Department of Health Budget Review

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Health

28 February 1999
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HEALTH PORTFOLIO COMMITTEE

HEALTH PORTFOLIO COMMITTEE
1 March 1999
DEPARTMENT OF HEALTH BUDGET REVIEW

Documents distributed:

Presentation to Portfolio Committee on Health in Preparation for Health Budget Vote: 1999
National Department of Health: Budget and Actual Expenditure

SUMMARY
A budget of R601 million for 1998/99 was only 88% utilised (R533 million), though hospital grants will be rolled over. The Director-General and various members of the Department presented parts of the budget and the work achieved and planned. Problem areas included: redistribution of hospital service grant and hospital rehabilitation grant (both areas in desperate need of attention); slow progress of Umtata hospital; bad governance of national nutritional (school feeding) scheme; slow progress in implementing poverty relief project. The department assessed progress in HIV/Aids prevention programme, in clinic building, rural health schemes and upgrading of hospitals, pharmaceuticals, food control and radiation control planning.

MINUTES
(1) Presentation by Mr Muller of the Department.
-- In 1998/99 budget the Department had spent 88% of its budget to date (i.e., R533 million of its R601 million).
-- Hospital grants have not been fully utilised, but will be rolled over. About R200 million will be allocated in the next budget for hospital rehabilitation; between R55 million and R112 million for redistribution of Hospital Service grants.
-- The nutrition programme has not been up to scratch, mainly through lack of proper administration. A 5% increase will be made in the next year.
-- Poverty relief project has been very slow to implement, mainly because of administrative difficulties as it is difficult to initiate these projects on ground level as they must develop into self-reliant sustainable projects.
-- New grants are planned for Hepatitis B, R88 million; Vaccine production, R20 million; HIV/Aids government plan, R58 million.

(2). Presentation by the Director-General.
The Director-General would like to see integration of the nine departments; there are 42 health regions and 174 demarcated districts, and a great need for district managers.
-- Clinic upgrading and building (see pp 3-5 of Presentation Document). There are now 495 new clinics, 92% of which are operational. Pharmaceuticals are outsourced, and improvements seen in some provinces. Many of 7200 staff are redeployed from hospitals, and this has presented many problems. In future medicines in hospitals/clinics will only be on a limited list, and if sold illegally, can easily be identified. (See pg 33 and pp 37-42 of Presentation Document).
-- New Umtata Hospital (pg 11): estimated cost R367 million, some of which (R164 million) is contributed by the Department. There will be around 500 beds, and it will become a referral hospital.
-- New Durban (Cato Manor) Academic Hospital (pg 10): has been slow in completion. Total estimated cost is R1,12 billion.
-- HIV and Aids: R53 million has been allocated, particularly for Aids education, because youth appear to have a very shallow knowledge of the condition.
-- About 1000 junior doctors have been successfully deployed. Dentists and pharmacists next (pg 45).
-- Crime prevention strategy, i.e. looking at causes of death. 75% in Soweto are gunshot related. 53% in Pretoria are motor-vehicle related. Hopefully, this kind of analysis will assist in crime prevention.
-- Decentralisation of hospital management in 15 of the largest hospitals (pg 16), and design competency management, efficient spending. Later Dr Tim Wilson spelt out the plan to "twin" hospitals with UK hospitals, learning management techniques from each other.
--Nutritional Programmes (pg 47): forensic audits had been planned in 1995, but not yet completed in all provinces, where there was shown to be no financial control programmes, no business planning, poor performance by personnel, who needed training. Challenges and resolutions, pg 53.
--Poverty Alleviation Programme: R28 million. Projects not yet implemented because must become sustainable.

Questions:
Dr Jassat (ANC) asked why AZT was not going to be used on pregnant women to prevent transmission of Aids.

Answer: Cost (around R60 to R70 per person), and this would not be dealing with causes. Research has shown that about 40% of babies get Aids from breast-feeding. However, the Department has not closed its mind to the possibility, though they still wish to concentrate on prevention.

Ms Baloyi (ANC) asked questions about the slow progress of the Umtata Hospital, and about the appalling ambulance service, particularly in the Eastern Cape.

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