Final Vote 6 Speech - Dr Nomafrench Mbombo - 2024

2024/25 VOTE 6 BUDGET SPEECH

Department of Health & Wellness

MINISTER PROFESSOR NOMAFRENCH MBOMBO

Wednesday, 27 March 2024

Speaker,

Deputy Speaker,

Premier,

Cabinet Ministers,

Leaders of the Opposition,

Members of the Western Cape Provincial Parliament,

Departmental Officials,

Members of the Media,

Residents of the Western Cape.

Honourable Speaker, I would like to take this House on a history lesson and begin my speech by speaking to the Pantheon – the iconic landmark in Rome.

Built nearly two millennia ago, the Pantheon stands as a marvel of architectural achievement. Commissioned by Marcus Agrippa in 27 BC and later rebuilt by Emperor Hadrian around 126 AD, the Pantheon was dedicated to the worship of the Roman gods, with a particular focus on the celestial deities.

But what sets the Pantheon apart from other ancient structures is not just its grandeur or its historical significance. It is the remarkable fact that this architectural masterpiece has endured the passage of time.

The secret to the Pantheon's longevity lies in its construction, particularly the innovative use of Roman concrete. Unlike modern concrete – which needs consistent repairs – this ancient building material, composed of lime, volcanic ash, and aggregate, proved to be a game-changer in the realm of architecture. The Pantheon's iconic dome, one of the largest of its kind in the world, owes its strength and durability to this remarkable material. Built without the use of modern reinforcement techniques, the dome stands as a testament to the resilience and engineering prowess of ancient Rome.

Many ancient structures around the world – like the Temple of Luxor in Egypt, the Parinirvana Stupa in India or the Great Mosque of Djenné in Mali – have stood for hundreds if not thousands of years due to the way they were built.

Like these buildings, the endurance and reputation of Western Cape’s health system is not by accident – it is by design.

The crust is to strengthen the whole health system, each block: World Health Organisation talks about health system is made of systems, namely:

1. Leadership and governance
2. Human resource
3. Health information
4. Health financing
5. Access to medicines
6. Service delivery

For years we have invested in our foundations, ensured that our facilities and management teams are composed of quality people and assets, and that our organisation is structured optimally to face the current demands of a modern world requiring to strengthen all the building blocks.

But that doesn’t mean that we are operating in a perfect world where our Department is operating perfectly. Like the Pantheon, Honourable Speaker, we have endured countless crisis. 

Polycrisis

For the past 15 years, the Western Cape, and more broadly, the world over has had to encounter and internalise several shocks on multiple fronts as time has gone on.

For Health and Wellness, these include climate-related events such as droughts, fires, and floods, as well as disease outbreaks. We have grappled with the geopolitical ramifications of conflicts in regions like Ukraine, Gaza, and Sudan, which have had far-reaching economic implications. Social instability, characterised by instances of social unrest, taxi violence, and rising costs of living, has further compounded our challenges. Technological threats such as cyberattacks and risks associated with artificial intelligence have been added to our concerns.

Moreover, the persistent issue of load shedding has underscored the fragility of our energy supply, while economic downturns and fiscal risks have posed significant hurdles to our prosperity. SA triple challenges of unemployment, poverty and inequality and other socio-econo-political and commercial determinants of health impact on us.

Honourable Speaker,

While our department is being stretched thin in these circumstances, we cannot and have not remained idle in such circumstances .

We communicate and engaged constantly with our stakeholders, from private, organised labour/unions, civil society and recently we hosted a multisectoral engagement with local governments and statutory bodies on 19 March in order to contexualise the challenges facing us and speak to how these will be mitigated going forward.

Out of all clinic committees and hospital boards 94% are constituted across the province, and will be taking the conversation at ward levels so that communities know how the upcoming budget period will affect their respective facilities.

Built Environment

Speaker,

Investment into critical infrastructure has been a key priority for Health and Wellness. Over the past five years, one of our primary focuses has been to ensure that our infrastructure remains modern, safe to use and effective in rendering health services to our communities. Currently, we have 15 infrastructure projects that are in construction. These include :

• The renovations and rehabilitations at Stellenbosch Hospital;
• The fire compliance measures at Worcester Hospital;
• The construction of the new Ladismith Clinic;
• The new Obstetric Theatre in the Paarl Hospital’s Maternity Until;
• The construction of four, brand-new Acute Psychiatric Units at Khayelitsha, Eerste River, New Somerset and Caledon Hospitals. These brand-new Acute Psychiatric Units will alleviate the pressure on our hospital platform. In total, these four projects equate to R279 million. Mental health is a priority
• The replacement for the Villiersdorp EMS station; and
• The upgrade and additions being made to Bothasig CDC.

Additionally, our health technology projects included a total of 117 projects in planning, 40 in the Procurement Stage, 9 that were being commissioned and 51 that were at the Exit Evaluation stage.

For our Face of Government Projects, we have now increased these to 520 interventions with the committed budget now being close to R9 million – approximately 30% of the allocated budget of R30 million. These resources are being used to fix our windows, install “afdakke” for our patients waiting in queues and improve the appearance of our facilities.

Earlier this year, I opened the R34 million Knysna Forensic Pathology Laboratory. The new facility has resulted in improved service delivery by offering improved medico-legal support to investigations for the justice system, an improved and dignified public experience with an appropriate public interface and bereavement space, as well as an overall improved staff morale.

In a few months, I will be officially opening the Observatory FPI, which cost R300 million and can accommodate 405 bodies.

I also recently inspected Tygerberg Central Laundry which received a total renovation of R137 million included three new washing units, which allows it to cater for 64 healthcare facilities in the metro and also for the entire Cape Winelands District. This also contributes in reducing carbon emission as part of contributing positively on climate change.

Speaking about Tygerberg, our commitment to the New Tygerberg Tertiary and Belhar Regional Hospitals remains resolute. Together, with Klipfontein, these projects are worth more than R16 billion and will greatly capacitate our Level 2 and Level 3 platforms in the Western Cape.

In terms of the Belhar Regional Hospital, work has since commenced with the project briefing on 30 October 2023. We have been in negotiations with the City of Cape Town (CoCT) to secure assistance in order to relocate or redirect sewer lines installed for a neighboring housing development in order for the project to continue.

From this, we have also created a joint task team in order to streamline the administrative processes going forward to the three hospitals we are building in the metro…. R16 billon, i repeat.

On Klipfontein Regional Hospital, Honourable Speaker, otherwise known as GF Jooste.  Concept Design is in progress, with the consultants working on the Site Development Plan and layouts; we anticipate these to be completed by August 2024.

Energy Resilience

Honourable Speaker, I have made it very clear that healthcare services cannot be switched on and off like a lightbulb; lives quite literally depend on a steady supply of electricity.

In addition to maintaining 195 generators at our large facilities, we have installed 47 inverters at rural clinics and will continue to roll out this programme into the future. This means that even in our most distant communities, our healthcare facilities will ave electricity.

In an effort to be greener and more cost-effective, 13 of our hospitals will receive solar panels. While our hospital have generators, the solar panels will save our facilities from having to spend millions every month on diesel and will free up resources for where they are needed most. This project has been allocated R73 million over the next two years.

Violence Prevention Unit 

Speaker, one of the most impactful factors is that of crime.

Two years ago the Premier announced that a Violence Prevention Unit would be established in the Department of Health and Wellness.

Following my last budget speech, the VPU has been capacitated and is providing safety stakeholders both in government and civil society with these tailored, evidence-based interventions for their communities based off the local data and trends in their area.

Our 12 VPU coordinators across 18 Area-Based Team (ABT) areas are working with these stakeholders in their respective districts to make our communities safe for all.

This is a commitment we will continue to expand, specifically with nearly R94 million being spent on violence prevention in terms of our District Health Services over the MTEF.

Telehealth and Innovations

Health needs to be consistently evolving in order to provide the right care to our patients, and needs to stay abreast with the constant developments of technology.

One such example, which has been mentioned by the Premier, is that of our TeleICU robot in George, which connects specialists in Groote Schuur with doctors in George Hospital without having to transport patients or clinicians more than 400km for a consultation. Gone are the days when we solely had to rely on a R200 000 airlifting mission.

But that is not the only innovation we have.

We are the only health department to be licenced by the South African Civil Aviation Authority to operate drones, which are used in our search and rescue operations. These allow for quicker findings in inaccessible areas where other vehicles would have been used. We currently have 5 drones across the province who are saving lives on a daily basis.

Our Da Vinci Robotic Surgery systems have continued to perform and have conducted more than 550 surgeries since their commissioning. These are just few examples, some include cutting edge operations such organ transplants at our three tertiary hospitals.

Transitional Care Facilities

Post Covid-19, we introduce transitional care as part of our service redesign, to reduce service pressures from our acute hospital platform.

Facilities such as Brackengate have now been transformed into Transitional Care Facilities. This means that medically stable patients who are unable to be discharged but do not require acute care, will be able to fully recuperate without congesting the hospital platform.

These Sub-acute, Step down and Chronic Medical Hospitals will get allocation of R469.875 million to expand our Transitional care platform.

Competent Health Staff and Training Institutes

Through you Speaker, the Honourable Pretorius recently mentioned that “state-of-the-art facilities mean nothing without state-of-the-art staff” and I cannot agree more to that statement.

Here, in our province, we are investing in our own timber and producing quality healthcare professionals.

R65.3 million has been allocated for bursaries, with R204.4 million being for the training of officials in the Department.

The Western Cape College of Nurses is the only public nursing college in South Africa to offer a bachelor’s degree in nursing as well as postgraduate diploma courses. These are otherwise offered in private institutions or universities, which proves how our college is creating quality healthcare staff and specialists.

Through approval from the South African Nursing Council (SANC) and Council on Higher Education (CHE), WCCN is now offering seven Postgraduate Diploma nursing specialty programmes namely: Perioperative Nursing, Critical Care Nursing, Mental Health Nursing, Trauma and Emergency Nursing, Midwifery, Primary Care Nursing and Orthopedic Nursing. The graduates from these programmes will then be allowed to be registered as as a nurse or midwifery specialist.

The Western Cape Government College of Emergency Care (CEC) has also been accredited by the Council on Higher Education. It is accredited by the Health Professions Council of South Africa (HPCSA) and holds a SAQA certificate to provide undergraduate emergency medical care training. The CEC currently provides the Higher Certificate (Emergency Care Assistant NQF 5) and is awaiting accreditation to offer the Diploma in Emergency Medical Care and Bachelor's Degree in Emergency Medical Care.

Going Forward

As I conclude this speech, we are in a period of business unusual.

While that may be the case, we must use our successes to buffer us going forward.

We have introduced cutting edge technologies like robotic surgery, telehealth initiatives like our TeleICU robot, dashboards and HECTIS which are making our services more efficient.

Our efforts towards service redesign has equally put us in good stead, particularly our policies on Community Oriented Primary Care relating to “hospitals without walls”, healthcare on wheels and wellness hubs.

The polycrisis impacting the Department incentivises even more to put in the necessary changes to achieve UHC and improve our human development index (HDI) outcomes.

But we also cannot only focus on the present; we have to focus on the future and how climate change is impacting all of our lives.

The Department has joined the Global Green and Healthy Hospitals, which is an international network of more than 68,000 hospitals, healthcare facilities, health systems, and healthcare organisations dedicated to reducing their environmental footprint and promoting public and environmental health. To date, we have won awards in climate resilience and leadership, as well as green-house reduction.

This is healthcare without harm, and it must be seen in conjunction with the global policy of One Health where we are striving towards harmony with nature and animal health too. There has never been any other time health system in SA has been challenging yet exciting for future health reforms. Behind the scenes we are working with researchers to continue building it… where there is political will, there is a way.

Budget Allocations

This morning, I have the honour of tabling the 2024/25 Budget of the Western Cape Department of Health and Wellness amounting to R30.489 billion.

In comparison to the revised estimate for 2023/24, this represents an overall nominal increase of R658.032 million or an of 2.21 %.

The increase sounds substantial and may seem like an additional allocation that remedies the constrained fiscal climate every department is facing.

It is not.

The projected shortfall of R807 million, albeit 2.65% of the main allocation for the upcoming financial year, should not be seen as a misnomer. A figure like this has the potential to be the destabilising factor to a chronically underfunded health system and can represent the final storm that finally breaks the walls and foundations of a building upon which we all depend for our health.

In the 2024/25 financial year, the total appropriation for Vote 6 will be allocated according to the following:

• Programme 1: Administration has been allocated R947 827 000.
• Programme 2: District Health Services has been allocated R12 662 542 000.
• Programme 3: Emergency Medical Services has been allocated R1 378 029 000.
• Programme 4: Provincial Hospital Services has been allocated R4 908 128 000.
• Programme 5: Central Hospital Services has been allocated R8 194 637 000.
• Programme 6: Health Sciences and Training has been allocated R429 077 000.
• Programme 7: Healthcare Support Services has been allocated R661 913 000
• Programme 8: Health Facilities Management has been allocated R1 307 058 000.

It is important to note that these allocations have been made have been made with the following principles and assumptions for the upcoming financial year as a result of the increased fiscal pressure:

• For Compensation of Employees, the department was not able to fully provide for the inflationary increases as indicated in our allocation letter. As such, the inflator for CoE has been reduced by approximately 2.73 per cent and translates to around 1 300 fewer headcounts.
• For Goods and Services, all inflators have been reduced to 0 per cent.

When accounting for the increases in the prices of electricity, food, transport, as well as clinical goods and services, this means that our budget for such items will face immense pressure over this financial year.

• For Transfer and Subsidies,, Payment for Capital Assets, and Service Expansion, there has been no allocation for inflation over the next three years.

As the world around us is fast changing and creating challenges for many to adapt and survive, let us remember the Pantheon we have built in the Western Cape.

Our Pantheon has stood strong against many crisis and scenarios that have posed as risks to destabilise the whole sector.

While we will be required to continue to change and evolve over time, we have established a strong core that is made up of quality characteristics and stands as a testament to who we are.

Our Pantheon is a legacy that needs to be protected and is the foundation of our future successes, which will not only assist healthcare in the Western Cape but also that of South Africa.

I hereby table the 2024/25 Budget for the Department of Health and Wellness.

I thank you.