Health Budget Vote 6

HEALTH BUDGET 2019

Preserving patient dignity

Dr Nomafrench Mbombo

2019 Department of Health Budget Speech

Madame 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

The Citizens of the Western Cape, and Guests in the gallery

kubacholi-choli bendaba

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

Today, I deliver the final budget speech for this political term in Health. Indeed it was a privilege to serve the people of this province.

This budget is about maintaining the dignity of the millions of patients that we serve. We are highlighting the work we have done, but also to show how we work smarter and technically disrupt the space to maintain and preserve patients’ dignity.  With this budget we are all about business unusual, to ultimately deliver patient centred care without compromising the quality.

The demand for healthcare continues to grow and this is unlikely to change in the short-term given the trends in the social determinants of health and wellbeing.

The Health sector, generally, is under severe pressures as result of:

• Budget cuts with a R9 billion cut over the MTEF.
• The WC Health cumulative budget cuts over the last three years (R602m) and MTEF (R574) is R1,2bn which is approx. 6% of the Dept Budget. Over the same period of this MTEF, patient numbers would have grown, at the current rate, to 12%. This is not sustainable.
• Urbanisation and in-migration
• A Burning service platform,
• Drought and Water shortages,
• Disease outbreaks and escalating burden of disease
• Staff safety – the attacks on EMS staff is undermining service delivery as staff often are traumatized and put on leave for extended periods
• Natural disasters like fires; and
• Load shedding is coming back to haunt us, again.

This situation places the provincial health system under enormous strain, and in the context of the above, 2019/20 is likely to be a very challenging year.

Despite these challenges, the Western Cape has the best health outcomes out of all 9 provinces. Western Cape citizens enjoy the best care compared to the level of service elsewhere in the country.

We have consistently had the highest life expectancy over the years due to better population health outcomes (lower mortality rates).  We have better coverage and access to health care services of 90% compare to other provinces where it is too far to access. Where there is no physical facility, we bring services through mobile or by other means like public private partnerships. This essentially speaks to the quality of care and access to health care in the Western Cape.

Access to health services is crucial for where we are going with Universal Health Coverage. We have made great progress with UHC. We will continue to engage to influence national policy. We have entered into an inter-provincial collaboration across KZN-EC and WC to begin with a Health System Strengthening   framework in 2019/20.

Madame Speaker,

As you may have noticed, there are no guests in the gallery today. Business unusual, we take the disruption of space at all levels.

This budget I am presenting to you today was presented to our stakeholders. The stakeholders include our statutory bodies, i.e. Health recipients themselves through health committees, hospital boards, mental health review board, IHHCC, DHC, Provincial consultative council, academics, Councillors, health professionals from community health workers to specialists, private health, business etc. NOTHING ABOUT US WITHOUT US. I once said in my first budget speech in 2015.

This is the people’s budget in the true sense of the word. We took these priorities to them because health is everybody’s business. Health is about partnerships. We had representatives from as far as Beaufort West, and Matzikama. More than 300 participants came to partake in this process.

I want to thank the participants for braving the rains and load shedding on that day. Baphuma imvula isitsho. More specifically, I want to thank Member Rev Gopie who attended from the Standing Committee, and for making a valuable input.

Participants at the State of Dept Health Address (health summit) raised pertinent input which I would like to share:

1. Mama Anelise from Heideveld Health Committee reminded us that social ills such as drugs and alcohol, and gangsterism impact on health services and there is dire need to have health and social development integrated approach and budgeting to tackle these.   I can assure Anelise that as part of PSG3 we are focusing on increase wellness, and safety and tackle social ills. The priority goals and various projects involved Department of Cultural Affairs and Sport, Social development, Community Safety and with Health as chair of the transversal engagement. The Dept of Premier lead the Alcohol Harms Reduction Game Changer which lead to interventions that focused on youth as well.  Health also, contributed to investing in Young Women and Girls Project, with R80 million from the Global Fund to empower young women and girls. Heideveld, in Klipfontein is part of this project where the project saw over 50 000 young women and girls participate the past 3years. Although these projects including Men’s dialogues come to an end in this financial year (as we were funded for 3 years), we want to reassure the communities that, through WoSA (Whole of Society Approach) we will continue the transversal projects with these departments beyond international funding. We are already doing that in Saldana where we use our own departmental funds. Saldanha also is now one of the sites where we are piloting UHC.

1.         Mr Anthony Vaughn from the Vredenburg Hospital Board wanted for reassurance about medico legal claims as they keep on escalating elsewhere. I can report that the WC has the lowest medico legal claims bill of all nine provinces and for us it begins with fixing the "MEDICO" portion to avoid the latter "LEGAL CLAIMS". Improve the quality so you worry less about the rest. I want to thank Dr Bass and his team for the outstanding work they are doing in this field to ensure we do stick to this promise.

2. Mr Mike Hofmeester and Mr Michael, from metro, Bishop Lavis, raised questions around the construction of GF Jooste; I can confirm that the Klipfontein Regional Hospital is in the planning phase and will elaborate  more under infrastructure section later.

3. Mr Wellington – Health Committee Murraysburg, Beaufort West, raised concerns around the town being the forgotten one as it next to EC and NC, thus making it too far to WC to access health services for patients for check ups. I want to remind Mr Wellington that we go beyond the call of duty and have put in place unofficial arrangements where patients in far remote rural town are being picked up from home in areas like the Garden Route District (Slangrivier, Haarlem, Avontuur, Herold, Waboomskraal, De Rust, Dysselsdorp, Zoar, Amalienstein & Calitzdorp) and Central Karoo (Merweville and Leeu-Gamka with Murraysburg, Nelspoort) as part of. Geen gemeenskap sal agtergelaat word nie.

4. Mr Swarbeck from the District Six Health Committee shared his concerns about the negative exaggerated reporting in media that affects staff morale. He urged media to be considerate and not to be one sided in their reporting. Thanks Mr S, indeed, our staff are major building blocks to strengthen health system, and if one link is weakened unfairly, especially for political point scoring, you are weakening the whole health system. Yes, we are not perfect, we err, sometimes we are wrong and irritate our clients, but we don't dismiss their truths. We investigate, we sit over a cup of coffee and we apologize. That's why we are the only province with Independent Health Complaints Committee manned by skilled people that are not employed by government to look at those cases where the clients still feel aggrieved despite the interventions. Thanks Prof Fannie Sonn, Advocate Mdludlu, Ms Ross who are current members of committee plus also to extend our appreciation to previous ones who served before; Adv Gerrie de Kock and Prof Sinegugu Duma.

5. Prof Julie from UWC raised questions around the training of nursing staff, and academic support to strengthen nursing. I can report to the house that the Nursing College and the Ambulance College are in the process of getting accreditation to be one of the leading higher learning institutions that will provide the best training to future nurses and emergency medical personnel.

In terms of Clinic Committees and hospital boards, in addition to the implementation of the Community engagement Act the house passed in 2016, I can report we have started the training and so far, we trained members at: Wesfleur -, Helderberg -, Ladismith Laingsburg-, Otto du Plessis – and Khayelitsha Hospital.

Madame Speaker,

As I continue this theme of maintaining patient dignity, I want to start by focusing on five key elements that really highlights the lengths and depth this Department has gone through, to deliver a service despite the challenging environment it operates within.

1. MEAP (Management Efficiency and Alignment Project)

This model of re-design of organizational efficiency and alignment is to make the organization leaner and strengthen service delivery. Critically, MEAP is mainly about changing the way the Department functions, how teams support a culture of continuous collaboration, learning and growth, and values driven leadership across the whole system.

With MEAP, we achieve a 10% cost saving which we can plough into other programmes to ensure we continue providing a high quality service.

We have concluded the first phase which involved extensive engagement with staff on the redesign of how we can improve alignment and efficiencies in the management systems. The next phase intention is to have the Senior Management Staff matched and placed within the first quarter of 2019 so to provide some certainty and stability to the lower level structure that has been completed already.

2. Innovation

Technology as part of our innovation is a key enabler and disruptor in doing business unusual. We have implemented several key initiatives to mainly reduce waiting times; waiting times at facilities; reduced waiting for theatres and at ECs to unclog our facilities. There are about 20 of these interventions, but I want to flag few. I want also to thank facilities and staff for other innovations.

a) Unique patient identifier is now implemented across the whole Department, including City services. This allow patients to move from one area of the province to the next, from a hospital to a clinic and their medical records will still be available on this data system. We are one of the few places globally with an integrated data system across the service platform. 

b) Electronic Continuity of Care Record/ E-discharge. This electronic Continuity of Care Record (eCCR) aims to support the patient’s journey between hospitals and primary health care, through a web-based application. This reduces the time patients spent at facilities post discharge, and lay the foundation to establish DRGs (Diagnostic Related Groups), which will assist with fair resource distribution.

c) Data Centre – It allows us to integrate provincial health data, which we can use to generate actionable information, giving managers a powerful tool for improving healthcare. The potential is incredible and it is possible to develop tools for almost every medical condition. We want to thank DotP for still providing the technical support.

d) Hectis Project – this innovation is particularly crucial in our ECs where we see the most pressure. This electronic system shows the triage code for every patient, how long they wait, and flag it when an elderly or child is waiting. This continue to support our drive to improve the dignity of vulnerable patients.  The project has been running for three years, and has been rolled at Mitchells Plain EC, Heideveld EC, George EC, and Groote Schuur C15 Medical EC. It follows the patient from the time of entry into the EC until the patient leaves the EC. The ultimate purpose is to keep track and movement of patients throughout the emergency centre. I’d like to commend the team Dr. Moosa Parak, Naadir Fredericks, Mr. Jashmeer Maharaj.

e) Theatre Admin project – Theatres are the most expensive units in a hospital, and also the scarcest resource. Optimising theatre performance require good management information, which this initiative is already happening in rural hospitals like Worcester Hospital.

3. Public Private Partnerships

This is key in our mission to preserve patient dignity. The Department has entered into several partnerships that have allowed us to provide access to much needed health services.

a) Family planning and Immunisation Services - This initiative was implemented to provide effective and efficient services as well as formalize partnerships with retail pharmacies like Dischem and Clicks as well as other smaller pharmacies to improve access to health care services for all, improving governance of resource management between the Department and private healthcare practitioners for family planning and baby immunization services in both the metro and rural communities.

b) Private Farm Owners – Du Toits Group, Lutzville Wines, Thornlands Group

These private owners have all established access to health services to agri workers to ensure a healthy work force. I visited all these farms personally and saw first-hand how this add value to the health of the farmworkers and to improve continuity of care.

c) Operation 100 – This initiative supported Mandela day and aimed to perform 100 elective surgeries for free. The team surprised us and reached 195 procedures. This initiative evidences the commitment to the dignity and care to our vulnerable patients, who received life-changing surgical procedures. These operations were additional to what the Department planned and budgeted for the year, but with the help of generous sponsors and donors we were able to improve the quality of these patients’ lives for the better who were on the department’s central waiting list for surgeries.

4. Infrastructure

 Madame Speaker

We delivered world class infrastructure projects in partnership with the Department of Transport and Public Works, and continue to maintain clean and functional infrastructure. Infrastructure projects contribute to improved access to healthcare in the province. Every single cent of the over R4 billion we spent over the past 10years on infrastructure, benefitted the people of this province.

Infrastructure is one of the building blocks within the health system, and forms part of our priorities as a way to address patient experience and service pressures. I am also proud to announce that we will spent our entire allocation on infrastructure in the 2018/2019.

Our key infrastructure projects include new District Hospitals in Khayelitsha (330 beds) and Mitchells Plain (391), 10 Emergency Centres replaced or upgraded, 14 new Primary Health Care facilities completed, and the building of 11 new ambulance stations. We also prioritized psychiatric units such as these in Paarl, Vredenburg, and Mitchells Plain Hospitals.

Some of the key projects delivered 2018/2019:

District Six CDC, Thembalethu CDC, Khayelitsha Hospital Ward & CT Scan Suite, Napier Clinic, De Rust Clinic upgrades, and Vredenburg Hospital upgrades.

For the coming financial year, we have earmarked the following infrastructure projects as part of our investment, amounting to R1.2 billion.

The construction of Gansbaai Clinic, Laingsburg Clinic, Caledon EMS communication centre, Victoria Hospital EC, Swartland Hospital EC, Helderberg Hospital EC and Observatory FPL is underway.

De Doorns Ambulance station, Klipfontein Regional Hospital (In phase 3 of the project where service provider has been appointed), the new Avian Park Clinic and Psych capacity at Eerste River Hospital, Khayelitsha Hospital, and New Somerset Hospital is in the planning phase.

Focused interventions to save water resulted in massive savings. For e.g the Water Savings Project at GSH. We have also invested in borehole drilling at key facilities, and would like to highlight the progress made at Lentegeur Hospital. 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 in process.

5. Human Resources

I would like to commend our staff for their resilience amidst the challenging circumstances.

Our frontline staff is at the core of service delivery in health, which is why we need to ensure that we continue to create an enabling environment for our staff to deliver a high quality service.

I would also like to congratulate all our staff who managed to achieve success under these pressured circumstances.

I would like to in particular mention Ms Patience Shipalena was named as the Democratic Nursing Association of SA's (Denosa's) most caring nurse of the year.

Dr Mirja Delport received a great honour after she was recently nominated as Integrity Idol 2018.  Integrity Idol is a worldwide campaign which was established to give credit to honest government officials for their work.

In my budget speech last year, I shared that we are the only Province that prioritized junior doctors commuted over time to reduce stress.

I can report that an amount of R135 million has formally been allocated to the Department for 2019/20 for the Human Resources Capacitation Grant. We have appointed community service medical officers, medical interns, and are in the process to fill other critical staff at health facilities to ease service load pressures.

I have also promised the appointed additional FPS officers to relieve the pressure in this service. I can report that we are appointing 2 additional specialists, 6 Forensic Pathology Officers, and have increased Forensic assistant interns from 9 in 2017/18 to 50 in 2019/20).

We have also increased our investment in Primary health care hence you will see the largest share of the budget (40%) is allocated to District Health Services. Through this we have earmarked an increase in the remuneration for CHWs. We urge communities to support these foot soldiers who are faces with crime and potentially to be mugged and raped in these households. They walk distances in rains and suns, dodging stray bullets during their visits.

Staff safety remains a concern for the Department. Saturday evening, yet another EMS vehicle was attacked in Khayelitsha. Two EMS staff members were robbed at gunpoint, and left traumatised.

We view criminal attacks on our staff as an extremely serious matter, and a number of measures have been implemented in response. We have, to date implemented several initiatives in ensuring the safety of our Emergency Medical Services personnel. We have launched Operation Khuseleka to raise awareness and solicit community support for staff safety. We have been established inside the Transport Management City for improved collaboration, agilty and collective response with SAPS, DOCS, and traffic. We also co-operate with Neighbourhood Watches together with Department of Community Safety, we participate in the Provincial Joints Operations, and we have signed a memorandum of understanding with the City of Cape Town on efficiencies.

Before I get to the finances, I want to briefly highlight that Health has the largest footprint in the community. We provide health services to 75% of the population, 24/7, 365 days with 14 million PHC patient contacts. Over the past year, we acceded to calls from communities to improve services in particular pressurized facilities. We have to this end, developed improvement strategies for Khayelitsha District Hospital, Helderberg Hospital as well as Grabouw in recent weeks. In Khayelitsha, we’ve opened a new 30 bed ward, a new CT scan suite, and improved nurse governance.

In Helderberg Hospital, the new EC is underway, and in Grabouw we are extending the operating hours, to even operate on weekends.

These are all ways in which we aim to improve service delivery to the citizens of this province but more importantly restore the patient’s dignity. We err, we are not perfect, but if we work together as a ‘whole-of-society’ to ensure that services get to those who most need it.

Finances:

Madame Speaker, my heartfelt thanks to the Head of Department and her top management team for ensuring that we do not let the people of the Western Cape down.

I would like to commend them for the 14 year-record of an unqualified audit.  Clean and accountable governance is crucial, and reinforces public trust in the way we manage the public purse.

I rest easy tabling this R24.8 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 2019/20 budget:

Budget:

The health budget allocation for the 2019/20 financial year is R R24.8 billion as indicated by Western Cape Provincial Treasury. This unfortunately is still a reduction in real terms with a shortfall of about R187million.

Budget allocations

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

R14.7 billion for compensation of employees; 59% of the total budget

R7.7 billion for Goods and Services; 32% of the total budget

R1.3 billion for transfers and subsidies; 5% of the total budget

R1 billion for capital assets, 4% of the total budget.

National Conditional Grants R6.4 billion

National Tertiary Services Grant: R 3.2 billion

Health facility Revitalization Grant: R813 million

Health Professional training and Development Grant: R606 million

Human Resource Capacitation Grant: R135 million

Human Papillomavirus Vaccine: R 20.7 million

Comprehensive HIV/Aids Grant: R1.6 billion

Programme 1: Administration

Administration is allocated R844 million; 3 per cent of the vote in 2019/20. This amounts to an increase of approximately R46.730 million or 5.86 per cent.

Programme 2: District Health Services

District Health Services is allocated R9.9 billion; 40 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R575.6 million or 6.1 per cent.

Programme 3: Emergency Medical Services

Emergency Medical Services is allocated R1.1 billion; 5 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R47.08 million or 4.2 per cent.

Programme 4: Provincial Hospital Services

Provincial Hospital Services is allocated R3.9 billion; 16 per cent of the vote during 2019/20. This amounts to a nominal increase of approximately R262.5 million or 7.2 per cent.

Programme 5: Central Hospital Services

Central Hospital Services is allocated R6.9 billion; 28 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R423.9 million or 6.5 per cent. 

Programme 6: Health Science and Training

Health Sciences and Training is allocated R352 million, 1 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R21.4 million or 6.4 per cent.

Programme 7: Health Care Support

Health Care Support is allocated R501 million; 2 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R27.6 million or 5.8 per cent.

Programme 8: Health Facilities Management

Health Facilities Management is allocated R1.1 billion; 5 per cent of the vote in 2019/20. This amounts to a nominal increase of approximately R232.4 million or 25.1 per cent.

Conclusion

Madam Speaker, tabled here is the 2019/20 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 make maximum citizen impact through adding public value, by providing quality healthcare to the people of this province, improving the dignity of our citizens.

We need the ‘whole-of-society’ to ensure we keep on improving health outcomes in this province.

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;

• The 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

• The wind beneath my wings; my ministerial office staff for their commitment and resilience.

• And lastly my family and loved ones for their support and understanding the past five years!

Madame Speaker, I table 2019/20 Health Budget of Western Cape

I thank you! Enkosi