Proportion of District Health Services Expenditure on District Hospitals

This indicator shows the proportion of total district expenditure on hospitals and is helpful in assessing the focus of service delivery in the district. The proportion of total district expenditure on district hospitals during 2008/09 was 41.8% and this proportion has been in an annual and steady decline from 44.9% in 2005/06. This is partly due to the corresponding rise in the proportion spent on district management teams but is more likely due to increased expenditure on HIV/AIDS via conditional grants, an expenditure which was 11.9% in 2008/09 compared with 9.2% in 2005/06 (see Table 1).

Table 1: Total HIV/AIDS conditional grant to districts 2005/06 - 2008/09

Figure 1, Percentage of district health expenditure on district hospitals by district, 2008/09, shows the range of expenditure by districts on their hospitals. At the low-end of the scale are the two metros, City of Johannesburg and Ekurhuleni (GP), and the district of Frances Baard (NC), where there is inappropriate reliance on tertiary and academic hospitals to provide primary level care. Metsweding (GP), with zero spend, does not have a district hospital. At the high-end, Siyanda (NC) and Gert Sibande (MP) spent over 63% of total district expenditure on hospitals. This has been a consistent pattern for the past four years, as has been the fact that these two districts are amongst the five districts with the lowest non-hospital PHC per capita spending. Increasing the expenditure on PHC, outside of the hospitals, would have the dual effect of improving their equitable expenditure on non-hospital PHC as well as getting the proportion of hospital expenditure closer to the average for South Africa.

Figure 2, Percentage of district health expenditure on district hospitals by metro district, 2008/09, shows that the proportion of district spending on hospitals in the metro districts has remained largely unchanged from 2007/08. There is an eight-fold variation between the City of Johannesburg (GP), which at 6.2% has the lowest proportion of spending on hospitals of any district, and eThekwini (KZN) which has the highest at 50.9%. There is also a large difference between the average proportions spent on hospitals in the metros (31.9%) and in the ISRDP districts (49.3%), both of which differ markedly from the South African average.

Figure 3, Percentage of district health expenditure on district hospitals by ISRDP district, 2008/09, shows that the proportion of expenditure on hospitals in all the ISRDP districts, with the exception of Thabo Mofutsanyane (FS), was above the national average. There was a large increase in the expenditure on hospitals in Alfred Nzo (EC), from 43.2% in 2007/08 to 58.7% in 2008/09. There has been a large increase in the total expenditure in this district in the last year, most of which has gone into the district hospitals.

Figure 4, Trends in percentage of district health expenditure on district hospitals, 2005/06 - 2008/09, shows the proportion of expenditure on hospitals over a four-year period. In most districts trends have been fairly stable but in those districts where trends are unstable, e.g. Alfred Nzo (EC) and Bojanala Platinum (NW), careful analysis and explanation by management at all levels is needed. In some cases, the reasons are quite clear, e.g. the conversion of the three previously provincial hospitals to district hospitals¹ which accounted for 96% of the increase in expenditure between 2006/07 and 2007/08 in the City of Cape Town (WC).

Figure 1: Percentage of district health expenditure on district hospitals by district, 2008/09*

^*Metsweding has no District Hospital, thus the zero expenditure

Figure 2: Percentage of district health expenditure on district hospitals by metro district, 2008/09

Figure 3: Percentage of district health expenditure on district hospitals by ISRDP rural district, 2008/09

Figure 4: Trends in percentage of district health expenditure on district hospitals, 2005/06 - 2008/09

Resources:

The indicators in these sections are calculated from the Basic Accounting System (BAS) data obtained from National Treasury, North West Province's financial data, National Treasury data on Local Government expenditure, the current DHIS mid-2008 population estimates and the 3-year rolling average of medical aid coverage calculated using the General Household survey data 2005-2007.

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The downloadable pdf version of this article can be found at http://www.hst.org.za/publications/864

The undelying data spreadsheets can be found at http://www.hst.org.za/publications/864

^{1. see 2007/08 District Health Barometer, page 22. Durban: Health Systems Trust}