Reading the Auditor General’s report 2018-19 is not the way to finish off a week. It is a dismal tale of woe which adds another distressing layer to the state capture saga. What is truly distressing is that this information is in plain sight and very little is done from one year to the next. The Citizens version candidly spells it out: “overall audit outcomes take a turn for the worse over five years.” For me, it is much clearer that the boffins’ version of the report which sugar coats the message as “audit outcomes regressed since 2014/15.”
Provincial departments of health are in a bad state and need urgent intervention to prevent collapse. An exception is the Western Cape.
Serious weaknesses in the financial management of national & provincial government unaddressed in the last five years. (Section 4)
The quality of the performance reports slightly regressed since 2014/15 from 66% to 62% (auditees publishing credible reports).
Little improvement on key government programmes according to the National Development Plan Section 6 district health services (HIV/AIDS, TB &maternal & child health) box below water infrastructure development, housing development finance, school infrastructure delivery expanded public works programme.
72% of the auditees materially did not comply with legislation similar to the previous year & slightly higher than the 70% in 2014/15.
What does this mean for National Health Insurance Bill and sweeping changes needed for the financing of health care? The National Department of Health is not among those that received a clean (unqualified) audit.
Reading the Auditor General’s report 2018-19 is not the way to finish off a week. It is a dismal tale of woe which adds another distressing layer to the state capture saga. What is truly distressing is that this information is in plain sight and very little is done from one year to the next. The Citizens version candidly spells it out: “overall audit outcomes take a turn for the worse over five years.” For me, it is much clearer that the boffins’ version of the report which sugar coats the message as “audit outcomes regressed since 2014/15.”
Provincial departments of health are in a bad state and need urgent intervention to prevent collapse. An exception is the Western Cape.
Serious weaknesses in the financial management of national & provincial government unaddressed in the last five years. (Section 4)
The quality of the performance reports slightly regressed since 2014/15 from 66% to 62% (auditees publishing credible reports).
Little improvement on key government programmes according to the National Development Plan Section 6 district health services (HIV/AIDS, TB &maternal & child health) box below water infrastructure development, housing development finance, school infrastructure delivery expanded public works programme.
72% of the auditees materially did not comply with legislation similar to the previous year & slightly higher than the 70% in 2014/15.
What does this mean for National Health Insurance Bill and sweeping changes needed for the financing of health care? The National Department of Health is not among those that received a clean (unqualified) audit.
Finance Minister Tito Mboweni says the country needs to work on the implementation of policies if it is to realize improvements and growth in the country’s sluggish economy.
Mboweni made the comment when he delivered his opening remarks at the third economic colloquium on the South African economy on Thursday.
“One of the biggest constraints to economic growth in South Africa is lack of implementation about things that were decided upon. If we at least implement 30% of the things we said we would implement then we would be making great progress,” said Mboweni.
The third economic colloquium will see government officials, public and private sector economists, and academics deliberate on policy proposals on how to improve and grow the South African economy.
The colloquium comes in preparation for the Medium Term Budget Policy Statement (MTBPS) to be tabled in Parliament during October.
Following the first colloquium, the Minister presented ideas emanating from the engagement to the governing party – the ANC.
“One of the things I have learned over the years is that you need political buy-in. If you think you can just parachute policy from somewhere without political buy-in, then you are wasting your time, which most think tanks do not understand. Because at the end of the day, policy is politics.” said the Minister.
Tito Mboweni
The economic colloquium will also allow delegates to discuss the recently published paper on South Africa’s economic strategy titled “Towards a growth agenda for the South African economy”.
Mboweni said well over 700 comments were received on the paper by the National Treasury.
“My guidance to the Treasury staff when going through the comments was that ideas which are internally consistent with what we are trying to do we should incorporate.
“Those that are internally inconsistent we should just appreciate the contribution and say this is not consistent with what we are trying to do,” he said.
Mboweni said he and his team would spend the upcoming weekend putting the final touches to the MTBPS while also finalising the economic strategy document.
“We are now at the tail end of the preparations so this meeting gives us the opportunity to have the last bite.
“The expectation is that when we submit the MTBPS we should also provide the finalised version of the economic strategy document,” he said.
While the MTBPS was scheduled to take place on 30 October 2019, Minister Mboweni announced that this was likely to change to allow the President to attend.
“I need to say here that the Medium Term Budget Policy Statement is likely to be presented earlier than the 30th of October. We had initially planned on the 30th.
“We had planned that around the President’s diary. It turns out that he might be out of the country. So we are going to have pull back the date. We are looking at the 29th of October 2019,” he said.
According to Treasury, SA’s current economic path is unsustainable with the country facing the triple threat of stagnating economic growth, rising unemployment and high inequality.
Since his appointment, Mboweni has hosted two successful economic colloquia.
The previous colloquia assessed some of the viable policy proposals and interventions that encourage new models and paradigm shifts to support faster and more inclusive economic growth in South Africa.
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?
Figure 1:
Looking at the details of the health budget
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
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.
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.