The HIV/AIDS epidemic means that even real growth in future health budgets will not be adequate to deal with the increase in demand for services and the effects of the syndrome on health resources.
The 2001 Intergovernmental Fiscal Review contains a comprehensive assessment of provincial and local government budgets and expenditure patterns, with particular reference to education, health, social development, housing and roads. It noted that patients admitted to public hospitals with HIV/AIDS-related problems had grown substantially and were progressively displacing other patients, as hospital outputs had not increased significantly.
Provincial governments were estimated to spend about R4bn on HIV/AIDS, and the report said the effect of the disease is becoming more visible and is likely to be felt severely in the provincial and local spheres. It added that: it is clear that the current social safety net is not adequately designed for dealing specifically with the impact of HIV/AIDS on households and to confront the complex interaction between HIV/AIDS and poverty. There has been close interaction between the department of health and national treasury recently to ensure that programmes to confront the disease are expanded to the required scale in coming years. Apart from HIV/AIDS, the report highlighted the stark inequities in health provision between provinces.
Excluding central funding for hospitals, per capita expenditure on health services in Gauteng was nearly twice that of Mpumalanga and 1,6 times higher than that of Northern Province. Hospital beds ranged from 3,49 per 1 000 people in Gauteng to 1,82 per 1 000 in Mpumalanga. Hospital admissions ranged from 155 to 85 per 1 000, and there was unequal access to specialists with Mpumalanga having 0,9 specialists per 100 000 compared with Gauteng's 30,9. And while there had been progress in the quality of primary healthcare services, significant inequity remained and the report urged further investigation into the real budget decline in allocations for primary care over the next three years.
An audit of health facilities in 1996 found a third of hospital facilities required replacement or major repair. This was estimated to have reached about 40% in 2000 and estimated then to cost R12bn over eight to 10 years. Provincial health expenditure grew by more than 2% in real terms in 2000/01 after real declines in the previous two years and was projected to continue rising over the period from 2000/01 to 2003/04 by an average of 1,7% a year. All provinces, except Western Cape and Eastern Cape, would see real growth in health spending over this period, with the bulk of real growth in non-personnel expenditure, which was set to grow in real terms by about 3,5% a year. Health capital expenditure was projected to increase from 4, 1 % of expenditure to 8,9%.
Source: Business Day, 10 October 2001