Western Cape Health Budget Speech 2005 / 2006

Speaker, honourable members and guests, it is my privilege to present the 2005/06 budget for the Western Cape Department of Health to you.

Speaker, as we mark the 50 th anniversary of the Freedom Charter, a document that remains a moral compass for our country and its people, we acknowledge that in the first decade of freedom we have made quality health care more accessible to the poor, through among other things, the provision of new clinics and free health care, especially for pregnant mothers, young children and people with disabilities.

At the same time we remain committed to improve the services provided in our health facilities through improved training, recruitment and retention of health personnel, improved infrastructure, and enhanced health promotion and awareness.

Ons is bevoorreg in die Wes-Kaap om 'n regering te hê wat al ons mense dien en hulle behoeftes verstaan. Ons is eweneens bevoorreg om 'n Premier en 'n Kabinet te hê wat verbind is tot die verbetering van die lewensgehalte van arm mense en die herstel van hulle menswaardigheid. 'n Regering verbind tot gelykheid in die werkplek en gelyke toegang tot dienste. 'n Regering wat, soos die Premier dit stel, dit hom ten doel gestel het om mense hulle eie stemme te help vind om ons te vertel hoe ons dienslewering moet verbeter en die regering meer toeganklik kan maak.

Together with other role players - in national, provincial and local government - this Department is ready to join in the fight against poverty and to begin to address the imbalances of the past. In his budget speech before this House on 12 April, Premier Rasool, highlighted the role played by our Provincial Growth and Development Strategy, iKapa Elihlumayo, in setting out the goals and targets aimed at fighting poverty and dealing with the challenges we face in this regard.

The association between social and economic conditions and ill health is well established. Whether socio-economic status is measured in terms of income, education, and employment or housing, people living in poor conditions suffer the worst health. The challenge of the Western Cape is to address inequity, to develop our communities and by doing so make the Western Cape a Home for All.

As 'n departement is dit ons plig om tot die gesondheid en welstand van gemeenskappe in ons provinsie by te dra deur aan hulle die nodige ondersteuning te verleen om gesonder te leef, en hulle van inligting te voorsien om hulle gesondheid in die lang termyn te bestuur. In kort gaan dit oor bemagtiging.

This is a course of action that we, as Provincial Government are committed to and is one of the guiding principles behind the reforms of our health service driven by our Health Care 2010 plan. In essence Health Care 2010 is about strengthening the frontline of our health services focusing on primary-level services, community-based care and preventative health with all the many benefits it holds for our people. It will also maintain a core of essential highly specialised health care services.

In the year ahead it is our goal not only to take health closer to the people by making it more accessible to those with the highest level of need but also to promote healthy living in our communities.

The past year has been one in which the Department faced exceptional challenges - and I want to thank the Premier and Cabinet colleagues for their support in overcoming some of the hurdles. I also want to thank Finance Minister Lynne Brown and Dr JC Stegmann, Head of the Provincial Treasury together with Minister Tshabalala-Msimang and Minister Manuel for their ongoing support in helping to ensure that the delivery of health services to our people went ahead unhindered.

The perseverance and the unwavering commitment of our management and staff deserve special recognition and I want to dedicate this speech to the specialists, doctors, nurses, support staff and everybody that helps in providing a quality health service to the people of this province.

So often we forget that Health is about people caring for people - and about us having to care for the carers. Today - as we must everyday - we honour our carers and the noble work they do. Thank you.

Speaker, allow me to review some of the key challenges referred to in my 2004/05 budget speech and the progress made in this regard:

One of the key challenges identified during last year's budget dealt with: "Staff costs and what needs to be done to improve the morale of health care workers across the province."

Personeelkoste het relatief stabiel gebly ondanks toenemende pasiëntgetalle wat van ons dienste gebruik gemaak het. Die departement beskik tans oor 23 201 gesondheidswerkers. Die afgelope jaar het ons begin om ons bestaande menslike-kapitaalhulpbronne te versterk deur veral poste in ons daghospitale te vul. Ons het 33 bykomende dokters, 24 aptekers en 55 verpleegkundiges aangestel. Ek glo dat ons voortgesette hospitaal-opknappingsprogram en opgradering van ons gesondheidsfasiliteite sal bydra tot 'n beter werksomgewing en personeelmoraal. Natuurlik sal dit nie oornag geskied nie, maar ons werk hard daaraan. Personeelmoraal is ook aangespreek deur beter ondersteuning vir werkgewerbystandprogramme, die implementering van 'n toelaag vir mense met skaars vaardighede, asook groter interaksie met personeel deur middel van personeel-indabas en besoeke aan fasiliteite.

A second challenge referred to; "the triple burden of disease - trauma, lifestyle diseases and infectious diseases and said we faced a major challenge to reduce this burden through effective health programmes."

These were addressed through existing programmes but it became clear that business as usual will not suffice. As mentioned above other strategies chiefly by increasing community participation in and responsibility for their own Health will be implemented. This will be dealt with as part of the social capital formation strategy and community outreach for which funds have been allocated in the budget.

Thirdly; "The challenge to improve primary health care services across the province, especially in the Cape Metropole. Last year I gave details about our 100-day deposits."

100-day targets were achieved in 9 CHC's improving service delivery by better signage, better management with dedicated facility mangers, improved drug supplies with stock outs dramatically reduced. And these improvements have now been extended through the April targets to an additional 6 CHC's in the Cape Metropole (Michel Mapongwana, Crossroads, Heideveld, Nolungile, Macassar and Bishop Lavis). At the same time the computerisation of these facilities are progressing well - resulting in improved communication and patient management. (Our facility manager at Delft, Machelle Gordon, was a runner up in the nurse of the year Cecilia Makiwane awards in 2003 - and last year a chief professional nurse at the Gugulethu CHC, Ntombekhaya Bambani, was the provincial and national winner of this prestigious award.)

The fourth challenge as spelt out in the 2004/05 budget speech dealt with: "Funding for the provincialisation of personal primary health care services. At the time no additional funding was available for this purpose."

Intussen het hierdie regering suksesvol onderhandel vir bykomende fondse om op 1 April 2005 die verantwoordelikheid te aanvaar vir persoonlike primêre gesondheidsorgdienste wat tot einde Maart vanjaar deur nie-metropolitaanse munisipaliteite gelewer is. Hierdie proses is van stapel gestuur tydens 'n vergadering met georganiseerde plaaslike regering op 28 Februarie 2005. Tans is verskeie tegniese en spesialisspanne, met verteenwoordiging van beide provinsiale en plaaslike regering, besig om die fynere besonderhede van menslike hulpbronne, finansies en bates uit te stryk.

Our fifth challenge focused on: "Completing the takeover of Emergency Medical Services from the City of Cape Town as well as a general upgrading of the quality of EMS in the province, particularly response times and patient transport."

Only about 30 operational EMS staff remain in the City of Cape from the more than 350 staff originally. The service was placed fully under the operation control of the province early in 2004. While this presented some management challenges, it also resulted in a better coordinated emergency service. During the course of the year 73 contract EMS personnel were permanently employed.

"Our seventh, challenge - as defined in my 2004/05 budget speech - centred on the revising of joint agreements between universities and the Health Department."

I'm happy to report that an agreement on the process forward was reached with the four universities. A task team of senior officials has been constituted and progress can be expected in this protracted process that extended for more than ten years. The process of revising the joint agreements must be completed during 2005.

"An eighth challenge was the implementation of the National Health Bill."

Although it was expected that the National Health Act would commence during 2004 this was not the case.

Speaker, honourable members will be aware the President has now proclaimed that 10 of the 12 Chapters of the National Health Act will commence on the 2 nd of May 2005. This is an important development for the department as this Act, as the Preamble states, is "aimed at uniting the various elements of the national health system in a common goal to actively promote and improve the national health system in South Africa".

In this regard Section 26(2) of the National Health Act provides for the establishment of a Provincial Health Council chaired by myself and comprising one Councillor from the City of Cape Town; one Councillor from each of the district municipalities in the province; the head of the provincial department; not more than three representatives involved in the management of local government and such number of other persons as I may consider appropriate.

I will shortly extend an invitation to local authorities requesting them to nominate a Councillor to serve on the PHC. SALGA will also be advised to recommend persons representing it. The first meeting of the PHC will take place before the end of July 2005.

• The implementation of the comprehensive plan for the care, treatment and management of people living with HIV and AIDS with universal access to VCT being provided across the province and the roll out of the anti retroviral programme with antiretroviral drugs now available at 33 sites to a total of 7670 patients.
• Die opgradering van hospitale in die landelike gebiede by George, Worcester en Vredenburg, en die voltooiing en opening van die Wes-Kaapse Rehabilitasiesentrum by Lentegeur Hospitaal in Desember 2004. Ons het ook begin met die opgradering van die Mowbray Kraamhospitaal.
• During 2004/05 we also purchased new equipment including new state of the art CT scanners for Groote Schuur and Tygerberg Hospitals and recently delivered planning equipment for radiotherapy. On a wide front less expensive but equally essential equipment was acquired with in total over R85 million worth of equipment being purchased and delivered during the financial year including: T wo CT scanners at GSH and TBH, A screening room at TBH, Opthalmology equipment, ENT equipment, Anesthetic machines GSH and TBH, Monitoring equipment GSH, Mammo Unit TBH, X-Ray equipment at Citrusdal, Swartland, Riversdale, Mossel Bay and X-Ray upgrades at GSH, Radiotherapy equipment (R7 mil) - two simulators and an Endoscopy system at GSH.
• Special efforts were also made to address backlogs with additional funding going to and beginning to reduce the waiting lists for cataract operations, breast surgery and bone marrow transplantation.

As ons kyk na die 2005/06-begroting, kan ek dit nie beter saamvat as die positiewe terugvoer wat ek van ons bestuur en personeel by gesondheidsfasiliteite regdeur die provinsie ontvang het nie. Oor die algemeen is daar 'n gevoel dat daar nou meer ruimte is om asem te haal na die geweldige druk van die afgelope paar jaar - asook 'n verskeidenheid nuwe geleenthede deur die gefinansierde beleidsopsies waarna ek later in my toespraak sal verwys.

While this budget signifies the beginning of a new financial year, it also leads in a new chapter for Health Western Cape as we move towards Healthcare 2010.

• Provincialise personal primary health care services in the non-metropolitan areas of the Province;
• Improve the overall efficiency in primary health care services promoting the concept of a seamless service
• Improve the quality of emergency medical services
• Implement the revised service platform, revise the staff establishments, and apply the service packages and standard treatment guidelines within the framework of Healthcare 2010.
• Adopt urgent strategies to recruit and retain health professionals (especially nurses) in the public service to ensure the future stability of health services.

The budget as a whole has increased by 14% or R805 million from R4, 936 billion, including facilities, in the main appropriation for the financial year 2004/05 to R5, 743 billion in 2005/06. This is a significant increase and will go some way to enable the department to deal with the service pressures that it is experiencing. The Health budget makes up almost 28% of the total provincial budget.

In evaluating the many needs of communities and the department nearly 200 policy options were considered. In the end after a rigorous process only those that met the requirements of Government in terms, amongst others, of iKapa Elihlumayo, Healthcare 2010, National Health priorities and the Millennium Development Goals were included in the budget.

Program 1 (Administration) receives R196 million of which the majority is allocated to subprogram 1.2 to handle the overall management and administration of the department and the respective regions and institutions within the department. Funded policy options in this programme includes:

• Befondsing vir die aanstelling van 'n transaksie-adviseur en -konsultante om 'n lewensvatbaarheidstudie te doen vir 'n moontlike openbare/privaatvennootskap om 'n noodsaaklike nuwe forensiese eenheid by Valkenberg Hospitaal te bou.
• Befondsing vir die aanstelling van finansiële personeel by alle instellings en kantore om finansiële bestuurskapasiteit in die departement te verbeter.
• A chronic dispensing unit will be established at a cost of R8 million (plus R1,5 million for capital works) that will improve the distribution of chronic medication to initially around 50 000 patients a month. It is anticipated that this will reduce congestion initially within the community health centres in the Cape Metropole.
• Staffing issues that receive attention are: R1 million for the employee assistance program, R3, 85 million to upgrade clerk post salaries and R10 million to increase the personnel performance incentives to 1% of the personnel costs.

Program 2 (District Health Services) receives R1, 612 billion of which R322 million is allocated to community health clinics, R513 million to Community health centres, R418 million to district hospitals. Programs addressing HIV and AIDS receive R167 million. Funded policy options in this programme includes;

• The long awaited provincialisation of PPHC services in non-metropolitan areas as referred to earlier, is a major project that will allow for a seamless and integrated health service across all platforms throughout our province. An additional R65, 85 million over and above that already funded will be made available for this purpose in this year. The consequence of this is that these services will be taken over initially operationally and finally completely by transfer of staff and assets to the province.
• Verdere ontwikkelings met betrekking tot primêre gesondheidsorg is die toewysing van R8 miljoen vir die bevordering van gemeenskapsdeelname, en R7 miljoen om sosiale kapitaal te bou. Die verdere rekenarisering van gemeenskapgesondheidsentrums sal beter bestuur en administrasie by hierdie fasiliteite teweegbring. Sleutelgebiede vir optrede met betrekking tot die strategie vir die bou van sosiale kapitaal is wanvoeding, diarree en chroniese leefstylsiektes.
• District hospital services will be expanded within the Cape Metropole by the commissioning of 120 level 1 district hospital beds in Tygerberg and Karl Bremer Hospitals. These beds will form the nucleus of the beds to be placed in the envisaged district hospital in Khayelitsha. Thirty (30) district hospital beds will also be opened at Lentegeur to form the nucleus of the beds to be placed in the envisaged district hospital in Mitchells Plein. More good news is that 30 level 1 beds have been placed at the Eerste River Hospital and a trauma unit will also be established at this facility. This will be used to help alleviate the pressures experienced by Hottentots Holland Hospital.
• The treatment of tuberculosis remains a priority area. Of the total of R70, 7 million budgeted, R64, 1 million is budgeted for TB Hospitals. This is strengthened by R4, 4 million for additional staff and laboratory services in our clinics. An amount of R2, 23 million is also made available for the taking over of two municipal hospitals (the Sonstraal Hospital in Paarl and the Malmesbury Infections Diseases Hospital) and the SANTA (Harry Comay) Hospital during the financial year.
• With respect to HIV and AIDS funds are made available through a conditional grant of R82 million, with the total including other provincial earmarked funding amounting to R116 million. In addition R51 million will be received from the Global Fund all of which allow for the expansion of prevention, treatment and care of patients with this disease. The target for 2005/06 is to add 11 new treatment sites to bring the total to 44 sites by March 2006 providing treatment to 13 680 patients on a daily basis. It is also our goal to bring up the people who have undergone Voluntary Counseling and Testing from 200 000 to 400 000 in this year.

Program 3 (Emergency Medical Services) receives R254 million of which R249 million is allocated to emergency transport, which renders ambulance services as its main function.

• Mediese nooddienste ontvang spesiale aandag met 'n bykomende toewysing van R32 miljoen om diensvlakke te verbeter, asook R10 miljoen om kommunikasiesentrums in samewerking met die Departemente van Plaaslike Regering en Gemeenskapsveiligheid asook distriksmunisipaliteite te ontwikkel. Vier van die ses beoogde sentrums sal reeds gedurende vanjaar hulle deure oopmaak. R10 miljoen is geoormerk vir die indiensneming van 124 ambulanspersoneel in die Kaapse Metropool en landelike sleutelgebiede om reaksietye te verbeter. Die bykomende personeel behoort reaksietye met 20 minute te verkort vanaf die huidige onaanvaarbare 90 minute in die Metropool. R2 miljoen sal aangewend word om 'n mediese helikopterdiens te loods wat in Oudtshoorn gesetel sal wees en die Sentrale Karoo- en Eden-distrikte asook die sogenaamde pad-van-die-dood deur Laingsburg en die Drie Susters sal bedien. Sodoende sal 'n gevorderde lewensreddingsdiens binne 30 tot 40 minute aan ernstig beseerde of siek persone in hierdie gebiede gelewer word

Program 4 (Provincial Hospital Services) receives R 1, 276 billion of which the major allocations of R777 million is to general regional hospitals. Psychiatric hospitals are allocated R285 million and TB hospitals and chronic hospitals (Maitland Cottage Hospital, Booth Memorial, Western Cape Rehabilitation Centre, St Joseph's, Malmesbury Infectious Diseases Hospital and Nelspoort Hospital) are allocated R64 million and R97 million respectively. Funded policy options includes;

• Funds are allocated to improve regional hospital services with R3 million to Eben Donges Hospital and R5 million to George Hospital to increase bed numbers. In addition R12 million has been allocated for the filling of critical posts and a further R5 million to appoint additional medical specialists in George, Worcester and Paarl hospitals.
• Voorsiening is ook gemaak vir die akkommodasie van akute TB-pasiënte in algemene hospitale, terwyl chroniese-TB-hospitale multimiddel-weerstandige TB-gevalle sal opneem. R500 000 is hiervoor aan die Brewelskloof Hospitaal toegewys vir die vul van kernposte.
• The Mental Health Care Act have been promulgated and as a result R4, 9 million has been allocated for the implementation of the Act. This includes funding for a Mental Health Review Board which will play an integral role in ensuring that the rights of the mental health care users are protected. The Board has been established and its first meeting will take place on 6 May 2005. In the psychiatric hospitals R7, 6 million has been allocated to improve service delivery and R2 million for the filling of critical posts.
• R1, 2 million was allocated to create acute beds for children needing admission during the summer months when diarrhoeal disease and dehydration in young children is most frequent and an additional R1 million to extend much needed ear, nose and throat service in the Cape Metropole.
• The Department has prioritised the development of infrastructure in line with Healthcare 2010 and this is reflected in the Hospital Revitalization projects at George, Worcester and Vredenburg. Paarl Hospital will commence during 2005 while planning is underway for the envisaged hospital in Khayelitsha. Other major projects include the upgrading of Mowbray Maternity Hospital, Caledon and Riversdale hospitals. At primary health care facilities a new clinic will be constructed at Browns Farm to replace the current container clinic, a new clinic will be constructed in Montagu, upgrading will be undertaken at the Elsies River clinic, while upgrading will be undertaken at Simondium, Stanford, Swellendam and Wellington. With many in dire need of renovation, a start will be made with the upgrading of ambulance stations at Swellendam, Hermanus, Riversdale, Atlantis and at Lentegeur.

Program 5 (Central Hospital Services) is allocated R1, 936 billion, which makes it the largest single program with the funding being distributed between the three Central hospitals. Funded policy options in this programme includes;

• Central hospitals, Groote Schuur, Tygerberg and Red Cross hospitals were bolstered with an additional R93 million added to the National Tertiary Services Grant over the initial indicative MTEF figure which has for the first time reversed the decrease in real terms of the funding received from the grant. The NTSG increased by R111 million in comparison to the 2004/05 allocation. Nevertheless these hospitals, which receive the full NTS grant and 60% of the Health Professions Training and Development Grant (HPTDG) require an additional 27% of their funding from the provincial equitable share. These hospitals, which receive in total R1, 936 billion, receive respectively R811 million (Groote Schuur), R834 million (Tygerberg) and R247 million (Red Cross Hospital) in the 2005/06 financial year. This amount includes funding for increased capacity in theatres and intensive care units, maternity and neonatal services, modernization of management of especially theatres and generally improving access to the services.

Program 6 (Gesondheidswetenskappe en Opleiding) ontvang R83 648 miljoen met onder andere twee groot toewysings onderskeidelik R35 miljoen aan die Wes-Kaapse Verpleegkollege en R42 miljoen vir beurse hoofsaaklik vir verpleegstudente. Gefinansierde beleidsopsies in hierdie program sluit onder meer in:

• R500 000 om die oordrag van die Wes-Kaapse Verpleegkollege na die Kaapse Skiereiland Universiteit van Tegnologie (CPUT) te fasiliteer. 'n Aanvanklike stap sal die ondertekening wees van 'n bedryfsooreenkoms met die CPUT. R2 miljoen is geoormerk vir biblioteek- en opleidingslaboratoriumtoerusting asook vir verbeterde toegangsbeheer.

Program 7 (Health Care Support Services) receives R87, 457 million with R38 million allocated to laundry services and R30 million to engineering services.

Program 8 (Health Facilities Management) transferred from the Department of Transport and Public Works receives R296, 805 million for funding the construction and upgrading of health facilities in the province.

In total an amount of R116 million is allocated for all categories of equipment across all the programmes.

Significant increases are in Programs 2 and 3 while there is for the first time a reversal in the trend in Program 5 with an increase in real terms in the amount allocated. Program 2 District Health Services increases by 22% in nominal terms to R1, 612 billion forming 28% of the total Health budget. This is one of the largest increases in ten years. Program 3 Emergency Medical Services increases in total by 24% to R254 million which amount includes R10 million for the combined communication centre to be developed in collaboration with the Departments of Local Government and Community Safety. Central Hospitals Program 5 increases by 8% or R144 million in 2005/06 comprising 34% of the total budget. On the other hand Program 1 Administration decreases by 12% or R26 million, while still including R11 million for equipment earmarked for use in other clinical services, signifying the commitment to allocate funds to service delivery and keep central management expenses limited to a minimum.

Ter afsluiting wil ek u almal die versekering gee dat hierdie Regering en die Departement verbind is tot die verskaffing van gelyke toegang tot kwaliteit gesondheidsorg. Ter ondersteuning van hierdie beginsel is dit ons oortuiging dat die verwydering van sosiale en ekonomiese faktore wat tot ongelykhede binne en tussen gemeenskappe lei, van sleutelbelang is vir beter gesondheid.

Health has made a concerted effort to analyse social capital formation and its implications for the Department. It is clear that social capital plays a fundamental role in the prevention of disease and the promotion of health. As the successful functioning of the Department rests on an effective and efficient Primary Health Care service so does the development of social capital. The Department's Healthcare 2010 and social capital formation strategy are therefore closely aligned and both have a primary health care focus.

In addition to implementing Healthcare 2010, the Department has identified four issues with which to link the progress in social capital formation, i.e. diarrhoeal disease in children, immunisation, the management of chronic diseases, including HIV and AIDS; and trauma.

Daar word geglo dat deur die koestering van sosiale-kapitaalvorming, gemeenskappe verantwoordelikheid vir hulle eie gesondheid en hulle benutting van gesondheidsfasiliteite sal aanvaar. Die doel is om 'n wedersydse verhouding tussen die departement en die gemeenskappe wat ons dien, te ontwikkel.

As deel van hierdie proses, is dit ons verantwoordelikheid as 'n Departement om toestande te skep vir benadeelde mense om gesonder keuses te maak. Ons moet gesondheid en gesonder leefstyle bevorder en mense bystaan om aan gesondheid voorkeur te gee deur duidelik te wys hoeveel voordele dit vir ons gemeenskappe inhou.

On the issue of employment equity, I agree with the Premier that this year must be about making "significant movement towards a representative public service". Progress on this front up to now has been too slow - and my Department will in the coming year place even greater emphasis on achieving the goals set out in our Employment Equity Plan.

Finally, I would like to thank the Head of the Department Prof Craig Househam, for his steadfast leadership over the past year. Also our management team for their resourcefulness and resilience.

To all our health workers: Be proud of what you do and the contribution that you make; we are and you certainly deserve to be.

Ons moet nooit vergeet nie dat die Wes-Kaapse gesondheidsdepartement uitsluitlik daar is om aan die gesondheidsbehoeftes van al ons mense te voldoen. Ons moet te alle tye en deur alles wat ons doen, die beginsel van Batho Pele uitleef. Batho Pele - die mense eerste - gaan juis oor omgee vir ons mense deur gesondheidsdienste te lewer waarop ons trots kan wees.

But, let me add, the public also have a responsibility to treat our staff with respect and understanding.

Let's continue to work together to make the Western Cape a "Healthy Home for All".

Thank you.