National Health Department Annual Report card shows progress but not a distinction level yet (PC Health meeting 15 and 22 October 2014)
Progressive legislation has enabled South Africa to transform its healthcare system, but there are still stark differences between the public and private health sectors in terms of access and quality. Complicating this situation is the industry’s quadruple burden of:
- HIV/AIDS, which has now also entered a synergetic relationship with TB
- Maternal and child morbidity and mortality
- Increasingly prevalent non-communicable diseases (NCDs), mostly driven by risk factors related to life-style
- Injuries and trauma arising from violence
In response to these burdens, the Minister of Health developed a 10-Point Plan to overhaul its health system. Also, the Minister of Health and the President signed the National Service Delivery Agreement (NSDA), in terms of which the Department of Health committed to:
- Increasing life expectancy
- Decreasing maternal and child mortality
- Combating HIV/AIDS and decreasing the burden of TB
- Strengthening health system effectiveness
In its 2013/14 annual report, the Department of Health captures the key milestones of the financial year toward realising the 10-Point Plan, NSDA and the Medium Term Strategic Framework (MTSF) of 2009-2014 Priorities and Goals for 2013/14.
The Department of Health is guided by the National Development Plan (NDP), which integrates the policy plans of all government departments directed toward improving the lives of South Africans. With regard to health, the NDP identifies demographics and disease burden, health systems, and the social and environmental determinants of health as key areas to address.
In my opinion, unpacking the social determinants of health in particular demands urgent attention.
During 2013/14, the Department of Health continued to focus on defined strategic goals:
- Increase average male and female life expectancy at birth to 70 years by 2030
- Decrease maternal mortality from estimated 310 per 100 000 to 270 (or less) per 100 000 live births by 2014
- Decrease child mortality ratio from 42 per 1 000 live births to 38 (or less) per 1000 live births by 2014
- Combat HIV/AIDS and TB
- Strengthen the health system’s effectiveness by:
- Reengineering primary healthcare
- Improving patient care and satisfaction, health infrastructure, and human resources for health
- Improving healthcare financing through the implementation of National Health Insurance
- Strengthening health information systems.
Performance during 2013/14
For the year under review the Health Department’s budget was R30, 5 billion, of which it spent R29, 8 billion, or 97, 7 %. Its under-expenditure of R703 million, or 2, 3% is a significant decrease compared with the previous financial year. Sadly the performance of targets under each program was at 54%.
|Programme||Number of targets||Achieved||Not fully achieved||Percentage achieved|
|Health planning and system enablement||19||14||5||74%|
|HIV/AIDS, TB, and maternal, child and women’s health||24||8||16||33%|
|Primary healthcare services||29||14||15||48%|
|Hospitals, tertiary services and workforce development||15||7||8||47%|
|Health regulation and compliance||24||15||9||63%|
Each of the Health Department’s programmes has a clearly defined role.
Administration: This programme consists of all the administration support for the National Department of health. Allocated R405, 5 million, spent R363, 9 million (89, 6%).
National Health Insurance, Health Planning and Systems Enablement: This programme covers infrastructural projects, all the health systems improvement project and also House the NHI project incorporating and oversight for the 11 Pilot NHI projects. Allocated R492.9 million, actual expenditure R197.9 million. This shows a massive under-expenditure of R295 million or 40.1%.
HIV/AIDS, Tuberculosis, Maternal and Child Health: This programme consists of three sub-programmes dedicated to key MDGs that are critical indicators for the Department. This programme was allocated R11.035 billion and spent R10.9 billion (which translate to 99.3% expenditure)
Primary Healthcare Services: A number of sub-programmes are key policy interventions intended to improve the health service and reduce the quadruple burden of disease and violence. These programmes include Primary Healthcare and District Health Services, NCDs, and Violence, Trauma and EMS. The budget allocation for this programme declined from R761 million in 2011/12 to R113.8 million in 2012/13. It further declined to R100.9 million in 2013/14. This decline in budget is despite the fact that the Violence, trauma and EMS sub-programme was added.
Hospitals, Tertiary Health Services and Human Resource Development: This programme deals with the development of policies, delivery models and clinical protocols for hospital and emergency medical services. It also ensures that academic medical centres and health workforce development programmes are aligned. This programme has spent 98.6% (R17.483 billion) of its R17.728 billion allocated funds, resulting in under-expenditure of R244.842 million (1.4%).
Health Regulation and Compliance Management: The aim of this programme is to regulate procurement of medicines and pharmaceutical supplies, including food control and trade in health products and health technology. It also promotes accountability and compliance by regulatory bodies for effective governance and quality of healthcare. This programme has spent 95.9% of its allocated funds, amounting to R732.27 million (up from R545.52 million 2012/13), with under-expenditure of R31.14 million
Auditor General Report
The AG has expressed an unqualified audit opinion of the Health Department’s 2013/14 Annual Report, for the third consecutive year. This means that the Department’s financial statement fairly represents its financial position.
The Health Department filled a total of 1 410 permanent posts out of 1 476, which translates to a vacancy rate of 4, 34%. This is down from a vacancy rate of 28, 9% in 2011/12 and 7% last year, after adding 134 additional filled posts.
While not a perfect report card, it is clear the National Health Department is making good progress in key areas. The Department has again achieved an unqualified audit report. Overall the department is performing well with regards to spending. The Department spent 97.7% of its adjusted budget.
Under-spending in critical areas like NHI projects must be improved as a matter of priority, along with performance management on achieving set targets. An overall 54% achievement on the targets set for all 6 programmes is not ideal to improve the health of all our citizens.
More work around ensuring that the Department adopts strategies to improve spending of the infrastructure and National Health Insurance grants must be addressed. Personally I think while not a perfect score card good progress is being made.