select committee on finance national council of provinces national treasury september 2008

1

Provincial Health Budgets and Expenditure

as at 30 June 2008(2008/09 Financial Year)

[Section 32 of PFMA]

Select Committee on Finance

National Council of Provinces

National TreasurySeptember 2008

2

Health Provincial forecasting trends: 2004/05 - 2008/09

Table: Health Provincial forecast trends for 2004/05, 2005/06, 2006/07, 2007/08 and 2008/09 financial years

2004/05 2005/06 2006/07 2007/08 2008/09

Actual expenditure

as % of appro-

priation 1

Pre-audited under/ over(-)

Actual expenditure

as % of appro-

priation 1


Actual expenditure

as % of appro-

priation 1


Actual expenditure

as % of appro-

priation 1


Actual expenditure

as % of appro-

priation 2

Projected under/ over(-)

30-Apr 5.1% 312 336 6.1% 170 188 6.9% -204 416 6.3% -99 000 7.3% -946 556

31-May 12.7% -298 499 14.3% 106 343 14.7% -577 823 14.4% -667 880 15.6% -2 188 748

30-Jun 20.6% 125 753 22.3% -168 795 22.9% -1 323 602 22.2% -1 426 736 24.7% -4 622 253

31-Jul 28.5% 103 688 30.1% -326 495 31.3% -1 547 837 31.2% -1 002 035

31-Aug 37.0% 18 604 38.4% -996 668 39.6% -1 700 195 39.7% -799 115

30-Sep 45.6% -620 078 47.2% -1 159 151 48.3% -1 634 534 47.9% -1 443 360

31-Oct 54.9% -972 755 55.4% -1 157 087 56.8% -1 405 479 57.1% -1 888 121

30-Nov 62.3% 7 763 62.3% 38 677 63.7% -528 229 65.0% -1 241 015

31-Dec 70.2% 213 564 71.0% 132 169 72.7% -560 460 74.4% -1 474 247

31-Jan 78.8% 314 597 79.1% 469 110 80.6% -384 909 83.2% -1 517 904

28-Feb 87.7% 533 921 87.8% 647 450 90.0% -371 225 92.9% -1 559 889

31-Mar 98.5% 609 908 99.5% 234 139 100.7% -379 166 102.6% -1 597 442

R thousand

1. The actual expenditure as at 30 November to 31 March is compared with the adjusted appropriation.

3

Health (1)

• Spending at R17.1bn or 24.7% against R69.4bn main budget– 8 provinces projecting to overspend their main budgets

• GP – R1.8bn, KZN – R1.6bn• WC – R81.8m underspending

– Increase of R4bn or 30% compared to the previous year – Low rate of health spending in GP (21.8%) and WC (22.1%) – EC (28.8%) and FS (28%) reflects the highest rate of spending in health

• Health Personnel spending at R10.2bn or 26.6% (R38.4bn main budget)

• NPNC spending at R5.7bn or 23.8% of R24.1bn budget– Projected overspending of R645.2m in 5 provinces

• GP – R189.7m, EC – R175.6m

• Capital spending at R1.2bn or 17% of R7bn budget – Increase of 11.8% compared to pre-audited spending last year– Low rate of capital spending in NC (11.5%) and MP (12.3%) – FS (27%) and NW (22%) reflects the highest rate of capital spending in

health

4

Health spending by province

Table : Provincial Health Expenditure as at 30 June 2008

Eastern Cape 9 746 015 10 158 940 2 809 381 28.8% -412 925 – -4.2% 29.4% 38.8% 1 510 071 86.0%

Free State 4 287 858 4 666 452 1 200 596 28.0% -378 594 – -8.8% 30.0% 41.2% 848 420 41.5%

Gauteng 13 889 251 15 671 133 3 033 064 21.8% -1 781 882 – -12.8% 25.7% 42.8% 2 679 465 13.2%

Kw aZulu-Natal 15 042 826 16 639 293 3 924 732 26.1% -1 596 467 – -10.6% 30.6% 40.9% 3 448 952 13.8%

Limpopo 7 594 071 7 719 071 1 884 781 24.8% -125 000 – -1.6% 29.4% 36.5% 1 335 140 41.2%

Mpumalanga 4 241 773 4 455 331 971 921 22.9% -213 558 – -5.0% 21.8% 29.0% 669 047 45.3%

Northern Cape 1 773 588 1 929 644 426 411 24.0% -156 056 – -8.8% 25.6% 33.8% 332 074 28.4%

North West 4 222 549 4 262 081 964 409 22.8% -39 532 – -0.9% 25.3% 35.7% 735 923 31.0%

Western Cape 8 641 973 8 560 212 1 909 897 22.1% – 81 761 0.9% 36.1% 44.8% 1 615 347 18.2%

Total 69 439 904 74 062 157 17 125 192 24.7% -4 704 014 81 761 -6.7% 28.6% 39.3% 13 174 439 30.0%

R thousand

Main budgetProjected outcome

Actual Payments as

at 30 June 2008

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

% share of Health to

total provincial

expenditure

% share of Health to

total Social serv

expenditure

2007/08: Pre-audited

outcome as at 30 June

2007

Year-on-year

growth

5

Health: Programme Analyses

• Programme 2: Provincial District Health Services– Spending at R7.2bn or 25.4% of R28.2bn main budget– Lowest rate of spending in WC (21.9%) and GP (22.1%)– Highest in EC (31.3%) and FS (26.9%)

• Programme 4: Provincial Hospital Services– Spending at R4.2bn or 26.9% of R15.8bn main budget– Lowest rate of spending in WC (18.2%) and MP (20.2%) – Highest in KZN (31.2%) and NC (30.9%)

• Programme 5: Central Hospital Services– Spending at R2.4bn or 26.6% of R9.2bn main budget– Projected over-expenditure of R1.1bn in 3 provinces

• GP – R907m, KZN – R136.7m, FS – R60.6m

– Lowest rate of spending in NW (12.1%) and LP (21.4%) – Highest in WC (32%) and KZN (29.8%)

6

Health: District Services

Table : Provincial District Health Services Expenditure (Programme 2) as at 30 June 2008

Eastern Cape 4 237 898 4 563 008 1 328 382 31.3% -325 110 – -7.7% 13.9% 47.3% 724 072 83.5%

Free State 1 491 986 1 661 142 401 891 26.9% -169 156 – -11.3% 10.0% 33.5% 292 572 37.4%

Gauteng 3 667 278 3 968 432 809 966 22.1% -301 154 – -8.2% 6.9% 26.7% 586 617 38.1%

Kw aZulu-Natal 6 915 052 8 019 248 1 760 465 25.5% -1 104 196 – -16.0% 13.7% 44.9% 1 636 090 7.6%

Limpopo 3 897 792 3 967 792 994 862 25.5% -70 000 – -1.8% 15.5% 52.8% 688 136 44.6%

Mpumalanga 2 183 735 2 382 729 541 803 24.8% -198 994 – -9.1% 12.1% 55.7% 365 534 48.2%

Northern Cape 830 097 903 876 196 965 23.7% -73 779 – -8.9% 11.8% 46.2% 146 946 34.0%

North West 2 052 040 2 084 077 479 827 23.4% -32 037 – -1.6% 12.6% 49.8% 342 805 40.0%

Western Cape 2 964 886 2 964 886 648 144 21.9% – – 0.0% 12.3% 33.9% 553 516 17.1%

Total 28 240 764 30 515 190 7 162 305 25.4% -2 274 426 – -8.1% 12.0% 41.8% 5 336 288 34.2%

R thousand


Actual Payments as

at 30 June 2008

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

% share of DHS to total provincial

expenditure

% share of DHS to total

Health expenditure



2007

Year-on-year

growth

7

Health: Hospital Services

Table : Provincial Hospital Services Expenditure (Programme 4) as at 30 June 2008

Eastern Cape 2 298 463 2 457 840 692 381 30.1% -159 377 – -6.9% 7.2% 24.6% 538 803 28.5%

Free State 1 112 103 1 235 376 338 795 30.5% -123 273 – -11.1% 8.5% 28.2% 225 613 50.2%

Gauteng 3 234 450 3 637 625 816 432 25.2% -403 175 – -12.5% 6.9% 26.9% 700 011 16.6%

Kw aZulu-Natal 3 899 492 4 255 094 1 216 007 31.2% -355 602 – -9.1% 9.5% 31.0% 866 161 40.4%

Limpopo 862 542 917 542 246 775 28.6% -55 000 – -6.4% 3.9% 13.1% 196 390 25.7%

Mpumalanga 569 292 569 292 114 984 20.2% – – 0.0% 2.6% 11.8% 99 209 15.9%

Northern Cape 431 616 481 185 133 439 30.9% -49 569 – -11.5% 8.0% 31.3% 89 653 48.8%

North West 1 084 885 1 089 782 271 416 25.0% -4 897 – -0.5% 7.1% 28.1% 220 182 23.3%

Western Cape 2 305 977 2 305 977 418 897 18.2% – – 0.0% 7.9% 21.9% 280 913 49.1%

Total 15 798 820 16 949 713 4 249 126 26.9% -1 150 893 – -7.3% 7.1% 24.8% 3 216 935 32.1%

R thousand


Actual Payments as

at 30 June 2008

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

% share of PHS to total provincial

expenditure

% share of PHS to total

Health expenditure



2007

Year-on-year

growth

8

Health: Central Hospital Services

Table : Central Hospital Services Expenditure (Programme 5) as at 30 June 2008

Free State 768 473 829 097 212 655 27.7% -60 624 – -7.9% 5.3% 17.7% 156 698 35.7%

Gauteng 3 769 300 4 676 298 906 826 24.1% -906 998 – -24.1% 7.7% 29.9% 869 585 4.3%

Kw aZulu-Natal 1 440 152 1 576 873 429 154 29.8% -136 721 – -9.5% 3.3% 10.9% 326 156 31.6%

Limpopo 695 602 695 602 148 538 21.4% – – 0.0% 2.3% 7.9% 118 619 25.2%

Mpumalanga 538 437 538 437 140 163 26.0% – – 0.0% 3.1% 14.4% 85 511 0.0%

Northern Cape 28 719 33 809 8 063 28.1% -5 090 – -17.7% 0.5% 1.9% – 0.0%

North West 117 317 117 317 14 235 12.1% – – 0.0% 0.4% 1.5% 11 891 19.7%

Western Cape 1 801 295 1 801 295 576 044 32.0% – – 0.0% 10.9% 30.2% 531 964 8.3%

Total 9 159 295 10 268 728 2 435 678 26.6% -1 109 433 – -12.1% 4.1% 14.2% 2 100 424 16.0%

% share of CHS to total provincial

expenditure

% share of CHS to total

Health expenditure



2007

Year-on-year

growth

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

R thousand


Actual Payments as

at 30 June 2008

9

Health: Personnel

Table: Provincial Personnel Expenditure: Health as at 30 June 2008

Eastern Cape 5 480 717 5 767 176 1 534 432 28.0% -286 459 – -5.2% 28.6% 54.6% 1 006 003 52.5%

Free State 2 599 600 2 847 328 691 333 26.6% -247 728 – -9.5% 30.1% 57.6% 514 280 34.4%

Gauteng 6 987 921 8 440 492 1 888 990 27.0% -1 452 571 – -20.8% 34.8% 62.3% 1 401 571 34.8%

Kw aZulu-Natal 8 707 238 10 501 434 2 435 258 28.0% -1 794 196 – -20.6% 33.7% 62.0% 1 865 939 30.5%

Limpopo 4 357 296 4 482 296 1 096 605 25.2% -125 000 – -2.9% 24.0% 58.2% 858 027 27.8%

Mpumalanga 2 307 646 2 532 674 602 937 26.1% -225 028 – -9.8% 22.1% 62.0% 435 789 38.4%

Northern Cape 915 369 929 337 214 481 23.4% -13 968 – -1.5% 23.8% 50.3% 177 783 20.6%

North West 2 268 883 2 300 537 597 741 26.3% -31 654 – -1.4% 25.7% 62.0% 433 156 38.0%

Western Cape 4 771 834 4 771 834 1 154 337 24.2% – – 0.0% 36.5% 60.4% 872 602 32.3%

Total 38 396 504 42 573 108 10 216 114 26.6% -4 176 604 – -10.9% 30.0% 59.7% 7 565 150 35.0%

% share of Health

Personnel to total

personnel expenditure

% share of Health

personnel to total Health

expenditure



2007

Year-on-year

growth

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

R thousand


Actual Payments as

at 30 June 2008

10

Health: Non-personnel Non-capital

Table : Provincial Non-Personnel, Non-Capital Expenditure: Health as at 30 June 2008

Eastern Cape 3 171 115 3 346 723 1 042 233 32.9% -175 608 – -5.5% 10.9% 37.1% 444 322 134.6%

Free State 1 288 570 1 419 436 401 318 31.1% -130 866 – -10.2% 10.0% 33.4% 267 993 49.7%

Gauteng 5 496 287 5 685 995 896 342 16.3% -189 708 – -3.5% 7.6% 29.6% 997 065 -10.1%

Kw aZulu-Natal 5 082 095 4 934 366 1 304 250 25.7% – 147 729 2.9% 10.2% 33.2% 1 274 273 2.4%

Limpopo 2 373 213 2 373 213 663 639 28.0% – 0 0.0% 10.4% 35.2% 358 483 85.1%

Mpumalanga 1 415 972 1 400 288 305 040 21.5% – 15 684 1.1% 6.8% 31.4% 196 984 54.9%

Northern Cape 559 465 701 553 177 648 31.8% -142 088 – -25.4% 10.7% 41.7% 128 684 38.0%

North West 1 504 284 1 511 167 267 657 17.8% -6 883 – -0.5% 7.0% 27.8% 246 539 8.6%

Western Cape 3 197 519 3 197 519 671 714 21.0% – – 0.0% 12.7% 35.2% 639 825 5.0%

Total 24 088 520 24 570 260 5 729 841 23.8% -645 153 163 413 -2.0% 9.6% 33.5% 4 554 168 25.8%

R thousand


Actual Payments as

at 30 June 2008

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

% share of NPNC to

total provincial

expenditure

% share of NPNC to

total Health expenditure



2007

Year-on-year

growth

11

Health: Capital

Table: Provincial Capital Expenditure: Health as at 30 June 2008

Eastern Cape 1 094 183 1 045 041 232 716 21.3% – 49 142 4.5% 27.7% 8.3% 59 746 289.5%

Free State 399 688 399 688 107 945 27.0% – – 0.0% 25.3% 9.0% 66 147 63.2%

Gauteng 1 405 043 1 544 646 247 732 17.6% -139 603 – -9.9% 62.9% 8.2% 280 829 -11.8%

Kw aZulu-Natal 1 253 493 1 203 493 185 224 14.8% – 50 000 4.0% 17.4% 4.7% 308 740 -40.0%

Limpopo 863 562 863 562 124 537 14.4% – – 0.0% 37.1% 6.6% 118 630 5.0%

Mpumalanga 518 155 522 369 63 944 12.3% -4 214 – -0.8% 15.8% 6.6% 36 274 76.3%

Northern Cape 298 754 298 754 34 282 11.5% – – 0.0% 25.9% 8.0% 25 607 33.9%

North West 449 382 450 377 99 011 22.0% -995 – -0.2% 38.6% 10.3% 56 228 76.1%

Western Cape 672 620 590 859 83 846 12.5% – 81 761 12.2% 32.2% 4.4% 102 920 -18.5%

Total 6 954 880 6 918 789 1 179 237 17.0% -144 812 180 903 0.5% 28.7% 6.9% 1 055 121 11.8%

R thousand


Actual Payments as

at 30 June 2008

Actual Payments

as % of main

budget

(Over) Under

% (Over) / under of

main budget

% share of Health

Capital to total

Capital expenditure

% share of Capital to

total Health expenditure



2007

Year-on-year growth

12

Health Grants (1)Comprehensive HIV and Aids Grant

• Objective (Schedule 5 Grant):

– To enable the health sector to develop an effective response to HIV and Aids

– Support implementation of the National Operational Plan for Comprehensive HIV and Aids Treatment and Care

COMPREHENSIVE HIV AND AIDS - 30 JUNE 2008

Province

R thousandEastern Cape 300,522 300,522 65,739 65,739 70,620 21.9% 23.5% 70,620 229,902 Free State 189,630 189,630 47,406 47,406 35,771 25.0% 18.9% 189,630 - Gauteng 541,119 541,119 135,279 135,279 46,810 25.0% 8.7% 46,810 494,309 KwaZulu-Natal 629,694 629,694 144,225 144,225 43,006 22.9% 6.8% 629,694 - Limpopo 234,410 234,410 58,602 58,602 54,614 25.0% 23.3% 54,614 179,796 Mpumalanga 151,849 151,849 41,454 41,454 19,986 27.3% 13.2% 19,986 131,863 Northern Cape 91,444 91,444 21,204 21,204 25,554 23.2% 27.9% 91,444 - North West 205,288 205,288 52,305 52,305 26,648 25.5% 13.0% 205,288 - Western Cape 241,467 241,467 60,366 60,366 49,649 25.0% 20.6% 241,467 - Total 2,585,423 2,585,423 626,580 626,580 372,658 24.2% 14.4% 1,549,553 1,035,870

Payment Schedule:

Year to date

% Actual payments of

total available

Projected outcome for financial year

Received by province:

Year to date

% Transferred of national allocation

Provincial actual

payments

Division of Revenue Act, 2008 (Act No.

2 of 2008)

Total available

Projected (over)/under

13

Health Grants (2)Forensic Pathology Services Grant

• Objective (Schedule 5 Grant):– To continue the development and provision of a comprehensive Forensic

Pathology Service following the shift of this function to the health sector from the SAPS

FORENSIC PATHOLOGY SERVICES -30 JUNE 2008

Province

R thousandEastern Cape 58,129 58,129 14,533 14,533 9,092 25.0% 15.6% 9,092 49,037 Free State 31,198 31,198 7,800 7,800 4,842 25.0% 15.5% 31,198 - Gauteng 77,472 77,472 19,368 19,368 9,346 25.0% 12.1% 9,346 68,126 KwaZulu-Natal 127,757 127,757 31,940 31,940 18,174 25.0% 14.2% 127,757 - Limpopo 33,457 33,457 8,365 8,365 9,601 25.0% 28.7% 9,601 23,856 Mpumalanga 42,003 42,003 10,501 10,501 7,348 25.0% 17.5% 7,348 34,655 Northern Cape 19,169 19,169 4,793 4,793 5,860 25.0% 30.6% 19,169 - North West 22,158 22,158 5,540 5,540 4,665 25.0% 21.1% 22,158 (0) Western Cape 55,535 55,535 13,884 13,884 14,709 25.0% 26.5% 55,535 - Total 466,878 466,878 116,724 116,724 83,637 25.0% 17.9% 291,204 175,674


Received by province: Year

to date

Provincial actual

payments

Payment Schedule:

Year to date


total available

Projected outcome for

financial year



2 of 2008)

Total available

14

Health Grants (4)Hospital Revitalisation Grant

• Objective (Schedule 5 Grant):– To provide funding to enable provinces to plan, manage, modernise,

rationalise and transform the infrastructure, health technology, monitoring and evaluation of hospitals; and to

– transform hospital management and improve quality of care in line with national policy objectives.

HOSPITAL REVITALISATION -30 JUNE 2008

Province

R thousandEastern Cape 282,288 282,288 70,572 70,572 59,588 25.0% 21.1% 59,588 222,700 Free State 202,753 202,753 52,390 52,390 59,022 25.8% 29.1% 202,753 - Gauteng 718,312 718,312 227,770 227,770 105,915 31.7% 14.7% 105,915 612,397 KwaZulu-Natal 285,666 285,666 34,779 34,779 8,494 12.2% 3.0% 285,666 - Limpopo 248,540 248,540 81,562 81,562 20,693 32.8% 8.3% 20,693 227,847 Mpumalanga 244,322 244,322 32,868 32,868 13,794 13.5% 5.6% 13,794 230,528 Northern Cape 246,364 246,364 61,594 61,594 34,222 25.0% 13.9% 246,364 - North West 254,030 254,030 63,509 63,509 43,866 25.0% 17.3% 254,030 0 Western Cape 400,388 400,388 100,103 100,103 41,853 25.0% 10.5% 377,246 23,142 Total 2,882,663 2,882,663 725,147 725,147 387,447 25.2% 13.4% 1,566,049 1,316,614



2 of 2008)

Total availablePayment

Schedule: Year to date


total available


financial year



to date

Provincial actual

payments

15

Health Grants (5)National Tertiary Services Grant

• Objective (Schedule 4 Grant):– To compensate provinces for the supra-provincial nature of tertiary

services provision and spill over effects– To provide strategic funding to enable provinces to plan. modernise.

rationalise and transform the tertiary hospital service delivery platform in line with national policy objectives including improving access and equity.

NATIONAL TERTIARY SERVICES-30 JUNE 2008

Province

R thousandEastern Cape 468,088 468,088 117,024 117,024 117,652 25.0% 25.1% 117,652 350,436 Free State 545,350 545,350 136,338 136,338 152,557 25.0% 28.0% 545,350 - Gauteng 2,186,619 2,186,619 546,657 546,657 546,657 25.0% 25.0% 546,657 1,639,962 KwaZulu-Natal 903,297 903,297 225,825 225,825 303,637 25.0% 33.6% 903,297 - Limpopo 150,168 150,168 37,542 37,542 28,297 25.0% 18.8% 28,297 121,871 Mpumalanga 66,621 66,621 16,656 16,656 12,645 25.0% 19.0% 12,645 53,976 Northern Cape 152,120 152,120 38,031 38,031 23,541 25.0% 15.5% 152,120 - North West 117,317 117,317 29,331 29,331 14,235 25.0% 12.1% 117,317 - Western Cape 1,486,054 1,486,054 371,514 371,514 371,514 25.0% 25.0% 1,486,054 - Total 6,075,634 6,075,634 1,518,918 1,518,918 1,570,735 25.0% 25.9% 3,909,389 2,166,245



2 of 2008)

Total availablePayment

Schedule: Year to date

Provincial actual

payments


total available


financial year


to date


16

Health Grants (3)Health Professions Training and

Development Grant

HEALTH PROFESSIONS TRAINING AND DEVELOPMENT- 30 JUNE 2008

Province

R thousand

Eastern Cape 140,641 140,641 35,160 35,160 36,001 25.0% 25.6% 36,001 104,640 Free State 102,000 102,000 25,500 25,500 43,463 25.0% 42.6% 102,000 - Gauteng 610,828 610,828 152,708 152,708 152,708 25.0% 25.0% 152,708 458,120 KwaZulu-Natal 212,092 212,092 53,023 53,023 3,660 25.0% 1.7% 212,092 - Limpopo 79,834 79,834 19,958 13,306 19,524 16.7% 24.5% 19,524 60,310 Mpumalanga 59,935 59,935 14,984 - 4,545 0.0% 7.6% 4,545 55,390 Northern Cape 45,278 45,278 11,320 11,320 6,960 25.0% 15.4% 45,278 - North West 68,977 68,977 17,245 17,245 17,928 25.0% 26.0% 68,977 (0) Western Cape 356,414 356,414 89,104 89,104 89,104 25.0% 25.0% 356,414 - Total 1,675,999 1,675,999 419,002 397,366 373,893 23.7% 22.3% 997,539 678,460




to date

Provincial actual

paymentsTotal available

Payment Schedule:

Year to date


total available


financial year


2 of 2008)

17

Conclusion

• Concern around large over-spending projection

• Low spending on capital and conditional grants

• Interventions by Provincial DOHs and PTs required

select committee on finance national council of provinces national treasury september 2008

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