Factsheet on Non-Negotiable Budget Items in the Provision of Public Health and HIV/AIDS Services in South Africa

By Silindile Shezi, Plaxcedes Chiwire, Nhlanhla Ndlovu  |  | 


A recent benchmarking exercise done by the Health Systems Trust indicates that spending on health goods and services increased at a relatively slower pace that the compensation of employees, in the last three years (Day and Daviaud, 2014). The goods and services spending grew by only 4% whilst spending on personnel grew by 12% (ibid.) A balance needs to be struck between the two spending areas to ensure that health programmes are delivered to the population as needed. Given the fact that South Africa has the largest number of people living with HIV in the world, with a large burden of disease associated with HIV/AIDS, appropriate policies, programmes and budgets should be provided to mitigate the impact of the epidemic. There is a demand for increased capacity to manage the response to HIV/AIDS whilst simultaneously providing enough resources for goods and services. There is a concern, however, that some of the provincial departments are unable to get a feasible and effective balance between spending on personnel and spending on goods and services, though guidelines exist to guide the departments in balancing the spending on these two categories (ibid.). The National Department of Health (NDOH) has to carefully prioritise its spending areas to ensure that there is enough capacity to manage and provide services as well as enough resources for actual service provision. In the pursuit of proper prioritisation of spending, the National Health Council (NHC) introduced the so-called ‘Non-negotiables’ (NNs) in health sector spending to ensure that priority interventions are adequately funded and implemented. The NDOH has to ensure that these NNs are funded. The department has to do this after recognising that earmarked funds for specific programmes are not always allocated as intended either by provincial departments of health or provincial treasuries. The NDOH associates this misallocation to non-availability of clear norms and standards, and has committed itself to ensure credible budget planning by providing strategic leadership and advisory support to provinces.


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