Let’s join hands to walk the journey towards the best health outcomes for the WC

Let’s join hands to walk the journey towards the best health outcomes for the Western Cape (WC) 

In recent months much has been said about the effects of budget and resource constraints in the public health sector. The Western Cape Department of Health and Wellness can now confirm the following budget details.

For the coming financial year (2024/2025) the department has received a budget of R30.48 billion - an increase of 2.5% from last year's R29.78 billion. However, as a result of the increase not keeping up with inflation rates (in excess of 5%), it means that the department has a real decrease in its budget and has to absorb the costs of rising inflation.

This means that for every R100 000 of the department’s budget that was allocated in the 2023/24 financial year, R105 250 would be needed to offer the same services when accounting for inflation in the 2024/25 financial year, while the department received R102 500. When considering the department’s R30.4 billion budget, this represents a real shortfall of R807.866 million. It is important to note that these figures are based on conservative rates of inflation and do not account for possible increases in operational costs.

In real terms the department can therefore offer fewer services compared to last year. While budget cuts have been an ongoing trend for the health sector in the recent years, the department has already had to manage an in-year decrease in its baseline budget in 2023/24.

These consecutive cuts put additional strain on a system which is already under pressure and must provide services to an increasingly uninsured population, with increasing healthcare needs. 
 

How will we cope?

Despite this reality, the department remains committed to continue to provide quality health services within its available budget allocation. The Head of Department for Health and Wellness, Dr Keith Cloete, remarks: “We know that people rely on us to continue to function, and we are determined to do just that. While the in-year budget cuts last year were very challenging, we now have advance notice to ensure we adapt our service delivery strategy. The strategy of the department to cope with the budget cuts involves two complementing approaches: on one hand increasing revenue and on the other to streamline and innovate where possible, to reduce costs.”

The Western Cape Department of Health and Wellness has been proactive in establishing stronger partnerships with multiple stakeholders, to build our resilience during these challenging times. As we did during the Covid-19 pandemic and before, the department is exploring a number of relationships to potentially bring additional resources into its system, to supplement our government and donor fund allocations, while we will continue to advocate for additional funding.

While the department is managing to keep its current staff levels constant, it will apply careful consideration to the filling of essential posts. The department is unlikely to implement big service cuts but will need to prioritise and will need to limit certain services - people might have to wait longer for services, there might be more discomfort for families. This is an unfortunate and unavoidable consequence of increased demand with a restricted budget allocation.

The department will continue with its cost-saving interventions, as well as applying extra focus on service prioritisation and service redesign. Internally, an ethical decision-making framework and set of principles has been established for healthcare service repriorisation.  The department will consider the best available evidence for health outcomes as well as the needs of the public when making decisions on how to ensure we deliver the best possible service, within these constraints.

Our teams in local geographic areas will continue to do resource planning based on the local health care needs of people in their specific geographic areas. These extraordinary and competent local teams will ensure that service delivery continues, with as little disruption as possible, considering their unique local contexts. Service prioritisation will be applied across the whole system to ensure equity and fairness in the provision of services across the province.

The reality is that the public health system will remain under pressure for the next 3 to 5 years. 
 

We are in it together

Towards the end of last year, the department engaged internal and external stakeholders – notably those in civil society, higher education institutions, private health sector and organised labour – on reaching a common purpose in working together in the years to come. In these sessions various groups, including staff and clinical managers, were consulted about the way forward. These consultations will continue during the next year.

Minister Mbombo, MEC for Health and Wellness, highlighted that, “The process of engagement is crucial to any healthcare system, especially on any health journey that requires change to the status quo.”  

It is very important that patients and communities assist the department by safeguarding their own health and wellness. By taking care of their personal wellness, making healthy lifestyle choices and avoiding situations of potential violence, communities can assist the department in protecting our health care system. It is important now more than ever to ensure that we use our health care services as effectively as possible.