NATIONAL ASSEMBLY PORTFOLIO COMMITTEE ON HEALTH

QUESTIONS FOR BUDGET HEARINGS 2003/04

14 APRIL 2003

DEPARTMENT OF HEALTH: KWAZULU-NATAL



1. Please indicate what the total health allocation was in 2002/03.

R7,419,706,000 for 2002/03

R8,055,650,000 for 2003/04


2. What was the percentage increase (real increase) between 02/03 and 03/04?

Increase in nominal terms is -- 8.57%

Increase in real terms according
to Treasury inflation guidelines, is -- 2,58%

Decrease in real terms if additional
mandates and health inflation are
taken into account -- (1.29%)


What was the total overspending, if any, specify, provide reasons?


The estimated over-expenditure for 2002/03 is R119,394 million, resulting from the following:

R38 million for old nutrition accounts written back to budget as agreed with the Provincial Treasury;

R26,7 million for the additional cost of the Primary School Nutrition Programme;

R6,5 million for the expansion of the Community Service to other Health professions;

R14,400 million for the enhancement of the ambulance fleet;

R33.8 million resulting from general service and inflationary pressures.
What is important to note, however, is that the Department had to freeze posts, curtail maintenance and capital programmes, limit items on prescriptions and slowdown the expansion of services to underserved areas during the year, to ensure the overrun is manageable.


4. What was the total under spending, if any, specify, and provide reasons?


Not applicable.


5. Provide variance by programme between budgeted allocation and actual expenditure for 2002/03.


PLEASE NOTE: The amounts differ from the budget statements because of programme changes taking effect in 2003/04


6. Which health programme has received the highest budget increase within 02/03?
AND
7. Which programme has received the least increase, please indicate why.

Programme

2002-2003

2003-2004

Diff

%

COMMENTS

Administration

144,677

156,437

11,760

8.13

The increase will not even cover statutory salary increases

District Health Services

3,630,479

3,665,126

34,647

0.95

The apparent decrease in real terms is as a result of the SPS, which requires beds to be classified correctly. Many beds previously classified as district beds are being used as beds for the treatment of TB, acute Psychiatric and long-term chronic beds. The budget for these beds is now in Provincial Hospital Services

Emergency Medical Services

182,981

246,314

63,333

34.61

New Programme. Increase for expansion and fleet replacement

Provincial Hospital Services

1,904,271

2,457,126

552,855

29.03

See comment under District Health Services. Apart from this it reflects the transfer of the Regional services associated with King Edward VIII to the correct programme. Only IALCH and Greys will in future utilise the Tertiary and Central Hospital programme

Central Hospital Services

920,713

763,653

(157,060)

-17.06

See comment under Provincial Hospital Services. Apart from this the commissioning of the IALCH is almost completed and the "hump" expenditure is not required in the new year. Only IALCH and Greys will in future utilise this programme.

Health Sciences & Training

232,461

285,644

53,183

22.88

Increase due to increase in student nurse intake and the transfer of funds for interns from other programmes to this programme as agreed nationally

Health Care Support Services

5,000

2,400

 

 

This programme deals only with the funds required for the Medicine Trading Account and provision is made for the inflationary effects on the value of the stock

Health Facilities Management

398,598

478,388

79,790

20.02

The increase is mainly due to the increase in the Revitalisation grant and the Provincial Infrastructure grant

Sub-total

7,419,180

8,055,088

635,908

8.57

 

Statutory payment

526

562

36

6.84

 

 

7,419,706

8,055,650

635,944

8.57

 




8. Indicate the proportion of the budget that is spent on personnel.

Standard item

2002/03

% of Total

2003/04

% of Total

Personnel

4,288,050

57.80

4,825,691

59.91

Administrative expenditure

189,700

2.56

218,119

2.71

Inventory

1,147,474

15.47

1,239,973

15.39

Equipment

372,836

5.03

336,964

4.18

Land and buildings

227,327

3.06

282,858

3.51

Professional and special services

812,545

10.95

725,347

9.00

Transfer payments

376,072

5.07

419,110

5.20

Miscellaneous

5,176

0.07

7,026

0.09

Total

7,419,180

8,055,088




9. What proportion of your 02/03 budget was transferred to Local Government?

R48,8 million or 0.66% in 2002/03
R46,0 million medicine provided in 2002/03

R53,4 million or 0.66% to be transferred in 2003/04
R49,0 million medicine to be provided in 2003/04

10. What was the total amount received for Donor Funding, and provide a breakdown of how the money was disbursed and spent and the criteria used making the allocations.

Funding is usually provided for specific projects. Projects for which donor funds are provided often extend across a number of financial years









11. Give proportion of budget spending on personnel.

See Question 8. Repeat of the same question?


12. Give proportion of budget spent on district health services.

DHS including District Hospitals 48.93% in 2002/03
45.90% in 2003/04


13. Give proportion spent on Community Health Services and Primary Health Services.

DHS excluding District Hospitals 20.90% in 2002/03
22.63% in 2003/04


14. How does the budget accommodate the provision of free care to the Disabled as announced by the President on 14 February 2003.

It is not anticipated that the policy would have a significant effect on the budget of the Department as all its services are already available to the majority of disabled persons and it has well developed programmes directly aimed at the disabled in place. The only area that may be affected is a reduction in any revenue received previously, but again should not have a significant impact.


15. What proportion of the provincial budget does health budget account for.

24.48% of the Provincial Budget.


16. Based on the 2003/04 budget allocation what is your per capita budget allocation.

R850.32 per capita.


Conditional Grants


17. Give the overall HIV/AIDS budget allocations for 2003/04 and the percentage increase from 2002/03.

HIV/AIDS Total

2002/03

R 143,313 m

2003/04

R 246,523m


R 103,210 m

72.02 %

HIV/AIDS Grant

R 55,219m

R 85,591m

R 33,095m

63.04


18. Provide variance for 2002/03 between allocated budget and actual expenditure.

The Department exceeded the funds provided for this Conditional Grant by R57,612m. The Province has covered the difference in the funding.

19. Provide a breakdown of HIV/AIDS budget allocations by area of focus e.g. life skills, education in schools, condom distribution prevention and community based programmes and by province (how much each province is allocated).

The Conditional grant for 2002/03 was utilised for the following

Management R 1 494
Home Based Care R 10 437
MTCT R 24 554
CVT R 10 632
Step down Care R 8 102
PEP R 12 000
General Awareness R 3 236

159 389 Female condoms and 16,355 million Male condoms were distributed in 2002/03 and the target for 2003/04 is 55 million

The grant for education in schools is controlled by the Department of Education.


20. Spending on HIV/AIDS conditional grants was a problem in 2001/02, can you provide a progress report and indicate what measures were taken to improve the capacity to spend.






The under-expenditure for the 2001/02 financial year was mainly related to difficulty in initiating the various HIV/AIDS programmes owing to problems experienced with establishing a suitable infrastructure, difficulty in setting up contracts with lay counsellors and delays in acquiring requirements as a result of tender board procedures. This has now been resolved.


21. Highlight any areas that have experienced under spending in the last financial year and reasons therefore.

Not applicable to this Department.

22. An allocation was made for the provision of step-down facilities, please provide a progress report, also indicate how much of the allocation was spent.

Step down facilities for AIDS patients are being created at all District and some Regional hospitals in the Province. The funds provided are however, insufficient to cater for the demands placed on hospitals to provide these services. In terms of the Strategic Positioning Statement the financial need to cater for the expected demand is R 128 million compared to the grant of R 8,012 million. It is estimated that the Department is already spending R 51,5 million on longer term hospitalisation resulting from AIDS.

23. Provide variance for 2002/03 between allocated budget and actual expenditure.

SEE QUESTION 18 --- Repeat

24. Provide a breakdown of HIV/AIDS budget allocations per area of focus e.g. life skills, education in schools, condom distribution, prevention and community based programmes, and by province (how much each province is allocated).

SEE QUESTION 19 --- Repeat

25. Spending of HIV/AIDS conditional grants was a problem in 2001/02, can you provide a progress report and indicate what measures were taken to improve capacity to spend.

SEE QUESTION 20 --- Repeat

26. Highlight any areas that have experienced under spending in the last financial year and the reasons therefore.

SEE QUESTION 21 --- Repeat

27. An allocation was made for the provision of step-down facilities, please provide progress report also indication how much of the allocation was spent.

SEE QUESTION 22 --- Repeat


EQUITY

28. Inter-provincial equity remains a major area of concern. How is the Department addressing this.

This Province agrees with this statement and has over the past 8 years campaigned for a clear policy to address this issue. The major inequity, which exists in regard to Tertiary services, has forced this province to slowdown its primary health care programmes to fund part of its tertiary services because of the inequity in the conditional grant distribution


29. Similarly, intra-provincial inequity still persists. How is the Department working to ensure a more equitable distribution of funds, especially at district and sub-district level.

Since 1998/99 this Department has embarked on a programme to eradicate funding inequity between its Districts in terms of a formula based on population and per capita income levels. In the allocation of funds for the 2003/04-year the Department has used the SPS model that provides for an equitable distribution of funds based on population, poverty, disease profiles and for certain services a rural factor. Districts are the main fund holders for services such as regional hospital central and tertiary hospital services, to ensure that those hospitals providing those services, include patients from the fund holder districts.

The system allows for negotiation between the districts for those services not yet available in a district. The model can also be utilised to ensure equity in sub districts.

Whilst the distribution of funds is relatively easy in terms of the model the actual service delivery equity remains a challenge. The lack of acceptable incentives for staff in the rural and deep rural areas is the main stumbling block.


30. Highlight areas of the budget and the budget process where the Department might require assistance/advocacy of the Committee in facilitating the necessary changes.

This Department believes that a special fund is required to achieve equity in the short to medium term. This fund should deal specifically with the expansion of services in the underserved area whilst another area is still providing the service. The present system forces the Department for example, to expand a service such as Emergency Medical Rescue Services at the cost of another service.


OTHER ISSUES


31. Provide the number of district management posts and how many are filled. Provide reasons for vacancies.

Out of the eleven District managers post only two are appropriately filled. Three of the vacancies are newly created districts. The other six vacancies resulted from four resignations, one disciplinary case, one retirement and one displaced official. Eight of these vacancies are in the process of being advertised and filled whilst the one is subject to a disciplinary hearing.

32. What guides your district and sub district budget allocation e.g. formula, etc.

The Department is utilising the Strategic Positioning Statement model for each district to allocate funds to the districts and the responsibilities in that districts. The Districts themselves play the leading role in the intra-district distribution of funds. Presently the district plans and historic patient loads is still the main guiding principle utilised in the distribution. Although the SPS model is capable to be utilised the input information is still suspect.


33. What steps have been put in place to facilitate implementation of the rural incentive scheme.

Presently only the Rural allowance system for certain categories of staff in certain areas is in place. National negotiation in this regard is taking place but this Department has no details thereof. The Department has however over the past four years made some progress in improving facilities, equipment and accommodation in these areas.