Public Health Service Issues to be Raised by March in City Centre
Media Statement by Theuns Botha, Western Cape Minister of Health
Following the Western Cape Department of Health's withdrawal of funding from the Cape Metro Health Forum, the forum is holding a march in the city centre this morning.
The withdrawal of funding from the forum follows the establishment of the District Health Councils as a legal entity in terms of the relevant legislation. The communities served by Western Cape Health are now represented on the Cape Metro District Health Council. The Cape Metro Health Forum, which is an independent community structure, can continue in its own right but the role that it played prior to the establishment of the district and provincial health councils will be addressed by the new structures in a more integrated manner.
While the public health services in this province are acknowledged by many for the quality of healthcare they provide to many under difficult circumstances, I am the first to admit that there are many challenges. However, in comparison to the reports of failing health services and mismanagement in neighbouring provinces, the Western Cape Department of Health is providing accessible quality care to most in the province within the limited budget.
The issues that the Cape Metro Health Forum raises in their memorandum are the following:
- Lack of response to chronic medicine dispensing problem.
- Silencing of the community voice in community participation.
- Abuse of power at a management level.
- The lack of taking responsibility for community-based services.
- Exploitation of community care workers.
- Funding challenge faced by communities.
1. Lack of Response to Dispensing Problem:
- The department has entered into a contractual relationship with a new provider (UTI) for the chronic dispensing service, as from 1 April 2012.
- There were initial significant challenges during the months of April and May 2012, which resulted in long waiting times and inconvenience to patients at most primary healthcare facilities.
- The department has actively managed the specific challenges at each of the facilities. The situation has stabilised over the last two to three weeks.
- The department has implemented a set of steps with UTI that will see the service returning to normality by end June 2012.
2. Silencing of the Community Voice in Community Participation:
- The department has developed appropriate legislation, in line with the National Health Act, to establish duly legislated district health councils. These district health councils have now been established in all six districts in the Western Cape.
- The department has also established duly legislated hospital facility boards for all hospitals in the province. All these boards have community representatives.
- The department will develop appropriate legislation for primary healthcare facility - clinics and community day care centres committees, which will all have community representatives. It is the intention to have requisite legislation promulgated in 2012 for implementation in 2013.
- These measures will strengthen and formalise community participation in governance structures in the public health system in the Western Cape.
3. Abuse of Power at Management Level:
- The allegations of abuse of power at management level in the department are baseless.
- All legitimate complaints of abuse of power on the part of managers in the department will be properly investigated and appropriately dealt with.
- The Head of Department has confirmed that he has full confidence in the management of the department.
4. The Lack of Taking Responsibiity for Community-Based Services:
5. Exploitation of Community Care Workers:
6. Funding Challenges Faced by Communities:
- The department has invested significant resources in its community-based services over the past eight years, starting with the EU funded Partnership for Primary Healthcare Programme in 2003.
- The department has increased its total funding to NPOs for community-based services from R155.592 million for 2011/2012 to R164.928 million in 2012/2013 (6% increase).
- The department currently contracts 145 NPOs in the 2012/2013 financial year to provide a full range of community-based services, including:
- Community home-based care:
The funded community care workers have increased from 2 500 in 2010/2011 to 3 000 in 2011/2012.
- TB and HIV adherence support
The Metro District Health Services are integrating TB DOTS and ARV adherence supporters into an Integrated Adherence Supporter, paid the same stipend as other community care workers. By the end of the 2012/2013 financial year there will be between 400 and 500 of these Integrated Adherence Supporters and this will increase the number of community care workers to +/- 3 500. Additional funding has been made available for this expansion.
- Sub-acute, in-patient palliative care and chronic care
The department has reviewed the current community-based services in-patient policy so as to integrate these services and to focus more on improving the clients' functional impairment needs. The department has convened annual community-based services summits to consult with NPO partners. The last summit was held in September 2011 and attended by 300 delegates, where the move to "intermediate care" was endorsed. The next consultative community-based services summit is planned for August/September 2012.
- Community mental health care
The department reviewed the funding norms for community mental health services in 2011/12 and added an additional R10 million to the budget.
The increases were as follows:
- Special daycare centres for children with severe and profound Intellectual disability received a 68.4% increase from R534 to R900 per child per month
- Residential 24-hour care facilities for persons with severe/profound intellectual disability received a 74% increase from R2 182 to R3 800 per child per month
- The department operates within the national policy framework for Expanded Public Works Programmes and community-based services.
- The department has invested significant funding (R13 000 per learner per NQF level) in the formal training of community care workers over the past five years.
- The accredited NQF 1 to NQF 4 training has been offered over the past five years and the training numbers are depicted below:
Period Trainees 2007/2008 1 009 2008/2009 1 805 2009/2010 1 840 2010/2011 1 614 2011/2012 1 919 Total 8 187
As part of creating career paths for community care workers each year for the past three years, 24 community care workers were admitted into Nursing the first year and thereafter 45 each year for the past two years. Some community care workers were admitted into the Pharmacy Assistant training programme as well.
- The department has also increased the stipends for the community care workers from R1 028 to R1 090 entry level for 4.5 hours/day and introduced a sliding scale where the highest stipend of a community care workers with NQF level 4 has increased from R1 415 to R1 500 for 4.5 hours/day.
- The departmental policy is not to remunerate community members serving on governance structures.
- The department has discontinued the previous funding of the Cape Metro Health Forum, as from 1st April 2012, for the reasons outlined above.
- The department will develop appropriate legislation for primary healthcare facility including clinics and community day care centres committees, which will all have community representatives.
- Community home-based care: