Limpopo and Gauteng Provincial Health Budget: briefings

Meeting report

HEALTH PORTFOLIO COMMITTEE
16 March 2005
LIMPOPO AND GAUTENG PROVINCIAL HEALTH BUDGET: BRIEFINGS

Chairperson: Mr L Ngculu (ANC)

Documents handed out:
Limpopo Department briefing
Gauteng Department briefing

SUMMARY
The Limpopo Department presented its provincial priorities, strategic objectives and targets. The budget allocation for non-personnel expenditure in 2007/08 was a concern for the province. It noted that the under spending would be minimal this year. Members questioned the utilisation of conditional grants, the termination of pregnancy services and the use of mobile clinics.

The Gauteng Department presented its strategic plans, goals and budgetary programmes. The Committee questioned the budget allocations for HIV/AIDS, and expressed concern about cross-border patients. The Committee concluded that the presentation had not included information about the previous year’s budget expenditure and therefore another meeting should be scheduled when this information was available.

MINUTES

Limpopo briefing
The Head of Department, Dr H Manzini, presented their priorities which included hospital revitalisation and the development of a medical school. Information on strategic objectives and targets for health administration, district health services, emergency medical services, health sciences, training and health facilities management were included.

The Department’s budget had been calculated according to the New Equitable Share Formula. This technically should have amounted to R4735 million, 26% of the provincial budget. The amount allocated to the Department however was 24.1 %, amounting to R4431 million. The MTEF budget was expected to increase from R4218 million in 2004/05 to R5552 million in 2007/08.

Dr Manzini expressed concern for non-personnel expenditure in the outer years. The 2007/08 projected year showed a decrease from the previous year of R 6.803 million that left almost no growth in the budget for non-personnel expenditure. The allocation for the purchase of drugs however had shown real growth. These funds would be ring fenced. The Department’s revenue collection targets had been set at R60.409 million for 2003/04 and, in fact, R64.974 million had been collected. The collection target for 2005/06 had been set at R63.911 million. The expenditure trends for 2005/06 were in line with the projected budget increase of 17.88 %. The personnel versus non-personnel trends were estimated at 62.7% of the budget to 32.3% respectively.

Discussion
The Chairperson noted that he had accepted an apology for the absence of the MEC for Health in Limpopo.

Mr I Cochalia (ANC) suggested that support would be required from higher levels such as tertiary institutions. He asked what proportion of the Provincial Conditional Grants had been allocated to Health Conditional Grants and if the Department anticipated any under expenditure in 2005/06. Had the Department applied for the roll-over of any grants? He asked for comments on the monitoring of these grants.

Dr Manzini answered that the R8 million mentioned in the presentation was over and above the amount allocated in the human resource budget. In addition the Health Professional Training and Research Grant added to the human resource budget. The reason the Hospital Management Grant had decreased was that the grant was intended to put certain systems in place. Once these systems were in place, they would be maintained and run within the normal health budget. The Department would definitely under spend this year due to the HIV programmes having started so late because of the Department’s under capacity. Systems had been put in place to monitor these grants on a monthly basis.

The Chief Financial Officer, Mr Mofokeng, stated that the expected under spending would be minimal.

Ms B Ngculu (ANC) noted that the termination of pregnancy rate had been quite high between the ages of 18-20 year olds. She asked what the extent of condom distribution had been between these ages and what the staff attitudes were regarding the terminations. Had any patients with cervical cancer been identified during the awareness campaigns? She asked for comments on multiple drug resistance.

Dr Manzini replied that she did not have figures on condom distribution however condoms had been distributed extensively. She stated that the use of female condoms was however quite low. Across the board some staff member had been resistant to supporting the choice of terminating pregnancy however a good number of committed staff ran the termination programmes. Educational programmes had however been successfully run. Cervical cancer was routinely scanned for and awareness campaigns had been run during August 2004. The cervical cancer numbers were quite high. Multiple drug resistance was a problem.

Ms R Mashigo (ANC) expressed concern about the mobile clinics stating that the rural areas service had been suspended as of November 2004. She asked if new hospitals would be built and how would they be funded.

Dr Manzini replied that the tender for converting vehicles to mobile clinics had been granted to a youth group who were struggling to deliver. This had caused a backlog with the mobile clinics. She answered that in the spirit of rendering health care to as many people as possible, "many" clinics were preferred to "few" hospitals.

Ms M Madumise (ANC) asked if any deaths had been experienced during the termination of pregnancy. How were patients with HIV treated as problems had been reported with the roll-out of anti retroviral drugs?

Dr Manzini replied that that the Community Health Care Project cared for the HIV patients not on anti retroviral treatment. The anti retroviral programme had been linked to the community nutrition programme.

Mr S Njikelana (ANC) asked if the goal of providing a further 100 clinics was not over-ambitious as the vacancy level in the Department was at 34%. With the Public Private Partnerships (PPP) for renal dialyses, had measures been taken into account to ensure they were affordable and accessible? How did the complaints processing centre perform? To what extent had cross border migration of patients affected the Department?

Dr Manzini replied that Department’s goal had been set at 20 clinics per year. These would include the updating of existing clinics and therefore would not affect staff. The reason for turning to PPP with renal dialyses was that the province’s capacity to run a renal unit was not up to scratch and the private sector partnership was a better option. The Transversal and Transformation Services Unit was the complaints processing unit in the Department. Many complaints had been resolved through this unit. Cross border patients were a problem as these patients were treated as any other patient.

The Chairperson regretted that more time was needed to discuss some issues thoroughly time constraints did not allow them to deal adequately with the substance of the presentation.

Gauteng briefing
Head of the Department, Dr L Rispel, presented the 2004-2009 Strategic Plan and Medium Term Expenditure Framework (MTEF) for the province. She outlined the goals and policy context for the 2005/06 budget. The risks associated with the devolution of health services to local authorities had been estimated at R375 million for 2005/06 and the funding of the Department package in accordance with the IHPF had been estimated at R771 million per annum. The MTEF budget for the years 2005/06, 2006/07, 2007/08 were set at R9 257 million, R9 899 million and R1 0355 million respectively. The budgetary increase for the year 2005/06, 2006/07, 2007/08 had been set at 3.5%, 6.9% and 4.6% of the provincial budget respectively.

After identifying the eight budgetary programmes, Dr Rispel identified district health services, provincial health service and central hospitals as claiming the major component of the budget taking 23%, 28.3% and 32.5% respectively.

She concluded that the budget had been considered reasonable in the light of its context and other pressures. The 2005/06 budget was considered to be tight but there would be a constant drive for efficiency and accountability. She mentioned that equity was paramount.

Discussion
Ms S Rajbally (MF) asked if the 43 000 staff members were only for the Gauteng province. What had happened to the cross-border patient flow as they had not been taken into budgetary consideration?

Dr Rispel answered that 43 000 staff member were based in Gauteng and that cross-border patients would be treated as any other patient.

Mr Cachalia asked what percentage of the Department’s budget had been allocated to the prevention and treatment of HIV. What allocation did the province receive from the National Department for the Comprehensive HIV Conditional Grant for 2005/06? Did the Department receive any other funds such as donor funding?

Dr Rispel answered that the conditional grant for HIV had been set at R185 million. Over and above this, the provincial grant had been set at R250 million. Only Nevirapine had been donated.

The Chairperson asked for an indication on how the previous year’s budget had been spent as he felt this would be necessary for a comparison and proper evaluation of the budget.

Dr Rispel stated that the previous year’s budget information had not been included and would be relayed electronically the following day.

The Committee concurred with the Chairperson and suggested that the previous year’s expenditure be included in the report and that a meeting on that should be scheduled.

The meeting was adjourned.