Health care spending is at lower levels than seven years ago, Health Department director-general Ayande Ntsaluba said in Boksburg today. Speaking at government's primary health care conference and looking back at nine years of primary health care services under democratic government, Ntsaluba also raised issues including a lack of adequately trained staff and reliable medical distribution that could negatively impact on government's promised antiretroviral treatment rollout for all.
Ntsaluba, who said the size of the health cake is not growing very fast at all - in fact it is growing at a rate less than GDP, noted that health care spending in 1995/96 was at R29.7-billion (2002/03 prices) and R35.5-billion in 1996/97.
Giving one of his last speeches as director-general before he leaves his post on Friday, Ntsaluba noted that, spending in 1997/98 and 1998/99 fell by over nine percent and four percent respectively.
After this there was a slow and uneven recovery in spending to reach R33.8-billion in 2002/03 - which is less in real terms than the spending in 1996/97.
Some real rise in health expenditure is projected during the current medium term economic framework (MTEF) to reach R36.8-billion (at 2002/03 prices) in 2005/06, although little increase is anticipated for the outer MTEF year.
There were large inequities between provinces, with some spending as little as R75 per capita and others R245 per capita - with at least R200 per capita considered desirable by national government.
In part, he said, low expenditure rates reflected the inability of some provinces to attract staff to rural areas.
This in turn will pose a challenge for metro and district municipalities which, he said, will fund and render environmental health services by July 2004.
Indicating a growing health burden on provinces, he said too that provinces may decentralise other primary health care services to municipalities with funding coming from the provinces.
Addressing areas that could impact on government's capacity to roll out antiretroviral medications to all as part of a universal treatment programme, Ntsaluba pointed out that many clinics were single nurse services and could not provide a full range of services.
He said that two key pillars of effective medical service required more attention. One was effective data collection and the other reliable access to medication.
We need to ensure the effective ordering, delivery and use of medicines.
This in turn has implications for the roll-out of antiretroviral medications which demand a reliable supply of medication, and so does sufficient staffing.
Ntsaluba noted that the extension of primary health care services had put an additional workload on nurses. Our training strategy needs strengthening and our retention strategy
Experienced nurses are leaving the public sector for the private health sector and for jobs overseas. We think that improved working conditions will assist in this regard.
He said that the department was developing mid-level workers in a range of categories. Training had already begun with pharmacy assistants and we are looking at a medical or clinical assistant category at present.
Looking at positive aspects, Ntsaluba noted that government had built 701 clinics in the past nine years.
This improved health services to more than seven million people in underserved areas.
Nonetheless, he pointed out that primary health services had been extended to significantly more South Africans.
In 1994, President Nelson Mandela announced free health services for pregnant and lactating women and children under six.
Two years later the programme was extended free to all who needed it. This year President Thabo Mbeki extended free health services to the disabled.
Health department spokesperson Joanne Collinge said Ntsaluba would be sorely missed, he is liked by everyone.
She said he would not be replaced for the next eight months, we will wait until after the elections because if there is a new health minister, he or she will want to appoint their own director-general. (Source:, Business Day, 25 August 2003)