Public Health Funding and Health Service Delivery-A Case Study of the Gauteng Province, South Africa
In South Africa, the provision of health care services by public institutions has been reported to be under tremendous funding constraints. This paper reports the findings of an exploratory study to determine the funding process as well as factors which influence funding of the public health sector in Gauteng South Africa by interviewing relevant officials in the province, as well as outpatients at certain public hospitals, since the funding will eventually impact the level of health-care service delivered.
It became evident that allocating funds to the Gauteng Department of Health (GDoH) with specific conditions attached thereto, is an acceptable way of funding national policies and ensuring that such funds are ‘protected’ and spent only for the purposes as stipulated in the accompanying grant framework. There is need for the GDoH and the Gauteng Provincial Treasury (GPT) to ensure that the well-established provincial budgeting processes are followed, which should be accompanied by building technical capacity to ensure that all areas of spending are well funded, information is communicated to all the public health institutions, and that every unit adheres to the budget limitations to avoid overspending.
Keywords: public health service; health service financing; budgeting;
Gauteng Department of Health. 2011. Gauteng Health Turnaround Strategy: “Towards effective service delivery, strengthening primary health care and a clean audit in 2014”. Johannesburg: Gauteng Department of Health.
Gauteng Office of the Premier. 2013. Address by Gauteng Premier Nomvula Mokonyane on the occasion of the opening of the Gauteng Legislature. South African Government Information.
Gauteng Provincial Treasury. 2010. 2011 MTEF Treasury Guidelines. Johannesburg: Gauteng Provincial treasury.
Gauteng Provincial Treasury. 2013. Estimates of Provincial Revenue and Expenditure. Johannesburg: Gauteng Provincial Treasury.
McIntyre, D. 2007. Equity in public sector health care financing and expenditure in South Africa. Public Sector Financing, pp. 29-43.
National Department of Health. 2007. National Health Insurance in South Africa: Policy Paper. Pretoria: National Department of Health.
National Department of Health. 2012. 2013 MTEF Annual Performance Plan. Pretoria: National Department of Health.
Onyango, D. 2013. Improving level of funding the Gauteng public healthcare system [interview] (Personal communication, 11 May 2013).
Public Finance Management Act No. 1 of 1999, as amended by Public Finance Management Act No. 29 of 1999. Pretoria: Government Printers.
Section 27. 2013. Monitoring Our Health: An analysis of the breakdown of health care services in selected Gauteng facilities. Johannesburg: Section 27.
Statistics South Africa. 2012. Census 2011. Pretoria: Statistics South Africa.
Stephen, S., Muirhead, D., Doherty, J. & Muheki, C., 2000. Public Sector Financing. South African Health Review.
Thomas, S. & Gibson, L. 2004. Actor dynamics in financing reform: The contested process of health insurance policy development in South Africa, 1994-1999. Cape Town: Health Economics Unit.
World Bank. 1999. Poverty Reduction and Economic Management. Washington: Malcolm Holmes.
World Health Organisation. 2010. World Health Report. Geneva: World Health Organisation.