The ALP was reacting to Finance Minister Trevor Manual’€™s announcement this week that systems were being designed to improve the national health department’€™s ability to monitor provincial expenditure.

In the past few months, the HIV/AIDS treatment programme in the Free State virtually collapsed due to massive overspending in the province.

The province was unable to buy adequate supplies of antiretroviral medication, potentially affecting the 33 000 people already on treatment. Treatment for some 15 000 people who urgently needed ARVs was delayed.

KwaZulu-Natal has also overspent its health budget by over a billion rand, while most other provinces’€™ health departments are also in the red.

Health Minister Barbara Hogan has appointed a team of health and finance experts to visit provinces and assess the overexpenditures, as well as to assess the health services.

Hogan is well aware of the structural problems that hamper implementation of health services in provinces.

‘€œThe ANC identified both health and education as priorities at its Polokwane conference, as neither have been great performers since 1994,’€ said Hogan in an interview with Health-e.

‘€œWith both, there are concurrent powers [in the Constitution] and the provinces responsible for implementation,’€ said Hogan.

‘€œI can’€™t, as national Minister, instruct an MEC in a province to do something. I don’€™t want to tinker with the Constitution. But there are a number of misfits. We need to find smarter ways to deal with the lack of an integrated health system.

‘€œThe relationship between the Minister and the MECs is critical. We have to see ourselves working together as Team Health.’€

The ALP has said that by giving bigger health allocations to provinces, Manual has ‘€œreinforced the need for effective synergy and oversight of the provincial implementation of nationally determined priorities’€.

Meanwhile, the Institute for Democracy (Idasa) notes that expenditure on health ‘€œconstitutes more than one-fifth of all consolidated

government expenditure on social services in 2009/10’€.

The 2009 Budget allocates R17.1 billion to the national Department of Health, of which R15.6 billion goes to grants for provinces.

However, Idasa notes that the budget ‘€œis set to increase by 10.3% on average annually over the medium

Term’€, which is ‘€œlower than that projected between 2007/08 ‘€“ 2010/11, which was 14.1% on average’€.

Idasa also notes that the health department ‘€œappears to be struggling to spend its capital budget’€.

By the end of November 2008, when at least 75% of the budget should be spent, the health department had only spent 58 % of its capital budget and 63% of its current budget.

‘€œThis trend is suggestive of ‘€œfiscal dumping’€, in which the bulk of expenditure takes place in the fourth quarter of the financial year,

sometimes on wasteful and/or non-productive expenditure,’€ said Idasa.