Health Budget Vote 2013/2014
Honourable Premier Ms Helen Zille
Leader of the Opposition
Chairperson of the Standing Committee
Colleagues and friends
Citizens of the Western Cape
Speaker, the budget that I am presenting today, is the result of the Department of Health's continuous evaluation of the health needs of the people of the Western Cape in accordance with the strategic objective that we introduced three years ago – the strategic objective of increasing wellness.
The concept of increasing wellness as a public health management strategy, is taking root across the world in countries facing the challenge of high risk factors for disease. Our province is implementing the strategy with other departments. It requires a whole of society approach. The decrease of illness can only be achieved through integrated cooperation with the departments that create infrastructure – Local Government, Transport and Public Works, Economic Development - and the departments that can support the well-being of the people who live and work in the Western Cape - Education, Social Development, and Agriculture.
The aim is to create a society where every person has the opportunity to make choices, as opposed to an environment that forces citizens to accept dire education, health and other government services. The only way to achieve an environment of options is to lead the province into economic growth and development, as my colleague, Minister Winde, set out in his budget vote on Friday.
Economic growth is only possible through good governance. The health budget for the province that I am tabling today is a work come together as a result of strict financial discipline and I am proud to thank the management of the Department for that.
Speaker, in my address to the House I will focus on our department's growth through partnerships and the interventions that we have put in place to address the upstream disease factors. I will set out the budget allocations to improve service delivery as well as the allocation towards early detection and prevention of disease.
GROWING THE HEALTH ECONOMY THROUGH PARTNERSHIPS
In order to stay on par and set the trend in this country and this continent, we need to partner with the private sector to stretch the health rand. One of the key ways in which the Western Cape Government has tried to improve healthcare quality across the province is through innovative public-private partnerships that leverage the talents of the private sector for the benefit of public sector patients. It is based on a win-win philosophy that improves the physical health of patients and the financial health of the economy.
One example of such a partnership is the Clicks Helping Hand Trust. Partnering is a practical, sustainable way to expand the reach of public health care and enhance the quality of our pathways of care. By tapping into the potential of the private sector, we are creating beneficial outcomes for our patients and for our private sector partners to earn revenue and create jobs.
In line with the strategic objectives of our Government, this approach boosts the revenues of private businesses, thereby creating jobs, raising more taxes and growing the economy.
This is the wheel that is turning the health sector from a money consumer to an economy driver.
The establishment of The Health Foundation in the past year was one of the largest strides made in this provincial government towards that goal. The Health Foundation has the legal independence to spearhead new and innovative initiatives to generate resources for health. This is a significant step in strengthening the key relationship between the department and the private sector.
In 2013/2014 The Health Foundation will primarily focus on provincial health facilities that don’t have existing fund raising trusts in place, in particular primary health care facilities. The Health Foundation aims to facilitate donor funding through the partnership of local businesses with the district hospitals in their area, in view of their employees and their families who depend on these facilities for treatment. They will promote the Adopt-a-Facility strategy with potential donors.
The commercial partnership plans include viable retail kiosk opportunities, ATM opportunities and advertising opportunities at health facilities in accordance with agreed guidelines, as well as viable commercial rental opportunities for health care related businesses.
The monies generated through The Health Foundation will primarily be used to address the maintenance backlog at health facilities in the Province.
This model provides benefits for the public and private sector. Within this environment the private sector can co-operate with the state to deploy its expertise, currently only available to paying patients, to provide quality health care on a wider scale. It also implies a model to grow small- and medium-sized private health care enterprises, by offering them access to government business opportunities. The Western Cape Health Foundation is a vehicle that will facilitate an increase of funds and human resource capacity in the public health domain by offering economic growth opportunities for the private sector. It is a mutually beneficial vehicles which offers companies an opportunity to reshape the corporate social investment economy.
The establishment of The Health Foundation is a bold step by our government into new territory, and is strengthened by the Department's Business Development Unit and the Public Private Health Forum.
CALL FOR PHARMACIES
One of the major projects tackled by the Business Development Unit in the past year was the call for tenders on non-profit organisations for proposals for the re-provisioning of family planning and vaccines in cooperation with the private sector, of which the agreement with Clicks was a forerunner, but will now be followed by other pharmacy groups such as Dischem and independent pharmacies. This call will eventually grow smaller pharmacy businesses. The new private provider process to better manage the access to family planning and vaccines is a major part of strengthening strategic partnerships. Tenders have closed and the new service will commence on 1 July 2013. The project is in accordance with Western Cape Government’s Health Care 2020 vision which aims to improve the patient experience.
ADDRESSING UPSTREAM DISEASE FACTORS
The Department plays an important advocacy role ensuring that the upstream factors influencing the burden of disease are addressed by the appropriate departments or sectors of society.
The Department’s Directorate: Health Impact Assessment identifies the communities most affected by the burden of disease and its associated risk factors.
The focus areas are:
1) Decreasing the incidence of infectious diseases (HIV and TB)
2) Preventing violence and road injuries
3) Promoting a healthy lifestyle
4) Improving Woman’s Health
5) Improving maternal and child health
6) Mental Health
The cornerstone of the 2020 strategic framework is improving the patient experience. In the next two years the Department will embark upon a change management programme to improve the staff engagement with patients and by doing so improve the quality of patient care.
The current vacancy rate for Health in the Western Cape is 4,12% - the lowest in the country. In total there are 31 672 funded posts of which 30 366 are filled and 1 306 posts are vacant. Of the 1 306 vacant posts, 414 posts are in the nursing group and 562 in the group staff excluded from Occupational Specific Dispensations which represents 1.31% and 1.77% of the 4.12%.
The reorganization of the department to improve cohesion and deficiencies is a priority, and significant in terms of the rationalization of resources and simultaneous building of capacity to operate efficiently.
The Western Cape has an outstanding track record on filling vacancies, and we are regularly commended for our performance in this regard. We have a monthly monitoring system to check whether all vacant funded posts are being filled within a two month turnaround time.
Nurses form almost half of the staff component of the health department, and play a special role in providing and maintaining the health care system through the provision of a comprehensive quality health care service. Despite intense efforts to develop, recruit and retain specialised nurses, and despite the Occupational Specific Dispensation for nurses, the specialized services now have 25,4% less specialised nurses than 4 years ago. A main challenge remains to increase the number of nurses to be released and trained in specialty nursing.
Independent Complaints Committee
In terms of the handling of patient complaints, which forms an important part of our communication with patients, the Provincial Cabinet approved the drafting of provincial legislation to establish an Independent Complaints Committee to facilitate the resolution of complaints.
In addition the pilot complaints call centre that we piloted at 8 facilities in the Metro in the 2012 / 2013 financial year, proved so successful that we it will be rolled out to all health facilities in the Metro in this financial year. Each financial year another district will be added and eventually offer the service to all patients across the province by 2018.
Health Facility Boards / Gesondheidsfasiliteitsrade
Ons het onlangs in die media geadverteer vir nominasies vir die volgende drie jaar termyn, maar oor die algemeen het die publiek weer swak gereageer. Ek het die huidige termyn tot einde September verleng en dit is my vaste voorneme om Rade vir al ons hospitale in plek te hê. Dit is my ondervinding dat war daar behoorlike funksionerende rade in plek is, die skakeling met die gemeenskap beter is, die gemeenskap besit neem van hul hospitaal en dat dit tot voordeel van die personeel en inwoners van die bepaalde streek is. Ek wil ‘n beroep doen op my kollegas hier in die Parlement om betrokke te raak by die saamstel van ‘n effektiewe raad in hul area.
District Health Councils / Distriksgesondheidsrade
Die vyf distriksgesondheidsrade op die platteland funksioneer nou al effektief ‘n jaar en ek beplan om in die middel van die jaar ‘n oorsigvergadering met al die rade te belê om groeipyne uit te stryk en by mekaar te leer oor hoe ons ook hierdie rade beter kan aanwend tot voordeel van die gemeenskappe wat hulle verteenwoordig. Die Metro Distriksraad was nie effektief nie en ek het nou toestemming by die Kabinet gekry om die wetgewing aan te pas en sub-distrik verteenwoordigers ook op die raad aan te stel. Die proses sal binnekort begin. Die Provinsiale Gesondheidsraad vergader kwartaalliks en is ‘n effektiewe instelling wat tot voordeel van die Departement en die breë publiek ‘n belangrike beleidsformuleringsfunksie vervul.
Both the health councils and the facility boards have the potential to be meaningful channels for consultation and interaction with the public, and I encourage communities to support and use these structures to raise their concerns.
A major goal of the Department of Health is to create a “culture of wellness” at all levels of society in the Western Cape.
As part of the “Increasing Wellness” objective a group called Ideas42 Behavioural Economists from Harvard University together with a UCT Research unit in Behavioural and Neuro economics have been appointed for the behaviour change project for two years. It will be piloted from June this year till March next year. Thereafter evaluation will follow and possible roll-out after that.
The behaviour change project is anticipated to make a major contribution to our government's Strategic Objective 11: Building the best run provincial government in the world. Health has budgeted R700 000 for two years towards this project.
Later in this year I will make important announcements about stationary and mobile wellness centres to be rolled out in the Western Cape which will introduce the province's early detection and prevention plan. In brief it will encompass the roll-out of wellness clinics across the province that will deal with lifestyle health issues that should be monitored on a regular basis, but which too often remain undetected until someone goes to the hospital for treatment.
Funded by the private sector, these clinics will provide the opportunity to every state patient to have an annual health check-up. But more than this – these clinics will promote the responsibility that people must take to protect and enhance their own good health.
Chronic Dispensing Unit roll-out
In the past 9 months the CDU service was expanded to all remaining facilities in the Metropole, such as central and regional hospitals, with the concomitant expansion of ARV services in the Metro. The delivery of patient medicine parcels is planned to roll out to rural districts in this financial year, with home deliveries and postal deliveries planned to follow.
The CDU services are contracted using the following fees per prescription (VAT Incl):
• R21.00 to Health and other sites such as NPO's and old age homes
• R58.00 for home deliveries in the Metropole
• R20.52 additional fee per delivery for areas where there is a high risk to personal safety/ hijacking
• R50.00 for postal deliveries across the Province
IMPROVING SERVICE DELIVERY
The Department has prioritised the following service delivery areas:
1) Mental health: The appropriate management of behaviourally disturbed patients, with the strengthening of community outreach and support to address the frequent re-admission of patients to psychiatric hospitals.
2) Neonatal and child health: Improved and earlier ante-natal care with a continued focus on the factors that contribute to neonatal deaths.
3) Maternal and women’s health: The Department will focus on addressing the causes of maternal deaths, strengthening family planning and widening cancer screening programmes for cervical and breast cancer.
4) The Emergency Medical Services communications system will be replaced to improve EMS management and in particular the response time to medical emergencies.
5) Prevention, detection and effective management of chronic diseases including communicable diseases such as HIV and TB, and non-communicable diseases such as hypertension, diabetes and heart disease.
For the 2013/2014 financial year Health receives 36.34% of the entire provincial budget. This is a 7.47% or R1.103 billion increase over the revised estimate for 2012/13.
The Department of Health is allocated R15.872 billion in 2013/14, R16.970 billion in 2014/15 and R17.940 billion in 2015/16, amounting to a total of R50.781 billion over the 2013 MTEF.
Of this the provincial equitable share amounts to R10.906 billion in 2013/14, R11.721 billion in 2014/15 and R12.414 billion in 2015/16 with the contribution from national conditional grants amounting to R4.418 billion and the income from patient fees in 2013/14 estimated at R548, 5 million,
The various national conditional grants are:
• National Tertiary Services Grant R2,4 billion
• Health Professions Training and Development Grant R452 million
• Comprehensive HIV and AIDS Grant R928 million
• National Health Insurance Grant R4,85 million
• As of 2013/14 the Hospital Revitalisation Grant, Health Infrastructure Grant and Nursing Colleges and Schools Grant have been merged into a single infrastructure grant for Health, namely the Health Facility Revitalisation Grant. R629.786 million is allocated to the grant in 2013/14.
This National Health Grant is a new indirect grant introduced in 2013/14 that will be spent by the National Department of Health on behalf of provinces. The Grant has two components, one to support infrastructure projects and the second to support National Health Insurance scheme pilot sites. In respect of the infrastructure component, R61 million has been allocated to the Western Cape over the 2013 MTEF. Detail on the provincial breakdown of the NHI component is not yet available.
The Department remains committed to maximising revenue generation and collection from current sources of revenue whilst exploring alternative revenue streams to counter on-going budget constraints.
Hospital patient fees tariffs that are applicable to funded patients, for example medical scheme patients, will be increased by 5.5 % with effect from 1 April 2013. However, I am pleased to announce that the tariffs for unfunded patients without medical insurance will remain at the current levels.
Distribution of the budget:
The Health budget is divided between the 8 programmes with Programmes 2, 3, 4 and 5 funding the direct operational cost of providing health services amounting to R13.851 billion or 87% of the total allocation to the Department.
Compensation of employees accounts for R9.346 billion or 58.88% of the total budget. The Department has allocated R4.849 billion or 30.55% of the budget to the procurement of goods and services.
PROGRAMME 1: ADMINISTRATION
Programme 1 receives R523 million and amounts to 3.3% of the vote in 2013/14 versus 3% allocated in the revised estimate of the 2012/13 budget. This amounts to a nominal increase of R74.731 million or 16.7%.
The increase is allocated to:
• Implementation of the JAC Pharmacy system in the smaller hospitals;
• The rollout of the Primary Health Information System to rural facilities;
• Enterprise Content Management System;
• The accelerated rollout of the Hospital Information System;
• The implementation of the Nursing Information System to manage the cost of agency staff;
• A project to improve the behaviour of frontline staff. Ernest & Young has been appointed for this project.
• The increase of the volumes of scripts managed by the central Chronic Dispensing Unit; and
• Additional posts for an inspectorate to ensure compliance to rules and regulations.
The Western Cape Health Facility Boards Act, 2001 [Act 7 of 2001]:
This act amends the manner in which the Department regulates financial affairs of Health Facility Boards. Preparatory work is being done on a further amendment in order to accommodate the changes to this Act required as a result of the clauses of the National Health Act, 2003 (Act 61 of 2003) that came into effect on 1 March 2012. In terms of this act, the National Minister of Health will be responsible for appointing central hospital boards and provide a legal framework for establishing clinic and community health centre committees.
The Western Cape District Health Councils Amendment Bill, 2012 [Bill 5 of 2012]:
A Western Cape District Health Councils Amendment Bill has been drafted and published in the Provincial Gazette for comment. The purpose of this Bill is to allow members of sub-districts to be appointed to the District Health Council in order to ensure that the representation in the Metro District is comparable with that of the rural districts, which is not currently the case.
In terms of Section 30 of the National Health Act, 2003 (Act 61 of 2003), the Provincial Minister of Health in concurrence with the Provincial Minister of Local Government can divide a province into sub-districts and determine and change the boundaries of these sub-districts. This has been done and published under Provincial Notice 34/ 2012 in Provincial Gazette 7063.
PROGRAMME 2: DISTRICT HEALTH SERVICES
This programme is responsible for provision of health services within the district health system and is allocated R6.037 billion or 38% of the vote in 2013/14 versus 37.6% allocated in the revised 2012/13 budget. This amounts to a nominal increase of R487.518 million or 8.8%.
R4.850 million in respect of the National Health Insurance Grant in 2013/14, and R7 million in 2014/15 and R7.396 million in 2015/16 which in terms of the overall programme are marginal amounts.
Primary Health Care Services are allocated R2 788.855 billion or 46.2% in 2013/14 versus the 47% that was allocated in the revised 2012/13 budget. This amounts to a nominal increase of R178.740 million or 6.85%.
• These funds are allocated to clinics, community health day centres, community health centres and community based services, which provide primary health care services amounting to approximately 15, 2 million head counts per annum at an estimated primary health care utilisation rate of 2.54 visits per person in 2013/14.
• Community based services are allocated R165.532 million in 2013/14. These services reduce pressure on facility-based care by providing healthcare directly to the community and empowering the community to participate in preventive and adherence health programmes.
Lay health workers employed by non-profit organisations fulfil many of the tasks and roles carried out at the CBS level. The development of integrated community care workers who are multi- skilled is a key challenge going forward.
HIV and AIDS are allocated R927.547 million or 15.4% versus 13.3% allocated in the revised 2012/13 budget. This amounts to a nominal increase of R189.467 million or 25.7%.
Sub-programme 2.10 Global fund is allocated R190.862 million or 3.2% versus 3.1% in the revised 2012/13 budget. This amounts to a nominal increase of 9.6% or R16.727 million. Together these sub-programmes fund the prevention and management of HIV and AIDS with a combined budget of R1,12 billion.
Nutrition is allocated R32,376 million or 0,5% versus 0,55% in the revised 2012/13 budget. This amounts to a nominal increase of R1,73 million or 5,6%.
District hospitals are allocated R2. 097 billion or 34.7% versus 36% allocated in the revised 2012/13 budget. This amounts to a nominal increase of 5.1 % or R100.853 million.
While the Khayelitsha Hospital is now fully operational, it is anticipated that the newly constructed Mitchell’s Plain Hospital will be operational midway through 2013.
PROGRAMME 3: EMERGENCY MEDICAL SERVICES
I would like to use this opportunity to thank our EMS and Forensic Pathology Services for their outstanding service at the time of the recent tragic bus accident in the Hex River Pass where 24 people lost their lives.
This programme is allocated R786.339 million or 4.95% versus 4.8% of the revised 2012/13 budget. This amounts to a nominal increase of R81.819 million or 11.6%.
An additional R50 million has been allocated for the new computer aided dispatch system which will provide both the communication centre solution and a vehicle-based solution. It is anticipated that the system will improve the efficiency of the ambulance dispatch process by providing real time information.
Of the 52 EMS facilities, 73% are purpose built and steady progress is being made in providing 18 new stations.
PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES
Provincial hospital services are largely funded from the Provincial Equitable Share but receive an allocation of R60.367 million from the Health Professions Training and Development Grant to address the cost to the services of training health professionals.
Programme 4 is allocated R2.49 million in 2013/14 or 15.7% of the vote, which is unchanged compared with the revised estimate of the 2012/13 budget. This amounts to a nominal increase of R167.438 million or 7.21%.
Regional Hospitals is allocated R1.331 billion or 53.5% versus 52.8% allocated in the revised e2012/13 budget. This amounts to a nominal increase of R105.146 million or 8.6%. The sub-programme funds New Somerset and Mowbray Maternity Hospitals in the Metro, and the Paarl, Worcester and George Hospitals in the rural districts.
An additional operating theatre at new Somerset Hospital was commissioned during February 2013 and is fully funded in 2013/14 to address the increased workload within the Metro West area.
TB Hospitals is allocated R223.437 million or 9% versus 9.3% of the revised estimate of the 2012/13 budget. This is a nominal increase of R7.58 million or 3.5% which funds the 6 TB hospitals in the province. At present the Department has 23 GeneXpert machines distributed acoss the province, operated by NHLS.
Psychiatric Hospitals are allocated R660.421 million or 26.5% versus 27% of the revised 2012/2013 revised estimate. This amounts to a nominal increase of R34.182 million or 5.5% which funds the four psychiatric hospitals in the province.
The Western Cape Rehabilitation Centre is allocated R149.218 million or 6% versus the 6.1% of the revised 2012/2013 budget. This amounts to a nominal increase of R7.704 million or 5.4%.
Dental Training Hospitals is allocated R124.578 million or 5% versus 4.8% in the revised 2012/13 budget. This amounts to a nominal increase of R12.826 million or 11.5%.
PROGRAMME 5: CENTRAL HOSPITALS
Central Hospitals is allocated R4.538 billion or 28.6% versus 28.8% of the revised 2012/13 budget. This amounts to a nominal increase of R280.329 million or 6.6%.
• Of this amount:
o R2.401 billion is funded from the National Tertiary Services Grant; and
o R304.888 million is funded from the Health Professions Training and Development Grant
o Conditional grant funding therefore constitutes only 59.6%
• Clearly, the funding of the National Tertiary Services Grant and the Health Professions Training and Development Grant is insufficient to fund the grant related activities. The result is that the Department significantly subsidises these services from the equitable share and other sources of funding which decreases the funding available for service requirements elsewhere in the department.
PROGRAMME 6: HEALTH SCIENCES AND TRAINING
This programme has been allocated R236.184 million or 1.7% versus the 1.9% that was allocated in the revised 2012/13 estimate. This amounts to a nominal decrease of R18.133 million or 6.45%.
The allocated budget does not increase in real terms, and consequently the budget for bursaries has been materially reduced.
For this budget year the Department has allocated 466 bursaries to the value of R14.316 million.
PROGRAMME 7: HEALTH CARE SUPPORT SERVICES
This programme consists of 4 sub-programmes, namely laundry and engineering services, forensic pathology services and the Cape Medical Depot and is allocated R340.618 million or 2.15% versus the 2.1% allocated in the revised 2012/13 budget. This amounts to a nominal increase of R19.729 million or 6.2%.
Laundry Services is allocated R73.697 million or 21.6% versus the 22.1% allocated in the revised 2012/13 budget - a nominal increase of R2.723 million or 3.8%.
The modern equipment installed in the upgraded Lentegeur Laundry is designed to use less water, steam and electricity than the equipment it replaced.
Engineering Services is allocated R103.534 million or 30.4% versus the 29.6% of the revised 2012/13 budget - a nominal increase of R8.674 million or 9.1%.
It is anticipated that funding for engineering maintenance will not increase significantly over the next 5 years and that increases will be largely inflation linked. The Department has therefore initiated the Maintenance Hub Organisation Development Study to identify opportunities for efficiency and better utilisation of scarce technical skills. The establishment of a Supply Chain Management Office to implement a Construction Procurement System for the procurement of day-to-day, emergency, and routine maintenance work remains a priority.
Forensic Pathology Services is allocated R114.591 million or 33.6% versus the 33.5% allocated in the revised 2012/13 budget – a nominal increase of R7.101 million or 6.6%.
12 of the 18 forensic pathology laboratories still need to be relocated or upgraded.
The Cape Medical Depot is allocated R48.795 million or 14.3% versus of the 14.8% allocated in the revised 2012/13 budget - a nominal increase of R1.231 million or 2.6%.
PROGRAMME 8: HEALTH FACILITIES MANAGEMENT
This programme is allocated R2.8 billion over the MTEF period.
Programme 8 is allocated R893.751 million or 5.6% versus 5.99% of the 2012/2013 revised budget. This translates into a nominal increase of R9.205 million or 1%.
The Health Facility Revitalisation Grant has been reduced over the MTEF by R61 million and these funds will be used to fund the National Health Grant allocated to the Western Cape. The National Health Grant is a new indirect grant introduced in 2013/14 that will be spent by the National Department of Health on behalf of provinces.
70% of the programme’s funding is derived from conditional grants which include the Hospital Facility Revitalisation Grant made up from the Health Infrastructure component: R122.296 million, Hospital Revitalisation component: R493.526million, Nursing Colleges and Schools component: R13 964 million and Expanded Public Works Programme Integrated Grant for Provinces: R3 million.
In addition the following priority earmarked allocations of Provincial Equitable Share have been allocated for preventive maintenance: R20.465 million, baseline maintenance: R100 000 million and baseline: Capital: R128.500 million.
Sub-programme 8.1: Community Health Facilities
It is planned that in this financial year 43 projects will be in the identification/feasibility phase, with 8 projects in the design/tender phase and 3 in the construction/handover phase.
The following projects are in the construction/handover phase:
• The new Du Noon Community Day Centre;
• The new Hermanus Community Day Centre; and
• The new Symphony Way Community Day Centre in Delft.
Sub-programme 8.2: Emergency Medical Services
There will be 18 EMS services in the identification/feasibility phase and 2 in the design/tender phase. In addition to this, the new Robertson Ambulance Station will be in in the construction/ handover phase.
Sub-programme 8.3: District Hospital Services
It is planned to have 20 district hospital projects in the identification/feasibility phase, 4 in design/tender phase and the following 4 in the construction/handover phase:
• New bulk store at Robertson Hospital;
• New emergency centre at Karl Bremer Hospital;
• New emergency centre and out-patient department at Knysna Hospital;
• Phase 2 upgrading of Vredenburg Hospital.
Sub-programme 8.4: Provincial Hospital Services
It is planned to have 7 provincial hospital projects in the identification/feasibility phase and 7 projects in the design/tender phase.
Sub-programme 8.5: Central Hospital Services
It is planned to have 7 central hospital projects in the identification/feasibility phase with 2 projects in the design/tender phase. The Tygerberg Hospital emergency centre is in the construction/handover phase.
Sub-programme 8.6: Other Facilities
11 projects will be in the identification/feasibility phase with 7 projects in the design/tender phase.
National Health Insurance
The National Department of Health together with the provinces identified 10 pilot sites in South Africa to develop frameworks and models that could be rolled out to facilitate the phased implementation of NHI.
The Western Cape pilot site is the Eden District. The reason for the Western Cape participation is the belief that the province can contribute to the development of the best ultimate model.
The Western Cape Government policy is one of Universal Health Care for All which is supported by the World Health Organization, but through a model of a functioning health system at provincial level without the centralizing of all funding and management through the National Department.
Western Cape Government opposes the centralization of health facilities.
The extent of Western Cape Government’s management of the NHI pilot project is to strengthen health services in the Eden District and to provide the country with viable models of health care that have worked and will continue to provide quality patient centred health care services.
I would especially like to thank the employees of the Department of Health who form the backbone of health services in this province. Our best facility is our people.
The increase of wellness is not a health-only objective, but an overall objective that is the responsibility of all departments, but also of individuals. The Department of Health will take responsibility for our tasks, but individuals also need to take responsibility for their health. That is a state of well-being, and that is the state in which each individual takes responsibility for his / her choices. That is what we mean by the “Open Opportunity Society”.