South African attempts to reduce inequity have focused on the distribution of health expenditure. The central government uses formulae to determine allocations to the nine provinces, whose primary responsibility is delivery of social services including health, education, and welfare. Provincial governments allocate the funds among the services, as well as geographically within the province. They have limited capacity to raise additional revenue.
The formula used to distribute funds among the provinces is largely based on population figures. The health component of the formula includes adjustments for the age and gender distribution of the population, as well as a deduction for the estimated number of people who use private health services. A small component of the formula is based on historical infrastructure inequities.
The Eastern Cape Province has measured intra-provincial expenditure distribution among jurisdictions of several sizes (for example, regions and districts). Large inequities have been identified, which largely mirror health status inequities. The immobility of infrastructure and (to a lesser extent) personnel has, however, frustrated geographic redistribution of expenditure. Similarly, it has been difficult to close or down-size hospitals, thereby limiting redistribution of resources toward primary health services.
Among the issues raised by Eastern Cape experience is the increasing importance of cross-border patient flow as the jurisdiction's geographic area decreases. Another issue relates to the increasing cost of providing a specific service as population density decreases. The paper focuses on the impact of these issues on South Africa's efforts to reduce inequities in the delivery of health services.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will have: 1) An increased knowledge of health input disparities in South Africa 2) An increased understanding of methodologies to measure health input inequities and corresponding advantages and limitations
Keywords: Access to Health Care, International Public Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: USAID (funding of the EQUITY Project supporting health systems development in South Africa); Management Sciences for Health (technical assistance under the EQUITY Project)
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment with MSH