PHC Financing at District level Data, Equity & Analysis

June 2008Candy Day

Health Systems Trust

PHC Financing – district level

Is there progress in equitable allocation of resources?• Research in 2001 indicated

extreme inequity in public sector PHC financing and according to need (deprivation)

Stephen Thomas et alCh 4, South African Health Review 2002

PHC Financing – district level

DI vs PCE, 2001

0

100

200

300

400

500

600

Per c

apita

expe

nditu

re

.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

DI (h

igh

= m

ore

depr

ived

)

.

pcap_2001_r

DI_2001

Linear (DI_2001)

PHC Financing – district level

Health expenditure data• Data generally poorly coded for facility- or

district-level analysis• Published data don’t match well with National

Treasury data• Calculation of useful indicators requires

integration with other data sources

PHC Financing – district level

Measurement of Deprivation• Deprivation index (DI) is a measure

of relative deprivation across districts in SA

• Based on work done by HEU • Normalised DI = 1 (least deprived)

PHC Financing – district level

Variables for DI – Proportion:• children<5• of population Black• female headed households• household head with no schooling• unemployed• traditional/informal dwelling• no piped water• pit/bucket toilet or no toilet• no access to electricity or solar

PHC Financing – district level

Non-hospital PHC expenditure per capita

Provincial exp on non-hosp PHC

+ LG expenditure on PHC

Total population - Population covered by medical insurance

BAS/ Walker

Treasury

StatsSA GHSDHIS from

StatsSA

PHC Financing – district level

Treasury Budget Programmes PR1: AdministrationPR2: District Health Services District Management

Clinic servicesCHCCommunity-based servicesOther community servicesHIV/AIDSNutritionDistrict HospitalsCoroner Services

PR3: Emergency Medical ServicesPR4: Provincial Hospital ServicesPR5: Central Hospital ServicesPR6: Health Science & TrainingPR7: Health Care Support ServicesPR8: Health Facilities Management

PHC Financing – district level

Selected issues• Quality of coding

• Geography• Budget programmes• Facilities

• Cross-boundary areas• Trend analysis – inflation• Data quality

PHC Financing – district level

Data comparison 2005/6

KZN DC23 DC27 ETH

Annual Report

Prov PHC exp pc 246 109 159 118

LG PHC exp pc 36 48 0 113

Total PHC exp pc 178 78 159 215

Treasury Data

Prov PHC exp pc 199 154 269 203

LG PHC exp pc 32 18 0 84

Total PHC exp pc 231 171 269 287

PHC Financing – district level

Selected results• Non-hospital PHC expenditure per

capita increased from R222 in 2001/2 to R256 in 2006/7

PHC Financing – district level

PHC Financing – district level

PHC Financing – district level

General improvement in equity

2001/2 2006/7

Min exp G SibandeR55

SiyandaR151

Max exp EKUR513

NamakwaR497

Ratio 9.3 3.3

PHC Financing – district level

Metros vs ISRDP

PHC Financing – district level

Expenditure in relation to need

0

100

200

300

400

500

600

Per c

apita

exp

endi

ture

.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

DI (h

igh

= m

ore

depr

ived

)

.

pcap_2001_r

DI_2001

Linear (DI_2001)

0

100

200

300

400

500

600

Per c

apita

expe

nditu

re

.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

DI (h

igh

= m

ore d

epriv

ed)

.

pcap_2006_r

DI_2005

Linear (DI_2005)

PHC Financing – district level

PHC Financing – district level

AcknowledgementsThanks to others in the team who

worked with this data:Peter Barron, Mark Blecher,

Fiorenza Monticelli and Elliot Sello