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Show us the money for NCDs – draft health budget

Numbers don’t lie, especially if you take a look at the place of NCDs in the draft health budget. The words about NCDs imply commitment to solving a huge health problem.   That is superficial though when it comes to NCDs. There a heaps of great sounding words (policies and plans) but a clear lack of money. Especially for screening and treatment. Words, even printed ones, are cheap. Little has changed:

Whilst the Minister in the preamble of the Annual Performance Plan highlights importance of tackling non-communicable diseases (NCDs) there doesn’t appear to be any dramatic shift in budget allocation over the Medium Term. Can the department provide reasons for this?
Issues for consideration Parliament Research Unit. Vote15: Health Budget 2014/15 p.6

Health is allocated less than 5% of the proposed national budget (Figure 1). Defense get more yet SA loses more people to NCDs each day than in armed conflicts. Where are our national priorities?

2015budgetpie

Figure 1:

Looking at the details of the health budget

health budges

The smallest by far is Programme 4 for Primary Health Care (PHC) services (R 225 -million)
Most People Living With NCDs  get care at primary health care (PHC) clinics and this appears to be the reasoning why NCDs are placed within Prog 4 . People living with HIV/AIDS

Our information comes from the draft Annual Performance Plan (APP) and its accompanying budget.  – see pages 61-63. Click here to download the draft APP 2015/2016-2017/8

Fast facts stacking up Programme 4 vs other NDoH Programmes 2015/16

Smallest programme
budget by far
See Figure 2
1st place people costs Programme 4 cost of PEOPLE EMPLOYED R186.2 million = ↓ money available for implementation
2nd largest # people
employed
458 by only 10 people short of no 1 placed Programme 1 (p. 27)
Only programme to increase personnel costs Leaving less to spend on implementing programmes/ plans

3 NCDs issues related to HIV/AIDS and Maternal Child health appear in Prog 3 budget (cancer cervix, breast cancer policy, immunizations.) Cancer of the prostate does not warrant a mention in the APP.
The key to the APP is words not allocation of funds. Again NCDs screening and treatment is left high and dry.

Fast facts about NCDs Prog 4 budget

Where is the money for implementation of the NCDs plan in this budget?

89.37%  for people working on projects – personnel, contractors and consultants
0           for screening of target of 8 million people for high BP and blood glucose OR
NCDs Commission/ Health Commission
(more next week on this)
1.3 %       NGOs or non-profits  (< R 3-million) > 50% goes to 2 of 6 NGOs
National Council Against Smoking & SA National Council for the Blind.

prog 4 sub prog allocation

NCDs prevention and treatment cross cuts all Programmes especially at the PHC level. So we need to look at inside other programmes. However, without exception there is no separate financial allocation for stated NCDs targets like for example breast cancer policy development and cancer of the cervix screening in Programme 3 (HIV/AIDS & TB.)  Innovations like “ideal clinics” which are supposed to include NCDs take place without consulting NCDs civil society organisations.

Examples from Programme 2: NHI

  • Drug procurement and stock out management (all drugs including ARVs)
  • National Cancer Registry (words no money)

Programme 3: HIV/AIDS & TB

  • Cervical cancer screening
  • Breast cancer policy (more words no money)
  • Vaccinations against hepatitis & human papilloma virus
  • Obesity policy (more words no money)

Watchdogs must bark. An NCDs advocacy series. This is the first in a series on NCDs in policy documents.

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