A REPORT commissioned by the government says overspending in the Free State will lead to cuts in services this financial year unless radical measures are taken.
The HIV Clinicians Society in February estimated that up to 30 people were dying a day when the province ran out of money for drugs, including antiretroviral medication.
The report is part of a review commissioned by former health minister to investigate overspending. Its findings may yet reflect a similar trend in other provinces.
Blaming overspending on the cash-based reporting system, the report says unfunded mandates, such as the occupation-specific dispensation for public servants’ pay, were contributing to overspending in the Free State.
The report, compiled by consultants led by Deloitte & Touche, is part of a series that includes an assessment of the national and provincial health departments. Funding for the review, completed in April, was provided by the UK government.
In the past four years, the province’s health allocation was constant at a quarter of the budget. But the relative proportion of the national conditional grant for HIV/AIDS decreased.
The per capita health budget for 2005-06 to 2010-11 was lower than at national level.
The report says expenditure in the Free State was worsened by nurses’ occupation specific dispensation payment, higher budgeted pay rises, medical inflation and more patients on antiretroviral therapy than forecast. The review points to lack of cohesion between policy formulation, budgets and resources, leading to the perception that the public health sector was underfunded.
It notes a dearth of national guidelines, norms, standards and targets. Senior managers were preoccupied with bureaucratic functions, especially financial, and were not focused on service.
Monitoring and evaluation were inadequate, and “although much time and resources is invested in data collection, these data are not analysed, interpreted or used for decision-making and there is little or no feedback information from one level to the next”.
Planning was formulaic, based on compliance and not utilised as an effective management tool. There were many plans at different levels, “which do not support each other, and there is confusion around the terminology of various plans”, says the report.
It is critical of the model for scaling up antiretroviral therapy, saying it is “unsustainable from a health-systems perspective and unaffordable from a budgeting perspective”.
While in previous years overspending was funded with additional cash flow from the provincial treasury, in the past financial year none was provided, resulting in a reversal of the overspending trend and rationing of services such as the supply of antiretrovirals.
Department of Health spokesman Fidel Hadebe said he could not comment on the review. Free State government spokesman Teboho Sikisi could not be reached.
johwaw@bdfm.co.za