| Summary |
Introduction
This report documents the findings and conclusions of the first district expenditure review run for the Mt. Currie health district. The year under review is the government financial year, April 1997 to March 1998. Mt. Currie is a health district bordering on the Eastern Cape, in the southernmost part of the KwaZulu-Natal (KZN) province. Its close proximity to the Eastern Cape border, and the regions geography, have meant that the main towns in the district, Kokstad and Matatiele, have for years acted as commercial centres for rural areas extending into the Eastern Cape, or what was formerly known as the Transkei. This fact, together with the history of the regions administration, means that the health services in the district are well frequented by residents of the Eastern Cape. These cross-border flows made it essential to calculate the district catchment population, which was estimated at 247 537 people in 1997/98.
A full range of health services are rendered in the district, including primary health care services, environmental health services, district hospital level services and laboratory services. A number of health services to the district are still run directly by the province, or the regional office. In addition, as in many districts, there are two main public sector authorities running health services namely local governments (municipalities) and the KZN provincial government. The two local authorities in the district are Matatiele and Kokstad. |
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Executive Summary
Study Methods
The health services covered in the study included all health services rendered by the municipalities, the province, non-governmental organisations (NGOs) and the public work done by part-time district surgeons (also known as district medical officers). Services rendered by General Practitioners (GPs) to private patients were excluded from the scope of the review. The two district hospitals are Tayler Bequest (Matatiele) and E.G. & Usher Memorial (also referred to as Usher Memorial, in Kokstad). The third hospital in the district is the SANTA TB inpatient care facility in the town of Matatiele.
The methods of investigation included primary data collection, from service records and information system reports secondary data collection, from existing published materials (such as the KwaZulu-Natal (KZN) Informatics Bulletin) and interviews with various service providers in the health district.
All data, except for the facility maps, were only obtained in the form of documents or system reports. All numerical data were entered onto Excel spreadsheets. The maps were obtained in electronic and hard copy format from the Geographical Information System (GIS) of the KZN (provincial) Department of Health. Data entered by one researcher were crosschecked by another researcher for accuracy. Accompanying this report is an electronic copy of the indicator tables, as well as the line item expenditure breakdown from the FMS X112 reports for the two hospital responsibilities in Matatiele and Kokstad, respectively.
Two key groups of people influencing both the type of data collected and the methods used were the Health Expenditure Review Task Team (HERTT), who were developing guidelines for running district expenditure reviews, and the Mt. Currie District Expenditure Review Task Team (DERTT). Three of the authors were also involved in the HERTT. Both these groups generated lists of indicators and cost centres. In the end, the final review went further than the basic requirements of the HERTT team, except in supplying indicators using facility level catchment populations, which were not available from the Mt. Currie health services.
Results
Total district expenditure for the year 1997/98 was R54,056,359. About 5.6 % of this was capital expenditure. Total expenditure was divided between the two sub-districts as follows: R24,505,013 in Matatiele (45 %), and R29,551,346 in Kokstad (55%). Using the district catchment population, whose calculation is described in Appendix A, these amounts translate into expenditure of R148 per capita in Matatiele, R362 per capita in Kokstad, and R218 per capita in the district as a whole.
Most expenditure (80 %) in the district is under the control of the provincial health services, recorded under the hospital responsibility codes. About 10 % of expenditure in the district comes from a provincial subsidy, of which 85 % goes from the Eastern Cape government to the Khotsong SANTA centre, with the remainder going to the two municipalities in the district. Of the remaining 10 % of district health expenditure, 6 % comes from the provincial regional budget and 4 % comes from NGO and Municipality own-revenue.
About 81 % of district expenditure is on hospitals. About 10 % of expenditure is on mobile clinics, municipal fixed clinics and part-time district surgeon services to state patients. Of this amount, 7.7 % of expenditure is accounted for by mobile clinics, 2 % by municipal clinics and under 0.5 % by part-time district surgeons.
Expenditure on personnel in Mt. Currie is at least 68 % of total recurrent expenditure. The actual figure is probably higher, as some expenditure classified on the FMS system under the standard line item, professional and special services, includes personnel expenditure. Personnel expenditure for laboratories was not separated out (and is quite difficult to do). Drugs and a small amount of consumables (only from municipalities, whose consumables could not be separated out) account for 11 % of expenditure, with the remaining 21 % containing other types of expenditure, a particularly large amount of which comes from other types of hospital inpatient expenditure. |
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