Industry News

2011 AND THE BUDGET

06 April 2011

In Categories: Nursing , Industry News , Industry News > General , Medic-Legal , Industry News > Patients

By Lucas Malambe

Building on previous years the health kitty continues to bulge. Last year the healthcare sector got a shot in the arm when the Minister of Finance, Pravin Gordhan, announced a major rise to the industry’s pot to revitalise infrastructure and prepare the public sector for the renewed commitment to combat HIV/Aids. The 2011 budget will allocate R112bn (from R63bn in 2007/08) to health representing a 9.8% slice of the total R577.3bn social services expenditure (see HasaNews March).

Part of this tranche includes a R8bn over the next three years to lay the foundation for the proposed National Health Insurance scheme (NHI). Gordhan believes that the NHI plan came with significant cost implications and would require substantial organisational and financial reforms. Universal access to affordable quality healthcare is a clarion call by all progressive politicians, healthcare activists and health economists world-wide, and it seems Gordhan is considering all options on how to fund this system.

The major disagreements in NHI arise in the proposed funding models. The minister mentioned three options in his budget speech: a payroll tax (payable by employers), an increase in the VAT rate and a surcharge on individuals’ taxable income. Gordhan said the fiscal and financial implications of health system reform, and alternative revenue sources, would be examined in the year ahead as government phase in the NHI.

The South African health system subscribes to a Primary Health Care (PHC) approach (Department of Health, 2000), through a district health system (DHS). For the first time the budget speech touched on the formation of a family health scheme seen as important in reducing the load of hospitals, and the health care costs. Built around teams of doctors, nurses and community health workers, these family health schemes will visit homes in rural areas. The introduction of these step-down facilities will take R1.2-billion of the budget. The focus will be on providing promotive, preventive, and rehabilitative healthcare services.

Last year the Minister of Health, Pakishe Motsoaledi, called for more emphasis to be placed on PHC to both reduce the huge burden of disease South Africa is facing and as a building step towards NHI (Ministry of Health, 2010). Fostering community participation at the local policy level is a huge step towards achieving this, especially in health districts that serve socio-economically deprived communities (Okorafor, 2009).

For this to be successful and to smooth any jump starts in the introduction of NHI or a PHC approach as envisaged by Motsoaledi, the public health sector must not only learn to spend, but also learn to use its entire budget shrewdly if South Africa is to put the economic drag that is HIV/Aids and the poor state of healthcare delivery behind it for good. We need to get an appropriate balance between procurement, inventory control and distribution to make the most of this fund.

The 2010 budget was rather weak on the development of an NHI, and instead saw the need to revitalising the country’s major hospitals as a matter of priority. At the time Gordhan stressed that efficient public health facilities are a precondition for an NHI plan. In this budget R2.9bn is earmarked for the improvement of the quality in health facilities, medical equipment and hospital systems.

Gordhan appears to have seen that NHI can’t be implemented in a hurry. Gordhan said the Minister of Health would soon publish a policy paper for consultation, and that the government was looking at the costs of moving over a 14-year period and of having NHI as a key component of the health system. Gordhan’s insistence on revitalising the country’s health facilities is evidence that government is waking up to the fact that for NHI to work we need a health system that will provide the quality of healthcare all South Africans ought to have. For healthcare to work you also need human capital, and for these, the budget increased its allocation to training and development.

It may be that the private sector needs to wake up as well and partner government not only in speeding up the upgrading of public hospitals but also in the making of a more resourceful public-private-partnership system.

In general his budget speech is hailed a deft balancing act of a master juggler and it will go a long way in dealing with the major challenges facing the public health system such as poor infrastructure and maintenance, shortage of skills and the Occupation Specific Dispensation as well as instilling a culture of quality and patient care through the enforcement of standards. It is time, nonetheless, for the Department of Health to pick up the gauntlet and spend funds adequately in view of all its challenges.

REFERENCE LIST
Department of Health (2000) The primary healthcare package for South Africa – a set of norms and standards. Department of Health, Pretoria, South Africa

Ministry of Health (7 July 2010) Health minister calls for emphasis on Primary Healthcare. Media Release: Website [http://www.doh.gov.za/docs/pr/pr0707-f.html]

Okorafor O. A. (2009) Fiscal federalism and equity in the financing of primary healthcare: the case of South Africa. Doctoral Dissertation. University of Cape Town