Assessment of Inter-Provincial Inequity with respect to Public Healthcare Expenditure

1
Assessment of Inter-Provincial Inequity with
respect to Public Healthcare Expenditure

• Presentation by the NDoH
• to the Portfolio Committee

2
Purpose

• Brief the Portfolio Committee on the current
  situation of inter-provincial inequity with
  respect to public health care spending.

3
Outline of Presentation

• Present trends in Public Health care expenditure
  over a 10-year period
• Present trends in per capita expenditure over a
  10-year period (both nominal and real)
• Present trends including and excluding
  conditional grants
• Map a possible way forward
• Involvement of the Portfolio Committee

4
Trends in Public Health Care Spending
5
Trends in Public Health Care Spending (nominal
values)
6
Trends in Public Health Care Spending (real
values)
7
Trends in Per Capita Spending (nominal value)
8
Trends in Per Capita Spending (real value)
9
Distance from Equity (including Conditional
Grants)
10
Distance from Equity (excluding Conditional
Grants)
11
Assessment of Equity

• Massive inequities exist in the public health
  system
• Even if conditional grants are removed, the
  inequities are not significantly reduced
• Some provinces have made remarkable progress,
  however, concern of the pace of change.
• Western Cape
• The intentions of the Northern Cape need to be
  acknowledged.
• Overall the impact on reducing inequities has
  been small.

12
Intra-Provincial Inequity

• No comprehensive assessment done yet
• Limited studies show similar trends
• Rural and less advantaged areas have less access
  to resources
• District Health Expenditure Reviews
• Help assess the level of inequity and make
  informed decisions
• Guidelines developed
• Provinces are rolling them out

13
Obstacles to achieving Equity

• Fiscal federalism
• Global budgets are allocated to provinces and not
  to sectors specifically
• Equity needs to be properly assessed in the light
  of other social spending

14
Next Steps

• Development of norms and standards
• Definition of a basic package of health care
  broader than merely primary health care.

15
Way Forward

• It is recommended that as a way forward the
  following steps are operationalised
• Review of the budgeting system and the use of
  fiscal federalism to improve inter-provincial
  equity. Essential steps here include
• Conducting an incidence analysis of the financing
  and benefits health care in South Africa
• Review of the incorporation funding mechanisms to
  account for health sector specific problems, e.g.
  weighting for HIV/AIDS, TB, Malaria
• Improve the focus on equity of the approach

16
Way Forward

• Development of a definition of basic health care
  services
• Development of both quantitative and qualitative
  norms and standards
• Development of minimum funding requirements for
  health care provision.

17
Involvement of Portfolio Committee

• There are a number of areas where the Portfolio
  Committee on Health can influence the promotion
  greater equity in health care spending. These
  include areas where the National Department has
  little influence over
• Working with the portfolio Committee on Finance
  to understand why greater emphasis is not placed
  on inter-provincial equity

18
Involvement of the Portfolio Committee

• Together with the Portfolio Committee on Finance
  and the Select Committees of the NCOP to
  interrogate Provincial Legislatures and
  Treasuries in their allocation of revenue to
  Health departments
• As the NDoH defines basic Packages of Care and
  associated norms and standards, it is crucial
  that the Portfolio Committee on Health assist in
  obtaining buy-in of this process, to the end that
  there is commitment to deliver these packages and
  to fund their appropriate delivery.
• Assessment of funds earmarked for the
  implementation of Health Policies are
  implemented, e.g. HIV/AIDS, Personnel, Capital
  spending