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restructure tertiary and quaternary services across the country, to date no concrete policy on what should constitute tertiary and quaternary services in the future, throu
gh what types of institutions these should be provided and how they should be funded has emerged. Policy makers are working on the \lquote Modernisation of Tertiary Services Plan\rquote , which is reportedly being finalised}{
\cs16\fs24\lang7177\langfe1033\super\langnp7177 \chftn {\footnote \pard\plain \s15\ql \li0\ri0\nowidctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\cs16\super \chftn }{ Ibid}}}{
\fs24\lang7177\langfe1033\langnp7177 . Despite the lack of this framework, t
he national Health Department has been funding the building of tertiary hospitals in the Eastern Cape, KwaZulu Natal and Gauteng.  The Eastern Cape and KwaZulu Natal are now beginning to commission these new hospitals (the Nelson Mandela and Albert Luthul
i Hospitals respectively), with some impacts on the level of care split in these provinces.  At present, it is unclear exactly what roles these new institutions will play within a future network of health facilities. 
\par 
\par The health delivery terrain is dominat
ed by the HIV/AIDS epidemic, which places severe strain on health treatment facilities (clinics and hospitals).  Provincial health departments have been tasked in the national HIV/AIDS strategy with piloting and rolling out new modes of care and treatment
 
aimed at accommodating the crisis in a cost-efficient and effective manner.  These factors place health resources under heavy strain.  If health departments are to maintain existing levels of service and address HIV/AIDS, their resources have to be expand
ed significantly}{\cs16\fs24\lang7177\langfe1033\super\langnp7177 \chftn {\footnote \pard\plain \s15\ql \li0\ri0\nowidctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\cs16\super \chftn }{
 Hickey, A, What the 2002 budget means for HIV/AIDS, Budget Brief 90, February 2002, Idasa: Budget Information Service. }}}{\fs24\lang7177\langfe1033\langnp7177 .  
\par 
\par We investigate how provinces attempt to address a number of the budgetary issues emerging from the new constituti
onal order.  Do provinces allocate sufficient funds to health?  Are provinces shifting their spending priorities toward primary health care?  Have provinces managed to halt the escalation in personnel spending and the squeezing out effect of this escalati
on on spending on medical equipment, the construction and maintenance of health facilities and spending on medicines and other consumables?
\par 
\par The analysis presented here is best considered a rapid scan of provinces' health budgets for 2002/03.  We attempt to
 be consistent across provinces, clearly indicating where we are not. Although all provinces had to present their budget according to the Government Finance Statistics (GFS) format this year, considerable variation in the manner in which activities are as
s
igned to expenditure categories remains.  This necessitates some adjustment of figures to allow for comparison.  Furthermore some provinces appear not to have allocated all infrastructure grants.  There are also discrepancies between conditional grant inf
ormation contained in different parts of provincial budget statements, raising problems for the disaggregation of information. We footnote the general conventions used in this paper below}{\cs16\fs24\lang7177\langfe1033\super\langnp7177 \chftn {\footnote 
\pard\plain \s15\ql \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\cs16\lang7177\langfe1033\super\langnp7177 \chftn }{\lang7177\langfe1033\langnp7177 
 The data presented in the tables are taken from the Provincial Budgets for 2002/03, but in some clearly indicated places we used information from Budget Review 2002 and verbal communication with health officials.  We draw figures from the overall expendi
ture by programme tables and the corresponding tables giving expenditure by Economic Classification.  
\par 
\par We use estimated actual figures where possible for 2001/02, the base year of our analysis, as these most accurately refl
ect the actual outcome of budgeting - the amount of resources actually estimated to be used in carrying out policy.  In some cases we contrast budgeted growth from the previous years budgeted amounts with growth from estimated actual figures in the previo
u
s year to show the differences in increases from a budgeted baseline and increases from budgeted revised in-year.  Using a single year as a base for the analysis, however, means changes in the years proceeding it are not capture, and longer-term growth tr
ends are obscured.  Mpumalanga only provides budgeted or voted figures, and not estimated actual for 2001/02.
\par 
\par Most of the figures include actual or budgeted amounts for \lquote increases in conditions of service\rquote  which have to be set aside yearly to accommodate w
age increases arising from the centralised wage bargaining set-up. All amounts are inclusive of internal and external charges.  We have not attempted to take account of statutory amounts as these amounts are relatively insignificant and some provinces do 
not reflect the figures on their votes.
\par 
\par We have used annual average growth rates to capture nominal and real changes over periods of more than a year. GDP inflation rates used to calculate real changes are taken from the 2002 Budget Review.  We use 2001/02
 as the base year for calculations involving real change.  
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\cltxlrtb\clftsWidth3\clwWidth840 \cellx810\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth990 \cellx1800\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb
\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth990 \cellx2790\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth900 \cellx3690\row }\pard\plain 
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\par 
\par }}}{\fs24\lang7177\langfe1033\langnp7177 .  Specific conventions are footnoted throughout the rest of the text.
\par }}