Conducting expenditure and resource allocation reviews for effective district health system management - A review of expenditure and resource allocation in the Mmametlhake health district of Mpumalang

Author: 
Engelbrecht, Beth [ed]
Publication Year: 
2000
City: 
Durban
Country: 
South Africa
Published by: 
Health Systems Trust
ISBN: 
1-919839-26-7

Approach

A district health expenditure review task team conducted the survey, supported by facilitators. An integrated approach to financial, population and service data was followed to analyse how resources have been allocated and used in the district. The units of analysis were cost centres. The cost centres were as follows:

District as a whole
Each of the Sub-districts
Hospital facility
Inpatients and oupatients of the hospital
Each PHC facility separately
Emergency medical services

The cost centres were analysed according to four criteria:

Resource allocation
Equity
Efficiency
Sustainability

Overview

Mmametlhake Health District has three sub-district s Mmametlhake, Allmansdrift and Marapyane.
The health facilities for the district serves a catchment population of 140 000. There is one hospital, three community health centres, one 24 hour clinic, ten 8 hour clinics, and two mobile clinics.
Mmametlhake District budget for 1998/99 was R 22,197,975m with an over expenditure of R1,173,365m (5,3%). This excludes Emergency Medical services, as correct budget data could not be obtained.

Resource Allocation

Fifty One percent of resources were allocated to Primary Health Care (PHC) services. PHC in Mmametlhake includes services rendered at mobiles, fixed clinics and community health centres. There were no resources allocated to environmental health services, (an integral part of PHC).
Personnel costs form 88% of total costs in the district. For PHC services it was on average 91%. This is a very high proportion.
4,5% of district costs is spent on pharmaceuticals. This appears much lower than other districts. Mount Currie, for example, allocated 6,2% of its total district resources towards pharmaceuticals.
The average number of clients seen per nurse per day at fixed clinics ranged from 13 to 50. This demonstrated an imbalance in the allocation of staff.
The workload at 24-hour PHC facilities was on average 7 clients per nurse. This raised questions about staffing, scope of services and patient profile. This requires further investigation.
The average number of visits per person in the catchment population for PHC facilities was 1,8. The national target is set at 2,9 visits per capita 1.
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