Health Budget 2018

Dr Nomafrench Mbombo

2018 Department of Health Budget Speech

Madam Speaker

Honourable Premier, Helen Zille

Cabinet Colleagues and Members of the Provincial Parliament

Chairperson of the Standing Committee

Head of Department and Management of the Department of Health

Our Partners at the Academic Institutions, Civil Society and the Health Sector

Our special guests, the representatives from local communities,

Our consumers of healthcare, our partners in the private sector and business and most importantly, the Citizens of the Western Cape, guests in the gallery

kubacholi-choli bendaba

Goeie more almal - A very good morning to you all.

My speech is centred on showcasing this Department’s resilience as they are continuing to provide health services on a 24/7, 365 days a year to over 14 million patients (our headcount per annum)amidst the current economic climate and the systems challenges.

Madame Speaker, Health continues to face a growing prevalence of disease in a growing population. The disease profile has become increasingly complex over the last decade as patient co-morbidities have been seen to increase.

We also face unintended consequences like the fire disasters that Swartland – Knysna Hospitals last year, and just recently Groote Schuur and Mitchells Plain Hospital as well as the drought.

The Department has a Water Preparedness Plan in place, as water is an essential part of rendering health services. Hospitals are large consumers of water and many of the essential services can only be provided, if there is a supply of potable water. 

In co-operation with the Department of Transport and Public Works, we have already commenced with drilling boreholes at several hospitals as a precautionary measure.

A number of priority sites have been identified, based on the importance of the site in the health system – how many people served – as well as the local availability of municipal water.

We prioritized sites in three phases (72 in total):

Phase 1 sites were hospitals across all levels, for e.g Tygerberg Hospital Estate, Groote Schuur Hospital Estate, Red Cross WMC Hospital Estate, Lentegeur Hospital, as well as rural district hospitals.

I visited the Lentegeur Hospital estate recently to inspect the Water Security efforts on the ground, and I am pleased with the progress made to date. The Lentegeur Hospital boreholes were part of the Phase 1 boreholes that are equipped and in progress.

The estate has 10 boreholes in total (existing and new boreholes), and the installation of the 800 metre long, 160mm in diameter main pipeline is underway. They are also installing a booster pump, and working towards re-commissioning a 700,000 litre reservoir.

We also face outbreaks like listeriosis that claimed 29 lives in the Western Cape to date. That is why it is important for us to continue to create awareness amongst communities.

Response to Service Pressures

In response to the health system pressures the department various strategies in place. We are implementing short term efficiencies and cost savings to address the budget shortfalls;

We acknowledge that our coalface staff members do experience pressures at various facilities. Those who have witnessed the conditions under which health professional have to work where gang-violence continuously flares up, will understand how tall a task it is for nurses to always place the needs of the patients above their own. I want to commend every staff member for their resilience within this high pressured working environment. We know the conditions you were under are not always the easiest.

We have heard the cries of our staff and have since implemented the following:

• We are the only Province that prioritized junior doctor’s commuted over time to reduce stress
• We have, as part of Nationa Directivel, paid danger allowances for the first time to nurses working in selected mental health units, as well as Forensic Pathology Officers
• We have appointed additional FPS officers to relieve the pressure on current FPS officer.
• We are receiving new organisational structure where we want to protect our clinical service staff.

The 2017 Barret Survey found despite the challenges staff are faced with, they are still happy.

Madame speaker

We have undertaken initiatives as part of our transformation strategy. This includes the Management Efficiency and Alignment Project (MEAP).

It aims to improve the efficiencies in administrative structures, functions and processes across the various levels and offices in the Department.

The intention is to achieve a 10% saving in the managerial and administrative support service sections so to protect clinical service.

E-vision - Digital Innovations in health systems improvement: 

Since the implementation of our E-vision last year, we have made great strides with the road map of priorities.

We are close to achieving full coverage of basic IT systems across all 52 hospitals in the Province.

Two solutions used to enable health systems evaluation and improvement are the Electronic Continuity Care Record Project (eCCR) as well as Clinicom. We have made significant progress with the roll out of both these systems.

The Electronic Continuity of Care Record (eCCR) been implemented at 80% of the fixed health facilities (Hospitals and PHC facilities) in the Province. eCCR aims to improve the continuity of care of the patient between hospitals and primary health care and also allow for the recording and capturing of vital information about the patient encounter, which helps to inform the burden on disease.

The second innovation in the digital space, which is contributing significantly to health system improvement, is the unique patient identifier.

In practice, this means that when a patient’s details are created initially at any of the province’s hospitals or primary healthcare facilities, or any of the local government healthcare facilities, that patient’s information is immediately identifiable and available at all other public healthcare facilities within the province. This reduces waiting times for patients, assisting in improving the patients experience.

Public Private Partnerships

Madame Speaker, another example of value adding to public service is the WCG: Health partnerships with the private sector.  Over the last few years, my Department has come into many partnerships which have had immense impact on the accessibility of quality health services to the population.

One of these is the partnership having, had an impact on Infrastructure, is the partnership between our department and The Children’s Hospital Trust.

The Children’s Hospital Trust completed an upgrade project to the value of R130 million at Red Cross War Memorial Hospital – this included amongst others the Paediatric ICU and first ever radio station by children for children which is broadcasting from the Hospital.

The Children’s Hospital Trust is also upgrading the Neonatal Unit of Groote Schuur Hospital currently to the value of R46 million which was completed in Feb 2019.

PetroSA too has been invaluable to upgrading and expanding the existing clinic facilities in Mosselbay. This project was accrued to value of R6.7 million. Another initiative which they have been key to is the building of new clinic in Asla community to the value of R16million and estimated completion is within this calendar year.

UCT, one of the major tertiary institutions in the province, is funding the development of a Neuroscience Centre at Groote Schuur Hospital over the next 4 years.

Mediclinic SA also continue to provide support in the form of a formal partnership with the Department. I recently witnessed this in action at Mediclinic Durbanville. Da Vinci robotic surgery was used as part of the ongoing relationship between Mediclinic and the Western Cape Department of Health. Mediclinic Durbanville, together with urologist Dr Gawie Bruwer provided cutting edge prostate surgery to a patient that was on Tygerberg Hospital’s urology waiting list.

Other current partnerships include over 400 contracted service providers, like Clicks, Dischem, and other retail pharmacies, rendering the health services using state stock. These services include; for e.g family planning, baby immunisation, and HIV/Counseling and testing.

Collaborative service models between public and private sector have proven to increase patient access to care.

We are exploring further collaborations with the private sector and NGO’s over the next financial year. We currently in discussions with Hospitals Association of South Africa to explore possibilities to pilot universal health coverage.

Madame Speaker.

The need for transformation and redesigning the way we do business, has become a critical and urgent imperative

As part of this transformation agenda, our service priorities, amongst others include the service redesign, Community Oriented Primary Care (COPC) and the Whole of Society Approach (WoSA).            

We are working towards Service redesign through COPC and WoSA

Community Orientated Primary Care (COPC)

The primary health care platform is a priority area, hence you’ll see the largest portion of the budget on spent District Health Service. COPC has is a priority for WCG: Health aimed to achieve Universal Health Coverage. It aims to include the total population in a geographic area around Primary care facilities, also involving other service providers such as the City and the private sector. Furthermore it necessitates strengthening of home and community based care. This approach also further enhance the promotion of visible management at coalface.                     

Whole of Society Approach

The Whole-of-Society Approach is a reinvigorated way of addressing the challenges we face within communities. This approach will form the basis of PSG 3, which aims to provide safe, socially connected, resilient and empowered communities. We want to provide communities with equitable access to services and opportunities, through the alignment of resources, collaboration and partnership by all spheres of government.

The Head of Department of Health, Dr Beth Engelbrecht is leading the team of five HoDs, showcasing how we work transversally across Departments to achieve our goal of ultimately create healthy, inclusive, safe and socially connected communities.

WOSA will be implemented within the PSG 3 areas:

• Metro: Khayelitsha, Manenberg/Hanover Park
• Rural: Saldanha, Drakenstein

PSG 3 Progress

Madame Speaker, we are determined to continue with our health led PSG 3 projects: which are our Young Women and Girls, First 1000 Days, and Western Cape on Wellness (Wow).

I am happy to report The Wow project, is one of the projects we successfully implemented as part of PSG 3. It is aimed at upstream factors targeted toward non-communicable diseases such as diabetes, hypertension and obesity. There has been numerous notable achievements seen in participants whose lifestyles have changed, since it was launched. This includes significant reductions in their blood pressure, noteworthy improvements in healthy eating and an increase in their general health status.

Through the partnerships established with the Qhubeka, a NPO, the project is able to supply 3000 bicycles to learners at high schools in Paarl East and the Drakenstein municipal area. I want to acknowledge Dr Frederick Marais, Project Manager for his dedication to this wonderful cause and a special thank you to Qhubeka, for this wonderful initiative.

The WOW! project reach and impact has been recognised by the Public Health Association of South Africa having received the 2017 PHILA award in recognition of significant contributions to public health; an accolade the department is proud of.  

The Patient voice

Madame Speaker, central to my vision when I took office in 2015, was to improve the patients’ voice.

Our aim is to ensure that patients are active participants in health through these platforms.

The voice of patient, the voice of the community, and the voice of aunty Betty/Sarah came through strongly on the day. They want to have a say in a service that is designed for them, and with the passing of the Western Cape Health Facility Boards and Clinic Committees Act of 2016, we will increase the patient voice through the community representation at all levels of statutory bodies through appointment of Health Committees, Facility Boards, District and Provincial Health Councils.

We have made significant progress to strengthen the voice of the patient, through making communities part of the health system.

Patients can no longer be mere recipients for services, but it is fundamental to make them part of the health system, ultimately “strengthening the voice of the community”

Madame Speaker, strengthening the voice of the community came into practice when I engaged with the Muslim Judicial Council on the matter of utmost importance in terms of the Muslim faith; the release of Muslim bodies that end up at our Forensic Pathology Services due to unnatural deaths.

I would like to thank the MJC for standing up for Muslim communities, and giving them a voice. I am pleased to announce that we’ve reached an agreement with the MJC and significant progress have been made to date. Muslim undertakers have reported the swift conclusion of autopsies on Muslim bodies within the requested 24 hour period.

World class surgeries

Madame speaker, the Western Cape Health Department is extremely proud of the quality of work done by our highly trained team of clinicians. They have performed numerous world class surgeries

• A Medical team at GSH performed ground-breaking surgery by successfully treating a brain tumor through an eye socket. Such an operation has never been performed in the world.
• Groote Schuur Hospital performed it’s first ever bilateral sequential lung transplant in the Western Cape, and the first in the state sector nationally
• At Tygerberg Hospital Prof Pierre Goussard (Paediatric Pulmonologist) performed the first Bronchial balloon dilatation on a premature baby weighing 2kg.
• Robotic knee surgeries were performed for the very first time at District Hospital level - Victoria and Mitchells Plain District Hospitals

I would also like to acknowledge Professor Heather Zar named 2018 Woman in Science Laureate, in recognition of her wide-ranging contributions to child health, which have improved – and saved – children’s lives across the globe, as well as helping to shape international policy.

The prestigious award is given annually to five women scientists’ worldwide, one from each continent.

We thank all our clinicians for their hard work and dedication to improving the lives of all our people.

Infrastructure

Madame speaker, in the past financial year we have built, replaced and upgraded the following health facilities;

• Hill Side Clinic – Replacement (Beaufort West)
• Red Cross War Memorial Childrens Hospital - Paeds ICU Upgrade (Partnership with CHT)
• Khayelitsha Hospital - CT Scan and Ward Completion
• Prince Alfred Hamlet Clinic – Replacement

On 1 March I opened the upgraded Stellenbosch Hospital Emergency Centre. This state-of-the-art EC is now providing the people of Stellenbosch and surrounds with much needed relief to the large community which relies on the hospital for quality health care.

I am pleased and excited to announce that the new District Six Community Day Centre is complete and commissioned. Construction completed in December 2017 and commissioned in February this year. It is a modern and functional facility. I will officially open District Six CDC in May 2018.

Napier Clinic in Overberg District completed by the end of 2017, and will officially be opened in May this year. The 5.000 m² facility replaced the existing building which was too small, and is now bigger and better and more equipped to respond to the needs of the community.

Thembalethu CDC in George in the Eden District is also completed, and will officially be opened in June of this year.

Other major projects in the metro is the new Observatory Forensic Pathology Laboratory, which is well underway and will be ready for commissioning in February 2019.

Staff Safety

Madame Speaker, safety of our staff members remains a challenge.

Staff safety has been seen as a priority within WCG: Health since the attack on the 95 EMS staff members during the previous financial year, as well as threats to health professionals in high crime areas.

We are pleased to report a decrease of just under 50% over the last financial year with the number of events reported being declining to 49.

The Western Cape Government Health would like to express a special word of thanks and appreciation to our colleagues in the City of Cape Town with a special mention to Mayco Member JP Smith and his team for their commitment and support to our men and women in green – the Emergency Medical Services. Through our collective efforts, we have been able to commission our EMS desk with the City’s Safety and Security Cluster and the Transport Management Centre, and in so doing, create a network of support that enables EMS to serve those citizens in red zones.

The desk is staffed by a member of the team who is able to, at the moment’s notice, mobilize resources from within the city and SAPS, but more importantly through the City’s neighbourhood watch desk. This illustrates my belief that the provision of an effective health device involves all stakeholders, but none more important than the citizens and the communities we serve.

I would also like to acknowledge the sterling work the SAPS, and Department of Community Safety are doing to make such a collaboration possible. It is truly an example of a connected and committed government.

Finances:

Madame Speaker, please allow me to firstly thank my HOD and her top management team for their hard work and dedication to this Department. My heartfelt thanks to you and your team for ensuring that we do not let the people of the Western Cape down.

I would like to commend them for the 13 year-record of an unqualified audit. Clean and accountable governance is crucial. It reinforces public trust in the way that we manage the public purse.

I rest easy tabling this R23.064 billion budget knowing that it will be treated with the utmost care and spent to the benefit of the people that we serve.

This brings me to the details of the 2018/19 budget:

Budget:

WC has a shortfall of about R439million loosely translated. I would like to thank Provincial Treasury and the Premier for meeting the shortfall by half. I am thankful that Health’s share has increased by 1%; from 36% to 37%.

The health budget allocation for the 2018/19 financial year is R23,064 billion as indicated by Western Cape Provincial Treasury.

Budget allocations

From an economic classification point of view, this year’s budget allocation includes:

R 13.6 billion for compensation of employees; 59% of the total budget

R 7.3 billion for Goods and Services; 32% of the total budget

R 1.3 billion for transfers and subsidies; 6% of the total budget

R 747 million for capital assets, 3.25% of the total budget.

National Conditional Grants

National Tertiary Services Grant: R3 billion

Health facility Revitalization Grant: R678 million

Health Professional training and Development Grant: R574 million

Comprehensive HIV/Aids Grant: R1.5 billion

Programme 1: Administration

Administration is allocated 3.95 per cent of the vote in 2018/19. This amounts to an increase of approximately R42.4 million or 4.93 per cent.

Programme 2: District Health Services

District Health Services is allocated 40.66 per cent of the vote in 2018/19. This amounts to a nominal increase of approximately R551.9 million or 6.33 per cent.

Programme3: Emergency Medical Services

Emergency Medical Services is allocated 4.75 per cent of the vote in 2018/19 This amounts to a nominal increase of approximately R49.4 million or 4.78 per cent.

Programme 4: Provincial Hospital Services

Provincial Hospital Services is allocated 15.70 per cent of the vote during 2018/19. This amounts to a nominal increase of approximately R161.3 million or 4.72 per cent.

Programme 5: Central Hospital Services

Central Hospital Services is allocated 27.92 per cent of the vote in 2018/19. This amounts to a nominal increase of approximately R287.5 million or 4.73 per cent. 

Programme 6: Health Science and Training

Health Sciences and Training is allocated 1.47 per cent of the vote in 2018/19. This amounts to a nominal increase of approximately R19.3 million or 6.09 per cent.

Programme 7: Health Care Support

Health Care Support is allocated 2.01 per cent of the vote in 2018/19 in comparison to the 2.02 per cent allocated in the revised estimate of the 2017/18 budget. This amounts to a nominal increase of approximately R18.4 million or 4.18 per cent.

Laundry Services is allocated 23.23 per cent of the 2018/19 Programme 7 budget in comparison to the 24.26 per cent that was allocated in the revised estimate of the 2017/18 budget. This is a nominal increase of approximately R1.4 million or 1.39 per cent.

Engineering Services is allocated 21.65 per cent of the Programme 7 budget in 2018/19 in comparison to the 21.80 per cent that was allocated in the revised estimate of the 2017/18 budget. This is a nominal increase of approximately R4.3 million or 4.86 per cent.

Forensic Pathology Services is allocated 38.72 per cent of the Programme 7 budget in 2018/19 in comparison to the 38.11 per cent that was allocated in the revised estimate of the 2017/18 budget. This amounts to a nominal increase of approximately R11.3 million or 7.26 per cent in nominal terms.

Cape Medical Depot is allocated 16.33 per cent of the Programme 7 budget in 2018/19 in comparison to the 15.83 per cent of the Programme 7 budget that was allocated in the adjusted estimate of the 2017/18 budget. This amounts to a nominal increase of approximately R5.7 million or 8.90 per cent.

Programme 8: Health Facilities Management

Health Facilities Management is allocated 3.53 per cent of the vote in 2018/19 in comparison to the 3.85 per cent that was allocated in the revised estimate of the 2017/18 budget. This translates into a decrease of approximately R30.8 million or 3.69 per cent. The equitable share budget for Programme 8 has been reduced according to the need for infrastructure funds and due to the fact that the Department is allowed to use the Health Facility Revitalisation Grant (HFRG) partially for maintenance and equipment.

Conclusion

Madam Speaker, tabled here is the 2018/19 Budget for the Department of Health.

While the economic climate remains a challenge, as well as challenges within the Health system, as a government, we are committed to add public value by providing quality healthcare to the people of this province.

We cannot afford to be rest on our laurels, we need come up with innovative ideas on how best we can alleviate pressures in the public health system with under the current financial constraints.

Most importantly we need to keep in mind the needs of the clients that we serve.

None of the incredible work we have done would have been possible without the support of the following people;

• The Premier and Cabinet colleagues

• The Members of the Provincial Parliament and Standing Committee for keeping us to account;

• Over 32 000 dedicated staff in this Department under leadership of Dr Beth Engelbrecht assisted by top management.

• The support from our strategic partners, private sector, and academics. The support of our community structures

• My Ministry office staff for their commitment and resilience

• And lastly my family and loved ones for their support and understanding that the work of a Minister is never done!

Madame Speaker, I table 2018/19 Health Budget of Western Cape

I thank you!