2017 Department of Health Budget Speech: Dr Nomafrench Mbombo

Dr Nomafrench Mbombo

2017 Department of Health Budget Speech

Premier Hellen Zille

Honourable Speaker,                                              

Honourable members

Indwendwe zethu ezibekelileyo s in the gallery

 kubacholi-choli bendaba

Middag almal - A very good afternoon to you all.

This year, my speech is dedicated to one thing: Service transformation strategy

Which includes the following;

• Patient centred-care
• Service pressure mitigation
• Streamlining patient flow
• Strengthening primary healthcare platform

This strategy is a roadmap on how we streamline our efforts to promote a healthy population while rendering quality acceptable services under dire financial constraints.

Service Pressures:

Madam Speaker, despite health having the biggest slice of the budget, we are faced with a growing population and a complex disease profile, where people present with comorbidities leading to service pressures in our facilities.

Patients presenting with multiple conditions are more complex and expensive to investigate, diagnose and treat, and they have more complications with poorer prognosis.

Just to give an idea; during the past festive season, the total headcount at our Emergency Centres for December 2016 came to 32 519, indicating a total average increase of 4% - year on year since 2015.

During service high pressure times – which are bound to occur in emergency situations- we are looking at how we can improve the experience of our clients.

This is why the complaints management system is crucial in our line of work.

We have ensured that complaints resolution weighs heavily on the performance reviews of the Hospital CEOs.

The client voice is heard and taken seriously in all our facilities across the province. We see every complaint as an opportunity to learn and improve the service. 

Hence we have a revised approach in managing complaints. We have dedicated staff members who go beyond the call of duty for our clients. Where errors have been made, we are willing to admit, apologise and rectify those actions.

I want also to thank Independent health complaints committee (IHCC) for their contribution in assisting, more specifically, the outgoing Prof S Duma and Advocate de Kock for their contribution and time. Sadly, they have to leave the committee to pursue other commitments.  

It is crucial that communities don’t see our staff as the ‘other’ but see the service as an asset to them which they must take pride in and help to improve.

Health outcomes

Madam speaker, despite these conditions, the Western Cape Health Department still leads in all the nine (9) long-term health goals set out in the National Development Plan for South Africa.

We have raised the bar since 2009 and have continued to do so. For an example;

• Life expectancy is the highest in the country for both males & females and is rising since 2011.
• The percentage of deaths due to HIV/AIDS and TB has been decreasing year on year. 
• Stats SA shows that death from TB is the lowest in the Western Cape.
• Facility based Maternal deaths is lowest in the country.
• Children and newborns deaths are lowest in the country

Members, we are faced with a quadruple burden of disease. More than half of our patients present with more than two preventable chronic conditions.

In this Province, we are implementing strategies to address the upstream factors of preventable chronic conditions through promotive and preventive measures.

The current STATS SA report reveals that our number one cause of death in the province is Diabetes, which is a disease of lifestyle. Diabetes unlike some other non-communicable diseases does not only rely on the provision of chronic medication, but requires active lifestyle modification – healthy eating, exercise, weight management and no smoking.

Therefore, we have introduced, Western Cape on Wellness (WoW), a project that aims to fight non-communicable diseases such as diabetes, hypertension and obesity.

Our aim is to shift the emphasis from treating illnesses to promoting wellness. We launched Phase one in 2016 as a pilot in the Drakenstein area. We have seen good results with the 315 participants whose lifestyles have changed. We have seen a significant reduction in their blood pressure, significant improvement in healthy eating and an increase in their general health status.

We are expanding to Khayelitsha, GUNYA (Gugulethu and Nyanga) and Saldanah where we are targeting 2000 more participants to participate.

Honourable members, as the department we had to sincerely look at the amount of money we spend curing illnesses that could have been prevented through healthy living.

WoW is one of the answers to our problem. We need to stop mopping the floor but, we need to close the tap.  It is our responsibility as government to take a lead in changing behaviours. However, we cannot do this alone, it requires a whole of society approach to successfully address this mammoth challenge.

The second project that is aimed at addressing the burden of disease, is the Young Women and Girls initiative which consists of five projects targeting school going girls and young women aged 19 and 24.

This initiative is a direct response to the United Nations report which identified young women and girls as a key population.

To curb the incidence of HIV, the department has adopted the 90 90 90 strategy following the UNAIDS new global target for HIV treatment and scale up beyond 2015.

Madam Speaker, allow me to highlight one of the 5 YWG projects:  the Women of worth project.  It is being piloted in the Klipfontein (which includes these areas Gugulethu, Crossroards, Philllipi, Manenberg, Heideveld, Hanover Park and others) and Mitchell’s Plain Substructure which directly addresses HIV.

This project aims to empower young women and girls with skills enabling them to be independent while it also seeks to;

• Decrease new HIV infections in girls and young women
• Decrease teenage pregnancies
• Increase economic opportunities for young people through empowerment

This is done by providing the girls with healthcare service and life skills amongst other things. 10 000 girls have been selected and we have introduced a financial incentive that is meant to enable the girls to buy basic necessities.

Furthermore, what makes this project unique is that we do not only focus on young women and girls but men are also involved as well.

We have received funds from the Global Fund and will spend every single cent of that grant to ensure that we fight the blesser phenomenon in our communities.

First 1000 Days initiative

Madam Speaker, the 3^rd project, First 1000 Days, which I announced in previous budget year, I am pleased to announce that we have received funding for the social impact bond through our private partner Discovery.

Amongst other things,  the First 1000 Days project aims to create awareness for parents to start caring for their children before birth and within the first 2 years of life. It is said that the first 1000 days of life is the brain’s window of opportunity to shape healthier and more prosperous futures.

Our overall goal is to increase wellness and safety of children through:

• Creating wellness resource maps of patient journeys and referrals in PSG3 priority areas
• Developing a programme for CHWs to support pregnant women and mothers of young infants for the first 2 years of life (patient centred care for the 1^st 1000 days)
• Evaluate Adolescent and youth services in  priority areas.
• Training of staff on empathetic care in birthing units.
• Conducting Parenting workshops.

These projects are successfully implemented through transversal partnerships with other  Departments:  Community Safety, Social Development, Transport and Public Works and Cultural Affairs and Sport.

Ground-breaking medical initiatives

Madam speaker, this Health department prides itself by performing ground-breaking medical procedures. Our staff members continue to show their dedication by finding better ways to deliver quality of care to our patients.

I would like to salute the following staff members some of which are seated in the gallery this afternoon:

Sister Elizma Anthonissen, runs the eye clinic in Vredendal. She  is an Opthalmic Nurse specialist who renders a comprehensive eye care service with a focus on refractive errors; Glaucoma; Diabetic Retinopathy; Cataracts and childhood blindness in the Matzikama and Cederberg sub districts.

Through Sister Anthonissen and Medical Manager, Dr Jan van Dyk’s dedication, the Vredendal district hospital received about R1.2million donated by the Japanese Embassy to make the cataract theatre a reality.  

Dr Estie Meyer, one of the Specialist surgeons representing the surgical team, from the Groote Schuur Hospital who undertook a ground-breaking operation and successfully attached prosthetic ears to a 15year old boy, Tylor Baker who was born without ears. Tylor and his family are also here and he is one of 3 in every 10 000 children worldwide to be born without ears.

The People: Our Staff

None of the incredible work we have done would have been possible without the support of our staff.

Emergency services - Staff Safety

• Candice Sauls;
• Ntlakanipho Mtiyane;
• Snethemba Nebhisi;
• Noloyiso Qotyiwe;
• Siphiwo Christian;
• Mamkeli Makinani;
• Enrico James
• Sihle Ndunge;
• Dimitri Beukes
• Nopasika Ponco
• Bongi Lawulakhe  
• Cyril Marais

Honourable Members, these are some of the 95 EMS staff members who were attacked during this current financial year while they were on duty serving our communities.

Due to these attacks, we lost 3083 DAYS of work from just January to September 2016.

This speaks directly to the dedication of those who serve the people of the Western Cape- the women and men in Green.

Despite the dangerous conditions under which the emergency personnel work, they still prioritise serving our communities.

Last year, we launched #OperationKhuseleka. This project drew on the support of different sectors such as community leaders, civic organisations, religious groupings, trade union partners, community police and health forums, and ordinary citizens.

This project succeeded in sending a strong message to those who are hell-bent on attacking our emergency personnel and health care professionals, that we are united in the fight against this kind of violence.

The success of any intervention hinges entirely on our partnership with the communities that we serve.

Madam Speaker, today we as a collective need to send a very strong message that an attack on a health care worker is an attack on all of us. 

Safety of health care professionals is not only our problem as the health department but a social problem, that needs a social response.

Madam Speaker, I am happy to announce that this provincial cabinet took a resolution to dedicate resources from the Department of Community Safety to aid with this challenge. This is no longer a health issue but a societal one which requires a whole government approach.

In a couple of weeks, the Ministers of Community Safety, Education and myself will announce detailed plans on how we will be rolling out additional safety measures.

In the audience, I have mamuZoleka Siphunzi, a client who can attest to the delivery of quality healthcare services even in difficult conditions.

MamuSiphunzi was being assisted by our EMS staff in Harare, Khayelitsha when the two got robbed at gunpoint.

I am even more touched by her bravery when she joined the Khayelitsha community along with EMS staff members on the 10^th of March during the court case to say, ‘enough is enough’.

Honourable members, let us also remember all our health care workers who also work under difficult working conditions but continue to willingly serve our communities.

Madam Speaker, the majority of our services are nurse-driven. This is why it was crucial that we revised the Provincial Nursing Strategy which was recently approved for implementation.

The strategy addresses nursing leadership and governance, workforce planning, development and research practice.

It also seeks to address nursing challenges in order to outline and measure them. We will officially be launching this Strategy during International Nurses Day. The strategy outlines the nursing capability and interventions required for our HEALTHCARE 2030 promise and vision. 

To demonstrate our dedication to Nursing as a profession, the Western Cape is the first province to have a Nursing directorate in the country. It is led by Tendani Mabuda who was once the Registrar of the South African Nursing Council.

I cannot emphasise this enough, our staff are our greatest asset as we would not be able to roll-out this R21 billion budget and service 75% of the Western Cape population if it weren’t for each and every one of them.

I salute them for their incredible work ethic as they work under difficult conditions and yet they deliver quality healthcare to our clients.

Patient experience – Reducing waiting times

Madam speaker, you cannot touch on service pressures and staff and not touch on patient experience. In Health patients are key as none of what we do is meaningless if we do not put patients at the forefront.

That is why, I officially declare this year as the year of improving patient experience and reducing waiting times.

We cannot afford to be complacent, we need to come up with innovative ideas on how we can better alleviate pressures in the public health system with such financial difficulties and to sustain WC good story.

So far the department has established over 2500 alternate sites for the delivery of chronic medication to stable patients.

This has reduced waiting times and improved access for patients, and reduced congestion in our facilities – we will continue to expand these sites as we have seen good results.

The Premier made mention of the Mitchell’s Plain Community Health Centre in her State of the Province Address.

This facility is a great example of dedicated staff members who work tirelessly to improve patient experience by alleviating service pressures through a simple innovative idea.

The Mitchell’s Plain CDC came up with a Back to Basics system which ensures that chronically ill patients receive their medication pre-packed and available for pick-up on arrival.

With this system, stable chronically ill patients effectively bypass the Pharmacy and simply collect their medication. This frees up the pharmacy to deliver services to acutely ill patients. As a result, our overall waiting time at the Pharmacy have been reduced from 185 minutes to 76 minutes.  While picking up pre-packed medication now takes patients about 5 to 10 minutes. This has effectively reduced waiting time by 60%. I would like to acknowledge Sister Xapile and her team for such a great initiative.

Madame Speaker, in my previous speeches I made mention of strengthening primary healthcare platform

In pursuit of that, I am announcing another initiative,  Catch and Match. It is an exciting project that is aimed at reducing waiting times and alleviating services pressure.  We are ensuring that selected services are brought to the people at household level. .

This initiative is to respond to patient experience and promote patient centred care.

Our community health workers do home visits to ‘Catch’ those that a greater health risk. We have improved access to the existing services by strengthening health and transversal collaboration with ‘Match’-ing citizens to appropriate services with other departments eg. Social Development.

Through this project we also link citizens with service providers through our information systems with real-time integration and sharing of relevant information. Our Community health  workers do door-to-door health promotions and support services where one Community health  worker visits between 20 - 250 households in the three pilot sites, Nyanga, Delft and Khayelitsha.

Now, our Community health workers can link data of patients through their mobile phones. This will relieve Community health  workers writing patient information on paper but the data is captured and linked on a mobile phone. We link this data to our data centre to provide continuity of care and integrated information across the service platform.

Importantly, since this project allows for clients to receive care in their homes, it decongest our facilities subsequently improving waiting times.

I would like to acknowledge Philani, the NGO that has assisted us in rolling-out this initiative.

Madame speaker, I am happy to announce another forward thinking initiative intended to reduce waiting times:  eVision (electronic vision).

We are leveraging on our eVision and digital health innovations to improve the experience our patients have.

eVision includes piloting the ;

• e-prescribing
• e-patient record,
• e-referrals from periphery health facilities to central health facilities
• provincial health data centre

Madam Speaker, Prof Andrew Boulle, who is jointly appointed by the Department and UCT, has lead the team that worked on the data centre for the province. This will consolidate all available person level health data in a designated Provincial Health Data Centre.

This means that a patient will have a unique patient identifier and will allow patients to move from one area of the province to the next, from a hospital to a clinic and their medical records will still be available on this data system.

We are one of the few places globally with an integrated data system across the service platform. This, Madam Speaker, is where the world is headed with regards to public health.

Madam Speaker, last year in this house, I announced cabinet approval of WC hospital bed plan 2030. Today, I am pleased to announce that we have finalised the Primary health care plan 2030 for the metro which will allow us to consolidate our resources and facilities which will in turn improve patient experience. It will be tabled to cabinet for approval once consultation of stakeholders is completed. 

Patient voice

Madam Speaker, our audit outcomes and health outcomes will mean nothing if the experience of our patients does not improve. In order for us to truly acknowledge our good work,  umam’ uNozamile needs to feel like these outcomes translate to quality of service.

Central to our vision is making communities an integral part in the provision of services rather than mere recipients.

Therefore, it is crucial that we increase community representation at all levels of statutory bodies through the Health committees, Facility Boards, District and Provincial Health Councils.

In my 2015/16 budget speech, I made a commitment reinvigorate all health statutory bodies in the province to strengthen active citizenry in health care.

I am pleased to announce that we have successfully passed the Western Cape Health Facility Boards and Clinic Committees Act of 2016. Regulations have been developed and will be published in the next few weeks for public comment.

This will provide a guide on how governance issues are handled within the health committees.  

I want tto thank the standing committee, under leadership of Member Lorraine Botha, for conducting parliament public hearings, criss-crossing the whole province to expedite approval of the bill which was approved by this parliament unanimously.  

Madam Speaker, this year, we have launched the very first of its kind, ‘n gemeenskaps bosberaad with all community structures, where we were unpacking the public purse. This was an opportunity to engage with the community structures on health priorities and budget allocations.  

We thank the people of the Western Cape for coming out in their numbers and being true active citizens in this process. Nothing about you, without you.

Our aim is to ensure that patients are active participants in health through these various statutory bodies.

Infrastructure

Madame speaker, from 2015/16 financial year we have built and replaced the following health facilities;

• New Du Noon Community Health Centre,
• The expansion of Michael Mapongwana -  Maternal and Child Health Unit,

Our priorities are still maintaining the current infrastructure, and replacing and consolidating primary healthcare facilities.

I am pleased and excited to announce that the new District Six Community Day Centre will be completed in the next few months. It is a modern and functional facility. This Community Day centre is a result of the consolidation of two clinics currently located in the old and dysfunctional buildings (Robbie Nurock and Woodstock Hospital).

Other major projects in the metro is the construction phase of the new Observatory Forensic Pathology Laboratory.

Madam Speaker, a special programme has started to upgrade Tygerberg Hospital’s medical emergency department and to rehabilitate electrical, water, sewer, and medical gas services, as well as, improving the day-to-day maintenance. This will be completed in this current financial year.

Honourable members, pre-consultations on the Manenberg Upgrade programme are underway between the Western Cape Government, City of Cape Town and our community partners. The Klipfontein Regional Hospital forms part of the Manenberg upgrade under the leadership of the Department of the Premier. This hospital will be replacing the GF Jooste district hospital. We are in a process of finalising the brief which will be submitted to the National Department of Health which will then inform the site on which the hospital will be built.

In the rural districts, we are completing the clinic buildings such as: Beaufort West Hill Side, Napier, Prince Alfred Hamlet, and Wolseley. All of them are functional and purpose built facilities, in line with the design principles of the Ideal Clinic.

Members, a catastrophic fire razed the Swartland Hospital. A disaster of this scale requires swift response.  I am quite pleased with our staff who have already commenced with the implementation of the medium term strategy whereby all available facilities and nearby facilities are used to provide a full package of district hospital services within the next month.

If we ever needed an example of how a community and government department can easily work together, the Malmersbury community is textbook example. I would like to convey my sincere gratitude to the churches, local government and the broader community for their outstanding support during this crisis.

Finances:

Madame Speaker, it would be amiss if I do not turn my attention to the HOD and her top management team.

The 12 year-record of an unqualified audit. This is including a 2015/2016 clean finance audit which is the first of its kind in the country for a health department- over and above a clean Human Resources audit.

Clean and accountable governance is crucial. It reinforces public trust in the way that we manage the tax-payers’

 money and roll out services.

Thank you to you and your team for ensuring that we do not let the people of the Western Cape down.

I rest easy tabling this R21 billion budget knowing that it will be treated with the utmost care and spent to the benefit of the people that we serve.

Which brings me to the details of the 2017/18 budget:

Budget

The health budget allocation for the 2017/18 financial year is R21.7 billion as indicated by Western Cape Provincial Treasury.

Budget allocations

National Conditional Grants

National Tertiary Services Grant:   2.9 billion

Health facility Revitalization Grant:    R   605 million

Health Professional training and Development Grant:    R   542 million

Comprehensive HIV/Aids Grant:                                        R1.5 billion

From an economic classification point of view, this year’s budget allocation includes:
R12.8 billion for compensation of employees; 59% of the total budget
R  6.9 billion for Goods and Services; 32% of the total budget
R  1.2 billion for transfers and subsidies; 6% of the total budget
R     713 million for capital assets, 3% of the total budget.

PROGRAMME 1

Includes the funding of Information Communication Technology projects for all programmes in the department.

The allocation is less than 4 per cent of the budget for the 2017/18 financial year, this amounts to an increase of 25 per cent from the previous financial year.

PROGRAMME 2

District Health Services: The allocation is 40 per cent of the vote, this amounts to an increase of nearly 10 per cent from the previous financial year.

This is the department’s priority programme, which explains the high increase in the budget.

The main components of Programme 2 are;

• Primary Health Care Services is allocated 45 per cent of the Programme 2 allocation.  This is an increase of 10 per cent from the previous financial year.
• HIV and AIDS is allocated 18 per cent of the Programme 2 allocation.  This is an increase of 10 per cent from the previous financial year.
• District hospitals are allocated 36 per cent of the Programme 2 allocation, this amounts to an increase of 7 per cent from the previous financial year.
• Global fund has been allocated R64 million. These funds are earmarked for the Young Women and Girls Programme in the Klipfontein / Mitchells Plain.

PROGRAMME 3

Emergency Medical Services: It is allocated 5 per cent of the vote.  This is a nominal increase of 4 per cent from the previous financial year. 

PROGRAMME 4

Provincial Hospital Services is allocated 16 per cent of the vote.  This amounts to an increase of 7 per cent.

The main components of Programme 4 are;

• General (Regional) Hospitals is allocated 55 per cent.  This represents a 7 per cent increase from the previous financial year.
• TB Hospitals is allocated 9 per cent.  This is a nominal increase of 5 per cent from the previous financial year.
• Psychiatric Hospitals are allocated 26 per cent.  This amounts to an increase of 7 per cent from the previous financial year.
• Dental Training Hospitals is allocated 5 per cent.  This is a nominal increase of 11 per cent from the previous financial year.

PROGRAMME 5

Central Hospital Services – Groote Schuur, Tygerberg and Red Cross War Memorial - is allocated 28 per cent of the vote in 2017/18. This amounts to an increase of 6.4 per cent.

Approximately 55 per cent of the Programme 5 budget is from conditional grants (National Tertiary Services Grant and Health Professionals Training and Development Grant).

PROGRAMME 6

Health Sciences and Training is allocated 1.5 per cent of the vote.  This is a nominal decrease of 8 per cent.

It must be noted that this amount excludes the training and development expenses that happen through every programme.

 

PROGRAMME 7

This programme includes Laundry Services, Engineering Services, Forensic Pathology Services and the Cape Medical Depot.

The allocation for programme 7 is 2 per cent of the budget.  This amounts to a nominal increase of 7 per cent.

PROGRAMME 8

Health Infrastructure: The allocation is 4 per cent of the budget.  This translates to a decrease 6 per cent from the previous year.

An inter-ministerial committee chaired by Provincial Treasury, consisting of Health and Education has been established. This will streamline our efforts to ensure that we work together as the Western Cape Government to deliver infrastructure timeously.

The work that we do in Health mostly depends on our infrastructure, that is why infrastructure forms part of our priorities as a way to address to patient experience and service pressures. Maintained, clean and functional infrastructure are at the core of our agenda.

Conclusion

Madam Speaker, tabled here is the 2017/18 Budget for the Department of Health.

While the fiscal conditions remain a challenge, we cannot compromise on the quality of care in the province.

The tension between available resources and the service demands is becoming tougher and more untenable year on year.

We cannot afford to be complacent, we need come up with innovative ideas on how we can better alleviate pressures in the public health system with such financial difficulties.

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;

• Premier Helen Zille, for her leadership
• Cabinet colleagues
• The Members of the Provincial Parliament and Standing Committee for keeping us to account;
• The incredibly dedicated staff in  this Department under leadership  of Dr Beth Engelbrecht assited by top management.
• The support from our strategic partners, private sector, academics. Most importantly, WC Mental Health Review board under leadership of Dr Sutcliff for its advisory role so we avoid repetition of GP Esidimeni crisis in SA Health Foundation for fund raising for the Department for us to have such other projects such as Leading Safe choices to render long lasting contraceptives and comprehensive abortion care services access to women in WC. Too many projects we have initiated, but not enough time to mention all.
• The support of our community structures
• My Ministry office for their resilience in the face of perfectionist;
• And my wonderful family for sharing my time with the people of the Western Cape.

Ningadinwa nangamso.

Madame speaker, I arise to table 2017/2018 Health Budget of Western Cape
I thank you!