“We are concerned by the lack of focus on health in the budget speech,” comments SECTION27’s health and education team. “Neither the health priorities as outlined in the State of the Nation Address (the management of tuberculosis and the creation of a State pharmaceutical company), nor the Ministerial priorities in the Negotiated Service Delivery Agreement are addressed in the budget speech.”
Most of the focus is on talking up South Africa’s ARV programme for health, and the three million people on it, but questions about its sustainability need to be addressed – what use is it to have so many people on ARVs if their access to drugs is intermittent, for instance?
SECTION27 says the “shift of responsibility for NHLS [the stricken National Health Laboratory service] to the National Department of Health is to be welcomed. This is an institution that requires significant investment to ensure its recovery from its near collapse due to non-payment by provinces. In particular, the NHLS [has] lost many staff members and needs both financial and human resources to effectively play its role in the health system, specifically with regard to HIV and TB testing.”
From a practical point of view, it’s good that the Office of Health Standards Compliance has received its own budget. It should play a vital role in ensuring the success of the National Health Insurance (NHI) project.
On that note, once again we’ve received a promise of the elusive White Paper on NHI.
“Treasury still has not released its paper and this appears to be holding up the policy making process,” says SECTION27. “No business plans for the piloting programme were published last year, making the tracking of progress near impossible.” We’re in the fourth year of this process, and so much is still up in the air.
We need to have some bullet points about progress, money already spent and how money should be spent this year and next – having this hanging over our heads as an amorphous shadow is untenable, love it or loathe it.
One of the huge elephants stomping round the healthcare room is inefficiency in various spheres of public sector management. “The statement that non-payment of suppliers (a huge challenge in health) is to be remedied through a requirement in performance agreements of accounting officers is already an obligation in the Public Finance Management Act, so is unlikely to address the problem,” says SECTION27.
It’s nice to see that the Eastern Cape – a poor performer on public health, and one where there are huge gaps – get so real with its planning that it gets a nice juicy chunk of additional spend. How is it going to be managed and accounted for?
All in all, an unenlightening budget for the healthcare system which leaves one wishing for more – not more money, perhaps, but a tighter sense of how it will be spent, and how we will achieve more efficient spending which allows for more to be dedicated to some serious but neglected needs.
Main take-home points*
The health department's budget allocation for 2015/16 is R157.3bn (around 8% up from 2014)
The ARV treatment programme now reaches 3m patientsThe mother-to-child transmission of HIV has decreased from 20% a decade ago to two percent last year, and is expected to decline further over the period ahead.
A pack of 20 cigarettes will now cost around R36.62, an effective R13 366.30 per year for someone who smokes one box a day. For someone who smokes 40 a day, that amount soars to over R25 000.00
Beer goes up by 15,5 cents a quart, a bottle of wine by 15 cents, a bottle of sparkling wine by 48 cents and a bottle of whisky by R3.77.
A substantial part of the budget was for HIV/Aids, tuberculosis, and maternal and child health.
R1.5bn was being shifted from provincial budgets to the national health department to enable the National Institute of Communicable Diseases to be directly funded. This shift would be offset by lower tariffs for services provided by the National Health Laboratory Service.
The Office of Health Standards Compliance had been listed as an independent legal entity. This office would be responsible for inspecting and accrediting all public and private health facilities.
The department was in its fourth year of the phased 15-year roll-out of the National Health Insurance (NHI). A NHI fund would be established over the medium-term to purchase health care services on behalf of the population.
There had been a marked reduction in child mortality in the past five years, supported by improved access to antenatal services.
With effect from 1 April 2015 the old age, war veterans, disability and care dependency grants will increase by R60 a month to R1 410; child support grants increase to R330; foster care grants increase by R30 to R860.
*Additional reporting by Health24.com
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