Final Vote 6 Speech - Dr Nomafrench Mbombo - 2022

Speech by Dr Nomafrench Mbombo,

Minister of Health and Wellness,

Budget 2022/23

Western Cape Provincial Parliament, Cape Town,

29 March 2022 

Speaker and the Deputy Speaker

Premier and Cabinet Ministers

Leaders of Opposition Parties

Members of the Western Cape Provincial Parliament

Heads of Departments

Media Houses

People of the Western Cape 

2022/23 Budget Allocation

Speaker,

I rise to table the 2022/2023 Western Cape Health budget of R29 094 331 billion.

This is my 8th health budget speech, in all these past years, I reported on the progress made in implementing the previous year’s budget promises. This year, I want to take this accountability further back in the past 7 years and share a few progress on promises I made each year.

This Budget is about the journey to health recovery and post-COVID healing, nguVULIMPILO budget. The covid-19 pandemic has shown us flames and has left our health system more fragile. Not only are we taking care of COVID wounded society, but we are also psychologically wounded health care workers. We all need to heal, non-COVID health services have to recover. Let us all come together and rebuild the walls of the health care system.

Later I will highlight some of the non-Covid health services we are recovering and our budget commitments to them.

The road to wellness

Speaker,

The 2022 budget is not only uVULIMPILO, it is also the KUJIKA IZINTO budget. I once reminded this house that we are a department of health that focuses on both illnesses and wellness. We also offer preventive and promotive health services just as we also offer curative & hospital-based services.  Our WC Health care 2030 plan, the Road to Wellness, a 3rd WC health reform after Comprehensive service plan 2010, is the long-term strategic vision and direction of the department endorsed by the Provincial Cabinet. We have implemented some of its provisions since 2015, this includes bringing in more preventive & promotive health focus through community-oriented primary care (COPC), a slight shift from a hospicentric health system and that we offer patient-centred quality care with the community’s voice being integral. Wellness is defined by the World Health Organization, as not merely the absence of disease, but a complete state of physical, mental and social wellbeing. The Western Cape Healthcare 2030 is the Road to Wellness,

Speaker,

That’s the promise I made in my 2015 budget maiden speech:  that delivering a health service will be business unusual. We cannot continue mopping the floor only - we have to close the tap.  I introduced new legislation to strengthen the voice of the community to be partners in health service delivery. Uncle Polly, you should be happy to see that, we didn’t only pass the legislation in 2016, but as of today all our statutory structures that require community partnership, we have made 80% of appointments: from the district health council, hospital boards, health committees, a 50% plus community membership is mandatory so to provide more community voice.

Speaker,

Two weeks ago, the Dept hosted our Health Indaba to remind us indeed, our journey to VULIMPILO and recovery is to do business as unusual and that health is everybody’s business. I am proud to announce that we are no longer the WC Depart of Health but renaming ourselves as the WC Department of Health and Wellness. The first and only one in the country. ZAJIKA IZINTO

Recovering Non-Covid health services

Violence Protection Unit

Speaker,

It is in the WC Health 2030 reform that made provision for us to tackle social determinants on health, with Violence Prevention as one of those. As health, what lands on our shores, is not only health problems but socio-economic and politico-cultural problems that lead to illnesses and a burden that drains our health system.

Premier announced that there will be a dedicated Violence Prevention Unit will be established in our department. We welcome the challenge. In most parts of the world, a public health approach uses a Cardiff model, where trauma morbidity and mortality data is shared with other sectors for prompt intervention. Thanks to HECTIS (Hospital Emergency centres trauma information system) an innovation we showcased in my 2016/2017 budget speech.

Speaker

Just a quick reminder, that during that budget speech, I made a promise of Digital innovations in the health system through the E-vision strategy I introduced then.F HECTIS was one innovation I bragged about, others were to develop a unique patient identifier, establishing electronic health records. That HECTIS, which has been scaled to more than 20 of our emergency care centres, is one that helped us on determining the impact of alcohol on our trauma centres and the impact of mental health on our ECs. Now the HECTIS is central to gathering data for VPU. The VPU will utilize data and evidence, develop policy, and work with relevant stakeholders at the local geographic level to implement measures that reduce violence. It is critical to note that this will not only involve the department but will also be a collaborative effort with all the government departments. Already, we have transversal WoSA and WoGA that is co-chaired by HODs of Health and Safety. We continue what we already started. This unit will straddle the Strategic Cluster, Emergency and Clinical Support Services within the department. This will be the first violence prevention unit to be established in South Africa and R10 million rands is allocated to it for this financial year. ZAJIKA IZINTO

COVID RESPONSE

Speaker,

The covid pandemic has been brutal to our Healthcare Workers, 209 did not make it, this is tragic, I convey my words of condolences to their families, may God continue to comfort them. It may be less than 2% of our staff complement, but these are not just numbers, but faces of soldiers that died fighting the COVID battle FOR YOU and me. 

This virus is still around and is predicted to be around for the next two years, hence the need to re-integrate with other non-COVID healthcare. People ca. now access vaccines at their health facilities together with other health services as we decommission more vaccination sites like stadiums.

We have allocated R777,043 for COVID-19 for integration and other aspects in case of a severe 5th wave. We welcome that Health regulations will be used to manage the pandemic/ endemic as is always the case with other categories of medically notifiable conditions. I encourage people to engage and make submissions and input to the national health department.

Mental Health

Speaker,

The province has had to manage more acute mental health admissions in the last 2 years, which is challenging at all levels. The concern is that vulnerable groups, including children and adolescents, elderly patients, and persons with intellectual disabilities, require tailored management. Last week I engaged with the mental health review board, the “ombuds” for mental health users, they also shared similar concerns about mental health users who defaulted treatments and others who came for readmission during the COVID lockdowns. COVID has worsened the mental health well-being of the community in general. It is, for this reason, WCG identified a need for transversal response to mental well being beyond pathologising it but as a state of wellness. As is with Violence prevention, the HoDs of Health, Social Development, DCAS co-chair this making sure the focus is throughout the life span.

Weeks ago, we opened an Adolescent Center of Excellence under Groote Schuur Hospital, it provides a full range of social, psychological, psychiatric, and endocrine/physical needs for these adolescents. The response to the mental health pressures requires a whole-of-government and a whole-of-society approach. For example, dealing with substance abuse requires an intensive effort from all of society, not only the health sector, if we are to effectively deal with the impacts of substance abuse on one’s mental and physical health. We are allocating an additional R 30m in this budget year. VULIMPILO

Surgical Backlogs:

Speaker,

COVID-19 pandemic meant that elective surgical services had to be significantly de-escalated, as staff were deployed to COVID services, and this resulted in an increase in the backlog of operations. Hence a specific practicable plan to address this backlog in the short and long term has been developed. We have procured two da Vinci surgical robotic machines for Groote Schuur and Tygerberg hospital to fast track these surgeries. WC health and wellness is the first in Southern Africa (Africa) public health to perform robotic operations.  The advantage is that the system’s versatility and its use by multiple surgical specialities will maximise the number of patients who will benefit from this sophisticated medical technology. These robotics will be beneficial in reducing our theatre slate and it’s a less invasive surgery with low blood loss and with faster and better recovery periods. The main disease conditions that the programme will focus on are colorectal, liver, prostate, kidney and bladder cancers, and women with severe endometriosis.

We are allocating R20 million for surgical backlogs from this budget to be used to procure the required staff. This will allow a faster turnaround of patients requiring theatre and we are reviving the Mandela Day Surgeries. I also want to thank private hospitals for assisting us to reduce our theatre slates by using their corporate social investment funds to operate free of charge on many of our patients waiting for surgeries. One, in particular, is Mediclinic.

Speaker, Mrs Gys, from Eerste Rivier is the first patient to be operated on by a robotic machine. Mrs Gys is here. (can she please stand up?) VULIMPILO. 

Realignment of health services in metro

Nine Joint Facilities

Speaker, as part of WC Healthcare 2030, we are committed to engaging the city of Cape Town to explore efficiency, effectiveness to realign city and provincial health facilities to improve health outcomes. The discussions on provincialisation started way back after we completed the provincialisation of rural health services more than two decades ago. Last year, the City council approved that provincial where the provision of health services by the City of Cape Town (CoCT) functions alongside the provision of comprehensive health services with the WC department, the City will let go of those to be managed by the province. There are NINE Joint Facilities, to be transferred to the province in this budget year, and whilst the processes on assets and staff are being followed, we are allocating R18.094 million this year towards the transfer of these PPHC facilities. ZAJIKA IZINTO

Innovations 

Speaker

In every budget speech, I always brag about our technological innovations and 4th industrial revolution readiness. In addition to e-vision provisions, robotics and others, this year I want to share a few practical innovations to show our versatility. Innovations are not only about devices but ideas.

• Dashboard communication: TB response plan using the dashboard, the platform initially created through COVID  that made us win as many awards in the previous year. We have dashboards accessible to the public for COVID cases, vaccination, TB, and now for violence prevention and one can zoom area by area. ZAJIKA IZINTO
• The “Ask a Doctor” initiative was activated when we experienced vaccine apathy, the medical specialists go to taxi ranks, the malls etc. They promote vaccines. People get an opportunity to ask a qualified doctor about all their vaccine concerns which helped to increase vaccine uptake.
• Vaxxi-Taxi Our now world-renowned Vaxi-Taxi transformed EMS Ambulances from only being vehicles ferrying patients to bringing vaccination to the taxi ranks. This initiative greatly impressed the WHO Director, Dr Tedros Ghebreyesus, who has advised other countries to emulate what we are doing
• Groote Schuur Hospital Diabetes Centre is another great example of innovation at its best. At this Center, we focus on complicated diabetes such as Type 1 diabetes, diabetes in pregnancy, diabetes in special situations such as patients with organs transplants, cystic fibrosis, steroid-induced, atypical, preoperative optimization of diabetes.

Infrastructure:

Speaker, the 2019 budget speech was more on infrastructure, it was a budget of bringing dignity to people through new infrastructure, maintenance, and refurbishments. We requested input from our statutory structures, only to realise that for the next two years we will be held at ransom by COVID PANDEMIC but through it all, we manoeuvred and made a way in a seemingly impossible situation under lockdowns.

This is the reason I am proud to announce the following completed projects:

• Cape Winelands: The new De Doorns EMS and the new Avian Park Clinic
• Garden Route: Mosselbay Clinic and Oudtshoorn Clinic
• City of Cape Town: Victoria Hospital EMS Unit, Red Cross Children’s Hospital EC Unit and Heidleberg Hospital EC Unit.
• Overberg: Elim Clinic, Genadendal Clinic, Caledon EMS Tower and
• Central Karoo: KwaMandlenkosi Clinic, and Laingsburg Clinic and
• Weskus: Refurbished Swartland Hospital and Vredendal North Clinic

Somlomo, I don’t just talk, I deliver, and I stand here proud to say I have delivered.

As the department that is moving forward, we have other infrastructure buildings that we plan to prioritize for the 2022/23 financial year.

Klipfontein Hospital/GF Jooste Hospital

Speaker,

GF Jooste Hospital in Manenberg served about 1.1 million people, with 224 beds and over 12 000 admissions annually.

It served people from the communities of Klipfontein. Patients were referred by community clinics, day hospitals and private general practitioners.

A report by the Council for Scientific and Industrial Research confirmed that the old GF Jooste Hospital infrastructure was inappropriate as a framework for a new hospital and demolition was recommended.

A lot has been done to move forward with this capital project. Tender evaluation is currently in progress to procure multi-disciplinary professional services, this is anticipated by April/May 2022.

Observatory FPS

The Observatory FPS is complete with minor snags that are being fixed as well as installing health technology equipment in the facility.

All snags in this facility must be completed before operations resume to ensure that the evidence will be collected accurately.

The commissioning of this facility is in phases. The Administration component has already moved into the building.

Since this building is the first of its kind, various tests have to be conducted to determine the functionality of computer systems, ventilation, and water reticulation as part of staggered commissioning. The full commissioning of the facility is expected to take place by end of August 2022.

Belhar- Tygerberg Regional Hospital

Due to the size and complexity of the Hospital, its redevelopment is classified as a ‘megaproject’ and the support of not only provincial but also national stakeholders is required.

The process of consultation and refinement of the draft Feasibility Study commenced in 2017; further refinement and consultation are underway following positive feedback and constructive comments received from National Treasury.

The aim of this process, which has been delayed due to the COVID-19 pandemic, is to attain stakeholder support and National Treasury approval for the most suitable approach to procuring value for money, fit-for-purpose health infrastructure that is affordable to build, equip and operate.

Khayelitsha District Hospital

Speaker

Whilst we understand that it takes longer to build a new hospital, we are not blind to the realities of population increase in areas like Khayelitsha, hence we already did the following improvements:

To reduce the waiting period at EC –HECTIS assists with easier monitoring.

The filling of the third EC consultant post assisted greatly. WE did increase beds by adding step down beds for intermediate care patients. Noting during the high COVID waves, Khayelitsha had separate additional hospital at Thusong centre through partnership with MSF, thus made it possible for main hospital to tackle emergencies. There is a plan to extend more psychiatric beds by building new Psychiatric Ward this financial year.

Infrastructure projects to be prioritized in 2022/23:

• Cape Winelands: Ceres Hospital: New Acute Psychiatric Ward, an extension of beds, Upgrade and extension to the Paarl Community Day Centre; the new facility, Robertson CDC
• Overberg: Villiersdorp Clinic; replacement facility, Villiersdorp Ambulance Station, and Caledon Clinic
• Central Karoo: Nelspoort Hospital, Beaufort West Hospital expansion and upgrades, Matjiesfontein Satellite Clinic
• Metro: Klipfontein Regional Hospital, Gugulethu CDC, Belhar Tygerberg Regional Hospital, Parow - Tygerberg Central Hospital
• Westcoast: Swartland Hospital, Diazville CDC, Sandy Point Satellite Clinic: and Vredenburg CDC:
• Garden Route: Knysna Forensic Pathology Services (FPL), George Satelite, Hornlee Clinic, Ladismith Clinic and Hospital

Budget Tabling

Speaker,

This is the last time we get so much allocation, in this 2022/23 financial year, the Western Cape Department of Health is allocated R29 094 331 billion to provide quality healthcare to, approximately, 7 million people, who do not have access to private health insurance. 

I would also like to commend the Head of Department and his team for the sterling work they do as reflected by the clean audit findings for three consecutive years. Accountable governance is crucial and reinforces public trust in the way we manage the public purse.

This brings me to the details of the 2022/23 budget:

Budget:

Speaker, for the 2022/23 financial year, the department has been appropriated twenty-nine Billion and ninety-four million, Three Hundred and Thirty-One Thousand rands (R 29 094 331). 

• Programme 1 Administration: has been allocated R1 419 217
• Programme 2 District Health Services: has been allocated R11 982,435 which is a 3.4% increase 
• Programme3 Emergency Medical Services: has been allocated R1299,323 which is a 4.7% increase
• Programme 4 Provincial Hospital Services has been allocated R4 461,150 which is a 4.2% increase 
• Programme 5 Central Hospital Services: has been allocated R7 773,200 which is a 3.7% increase
• Programme 6 Health Sciences and Training: has been allocated R 397,932 a 5.8%
• Programme 7 Healthcare Support Services: allocated R 584,281 which is a 1.7% decrease 
• Programme 8 Health Facilities Management: allocated R1 176,593, an 8.4% increase

Conclusion

SPEAKER

Given the budget pressures, it cannot be business as usual, especially the national treasury has informed us that WC (and GP provinces) budgets will be cut in the next two outer years. Increasing efficiency and productivity in every corner of the Department is mandatory to get the best value for our money.

The current financial challenges we face are not the first and will not be the last. We have to be innovative and solution-seeking. We have to be creative and collectively consolidate our interventions in these very trying times. 

It is important to communicate with our stakeholders and communities keeping them abreast of our mission, vision, projects and budgets.

Two crucial engagements platform include sharing Health Indaba resolutions with our external stakeholders for their input. The date is already set for 29th April for the first engagement.

To further strengthen community participation and amplify people’s voices, I will embark on a Nothing about you, without you, people of the Western Cape campaign to engage with statutory bodies as community representatives.

Furthermore, I will strengthen our position as UHC stewards, this conversation started a long time ago, for me, it is about how can we use all this information obtained from COVID-19 going towards Universal Health, which is the main goal.

I WANT TO THANK PRIVATE PASTNERHIPS for helping us during our worst moments: to name a few: local government through mayors and Cllrs, private health, CIPLA, GIFT OF THE GIVERS, HOSPITAL HEROES, SHOPRITE, OCEANA

I thank the Premier, my Cabinet Colleagues for their support, our partners for their collaboration and most importantly I thank every member of staff for their dedication and hard work, without which our performance would not have been what it is: amongst the best in the country.

I also thank the staff in my office whose unstinting support is invaluable in enabling me to conduct my duties. Lastly, I would like to thank my family and friends whose understanding, sacrifices and support have enabled me to do what I do. 

Speaker, I table 2022/23 Health Budget of Western Cape

I thank you! Enkosi