2014 HEALTH
BUDGET
2 JULY 2014
POLICY PRIORITIES
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POLICY PRIORITIES
STATE OF THE NATION ADDRESS JUNE 2014
The President highlighted the following health-related priorities:
•Improved access to primary health care (PHC);
•Increasing life expectancy at birth from 60 years in 2012 to 63
years in 2019;
•Continue to invest in education and skills development
including doctors;
•Reducing child and maternal mortality ratios;
•Implementation of the National Health Insurance;
•Improve the quality of care in the public sector; and
•HIV and AIDS treatment and support programme by expanding
mass HIV prevention communication campaigns.
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POLICY PRIORITIES
NATIONAL DEVELOPMENT PLAN
Nine goals for health have been identified in the NDP:
•Average male and female life expectancy at birth increased to 70 years;
•Tuberculosis (TB) prevention and cure progressively improved;
•Maternal, infant and child mortality reduced;
•Significantly reduced prevalence of non-communicable chronic diseases;
•Injury, accidents and violence reduced by 50 per cent from 2010 levels;
•Health system reforms completed;
•Primary health care teams deployed to provide care to families and
communities;
•Universal health coverage achieved; and
•Health posts filled with skilled, committed and competent individuals.
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POLICY PRIORITIES
NATIONAL DEPARTMENT OF HEALTH (DOH) STRATEGIC PLAN 2014 2019
The Department’s strategic goals are to:
•Prevent disease and reduce its burden and promote health;
•Make progress towards universal health coverage through the
development of the National Health Insurance scheme, and improve the
readiness of the health facilities for its implementation;
•Re-engineer primary healthcare;
•Improve health facility planning by implementing norms and standards;
•Improve financial management by improving capacity, contract
management, revenue collection and supply chain management reforms;
•Develop an efficient health management information system for improved
decision making;
•Improve the quality of care by setting and monitoring national norms and
standards, improving system for user feedback, increasing safety in health
care, and by improving clinical governance; and
•Improve human resources for health by ensuring adequate training and
accountability measures.
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BUDGET ANALYSIS
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BUDGET ANALYSIS
HEALTH BUDGET FOR 2014/15
Budget
Programme
R million
2013/14
2014/15
Nominal
Real
Increase / Increase /
Decrease in Decrease in
2014/15
2014/15
Nominal
Percent
change in
2014/15
Real Percent
change in
2014/15
Programme 1: Administration
405.7
399.7
- 6.0
- 29.3 -1.48 per cent
-7.23 per cent
Programme 2: NHI, Health Planning and Systems Enablement
491.8
621.3
129.5
93.2 26.33 per cent
18.96 per cent
11 042.0
13 049.9
2 007.9
1 246.0 18.18 per cent
11.28 per cent
102.6
93.5
- 9.1
- 14.6 -8.87 per cent
-14.19 per cent
17 722.4
18 925.8
1 203.4
763.7
865.3
101.6
30 528.2
33 955.5
3 427.3
Programme 3: HIV and AIDS, TB and Maternal and Child Health
Programme 4: Primary Health Care Services
Programme 5: Hospitals, Tertiary Services and Human Resource Development
Programme 6: Health Regulation and Compliance Management
TOTAL
98.5
6.79 per cent
0.56 per cent
51.1 13.30 per cent
6.69 per cent
1 445.0
11.2 per cent
4.73 per cent
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HEALTH BUDGET FOR 2014/15
BUDGET ANALYSIS
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BUDGET ANALYSIS
HEALTH BUDGET FOR 2014/15
Highlights
•The Department receives R33.9 billion for 2014/15, up 11.2% from
R30.5 billion in the previous financial year.
•The two largest programmes namely Programme 5: Hospitals,
Tertiary Services and Human Resource Development and
Programme 3: HIV and AIDS, TB, Maternal and Child Health
jointly constitutes almost 94% of the total budget.
•The allocation for Programme 4: Primary Health Care Services
again declines (-8.87 %) in 2014/15. Less than one per cent (0.28
per cent) is allocated to this programme (R93.5 million).
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PROGRAMME 1: ADMINISTRATION
Sub-programme 5: Financial
Management, 51.7, 13%
BUDGET ANALYSIS
Sub-programme 1: Ministry,
31.0, 8%
Sub-programme 2:
Management, 26.5, 7%
Sub-programme 1: Ministry
Sub-programme 2: Management
Sub-programme 3: Corporate Services
Sub-programme 4: Office
Accommodation, 105.8,
26%
Sub-programme 3: Sub-programme 4: Office Accommodation
Corporate Services, 184.6,
46%
Sub-programme 5: Financial Management
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BUDGET ANALYSIS
PROGRAMME 1: ADMINISTRATION
KEY POINTS
•The purpose of the Administration Programme is overall
management of the Department and providing centralised support
services.
•The Programme budget decreases by 1.5 % from R405.7 million in
2013/14 to R399.7 million in 2014/15 .
•Office Accommodation receives 26.5 % of the Programme budget,
and is the only sub-programme allocation to increase, from R97.5
million in 2013/14 to R105.8 million.
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PROGRAMME 2: NATIONAL HEALTH INSURANCE,
HEALTH PLANNING AND SYSTEMS ENABLEMENT
Sub-programme 1:
Programme Management
1%
Sub-programme 6:
International Health and
Development
8%
Sub-programme 2: Technical
Policy and Planning
0%
BUDGET ANALYSIS
Sub-programme 3: Health
Information Management,
Monitoring and Evaluation
9%
Sub-programme 4: Sectorwide Procurement
4%
Sub-programme 1: Programme Management
Sub-programme 2: Technical Policy and Planning
Sub-programme 3: Health Information
Management, Monitoring and Evaluation
Sub-programme 4: Sector-wide Procurement
Sub-programme 5: Health Financing and National
Health Insurance
Sub-programme 5: Health
Financing and National Health
Insurance
78%
Sub-programme 6: International Health and
Development
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BUDGET ANALYSIS
PROGRAMME 2: NATIONAL HEALTH INSURANCE,
HEALTH PLANNING AND SYSTEMS ENABLEMENT
KEY POINTS
•The purpose of the Programme is to improve access to quality
health services through planning, integration of health systems,
reporting, monitoring and evaluation, and research.
•The Programme budget increases by 26.3% from R491.8 million in
2013/14 to R621.3 million in 2014/15 .
•The NHI sub-programme receives the largest portion of the
Programme’s budget, at 78.4 % (R487.2 million)
•The 31.6% increase in this sub-programme is to ensure that General
Practitioners (GPs) are contracted for the NHI.
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PROGRAMME 3: HIV AND AIDS, TB, MATERNAL
AND CHILD HEALTH
Sub-programme 5: Child ,
Youth and School Health,
218.4, 2%
Sub-programme 4:
Womens Maternal and
Reproductive Health,
17.1, 0%
BUDGET ANALYSIS
Sub-programme 1:
Programme Management,
3.6, 0%
Sub-programme 3: TB,
26.4, 0%
Sub-programme 2: HIV
and AIDS, 12 784.4, 98%
Sub-programme 1: Programme
Management
Sub-programme 2: HIV and AIDS
Sub-programme 3: TB
Sub-programme 4: Womens Maternal and
Reproductive Health
Sub-programme 5: Child , Youth and School
Health
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BUDGET ANALYSIS
PROGRAMME 3: HIV AND AIDS, TB, MATERNAL
AND CHILD HEALTH
KEY POINTS
•The aim of this programme is to coordinate, manage and fund HIV
and AIDS, Tuberculosis (TB) and maternal and child health subprogrammes.
•98% of this programme’s budget is allocated to the HIV and AIDS
sub-programme, amounting to R12.8 billion. This represents a
nominal increase of 16.4 % from R10.9 billion in the previous year.
•The four remaining sub-programmes combined receive less than 2.0
per cent of the programme’s budget.
•TB sub-programme increases slightly from R25.8 million to R26.4
million, which means it declines 3.65% in real terms.
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BUDGET ANALYSIS
PROGRAMME 3: HIV AND AIDS, TB, MATERNAL
AND CHILD HEALTH
KEY POINTS
•The Women’s Maternal and Reproductive Health subprogramme is responsible for amongst other interventions,
deploying obstetric ambulances, establishing Kangaroo Mother Care
facilities, midwifery education and training, and strengthening infant
feeding practices.
•This sub-programme increased by only R100 000 as it received
R17.1 million which is less than 1% (0.13%) of the programme
budget .
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PROGRAMME 3: HIV AND AIDS, TB, MATERNAL
AND CHILD HEALTH
BUDGET ANALYSIS
KEY POINTS
•The Child, Youth and School Health sub-programme develops
and monitors policies and guidelines, and sets norms and standards
for child health.
•The budget increases from R17 million to R218.4 million. This is
mainly due to roll-out of the Human Papilloma Virus (HPV) Vaccine
which prevents cervical cancer, to be provided to Grade 4 girls.
•Over the medium term, key initiatives will be the continued rollout of
the integrated school health programme to cover all learning phases,
and strengthening the immunisation programme.
•Empirical evidence shows that South Africa has managed to reduce
child mortality in the last five years. This is a positive outcome
emanating from the scale-up of prevention of mother to child
transmission of HIV, the rollout of antiretroviral therapy, new child
vaccines (pneumococcus and rotavirus) and other child survival
programmes.
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BUDGET ANALYSIS
PROGRAMME 4: PRIMARY HEALTH CARE SERVICES
Sub-programme 6: Violence
Trauma and EMS
4%
Sub-programme 5: Health
Promotion and Nutrition
23%
Sub-programme 1:
Programme Management
3%
Sub-programme 2: District
Services and Environmental
Health
28%
Sub-programme 1: Programme Management
Sub-programme 2: District Services and
Environmental Health
Sub-programme 3: Communicable Diseases
Sub-programme 4: Non- Communicable
Diseases
Sub-programme 4: NonCommunicable Diseases
27%
Sub-programme 3:
Communicable Diseases
15%
Sub-programme 5: Health Promotion and
Nutrition
Sub-programme 6: Violence Trauma and EMS
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BUDGET ANALYSIS
PROGRAMME 4: PRIMARY HEALTH CARE SERVICES
KEY POINTS
•The Primary Health Care Services programme aims to develop
and implement a uniform district health system and to develop policy
for district health services.
•The budget decreased by 8.9%. This is despite the Department’s
stated aim of providing health services based on the primary health
care approach.
•The Non- Communicable Diseases sub-programme assists
provinces in implementing and monitoring chronic diseases,
disability, elderly people, oral health, mental health and substance
abuse.
•Its allocation decreases from R25.9 million to R25.7 million.
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PROGRAMME 5: HOSPITALS, TERTIARY HEALTH SERVICES
AND HUMAN RESOURCES DEVELOPMENT
BUDGET ANALYSIS
Sub-programme 5: Human
Resources for Health
12%
Sub-programme 4: Hospital
Management
0%
Sub-programme 7: Forensic
Chemistry Laboratories
1%
Sub-programme 1: Programme
Sub-programme 6:
Management
Nursiing Services
0%
0%
Sub-programme 2: Health
Facilities Infrastructure
Management
33%
Sub-programme 1: Programme Management
Sub-programme 3: Tertiary
Health Care Planning and Policy
54%
Sub-programme 2: Health Facilities Infrastructure
Management
Sub-programme 3: Tertiary Health Care Planning
and Policy
Sub-programme 4: Hospital Management
Sub-programme 5: Human Resources for Health
Sub-programme 6: Nursiing Services
Sub-programme 7: Forensic Chemistry
Laboratories
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PROGRAMME 5: HOSPITALS, TERTIARY HEALTH SERVICES
AND HUMAN RESOURCES DEVELOPMENT
BUDGET ANALYSIS
KEY POINTS
•The aim of the Hospitals, Tertiary Health Services and Human
Resources Development Programme is to accelerate the delivery
of health infrastructure and strengthen human resource capacity in
the health sector. The budget for this programme has increased by
6.8% (nominal).
•The Forensic Chemistry Laboratories sub-programme allocation
increases by 55.8% from R78.9 million to R122.9 million.
•The Hospital Management sub-programme allocation declined in by
1.8%.
•Similarly in 2014/15, the Nursing sub-programme allocation declined
by 34.2% from R3.8 million to R2.5 million.
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PROGRAMME 6: HEALTH REGULATION AND COMPLIANCE
BUDGET ANALYSIS
MANAGEMENT
Sub-programme 6:
Compensation Commissioner
for Occupational Diseases and
Occupational Health
6%
Sub-programme 1: Programme
Sub-programme 2: Food
Management
Control
0%
Sub-programme 3:
1%
Pharmaceutical Trade and
Product Regulation
11%
Sub-programme 1: Programme
Management
Sub-programme 2: Food Control
Sub-programme 5: Office of
Standards Compliance
13%
Sub-programme 3: Pharmaceutical Trade
and Product Regulation
Sub-programme 4: Public Entities
Management
Sub-programme 5: Office of Standards
Compliance
Sub-programme 4: Public
Entities Management
69%
Sub-programme 6: Compensation
Commissioner for Occupational Diseases
and Occupational Health
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PROGRAMME 6: HEALTH REGULATION AND COMPLIANCE
BUDGET ANALYSIS
MANAGEMENT
KEY POINTS
•The Health Regulation and Compliance Management
programme aims to reduce the time taken for medicines to reach the
market, establish the Office of Health Standards Compliance and
establish a National Public Health Institute.
•The programme budget has increased by 13.3 % from R763.7
million in 2013/14 to R865.3 million in 2014/15.
•Most of the funds (68.5 per cent) that is R592.5 million of this
programme budget is allocated to the Public Entities Management
sub-programme.
•The Office for Health Standards Compliance sub-programme
increases by 87.4 % to employ additional staff to establish itself and
build its inspectorate function.
•The Compensation Commissioner for Occupational Diseases, has
still not tabled an Annual Report for last year.
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ISSUES FOR
CONSIDERATION
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ISSUES FOR CONSIDERATION
KEY ISSUES FOR CONSIDERATION BY PARLIAMENT
• Maternal Mortality: why no significant increase in this subprogramme’s budget, given the challenges?
• Primary Health Care is given as the department’s approach to
health care yet this programme does not receive budgetary
priority.
• Non-communicable diseases (NCDs) also don’t get a significant
increase despite being highlighted as important.
• NHI: Slow spending on conditional grants need to be addressed.
• TB programme budget not increasing significantly, despite SA
having high rate of TB. Why is this?
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Thank you!
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