A budget of resilience and action, despite funding pressures

Yesterday, Minister Nomafrench Mbombo tabled her 9^th budget for the Department of Health and Wellness of R23.804 billion for the 2023/24 financial year. This is a decrease of R289.766 million in comparison to the previous year.

For the first time, the department will be receiving a reduced allocation for its Equitable Share and Conditional Grants. When considering the impacts this has on Cost of Employment (CoE), Goods and Services (G&S), and Transfers, the Department of Health and Wellness faces a budget shortfall of more than R1.5 billion for 2023/24 and R2.1 billion for the following financial year.

Even though the Provincial Treasury has increased its Provincial Revenue Fund allocation to the department to more than R1 billion – which, is more than four times the allocation for 2022/23 – it is not a tenable, long-term solution.
 

Despite these pressures, the budget will be appropriated and structured according to the following:

• Programme 1 (Administration): R1 043 673 000
• Programme 2 (District Health Services): R11 764 375 000
• Programme 3 (Emergency Medical Services): R1 316 456 000
• Programme 4 (Provincial Hospital Services): R4 660 955 000
• Programme 5 (Central Hospital Services): R7 685 197 000
• Programme 6 (Health Sciences and Training): R404 624 000
• Programme 7 (Healthcare Support Services): R623 456 000
• Programme 8 (Health Facilities Management) R1 305 869 000

Infrastructure

The Department will be spending 10% more this financial year on infrastructure. R2.59 billion will be spent over the next three years on maintenance and repairs, upgrades and additions, and refurbishments and rehabilitation of existing assets. In total, there are 285 projects in our pipeline which will further capacitate our services as a department.

We are also excited for the opportunities that await us with the removal of Chapter 16B of Provincial Treasury Instructions. In doing so, the delivery and maintenance of infrastructure will now be the responsibility of our department. We as Health will no longer use the Department of Public Works (now Infrastructure) as an implementer.

Energy

For any modern healthcare facility to work, it needs a stable supply of electricity. The electronic equipment used on a daily basis cannot be switched on and off like a light switch and runs the risk of being damaged overtime. Lives quite literally depend on them.

Between April 2022 and February 2023, we have spent more than R100 million on fuel supplies alone. This is a significant burden to our budget which could have otherwise been spent on service delivery. Owing to this, we have been implementing the following:

• The roll-out of inverters to 120 of our PHC facilities;
• Surpassing our energy saving targets in our facilities;
• The installation of solar panels onto the roofs of 15 of our hospitals; and
• The exemption of five additional facilities from load shedding, which include Karl Bremer, Mitchell’s Plain, New Somerset, Victoria and George Hospitals. We hope in the future that a further 14 facilities will be added to this mix.

In total, the budget request for these projects is R136,2 million for this year alone.

Mental health

As a department and province, we have prioritised strengthening our mental health response to improve the wellbeing of all and will be spending R72.4 million on mental health services to this end. Additionally:

• We have mental health steering committee of all relevant HODs;
• In Klipfontein and Witzenberg, we are busy with a mapping exercise to map all mental health services in the respective regions;
• Action plans were drawn up to deal with mental health burdens and will be rolled out once finalised; and
• Our psychogeriatric interventions have proven successful at Alexandra and Stikland Psychiatric Hospitals where they are currently being piloted.

Going above and Beyond

In order to respond to the demands of our communities, we need to capacitate our services even further. To name a few:

• R127.6 million will be used to expand our transitional care capacity in metro and rural health services. This will go a long way in alleviating pressure in our acute hospital platform;
• R30 million is being allocated to uplift the faces of our health facilities;
• R28.7 million will be spent on augmenting the Department’s TB interventions; and
• R6.2 million will bolster the capacity of the Violence Prevention Unit and further focus on our safety priority contributions.

Minister Mbombo says, “The Western Cape is going to have do much more with even less. But this is the task we have always known. As a province, we understand that we have a long road ahead to improve dignity and wellbeing of all of our residents in our communities. As we plot the course ahead and progress in realising our goal of true universal healthcare coverage, I am certain that this budget will give us the foundation to go above and beyond - even within the increasingly constrained fiscal climate. We must and will succeed.”