Guidelines for District Health Expenditure Reviews in South Africa

A District Health Expenditure Review (DHER) presents a clearer picture of funding, distribution and use of health resources within the district. This is an important foundation for planning. It will help to restructure distr4ict health services and manage resources more effectively to meet the needs of communities.

A DHER focuses on financial data and links this to other resources such as staff as well as service and population data. These are then analyzed according to performance measures for the various cost in the district

A DHER is a tool to help us improve the management of health services. It helps to answer important questions about the allocation of resources in a district. Conducting a DHER will help a DMT to:

• Draw up their service and financial plans for the next financial year
• Identify problems such as unequal distribution of services and inefficiencies in the system
• Develop plans for restructuring services and finances
• Involve all public health care provides and the public in the health systems
• Monitor district performances over time
• Compare performances according to criteria such as equity, resource allocation, efficiency and sustainability with that of other districts
• Assess the financial implications of policy changes
• Improve and develop skills in the following areas:
  • financial analysis and costing
  • financial planning and management skills
  • understanding the relationship between finances and services
  • using the key financial and management terms
  • data collection and organisation
  • developing and using indicators to measure performance
  • using information to help make decision
• Show how service delivery can be enhanced when resources are utilized efficiently and effectively
• Use DHERs to compliment existing quarterly or six-monthly financial monitoring procedures
• Report to communities and funding agencies such as the Department of Health about use of resources and hence, strengthens credibility and accountability
• Fulfill the requirements of the Public Finance Management Act (No 1 of 1999)
• Introduction the need for department to operate within budget constraints
• Introduce the need for districts to manage finance efficiently and effectively
• Encourage districts to find appropriate ways to measure performances
• Ensure greater accountability an responsibility