25,670 2,102 11,657 23,728 98,545 2.8

Table 5.19 Average length of stay (days) and bed occupancy (%) Type of hos pital Dis tr ict Re gional Ce ntralEastern Cape 5,4 6,9 – Free State 3,2 5,9 5,3 Gauteng 3,9 4,4 6,5 Kw aZulu-Natal 4,4 5,1 8,0 Limpopo 5,2 6,0 – Mpumalanga 3,4 4,7 – Northern Cape 2,8 3,2 – North-West 4,1 5,0 – Western Cape 2,6 4,4 5,2 South Afr ica 4,2 5,0 6,3 Be d occupancy Dis tr ict Re gional Ce ntralEastern Cape 44,0% 48,0% – Free State 60,0% 66,0% 73,0%Gauteng 63,0% 70,0% 78,0%Kw aZulu-Natal 61,0% 69,0% 73,0%Limpopo 60,0% 62,0% – Mpumalanga 56,0% 63,0% – Northern Cape 77,0% 95,0% – North-West 57,0% 74,0% – Western Cape 65,0% 88,0% 78,0%South Afr ica 57,0% 67,0% 80,0%

Table 5.20 Accredited or pre-accredited hospitals in KwaZulu-NatalFort Napier St. Mary's LadysmithGrey's Murchison RK KhanTow nhill St. Andrew s HillcrestUmgeni Care Niemeyer King GeorgeWentw orth CJ Memorial Ngw elazanaMcCords Eshow e New castle

Table 5.21 Trends in conditional grants1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06

R millionActual Actual Actual Estimate

d actualMedium-term estimates

National tertiary services – – – 4,207 3,995 4,273 4,529 Central hospitals 3,075 3,112 3,270 – – – – Redistribution of specialised services 52 207 178 – – – – Health Professions Training and Development – – – 1,269 1,333 1,434 1,520 Training and research 1,118 1,174 1,234 – – – – Integrated Nutrition Programme 460 534 489 642 809 950 1,042 Hospital revitilisation 140 323 550 694 718 912 1,027 HIV/AIDS – 10 46 207 334 482 535 Hospital management and quality improvement – – 124 114 133 142 150 Nkosi Albert Luthuli academic hospital 189 74 298 – – – – Nelson Mandela Academic Hospital 41 95 – – – – Pretoria Academic – – 50 222 92 – – Total 5,075 5,529 6,239 7,355 7,414 8,193 8,803

Table 5.23 Trends in medical schemes2000 2001 Change Change %

Beneficiaries 7,004,636 7,020,806 16,170 0.2%Pensioner ratio 6.25 6.00 Dependent ratio (Dependents/members) 1.59 1.57 Gross contribution income (Rmil) 30,864 37,000 6,136 19.9%Benefit payments (Rm) 27,157 30,800 3,643 13.4%Non-health expenditure (Rm) 3,976 5,346 1,370 34.5%Of w hich: Administration fees (Rm) 2,499 3,540 1,041 41.7%Benefits+ non-health expend (Rm) 31,133 36,146 5,013 16.1%Operating results (Rmil) -1,041 278 1,319 Net profit (includes investment income) 190 1,546 1,356 Accumulated funds (Rm) 6,100 7,400 1,300 21.3%Source: Registrar of Medical Schemes.