Health specialists have expressed concern that the budget announced by Finance Minister Trevor Manuel did not go far enough in addressing South Africa’€™s developmental health challenges.

Supplementary allocations made by Manuel are R120-million in 2001/02 for short-term poverty relief measures, including interventions in response to cholera outbreaks.

R580-million will also go to water supply and sanitation projects, particularly in areas affected by cholera.

Professor Lucy Geilson, deputy director at the Centre for Health Policy (University of the Witwatersrand) said although the allocation towards cholera was reasonable it was important to stipulate how it would be spent.

“Will it be linked to other interventions? The money in itself is not enough and when one takes into consideration that a rich country such as ours is in the midst of a cholera outbreak, you have to ask the question whether enough is being spent.”

Geilson welcomed the increase in social sector spending, but cautioned that it had to be seen in the context of previous years where there had been no increase.

“So, you have to pose the question whether this is sufficient in the light of the failure to increase it in previous years,” Geilson said.

She said the main thrust had always been fiscal constraint, but “we have to ask at what cost”.

Geilson said issues of capacity were also constraining spending. “Although the money is allocated to the provinces, they are frequently not in a position to spend it.”

At local government level, Geilson questioned whether the increases would be adequate to match the responsibilities given to these structures.

Professor Di McIntyre, Director at the University of Cape Town’€™s Health Economics Unit, pointed out that the increase in health over the next three years would average 7,3% per annum (that’s just keeping up with inflation). “That’s on a par with other social services, but overall it’s less than the consolidated national expenditure which will increase by 8,1% per annum over the next three years. This means that spending on health is falling behind,” McIntyre said.

“I don’t feel that health is getting the kind of policy priority that it has before. Prior to 1998/99 it was keeping up with inflation and was receiving increases that were higher than the norm.

“In fact what we’re seeing is quite a drop. In real per capita terms, the social services are in a serious predicament.

“I do think the arms deal has contributed to this – it’s clear from the increase in defence spending.” McIntyre said that in some ways the Minister had tried to protect social services by allowing the deficit to increase, but in the end the increase in defence spending would adversely impact on what money is available.

She said local government spending on health services was a very controversial area at the moment as there was a tug of war between provincial and local governments.

“By not specifying exactly what local government should spend on health care, it seems the Department of Finance is trying to let the health sector reach some kind of consensus about which way to go,” McIntyre said.

Andrew Boulle, Health Systems Trust research manager said the R3,75 billion grant was a lot less than was needed for hospital rehabilitation.

“The 1996 health facilities audit estimated that R12 billion over eight years was needed for the rehabilitation of public hospitals. This isn’t going to leave enough for hospitals to be improved,” said Boulle.

He said the Department of Health strategic framework plan drawn up in 1999, anticipated that they would have R400 million and R500 million respectively over two years for hospital rehabilitation.

“The money from the national fiscus will not be enough to meet the rehabilitation backlog. Either they will need to find additional revenue or they will need to align the rehabilitation of hospitals with the national planning framework for hospitals which has still be finalised. This should result in a smaller, more efficient hospital portfolio,” said Boulle.

McIntyre added, “from a public health perspective all the international research shows that it is a very good strategy to hike taxes on cigarettes.

The major effect on price increases in making cigarettes expensive is that it deters adolescents from starting smoking. As a public health strategy that’s marvellous.”