Minister Mireille Wenger’s 2024/25 Adjustment Budget Speech: A Strategic Response to Healthcare Challenges
Honourable Speaker,
Members of the Provincial Parliament,
Esteemed guests,
People of the Western Cape.
It is an honour to present the 2024/25 Adjustment Budget for Vote 6, Health and Wellness. This budget is more than a financial document—it is a lifeline for our healthcare system and a testament to our unwavering commitment to delivering equitable, quality healthcare services to the people of this province. The additional appropriation of R197,7 million to the department provides the fiscal space for urgent and strategic interventions to stabilise and protect a system under immense strain.
The challenges before us are severe and demand immediate attention. For years, the demand for healthcare services in South Africa has far outpaced the resources available.
This House is well appraised of the dire effects in the 2023/24 financial year, when the national government failed to fully fund the wage agreement. This left the Western Cape Government with an unforeseen and significant budget shortfall across all departments. Compounding this situation was the austerity measures implemented by the national government over the next three financial years which has affected all provinces deeply. This coupled with medical inflation outpacing ordinary inflation, without the requisite budget increases, has put significant pressure on our Goods and Services budget and putting essential items, such as medicine, medical supplies, and laboratory services at risk.
Unlike previous years, where cost-containment measures could target non-essential areas attempting to minimise the impact on service delivery, this year has been different. The financial strain is now directly affecting the services rendered by our staff and facilities and by extension our residents.
The reality on the ground presents significant challenges. Longer queues and growing backlogs are increasingly common, reflecting the immense pressure on healthcare workers who are doing their best with limited resources. Of particular concern is the closure of some operating theatres. This has extended waiting times for life-saving and life-enhancing surgeries, impacting on patients and their families. Despite these hurdles, the commitment to delivering quality care remains unwavering.
Honourable Speaker, we are at a critical juncture. The healthcare system is being pushed to its limits, and while this Adjustment Budget offers much needed in-year relief, it is clear that more sustainable solutions are urgently needed. Today, we take a step toward weathering this storm, but we must also look ahead, determined to advocate for the full and fair funding of our province’s healthcare needs.
Honourable Speaker,
Despite these immense challenges, the Department of Health and Wellness, alongside our dedicated Health Heroes, has valued innovation, which has been at the very heart of our work and culture. We have fostered a mindset that encourages out-of-the-box thinking to develop practical, cost-effective solutions. This approach has been instrumental in helping us adapt and stretch our resources to meet the growing needs of our communities.
Recently, I had the great privilege of attending ICON 2024, our department’s flagship innovation conference. This inspiring event brought together healthcare professionals from across the spectrum—from HR and administration teams to stock controllers, doctors, and nurses—all presenting their groundbreaking innovations. What began as a small initiative to nurture creative thinking has now evolved into an annual showcase of healthcare ingenuity, where both clinical and non-clinical ideas are celebrated.
The impact of these innovations is tangible. They have not only improved healthcare outcomes but also enhanced the efficiency of our systems, allowing us to better serve the people of the Western Cape. These solutions demonstrate how, even within tight financial constraints, we can find ways to deliver more with less.
Recently at the 2024 National Batho Pele and Innovation Awards, the Western Cape shone as a government that not only encourages innovation but implements it to the benefit of our residents. Nominees included the Mitchells Plain CHC for its Resuscitation Boxes for Primary Healthcare Facilities and our George Hospital TeleICU. But what I am incredibly proud of the fact that the two nominees for the Best Frontline Employee of the Year are from the Western Cape – Dr Roland Kroukamp and Mr Deon Terry.
Dr Roland Kroukamp, a Family Physician at Mitchells Plain CHC, was recognised for his leadership and dedication. During COVID-19, he addressed vaccine hesitancy and reorganised community care. He supports staff training, wellness initiatives, and departmental communication. In 2023, he won the Western Cape Government’s Gold Award for Best Frontline Service Delivery Employee.
And Mr Deon Terry won this category. As a community leader, he has trained hundreds of Emergency First Aid Responders and established a satellite ambulance station to serve the residents in Ocean View and Masiphumelele. He founded the Community First Responder Programme, focusing on community organisation and improving emergency care. He also supports participants with academic tutoring and bursary opportunities for paramedic training.
We can all be incredibly proud of the men and women in our clinics and hospitals who consistently rise to the occasion, working collaboratively to find innovative solutions to complex challenges. During my Listening and Learning Tour, I’ve been visiting every corner of the province to gain a deeper understanding of the daily realities our Health Heroes face and the struggles of the communities they serve.
What has stood out, time and again, is the remarkable dedication, energy, and ingenuity of our staff. However, even their extraordinary efforts have limits. It is clear that without sufficient financial resources, the demand for healthcare cannot be sustainably met. National government must prioritise the health of the nation and allocate resources accordingly.
In the Western Cape, we’ve made that choice. This Adjustment Budget serves as a vital lifeline, enabling the Department of Health and Wellness to stabilise its finances and protect our healthcare system.
However, let’s be clear: this adjustment is not about expanding services. It is a critical measure to address inflation in goods and services, plug budget gaps, and ensure financial stability. Our focus remains on doing more with less, safeguarding the core of our healthcare system for the people who rely on it most.
Honourable Speaker,
These adjustments represent a targeted response to our most pressing healthcare priorities, ensuring optimal use of limited resources. The budget adjustment of an additional R197, 7 million, to R30, 6 billion for the financial year, will mean significant support in relieving the Goods and Services pressures that the department faces, it will mean that we will be able to open up surgical lists and a reinforced focus on population health outcomes. We further welcome the un-earmarking of the infrastructure component of the budget by the Provincial Treasury, which will provide flexibility for the department in the latter part of the financial year.
Speaker,
Programme 1: Administration
Programme 1 will see a downward adjustment of R4.1 million. The shifted funds will be directed to other programmes where it will address critical administrative functions, including procuring essential IT equipment and replacing obsolete computers at District, Central, and Tertiary Hospitals. These upgrades are vital to ensure healthcare professionals have the necessary tools to maintain high standards of care.
Programme 2: District Health Services
District Health Services will receive an additional R59 million, bringing the total adjusted budget to R12 billion. These funds will support key projects, including providing laptops and office equipment for the chronic medication home-delivery team, as well as system development initiatives in Rural Health Services. Additionally, a R321,000 donation will fund the appointment of a professional nurse at Ceres Clinic to deliver Community-Oriented Primary Health Care. The reallocation also includes adjustments to the HIV/AIDS budget across service sectors.
Programme 3: Emergency Medical Services
An upward adjustment of R17.6 million will be made to the R1.39 billion budget for Emergency Medical Services. This funding will cover the costs of equipment carried over from the 2023/24 financial year due to supplier delays and higher-than-expected purchase costs.
Programme 4: Provincial Hospital Services
The budget for Provincial Hospital Services will increase by R11.68 million to a total of R4.91 billion. This adjustment is aimed at realigning compensation of employees under the Human Resources and Training Grant for Rural and Metro Health Services, as well as partially funding in-year service delivery pressures.
Programme 5: Central Hospital Services
As the backbone of our tertiary healthcare system, Central Hospital Services will receive a critical funding boost of R118.8 million. This funding will alleviate service delivery pressures and enable the procurement of essential medical equipment at Tygerberg, Groote Schuur and Red Cross War Memorial Children’s Hospitals.
Programme 6: Health Sciences and Training
Within programme 6: Health Sciences and Training, shifts have been made to pay the skills levy to the Sector Education and Training Authority (SETA). Additionally, R3 million will be allocated to the Western Cape College of Nursing to support increased operational costs associated with new programmes and additional students. However, an overall decrease of R1.7 million will result from shifting R4.78 million to Vote 10: Infrastructure to extend the lease for student residences at the Southern Cape Karoo Nursing Campus.
Programme 7: Health Care Support Services
Although the overall funding for Health Care Support Services programme remains unchanged, internal shifts within the programme will fund increased tariffs and replace old equipment and machinery in workshops and maintenance hubs.
Programme 8: Health Facilities Management
In programme 8: Health Facilities Management, we will realign R10 million earmarked for the installation of solar PV systems in Provincial Health Buildings to the 2025/26 financial year, aligning with procurement and installation timelines. Meanwhile, an additional R6.5 million from the Health Facility Revitalisation Grant will fund the reconstruction and rehabilitation of infrastructure damaged by floods and storm surges between December 2023 and July 2024.
These adjustments ensure that critical areas of the healthcare system receive the resources needed to maintain and improve service delivery, even within a constrained fiscal environment. In this financial year we will be commissioning numerous health technology projects, such as new and much needed CT scanners for Groote Schuur, Khayelitsha, Mitchells Plain and Karl Bremmer hospitals and a Cardiology Imaging System for Tygerberg Hospital.
Honourable Speaker,
Our ability to appoint staff has slowed due to new regulations from the national Department of Public Service and Administration. DPSA Circular 49 of 2023 introduced stricter controls for filling vacant posts, requiring each position to be advertised nationally. This has increased administrative burdens and delays, which are impractical for large service delivery departments like Health. This was coupled with an unexpected spike in resignations between July and September making the recruitment process cumbersome and filling of posts, slow.
As we navigate the process of filling these posts as quickly as we can, any additional resources have been allocated to priority areas to maintain uninterrupted service delivery. We are in active discussions with the DPSA to advocate for practical solutions, including looking at certain exemptions for large service delivery departments such as Health.
This Adjustment Budget helps to weather the storm of this year. However, Speaker, over the medium-term the Department of Health and Wellness will need stability for its budget baseline over the 2025 MTEF if we are to meet growing healthcare demands and deliver quality services. Stability and certainty in our baseline are essential for effective planning.
In conclusion, I extend my gratitude to the Department under the excellent stewardship of the Head of Department, Dr Keith Cloete. Dr Karriem, Mr Kaye and Ms Nkosi, thank you for your steady leadership. Hippocrates, to whom the Hippocratic Oath is attributed, and which is the foundational articulation medical ethics which continues to guide and inform medical practice, once said “Wherever the art of Medicine is loved, there is also a love of Humanity”.
Speaker, in all my listening and learning visits, criss-crossing the province I have been struck by the dedication, compassion and love of humanity of the many people that make up this department.
I would also like to thank my own team for always giving each day their very best and their commitment to serving the people of the Western Cape.
Finally, Speaker, I would like to extend special recognition to our healthcare workers and support staff. This has been an exceptionally challenging year, and as we approach the festive season—traditionally a period of increased pressure, especially in our emergency centres and on our emergency medical services teams —they will once again be on the frontlines.
To you, I say, thank you for your resilience, tenacity, and compassion. You are the foundation of our healthcare system, and your dedication does not go unnoticed.
Speaker, I look forward to the debate.
Thank you.