The Intergovernmental Fiscal Review, tabled in Parliament by Finance Minister Trevor Manuel, contains the following chapter on
Policy issues in health:
The transformation of the health sector and the increased emphasis on primary services substantially affect provincial health administration and budgets. Free health care services to pregnant women and children under six, clinic building and free access to primary health care all put pressure on recurrent health expenditure, as did the implementation of the Choice on Termination of Pregnancy Act.
Tertiary services are being rationalised and scaled down to accommodate the shift to primary health care services. The rationalisation of academic hospitals has been slow. The distinction between academic, central and regional hospitals is not uniformly applied between provinces. This is further complicated by the fact that a significant component of primary and secondary health services in Gauteng and, to a lesser extent,
the Western Cape and KwaZulu-Natal is actually delivered in academic hospitals.
Aligning current central hospital and health training grants to budgets represents a major challenge for health budgets. This challenge includes alignment between these and other hospital conditional grants (redistribution and rehabilitation grants). Recognising this challenge, the national Department of Health started a comprehensive review last year. This study was not completed in time for the 2001 Budget, but is expected to be incorporated into the 2002 Budget.
Restructuring the health sector is a complex process. Provinces such as Northern Province, Eastern Cape and Mpumalanga have difficulty in attracting health professionals. The shortage of health professionals, combined with supernumeraries at the lower end, is particularly acute in rural areas. The introduction of community service for doctors has helped to address inter- and intra-provincial disparities to some extent. However, the public sector as a whole has lost skilled health professionals to the private sector or other countries. The health sector faces the challenge of introducing further personnel service reforms to attract and retain the appropriate specialised health skills in the public sector.
The extension of the Basic Conditions of Service Act to the public service significantly affects personnel management in the health sector. The Act is designed to protect workers by limiting overtime work. While the principle is sound, paying health employees more for overtime and Sunday work will add to the personnel cost pressures.
While much has been achieved in extending basic health care to poor and deprived communities, the optimal balance between the different levels of health care must still be found.
The role of local government in the provision of health services must also be clarified if unfunded mandates are to be avoided.
Much remains to be done to improve the quality of financial management in hospitals. The PFMA provides the mechanism for appointing chief executive officers to run hospitals and for improving the quality of financial management. Government has allocated R30 million in 2000/01 to improve management in health departments and hospitals.
Concurrent to this complex transformation, HIV/AIDS is placing increased strain on the health system. In provinces such as KwaZulu-Natal, up to 40 per cent of patients in medical wards are HIV positive. Not only has the demand for health care increased substantially, but treatment for relatively simple diseases such as malaria and tuberculosis is also made substantially more expensive by the HIV/AIDS epidemic. The eventual budgetary implications pose a significant risk to health budgets in the public sector.
(Source: PulseTrack, 31/10/00)