sector skills plan for the health sector in south africa

Table 3-1 Health expenditure in public and private sectors: 2007 -2010
2006/07 2007/08 2008/09 Est 2009/10
Public sector
R Million
National Dept of Health 1 3,136 3,829 4,755 5,134
Provincial departments of health 51,938 60,645 72,444 87,596
Defence 1,602 1,743 2,024 2,265
Local government (own revenue) 1,317 1,478 1,625 1,793
Other (Correctional services, Police &
social insurance funds) 2 2,371 2,610 2,957 2,974
Total public sector health 60,364 70,305 83,805 99,762
Private sector
Medical schemes 58,349 65,468 74,089 81,128
Out-of-pocket 26,596 31,183 34,270 36,498
Medical insurance 2,056 2,179 2,452 2,660
Employer private 982 1,041 1,172 1,271
Total private sector health 87,983 99,871 111,983 121,557
Donors or NGOs 2,503 3,835 5,212 6,319
TOTAL 150,850 174,011 201,000 227,638
1. Includes selected public entities.
2. Social insurance funds are the Compensation Fund for workmen’s injuries on duty and Road Accident Fund. Costs of private
and public healthcare providers are included in the amounts paid.
Source: National Treasury. Budget Review 2010.
3.2.1 PUBLIC SECTOR SPENDING
Public spending on health declined in real terms between 1996 and 2005, and this resulted in shrinkages
of personnel and other resources. 41 However, public sector spending on health increased by 16.7%
annually between 2005/06 and 2008/09. By 2011/12 it is expected to be more than double the
spending in 2005/06. 42 Public funding of health is 3.7% of GDP and 13% of the main budget. In 2009 the
per capita expenditure was about R2,058. 43
Over the last 15 years the public sector has moved from a hospital-based approach to a primary
healthcare (PHC) approach. 44 This is also reflected in public sector spending. Government spends about
41% of public health funds on district health services which includes primary care clinics and community
health centres, district hospitals and AIDS interventions. Regional hospitals receive 18%, while central
and tertiary hospitals receive 15% of spending. 45 Hospital budgets declined by 2.3% in real terms, with
added pressure on central hospitals in Gauteng and KwaZulu-Natal and district hospitals in the Eastern
41 Harrison, D. 2009. An Overview of Health and Health care in South Africa 1994-2010: Priorities, Progress and Prospects for
New Gains. Published at www.doh.gov.za. (Accessed February 2010).
42 National Treasury. 2009. “Health”. In Provincial Budgets and Expenditure Review 2005/06 – 2011/12.
43 National Treasury. 2009. “Health”. In Provincial Budgets and Expenditure Review 2005/06 – 2011/12.
44 Coovadia, H., Jewkes, R., Barron, P. et al. 2009. “The health and health system of South Africa: historical roots of current
public health challenges”. Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010).
45 HEU Information Sheet 1. 2009. “Public sector health care spending in South Africa”. Health Economics Unit, University of
Cape Town. Published at http://www.heu-uct.org.za. (Accessed August 2010).
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