Table 7 Participants opinions on the budgeting and system challenges encountered

Budget allocations and its impact

“The needs expressed are far bigger than the budget you get allocated.”

“We make projections based on the items that we used in the previous year. But then that does not guarantee that we’ll get that money.”

“You can appeal… If you don’t get the funds you may have to make some very sad decisions.”

“We may need to then make cuts on the requirements or submit to the facility to indicate that in order to stay within your allocated budget which items we need to drop, or which services we need to stop.”

“Planning services around ethics criteria or access. An example would be your maximum number of patients that can be treated on a particular programme.”

“You upfront decide the entry criteria for entering the specific programme or put a limitation on how much you can do.”

Patients may have to be “referred to a higher level of care.”

“Shift funds between programmes just to make up for the shortfalls.” (Virement shift)

System challenges

“I can talk about problem-solving and the attitude, in general, is when things go wrong that's the only time people start acting and rectifying it. When being informed about the requirements in most cases, the finance officers know better. Management will not be able to find the funds or the appropriate budgeting.”

Receiving accurate data

“It is also quite important to know, our systems are quite manual. There's other peripheral facilities, so you pretty much depend on having good managers at those peripheries. If you don't have good managers, getting data that you require might be a challenge.”

Considerations that should be viewed when determining the budget

“When we start in the third quarter…September to December, you will see a spike in the number of prescriptions, items, and medicine expenditure. And in the last financial quarter which is January to March, you will see the drop… this is an indication that we have problems with the medical aid patients… their funds are exhausted and they come to the state to continue with treatment. It is their constitutional right…We have to give them treatment. We do not budget and consider that particular trend when we are preparing our budget… it contributes to an increase in the non-EML item… you try and continue with the product they have started which are quite pricey… As a pharmacist, you have to bare the ethical burden of continuing with the treatment.”

Capacity and resources to perform further analysis

“The people who do these reviews have full-time jobs elsewhere, they just happen to be members of the committee, so their work also depends on resource availability. They participate in other activities…it depends on people being available. It's often difficult to get a hold of them.”

“Certain analysis requires a health economists and is at a level a bit higher than my operational one.”

“Because of limited resources, we use cost-minimization, cost–benefit, cost-effectiveness analysis. We have limited resources for that, we mainly try to use a group of clinical pharmacists that we have in the province, to do the analyses.”

“Sometimes because of the long-distance, we do it telephonically.”