Budget Speech 2004/2005: Department of Health

Mr Speaker and Honourable Members, as we ready ourselves to celebrate ten years of democracy in the Western Cape on Youth Day 16 June 2004, it behoves us to remember that South Africa and its people surprised the world by making a peaceful transition to democracy a decade ago. Many a sceptic at the time predicted disaster. They said that the challenges presented by a divided society such, as ours was so enormous that it would be near impossible to overcome. But, together - men and women of goodwill - reached across the divide caused by decades of suffering, faced the challenges head-on and overcame them one by one.

I refer to this historic moment, Mr Speaker, because over the course of the next five years it is to this example that Provincial Health will turn when confronted by seemingly insurmountable challenges. If as a nation we could overcome the huge challenges on the path to establish and build our democracy, those involved in the health sector in this Province can surely overcome the challenges that stand in the way of delivering a healthier Province.

In Gesondheidsdienste het ons ons verbind tot 'n gesonde tuiste vir almal om deel te vorm van die Premier en hierdie regering se verbintenis om die Wes-Kaap in 'n "tuiste vir almal" te omskep. Al is ons deeglik daarvan bewus dat die uitdagings wat voorlê groot is, is ons doelwit van gelyke toegang tot volhoubare gesondheid van gehalte vir al ons mense, waarna ons streef.

THE CHANGING ENVIRONMENT

Mr Speaker, the environment in which health services are provided in the Western Cape constantly changes and places further pressure on our resources.

Currently, seventy-two percent of the Western Cape's four-and-a-half million people depend on State health services. There are also about 48,000 people who migrate into the Western Cape annually and make use of our health services. This year it is estimated that 110 000 patients from the Western Cape and 90 000 patients from other provinces will receive highly specialised care at Groote Schuur, Tygerberg and Red Cross.

Ons mense het toegang tot 'n verskeie dienste, vanaf die mees basiese tot die mees gesofistikeerde in die wêreld. Net soos ander provinsies, is die Wes-Kaap in 'n stryd gewikkel met veelvuldige eise - trauma weens geweld, voertuigongelukke en brandwonde; kroniese siektes soos diabetes en hipertensie; en aansteeklike siektes soos tering en MIV/VIGS. Ons het die hoogste voorkoms van tering in Suid-Afrika en 'n lae, maar toenemende voorkoms van MIV/VIGS.
As at the end of May 2004, there were 23,235 staff members providing health services. This is down from the nearly 27,000 people employed by the Department six years ago. I point out these reductions, Mr Speaker, to highlight the tremendous challenge to the Health staff, now and in the years ahead.

THE WAY FORWARD - HEALTHCARE 2010

Mr Speaker, in the short time that I have been the Minister of Health in the Western Cape, I have become aware of the tremendous complexity of providing quality health services to all our people who depend on them. Part of this complexity stems from the ever-present challenge of balancing overwhelming needs with limited resources.

With the implementation of Healthcare 2010 that will start in earnest in this financial year, I believe we have found a way forward that will not only improve the quality of health care but also make it easier for people to access that care. It will also allow us to apply our limited resources to maximum effect and keep expenditure within budget.

The Healthcare 2010 strategy rests on four pillars: services; people; facilities; and money.

First, we have to define clearly the type and quantity of services offered at each Health facility. Secondly, we have to ensure that people with the right skills mix and qualifications provide these services. Thirdly, we have to ensure that the services are provided in facilities that are well designed, accessible and secure. Fourthly, we have to secure sufficient funds to provide these services and then use these funds cost-effectively. At the same time, we need to generate as much revenue as possible to supplement these funds.

Alle betrokkenes is dit eens dat ons hierdie pilare stewig moet staanmaak. Daar is egter nog nie volkome eenstemmigheid oor presies waarvan die pilare gemaak moet word nie. Soos ek gesê het, mnr die Speaker, bevind gesondheid hom in 'n komplekse omgewing. Ons het aandeelhouers wat reeds goed gevestig is en 'n lang tradisie in die lewering van gespesialiseerde gesondheidsdienste het. Gesondheidsorg 2010 verlang van baie mense om hul uitgangspunte en hul gewoontes aan te pas. Baie sukkel om dit te doen en enkeles is huiwerig om dit te doen. Ons weet verandering is moeilik en dat dit selfs nog meer uitdagend is in 'n omgewing met beperkte hulpbronne.

However, it is a challenge that all role-players have to rise to in co-operation with one another for the benefit of the people we have to serve together.

HEALTH BUDGET

This year Health has been allocated a budget of R4.74 billion that amounts to just over 25 percent of the provincial budget. Conditional grants constitute 33 percent or R1,558 billion of the budget, with the National Tertiary Services Grant making up R1, 076 billion.

Revenue, reflects an increase over the MTEF period. The Department has succeeded in increasing its revenue from R98 million in 2000/01 to a projected R156 million for the 2004/05 financial year.

BUDGET DETAILS

I turn now to the respective budget allocations according to Budget Statement Number 2.

Spurred on by our beliefs, we are making our budget allocation go a very long way in the provision of health services.

In terms of Administration (Programme 1), we are putting more time into the application of staff profiling and the revision of staff establishments. This will ensure that costly human resources are optimally utilised. The generic models, which are crucial for ensuring that facilities have staff with the right skills mix for the services provided, have already been tested in some hospitals and will be tested in several more this year.

We are also beginning to reap the benefits of our quality assurance programme in that we are monitoring and resolving complaints better. This programme is important for identifying patients' expectations and measuring the quality of our service.

Under Programme 1 we have also invested substantial funds and effort on the development of effective supply chain management. This is enabling us to obtain optimal value as well as promote black economic empowerment through preferential procurement. We expect this to improve this year. We are also expecting to improve procurement processes, particularly regarding the ordering and supply of medicines.

In sy toespraak van 28 Mei het Premier Rasool klem gelê op die behoefte aan doeltreffende samewerking tussen die verskillende sfere van regering. Ter voorbereiding vir die oordrag van magte en funksies met betrekking tot persoonlike primêre gesondheidsdienste, is R12 miljoen toegewys om verwante sake aan te spreek wat betrekking het op die hoër befondsingvereistes wat hierdie dienste vir die provinsiale regering inhou.

Like last year, the Western Cape expects this year to have over 12 million patient contacts at the primary health care level. These contacts take place in 242 fixed clinics, 130 mobile clinics and 64 community health centres. This year much energy will be spent on enhancing the experience of Health' s clients at our community health centres in the Cape Metropole. We found that most of the complaints came from nine community health centres in the Cape Metropole. These are Delft, Elsies River, Gugulethu, Hanover Park, Khayelitsha, Kraaifontein, Mitchell's Plain, Retreat and Vanguard. Various measures are being taken to reduce the waiting times to acceptable levels at these facilities. Patients will on arrival be guided to the appropriate waiting areas. Patients who visit just for repeat medication will be accommodated in fast lanes. Shelters will be erected so that people don't wait in the cold and rain when they arrive before the facility opens.

Ons sal verseker dat die verskaffing van medisyne verbeter word sodat pasiënte nie meer sonder hul medikasie weggewys word nie. Indien die medisyne wat hulle gewoonlik kry nie beskikbaar is nie, sal ons 'n aanvaarbare vergelykbare middel verskaf.

Nog 'n verbetering binne die volgende 100 dae sal die aanstelling van bestuursfasiliteerders wees in die nege gebiede wat ek genoem het. Dit sal die bestuur van die inrigting in sy geheel verbeter. Ons verwag dat dit tot 'n meer doeltreffende diens en 'n beter moreel onder personeel sal lei.

With regard to the comprehensive management, care and treatment of HIV and AIDS patients, we have made laudable progress. The programme for the prevention of mother-to-child transmission has been fully implemented, and all pregnant women attending public health facilities can now access the programme. Facilities for voluntary counselling and testing are available at 344 sites. Anti-retroviral drugs are being dispensed at 19 fully operational sites across the province, and we plan to increase this number to 36 by 2005. By the end of this financial year we expect to be treating around 7,000 people.

On the question of TB, this year will see the further introduction of a new four-drug combination treatment, which will lead to improved cure rates. In addition, more strenuous effort will be made to reduce interruption rates.

Vir ons Mediese Nooddiensprogram (Program 3) het ons R186 miljoen begroot. Die klem sal hierdie jaar val op 'n verbetering van nooddienste deur nog vinniger reaksietye. Dit sal bereik word deur verbeterde kommunikasiestelsels en voertuig nasporing. Met die hulp van Staatsmotorvervoer van die Departement van Vervoer en Openbare Werke, sal nasporingstelsels voor die einde van die jaar in alle mediese noodvoertuie geïnstalleer word. Ons hoogs opgeleide nooddienspersoneel sal sowat 16 miljoen kilometres vanjaar aflê en ek is bly om te kan sê dat hulle dit in redelike nuwe en volledig toegeruste voertuie sal kan doen.

The budget for the provincial or regional hospitals (Programme 4) is R1, 1 billion. This year we will start addressing issues of restructuring within the regional hospitals, which we regard as the "backbone" of the provincial health services. The last year of the MTEF period (2006/07) will see the shift of a significant part of the current Tygerberg Hospital, which will begin to function as a regional and tertiary hospital in that year.

Within the TB hospitals there will be moves to strengthen the treatment of multi-drug resistant (MDR) TB by standardizing MDR protocols.

Ons sal nog vanjaar die opgradering van die toelatingsale vir kroniese psigiatriese gevalle en 'n verbetering van die forensiese psigiatriese saal by ons Valkenberg Hospitaal voltooi. Die beplanning van 'n lang-termyn oplossing vir die onaanvaarbare situasie met betrekking tot hierdie aspek van die diens het reeds begin en ons hoop om nog vanjaar duidelikheid te kry oor hoe hierdie noodsaaklike projek gefinansier gaan word.

In total, Mr Speaker, we expect around 172,000 patients to be admitted to regional, psychiatric and tuberculosis hospitals during this year.

Despite the decrease in the National Tertiary Services Grant, the budget for the three central hospitals (Programme 5) shows an increase of 8 percent. This indicates that the province is utilizing increasing portions of the equitable (provincial) funding to run these facilities. The key challenge in this programme is the restructuring of the highly specialized tertiary services in line with the nationally driven "modernization of tertiary services" process. It is of pivotal importance to consolidate these services so that they meet the needs of the country but also are affordable in terms of available national and provincial budgets. From a provincial perspective the restructuring of tertiary services must unlock resources to allow for development of other levels of services. The revision of the joint agreements with universities will be a key enabler of this process.

Ons verwag ook om tandheelkundige dienste aan 160 000 mense te verskaf.

The budgets for Training and Development and for Professional Support Services (Programmes 6 and 7 respectively) are R152 million.

Nagenoeg 800 mense word vanjaar as verpleërs opgelei en 100 word as mondhigiëniste opgelei. Bykomend tot hierdie formele opleiding, sal nog enkele honderde gesondheids-personeellede verdere kort-kursus opleiding ontvang in rigtings soos byvoorbeeld diversiteitsbestuur en effektiewe kommunikasie.

On the facilities side, there is much excitement surrounding the opening during August of the Western Cape Rehabilitation Centre, currently being built on the site of the Lentegeur Hospital. I would encourage honourable members to visit the Centre once it has been opened. It is truly heartening to see what has come out of the joint efforts of people who disagreed vehemently with one another in the beginning and then decided to work together in the interests of the people they serve. Health has invested more than R90 million in this project, and it is going to be worth every cent.

Our three major hospital revitalization projects are progressing very well. Upgrading of George Hospital (R79 million) is almost complete, and the upgrading of Worcester (R147 million) and Vredenburg (R48 million) Hospitals are in full swing. These upgrades provide not only for the complete renovation and extension of the buildings but also equipment and staffing. These projects demonstrate our commitment to service our rural areas and provide quality medical services to our people outside the metropole.

Nog meer opknappingsprojekte word in die vooruitsig gestel. Weens noodsaaklike funksionele vereistes sal daar vir die opgradering van die Mowbray Kraamhospitaal nog tydens die huidige finansiële jaar vir tenders gevra word. Die Departement is ook besig om 'n voorlegging op te stel vir die bou van 'n nuwe hospitaal in die Khayelitsha/Mitchell's Plein-gebied (R110 miljoen), wat reeds as 'n prioriteit deur die Provinsiale Regering geïdentifiseer is.

SOME KEY CHALLENGES FOR 2004/05

Allow me, Mr Speaker, to state the challenges posed to the Health Department by the 2004/05 budget.

It is absolutely clear to me that cooperation between the various spheres of government is key to achieving the all-important goal of a better and healthier life for all our people. Without the support of other departments such as Transport and Public Works we would not be able to upgrade or improve our health facilities. By the same token, local government plays an important role on several fronts not only in terms of the health services they provide but also in helping to ensure a healthy environment. By providing free water, sanitation and refuse removal, local government makes an enormous contribution to a healthier Western Cape. Without the support of our colleagues at national and local government sphere as well as here in our own province our task in Health would be that much more difficult - and I would like to thank them for their contributions in this regard.

Ons eerste groot uitdaging is dus om samewerking tussen egeringsfere en departemente te verbeter. So byvoorbeeld is Gesondheid 'n sleuteldepartement in die maatskaplike veiligheidsnet en is ons gretig om ons deel as departement by te dra. 'n Groot uitdaging is om ons menslike hulpbronne te ontwikkel om innoverend en koste-effektief al ons ander hulpbronne aan te wend. Die beste manier waarop Gesondheid die Provinsiale Groei en Ontwikkelingsplan, ikapa Elihlumayo, kan ondersteun is met maksimale doeltreffendheid op alle gebiede...

Another daunting challenge is to reduce staff costs and at the same time improve the morale of health care workers across the province. We believe that this is imperative if we are to retain staff where they are needed and attract new talent to the Department. Improved staff morale will also lead to improved quality of care.

I referred earlier to the triple burden of disease - trauma, lifestyle diseases and infectious diseases. Our third major challenge is to reduce this burden through effective preventative health programmes. These programmes will be aimed not only at increasing awareness amongst the public, but also changing behaviour. An approach, highlighted by President Mbeki in his State of the Nation address earlier this year.

Our fourth challenge is to improve primary health care services across the province, especially in the Cape Metropole. I have given details about our 100-day deposits. Our challenge is to introduce similar improvements across the health services at all levels and then to sustain them.

Our fifth challenge concerns the resolution of issues concerning the powers and functions related to personal primary health care currently delivered by local government.

Ons sesde uitdaging is om die oordrag van die Mediese Nooddienste vanaf die Stad Kaapstad te voltooi. Terselfdertyd moet ons 'n algehele opgradering van die kwaliteit nooddienste in die provinsie teweeg bring veral wat ons reaksietye en die vervoer van pasiënte in ons plattelandse gebiede betref.

Our seventh, and perhaps most far-reaching, challenge centres on addressing the problems within the highly specialised tertiary services. We need to rationalize certain tertiary services, restructure staffing establishments and revise the existing joint agreements with the respective universities so that we can build up secondary care as the backbone of our service.

'n Agste uitdaging wat ons moontlik nog vanjaar die hoof sal moet bied is die moontlike implimentering van die Nasionale Gesondheidswetsontwerp. Dit sal die aanstelling van distriksgesondheidsrade en die administrasie van die behoeftesertifikaat wat 'n omstrede saak blyk te wees behels.

People often joke that ambitious people spend their health to become wealthy, and then have to spend their wealth to get back their lost health. We don't want to make that mistake, Mr Speaker. We want to make the most of the talent and resources that we have now and improve them continuously. Ultimately, everything I have said today brings us back to the vision of Healthcare 2010: To ensure equal access to quality health care. That is what drives us as we move determinedly towards the future defined in our strategy!

CONCLUSION - THANK YOU

In conclusion, Mr. Speaker, I would like to thank professor Househam, his management team and every staff member at Health for their support and dedication to the task ahead of us. During the course of the past few weeks I've visited a number of our hospitals as well as some of our Community Health Centres. I found the staff at these facilities by-en-large to be dedicated to the well-being of their patients - some to the point where they had to be told to go home after their shift. This kind of commitment is an example to all of us - and one that continues to carry Health through difficult times. Thank you to our staff and their families for the sacrifices that you make on a daily basis.

Thank you also to the large number of community based organisations and trusts such as the well-known Red Cross Children's Hospital Trust that contribute to improvements at our facilities. This Trust, honourable members, have raised close on R150 million over the years for this purpose - a wonderful achievement. Add to this the individuals that over the years have played a critical role by volunteering their services to Health and we begin to understand that everything that we achieve in Health in our Province is made possible by cooperation.

This week is Volunteers Week and I would like to use this opportunity to thank the thousands of voluntary workers who often at great personal cost, offer their time, their expertise and especially their love to patients in our care. Currently there are close on 500 volunteers working in our Provincial Emergency Medical Services. The majority of them provide support to our ambulance services while about 120 are involved in specialised emergency and rescue services. Earlier this year the Ministry of Health presented certificates to 11 dedicated volunteers that between them had 222 years of voluntary service at the Red Cross Children's Hospital.

In baie gevalle sal ons nie in staat wees om die dienste te verskaf wat van ons verwag word sonder die hulp van ons vrywilligers nie. Ek wil my opregte dank teenoor hulle uitspreek en terselfdertyd meer mense in ons provinsie aanmoedig om betrokke te raak deur hul dienste aan hul plaaslike gesondheidsinrigtings aan te bied.

Ek dank U.