An assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa

Abstract

South Africa has one of the most unequal societies in the world with regard to income, gender, socio-economic status and the distribution of key social services. Much of these inequalities, which are also reflected in its health sector and the general health status of its different population groups, can be attributed to the discrimination and systematic disadvantaging of certain race groups under the apartheid rule. Many researchers have highlighted and raised concern about these substantial disparities in allocation of resources between provinces. In spite of efforts by the post apartheid government to reduce such inequities, these geographic disparities still exist not only between provinces, but also within provinces. Government resource allocation decisions are largely geographically based and the fiscal federalism, currently used in South Africa has been recognised in many ways for its incompatibility of promoting equity across national sectors. Though inter-provincial allocation of health budgets are set through the medium term fiscal framework process and are monitored for equity, most provinces still use historical budgets when making resource allocations at the district level, resulting in many rural areas and health districts being under- resourced. In a country like South Africa with gross inequities in health, equity in geographical allocation of resources can only be achieved through vertical equity, by preferential allocation of resources based on increased need. This descriptive study uses routinely available data to compare health expenditure to health needs in measuring the inequities in financial and human resource allocation, relative to need, between districts in the Northern Cape. By identifying the dependent population and then areas of increased need through the use of different indicators weighted according to their costs and burden on health services, it estimates a composite measure of need for a health district. This measure of composite need is then compared with the expenditure per district to measure the distance from equity for each district. The study also estimates the equitable number of professional nurses per district in proportion to the dependent population and also assesses the inequities in distribution of professional nurses between districts.