sahr2001 - Health Systems Trust

final stage is the approval of the municipal budget by its Council.
Klugman and McIntyre 4 noted that some health departments are under
considerable pressure when competing with other departments for a fair share
of their local government’s budget. This departmental resource competition
has been made more difficult by the continuing debates over the constitutional
definition of municipal health services. As one local official explained:
“Departmental heads think provinces should just take over [health services]
and pay. We think the municipality should pay more [towards health services]
but the department heads don’t like this. Politicians don’t seem that aware of
this issue.”
A number of interviewees in the current study indicated that local government
councillors are very unclear on what health services are the responsibility of,
and are provided by, their municipality, which limits their ability to make
informed decisions about the allocation between health and other local
government departments.
It is critical that resolution on the definition of municipal health services is
achieved. There is considerable concern that if municipal health services are
defined as including all district health services, local governments will be
expected to fully fund these out of their ‘own revenue’ and will not be able to
do so. However, this concern appears to be unfounded as the constitution
explicitly makes provision for each sphere of government to receive an
equitable share of nationally collected revenue to enable it to perform its
constitutional responsibilities. A large portion of the future integrated district
health services are currently funded through transfers from national Treasury
to provincial governments. If district health services were to become the
responsibility of local government, local government fears could be allayed
through reducing the provincial share of national resources (by the value of
current spending on district level health services) and increasing the local
government share of national resources by the same amount.
The process of local government budgeting is set to change dramatically
with the move towards Integrated Development Planning. Although
preparation of an Integrated Development Plan (IDP) by each local
government is a legal requirement under the Municipal Systems Act of 2000,
only one of the municipalities interviewed claimed to have an IDP in place.
The IDP is a participative process involving a range of stakeholders whereby
municipalities develop a strategic development plan, which is intended to
guide all planning, management and decision making in the municipality. 5
The IDP covers a five-year period in line with the period that the council will
be in office. It should explicitly outline the development priorities of the
municipality, (which should be based on the needs of the community), and
thus serve as a guideline for the strategic allocation of resources in pursuit of
these priorities. The IDP should be reviewed annually to respond to changing
needs and circumstances.
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