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At present, some (but not all) municipalities provide health services. There is considerable diversity between municipalities in relation to the range and extent of health service provision. Historically, local government health services have been restricted largely to the provision of preventive, promotive and rehabilitative primary care services, with particular emphasis on communicable disease control and environmental health. In addition, some municipalities provide ambulance services on an agency basis for the respective provinces (i.e. ambulance services have historically been a provincial responsibility, but in most cases provinces pay municipalities to provide these services on their behalf). In an effort to reduce fragmentation of health services, some municipalities are increasingly providing integrated preventive and curative primary care services.
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With the move to create a functioning district health system, there is a long-term commitment to integrated district health services being provided by the local government sphere, although there is still considerable debate about the constitutional responsibility of municipalities for health service provision. However, given the differential capacity across municipalities to provide health services, there will continue to be variable district health organisation across the country, ranging from district services being fully devolved to local government level in some areas to district services being fully provided by provincial health departments in other areas.
The purpose of this document is to provide a brief overview of what is currently known about health care financing and expenditure at local government level. It also outlines what is required to obtain accurate baseline information on financing sources, expenditure levels and resource allocation decision-making processes and information requirements for evaluating and monitoring the equity of local government health care financing and expenditure.
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