The treasury department’s intergovernmental fiscal review was released in Parliament this week. Barry Streek reports
Minister of Finance Trevor Manuel was upbeat this week on the government’s effect on development and delivery in South Africa. He said it was “the story of remarkable successes attained in a relatively short period”, but the harsh reality is that all levels of the government still face huge developmental challenges.
The point is starkly underscored by the treasury’s intergovernmental fiscal review, which revealed a R12-billion backlog in facilities in public hospitals, a lack of welfare facilities in the Eastern Cape and Mpumalanga, a decline in real spending on housing, and a R23-billion backlog in road maintenance. It also shows a decline in real terms in social security grants and a decline in the number of maths and science pupils, and shows that private health spending is double the inflation rate and more is spent on private than public health care.
Manuel told the National Council of Provinces that the spending and provision of social services is the key priority for provincial governments and the three social sectors education, health and social development accounted for 83% of provincial budgets. “We have made good progress in turning the education system round. The extension of primary health care has made basic health care more accessible to South Africans … The government spent more than R16-billion on provincial housing … Infrastructure spending is now growing strongly.”
Manuel did allude to some of the developmental challenges facing the government. “A staggering fact that emerges is the imbalance in the distribution of skilled personnel. For example, we find that per capita number of doctors in poorer provinces is shockingly low compared to Gauteng and the Western Cape.”
The review emphasises just how massive the disparities are. In Mpumalanga and the Northern Cape there are 0,9 medical specialists per 100 000 people, compared to 30,9 in Gauteng and 38,5 in the Western Cape. The Northern Cape has 207 private doctors, the Northern Province 363, Mpumalanga and North West both have 499, while Gauteng has 4915, the Western Cape 2818 and KwaZulu-Natal 2 061.
The availability of public hospital beds ranges widely across the provinces, from 1,82 to 3,49 per 100000, while hospital admissions range from 85 to 155 per 1000 people.
In the 1998/9 financial year private health expenditure was R33,3-billion, overshadowing the R28,7-billion spent in the public sector. Despite this, 16,4% of the population has medical aid.
“The 1996 health facilities audit found a third of hospital facilities to require replacement or major repair,” the review says. “This is estimated to have reached about 40% by 2000. The cost of backlog elimination and transformation of facilities was estimated at R12-billion over eight to 10 years.”
In education the gap in spending per learner across provinces has narrowed since 1996, but there are still significant disparities. In 2000/1 the provinces spent an average of R3 658 per learner. Those that spent the most per learner were Northern Cape (R4 801), Gauteng (R4 396) and Western Cape R4 392. Provinces that spent the least were KwaZulu-Natal (R3 067), Eastern Cape (R3 436) and Northern Province (R3 453).
“The reason for these disparities mainly lie in variations in the number of learners enrolled in the province as a percentage of population. Poorer provinces have a higher number of children and a legacy of high failure rates. Class sizes are larger and there are fewer qualified teachers.”
The review says a large number of teachers lack classrooms. Although the national tally of classrooms has increased by 25 102 since 1994, there is still a shortage of 50000 the bulk of them in the Eastern Cape, Northern Province and KwaZulu-Natal.
It says provinces have generally performed poorly in the maintenance of school buildings. It is estimated that the number of schools in good condition has declined from about 11 000 to 5 000 between 1996 and last year. The number of schools in need of repair has increased from about 10500 to 12100 and those in poor condition have increased from about 3 000 to 7000. The reason for the decline is that spending on routine maintenance dropped between 1996 and last year. Only 1% of all buildings were being renovated last year.