Financing and Need across District Municipalities

Decentralisation and equity are key goals of the South African health sector. Yet decentralisation typically threatens the equity of health care financing. This chapter maps the public funding of non-hospital Primary Health Care services across local government areas in four provinces. It also calculates measures of deprivation for each district municipality to indicate need for heath services. The equity of financing of Primary Health Care in relation to need is then evaluated and the equity of health care financing from different public sector sources is compared. This study reveals that the funding of Primary Health Care is extremely inequitable both across and within provinces. Local Government funding is the least equitable funding source, inversely related to need. Provincial funding does little to correct inequities and in some cases exacerbates the picture. Without intervention the country-wide financing of the standard Primary Health Care package, proposed by the national Department of Health, will prove impossible. A national mechanism is therefore required to manage the financing of decentralised health care and correct inequities in the fragmented funding of Primary Health Care. A system of targets for provincial budgets, using deprivation indices, is proposed. 6