Health Budget 2021/22 - Budget of Hope

 Dr Nomafrench Mbombo

2021/22 Department of Health Budget Speech
 

Speaker

Honourable Premier, Alan Winde

 

Cabinet Colleagues and Members of the Provincial Parliament

 

Chairperson of the Standing Committee
 

Head of Department and Management of the Department of Health
 

The Citizens of the Western Cape,
 

Members of the media
 

Goeie more almal, molweni - A very good morning to you all.
 

Speaker,

as we confront the COVID-19 global health crisis, we are strengthened by years of experience that have shown us that even when problems seem insurmountable, victory is certain. This is the reason I stand proud to deliver the budget for the people which is about giving hope amid hopelessness to the millions of patients we serve.

Whilst COVID-19 dramatically shifted our priorities and the way we work to ensure the health of our patients, it did not change our mission to protect people who are at risk and safeguard the lives of our frontline staff. This crisis only demonstrated how resilient our provincial health system is.

We had to make difficult decisions about which healthcare service can be safely continued, and which ones can be scaled back or temporarily halted. This led us to de-escalating services and yes there are backlogs in elective surgery and some Primary Health Care services that will be addressed going forward.

Everyone is under immense pressure, feelings of compassion fatigue, burnout, stress, insomnia, anxiety and depression are real, many of us have lost colleagues and loved ones due to COVID-19. It is this reason that Mental Health is on the priority on the list of the Non-Covid services that will be recovered.

The Western Cape Government and the City of Cape Town have secured R80 million funding from the Bill and Melinda Gates Foundation to implement a three-year Tuberculosis (TB) programme in the province.

The three-year TB programme will be used towards identifying people with TB, link them to care and ensure that patients are effectively treated. This effort is based on using a combination of innovation and the wealth of data available through the Western Cape Health Data Centre to drive a patient centric approach to TB control in the Western Cape.

 

Speaker,

This is a people’s budget in the true sense of the word, during this pandemic, I traversed the province talking to all the stakeholders hearing from them about what they want to see happening in their health facilities.

As I was distributing masks at Chatsworth Clinic in Swartland, I was called aside by Diana Swanepoel who told me how proud she was of the service they are getting in this state-of-the-art facility. It is these stories that inspire us to continue striving to ensure that we provide quality service.

How can I forget the highly charged emotional moment at the opening of the refurbished Swartland Hospital when staff and the community members recalled the day the Hospital was destroyed by fire? They all touched on one thing which is the cooperation between the community and the staff. Everyone from churches to individuals was willing to assist, I left the facility highly energized filled with hope that indeed we will win the battle against this pandemic.

Yes, others have complained about the size of their facilities, such as the community at Leeu-Gamka, their cries did not fall on deaf ears, we are making plans to ensure that they are not left behind. I will report on that next year.

Speaker,

As I continue this theme of the budget of hope, I want to start by focusing on six key elements that highlight the lengths and depth this department has gone through, to deliver a service despite the challenging environment it operates within, these are:

1. Innovation
2. Public-Private Partnership
3. Infrastructure
4. Human Resource
5. Vaccination Drive and
6. Statutory Bodies

 1. Innovation

Technology as part of our innovation is a key enabler and disruptor in doing business unusual. We built public trust by having the core markers on a public-facing dashboard that gets updated daily. This has also inculcated the practice of being data and evidence led. 

The dashboard innovation was built in house and won awards: 

• Silver Medallist- Next Generation Media Award for Technical Innovation. We competed with companies in the private sector such as Vodacom and SAB 

• Finalist for the BCX digital innovation award 

• Africa Tech Award Winner- Use of Technology in the Public Sector (Continental Award)

 

SPEAKER

Allow me to boast about the Western Cape Government Health’s Emergency Medical Services which became the first government institution in South Africa that is allowed to fly over national key points. We launched our Drone Rescue Project in December 2020.

I am proud to inform you that the first mission took place in Rooi-Els, on 28 January 2021 and it involved a search for a male who jumped off a cliff, into the water.

The second mission took place on 10 February 2021 and it involved a twenty-one-year-old male who went off the hiking path on Lions Head, close to the Clifton Crest Route and got stuck. The incident was logged at 10:35 and the drone located the twenty-one-year-old male at 11:43.

Other innovations include:

Vector project: where diabetics who were at high risk during COVID-19 peak periods were pre-emptively identified, followed up daily and were fast tracked and admitted at earliest signs of decompensation. This significantly reduced the mortality of diabetics from COVID-19.

Chronic delivery of meds: More than 1,3m medicine parcels were delivered to homes of chronic stable patients – this reduced their risk of travelling to health facilities. Funds have been earmarked to continue this project in the coming financial year.

 

SPEAKER

2. Public-Private Partnerships

This is key in our mission to preserve patient dignity. The Department has entered into several partnerships that have allowed us to provide access to much-needed health services.

Here are some examples:

Private Hospitals Partnership, the first lesson we learned from COVID -19 is that it does not discriminate. It knows no race, nationality, ethnicity or social standing. This is the reason why I called a meeting with the Private Hospitals and General Practitioners which led to the changing of Western Cape Private Health Licensing Regulation that enabled Private Hospitals to review their beds and prioritize COVID-19 beds. Western Cape was the first to complete the Public-Private Agreements on sharing critical beds using the same critical protocols. We are resolute in not creating binaries between Public and Private. This has led to fruitful working conditions and I am proud of the partnership.

The Shoprite, Oceana Group and the Gift of the Givers: – During this pandemic there was never a time where we ran out of PPE, we were inundated with donations from companies, grocery shops, civil society organizations, foreign countries and others. I would like to mention a few of these organisations: The Gift of the Givers for their generous donation of medical equipment, including Continuous Positive Airway Pressure Machine (CPAP), to several of our facilities in the Overberg and Garden Route.

The same humanitarian organisation donated R10 million towards renovating and equipping an entire ward of Mitchells Plain Hospital which is now used for COVID-19 patients. This proves that by working together we can ensure optimal care for our vulnerable communities. We are appreciative of the additional humanitarian support in fighting this COVID-19 pandemic.

 

I would also like to thank Shoprite and Oceana Group for their generous contribution, in the cold winter season they donated care packs consisting of blankets, socks, beanies, scarfs and hygiene packs. These came in handy to patients at Field Hospitals, Quarantine and Isolation Facilities.

 

3. Infrastructure

SPEAKER

We delivered world-class infrastructure projects in partnership with the Department of Transport and Public Works and continue to maintain clean and functional infrastructure. Infrastructure projects contribute to improved access to healthcare in the province. Every single cent we spent on infrastructure, benefitted the people of this province.

Infrastructure is one of the building blocks within the health system and forms part of our priorities as a way to address patient experience and service pressures.

Our key infrastructure projects include the refurbished Swartland Hospital that was destroyed by fire.

Some of the key projects delivered 2019/20:

Vredendal North Clinic, Chatsworth Clinic, Abbotsford Clinic

For the coming financial year, we have earmarked the following infrastructure projects as part of our investment.

Klipfontein Hospital:

The Tender for the Professional Service Providers has been advertised and is currently going through the various processes related to the tendering processes

De Doorns Ambulance Station Replacement Facility, Project Completion date is on the 21 April 2021, thereafter, a commissioning period of approximately 2 months will take place before the facility is fully operational.

Laingsburg Clinic - Upgrade and Additions, Phase 1 Sectional Completion was achieved on 08 December 2020 and is operational. Revised project completion of the whole project (Phase 1 & 2) is 25 March 2021.

Victoria Hospital New Emergency Centre Phase project completion is anticipated for the14 July 2021

Tygerberg Regional Hospital, the department is currently preparing the Clinical Brief

Observatory Forensic Pathological Lab – Replacement, Current expected Project Completion date June 2021

Helderberg Hospital; phase 3 – Project Completion has been reached /Phase 2 to be completed once decanting is done.

 

4. Human Resources

SPEAKER

Staff safety remains the biggest concern for the Department, with the EMS being the most vulnerable.

70 cases ranging from robbery, assault, theft and intimidation occurred in 2020. In one month alone, July 11 cases were opened. This is in the midst of a COVID pandemic! this is unacceptable and deserves to be condemned in the strongest and harshest terms.

SPEAKER

on a positive note, let me inform you that at the 2020 National Batho Pele Excellence Awards, the Western Cape Government Health received a Gold Award.

This is a significant achievement by any standard considering that we are honoured for being the best performing department in South Africa.

I am so proud of our recently retired HOD, Dr Beth Engelbrecht for being awarded the best performing HOD. Indeed, she deserves this honour, she was always a decisive leader who executed her responsibilities with great expertise and integrity

5. Vaccination Drive

SPEAKER,

This virus has been vicious to our Healthcare Workers and 123 did not make it, this is tragic, and I convey my words of condolences to their families, may God continue to comfort them.

The road to vaccination starts with the solid rollout plan and the vaccination process that gets bought by all stakeholders.

Our vaccination plan is to vaccinate about 5,1 million people in the Western Cape starting with phase one, 133 000 Health Care Workers of all categories for both public and private.

 

I am proud to announce that we have prioritized Healthcare Workers, currently we have vaccinated 41 314 healthcare workers.

I remember vividly the excitement on their faces as the first Healthcare Worker was inoculated, Zoliswa Gidi-Dyosi who went on to say the reason she agreed to be the first Nurse to be vaccinated is that she wanted to ensure that she is safe to protect patients and be in a position to perform her duties without the fear of infecting them. The first Doctor to be vaccinated Dr Sa’ad Lahri who said he took the vaccine because it gives hope, it’s hope for the nation to recover physically and economically he went as far as calling it the “vaccine of Hope” it is people like him that gives us hope, hope that this virus will finally be defeated. 

It is not a surprise that Western Cape was ready to implement phase one: I am standing with pride to announce that the first SA vaccinee is in the Western Cape, the President, and the health Minister were vaccinated in this province, at Khayelitsha, where we had our first COVID-19 case of community transmission.

 

6. Statutory Bodies

SPEAKER,

Community involvement in health is a crucial part of a good health system functioning and an integral part of Primary Health Care, that is why we are committed to meaningful engagement with communities and civil society.

Immediately after the COVID’s first wave, I embarked on a Vulimpilo Campaign; a roadshow where I engaged with Facility Board and clinic committee Members informing them about the department’s strategies to bring back health services that were halted due to COVID, unfortunately, the second wave hit us severely and we had to shelve it once again. However, the campaign allowed me to engage with Hospital Board and clinic committee Members and hear their suggestions and concerns.

COVID and the opportunity for social mobilisation around vaccines that we are embarking upon in the next weeks to months will provide me with an impetus to meaningfully engage with communities beyond vaccination acceptability.

 

We sincerely hope that the positive energy created in the process will also enable and provide impetus to the new wave of clinic committees and hospital boards that we intend to establish as part of the next three-year term.

In parallel to the social mobilisation process, adverts calling for nominations from communities will be placed in local newspapers, social media and radio stations. Local NPO networks will also be engaged.

I have called for nominations of Members of Provincial Legislatures from the Standing Committee on Health that can also assist on hospital facility boards. Councillors can assist local community reps on clinic committees.

The Department has put firm plans and processes to undertake the training of Clinic Committees and Hospital Facility Board Members. Community Liaison Officers have also been trained in this regard.

It gives me pleasure to announce that capacity at multiple levels within the department has been strengthened to include 6 Community Liaison Officers at the district level, a statutory structure support focal point at the head office within the Directorate: Quality Assurance to coordinate all aspects and capacity in my office.

An information system is at an advanced stage of development to help monitor progress with the establishment and functioning of Clinic Committees and Hospital Facility Boards.

Notwithstanding the complicated COVID context and many competing priorities, the department is hopeful and committed to establishing a robust network of clinic committees and boards. 

SPEAKER,

Before I get to the finances, I want to briefly highlight that the projected population of the Province in 2021 is just over 7 million of which 75 per cent is estimated to be uninsured. In fulfilling its Constitutional mandate to progressively realize the right to health care, the Department is committed to ensuring the provincial health system delivers high-quality care to all people of the province.

This includes preventive, promotive, curative, rehabilitative and palliative care services, which is provided across 591 service points, consisting of 467 primary health care service points, 53 hospitals and 49 Emergency Medical Services (EMS) stations. There are 33 districts, 5 regional, 2 central, 1 tertiary and 12 specialised hospitals. The Department also provides Emergency Medical Services (EMS) from 49 EMS stations and has 16 forensic pathology facilities.

These are innovative ways in which we aim to improve service delivery to the citizens of this province but more importantly restore hope. We err, we are not perfect, but we must work together as a ‘whole-of-society to ensure that services get to those who need them the most.

Finances:

 

SPEAKER,

I offer my gratitude to the Head of Department and his top management team for ensuring that we do not let the people of the Western Cape down.

I commend them for the clean audit finding for two consecutive years. Accountable governance is crucial and reinforces public trust in the way we manage the public purse.

I rest easy tabling this R27 213 billion budget knowing that it will be treated with the utmost care and spent to the benefit of the people that we serve.

SPEAKER

This brings me to the details of the 2021/22 budget:

Budget:

The health budget allocation for the 2021/22 financial year is R 27.392 billion as indicated by Western Cape Provincial Treasury, this is a 0.43 increase from the second appropriation.
 

Budget allocations

From an economic classification point of view, this year’s budget allocation includes:

Compensation of Employees – R15.616 billion

Goods and services- R9.200 billion

Transfers and subsidies – R1.593 billion

And Payments for capital assets – R982.719 million

 

Conditional grant funding total R6.971 billion which includes a COVID component allocation of R156.690 million.

Earmarked priority allocations include R1.124 billion for infrastructure including the Tygerberg hospital maintenance and capital program. Staff wellness programs, R5 million and home delivery of chronic medication R33 mil are new allocations for the current year.

The province has also invested in the battle against COVID. R832 million has been earmarked to provide R250 million to continue to invest in staff safety through the acquisition of PPE, R250 million for surveillance and testing and R332 mil invested into the healthcare platform to continue the operations of Brackengate Hospital of Hope and Sonstraal for the year and to provide relief to the central, regional and district hospitals by allowing for COVID staff contracts to be extended in anticipation of the third wave. The province has also provided the department with R150 million for vaccine implementation and procurement.

The budget has been allocated to the eight programs as follows:

Programme 1: Administration is allocated R1.522 billion.

Programme 2: District Health Services is allocated R11.166. billion.

Programme 3: Emergency Medical Services is allocated R1.208 billion, which is a 2.07% increase.

Programme 4: Provincial Hospital Services is allocated R4,140 billion

Programme 5: Central Hospital Services is allocated R7.309 billion.

Programme 6: Health Science and Training is allocated R360.579 million. 

Programme 7: Health Care Support is allocated R561.568 million.

Programme 8: Health Facilities Management is allocated R 1.124 billion.

 

Conclusion

SPEAKER

While the economic climate remains a challenge, as well as challenges within the health system, as a department, we are committed to making maximum citizen impact through adding public value, by providing quality healthcare to the people of this province, improving the dignity of our citizens.

We need the ‘whole-of-society to ensure we keep on improving health outcomes in this province.

Most importantly we need to keep in mind the needs of the clients that we serve.

None of the incredible work we have done would have been possible without the support of the following people;

• The Premier and Cabinet colleagues

• The Members of the Provincial Parliament and Standing Committee for keeping us to account;

• The over 32 000 dedicated staff in this Department under the leadership of Dr Keith Cloete assisted by top management.

• The support from our strategic partners, the private sector, academics organized labor and the support of our community structures

• My ministerial office staff for their commitment and resilience.

• And lastly my family and loved ones for their support and understanding over the past five years!

Speaker, I table 2021/22 Health Budget of Western Cape

I thank you! Enkosi