Health Minister Motsoaledi defends underspending on health insurance
The minister explains that he was thrifty with funds allocated to his department so as to meet other health priorities
Health Minister Aaron Motsoaledi on Thursday defended the slow spending in National Health Insurance (NHI) programmes overseen by his department, saying he had anticipated that the money would be needed for other purposes.
Treasury documents show that only 10.4% of the NHI indirect grant allocated for the 2018/2019 fiscal year had been spent by the middle of the year, or September 30. The Treasury redirected R546m from the grant to meet President Cyril Ramaphosa’s commitment to fill 2,200 critical health vacancies and purchase beds and linen, which he made when he announced his economic stimulus package in September.
“I did not push that that money was spent because I was warned as early as May we might not get any new money, that we might have to reprioritise [the budget] … and the NHI money was mentioned. I realised if we rush using this money for new things, it will be a crisis for the country,” said the minister.
“I really don’t regard it as underspending. It was a strategic way of solving problems that are here and now,” he said at an event in Cape Town hosted by the University of Stellenbosch Business School.
Figures provided by the department of health show none of the R491m allocated within the grant to the priority health programmes, such as school and mental health services, had been spent by October 25. Only 15% of the R160m budget for patient information systems had been spent, while a mere 29.6% of the R360m budget for the chronic medicine dispensing programme had been disbursed.
THe Treasury announced last week during the medium-term budget policy statement that about R350m had been set aside for the remaining period of the 2018-2019 fiscal year for hiring critical health-care staff, while R150m will be used to purchase linen and beds.
The priority posts have been identified as 442 medical interns, 100 medical officers, 421 registrars, 100 specialists, 200 nurse specialists, 1,000 nursing assistants, and 500 enrolled nurses, according to the department’s deputy director-general for human resources, Gavin Steel.
“These ratios are based [on] public health considerations. The precise distribution will be finalised in consultation with the provinces in accordance with service delivery needs,” he said.
The division of revenue bill shows that the biggest budget allocation for critical posts goes to Gauteng (R90.4m), followed by KwaZulu-Natal (R67.1m ), and Eastern Cape (R46m ). Western Cape is allocated R31.2m.
The minister said the national health department’s role is to help determine where the personnel should be allocated, but they would be employed by provincial health departments.
The beds are to be procured from a company called RT24, while linen will be purchased from an enterprise supported by the department of labour, which employs people with disabilities. These products will be procured centrally.
A total of 140,000 linen packs, including sheets, towels, blankets and pillow cases are to be procured and distributed to the provinces, depending on their budget allocation.
The minister told delegates that the reforms proposed under NHI are necessary if SA is to provide quality health services for everyone, and improving public health service alone would not do the job. Private health-care services are exorbitantly priced, and need to be regulated, he said.
The minister went on to say that it is “grossly unfair” that the state subsidises the medical scheme membership of civil servants and employees of state-owned enterprises, and the money could be better spent on NHI.