Final Vote 6 Speech - Dr Nomafrench Mbombo - 2023

Vote 6 Speech – Budget 2023/24
Dr Nomafrench Mbombo
Minister of Health of Wellness
Western Cape Provincial Parliament, Cape Town
29 March 2023

PART 1:

Speaker,
Deputy Speaker,
Premier,
Cabinet Ministers,
Leaders of the Opposition,
Members of the Western Cape Provincial Parliament,
Departmental Officials,
Media Houses,
Guests and, most importantly,
Residents of the Western Cape. 

Speaker,

Today, I have the honour to table the 2023/24 Budget of the Western Cape Department of Health and Wellness, which amounts to R28 804 565 000. This equates to an overall reduction of R280.929 million or a decrease of 0.97% from the 2022/23 financial year.

While there have been notable reductions in both our Provincial Equitable Share (PES) allocation and the total conditional grants awarded to us by the National Government, we are grateful for the substantial allocation of R1 078 726 from the Provincial Revenue Fund. In total, this is a 421.87% increase from the 2022/23! As a Department, we are fortunate to have a caring Provincial Government that understands the needs of health and wellness.

It has been more than 35 months since we first identified Covid-19 in our province. Even though it has been a long journey since March 2020, I can confidently say that we are in complete control of this disease. The Covid-19 pandemic now belongs in our history books as all Covid-19 interventions are now officially incorporated into the Department’s baseline services.

As we progress further into 2023 and leave the days of the pandemic behind, we are now faced with a different reality – one that is now overshadowed by domestic and international turmoil. While South Africa has more immediate concerns and is something I will outline more later on, one cannot forgo the constrained supply chain issues that originated from Covid-19 and, more recently, the Ukrainian conflict.

This, however, is not first time Ukraine has been a focal point of the world. Almost 150 years ago, the Crimean War brought multiple countries into the fold and plunged innocent civilians’ lives into disarray However, it also gave rise to a person would go on to transform patient care and form the foundations of modern nursing. Among soldiers she was labelled the “Lady with the Lamp”, but the world knows her as Florence Nightingale.

Speaker, 

With South Africa’s public healthcare system in crisis, we have been the ones who have stood firm, innovated and provided the basis for good governance. We are the ones holding the lamp for not only residents of the Western Cape, but also for all South Africans! 

In my 8th budget speech, I presented the concept of Vulimpilo and reflected on the achievements in the system for the seven years preceding it. This is where I introduced the name change of the Department and is a direct consequence of our vision found in the Healthcare 2030 plan. As before, I will begin my 9th budget speech by firstly reflecting on the delivery of my promises for the current financial year and the active shift from health to that of health and wellness.

The Department is wholly committed to its plans for a comprehensive service redesign. Since last year, we have had a variety of Indabas with public and private stakeholders which will allow us to form foundations for greater partnerships moving forward.

Between 2020 and 2023, the Department employed a total of 2 342 individuals to assist with the service demands of Covid-19. Out of these professionals, more than a 1 000 will be remaining in our employ. Of those who will be leaving us: 829 have left on their own accord, 471 have completed their contractual appointments and 694 have been served with termination notices. Despite the pandemic funding ending and the current budget shortfall we are facing, our Department has essentially been able to integrate its Covid-19 workforce into our equitable share baseline.

We are also proud to announce that we have allocated R127.6 million to expand our transitional care capacity, specifically in relation to our Brackengate and Sonstraal facilities. This will go a long way in alleviating pressure in our acute hospital platform and will further our progress to moving away from the historical service platform upon which we currently operate. 
 

Built Environment

Speaker, health infrastructure remains our top priority as it is our main vehicle of service delivery. 

While my colleague, Minister Simmers, has highlighted a number of projects in Health in his speech yesterday, I would like to reiterate what we have successfully completed since April last year:

• The Villiersdorp Clinic; 
• The refurbishment of the Gaansbaai Clinic;
• The new day clinic in Laingsburg;
• The Sandy Point Satellite Clinic; 
• Two EMS stations in Murraysburg and De Doorns;
• The Avian Park Clinic; 
• Through dedicated fundraising, the Red Cross War Memorial Children’s Hospital opened a new casualty centre;
• The Bergsig ward in Nelspoort;
• The Gouda Clinic;
• The Steenberg Cove Satellite Clinic;
• The first phase of Victoria Hospital’s Emergency Centre; and
• The developments at Swartland Hospital. 

Ongoing infrastructure developments

While our Department has obtained successful results from our completed projects, we are making promising developments with respect to our other infrastructure investments.

Ladismith Clinic is approaching the final stages of its construction and is expected to be completed by the end of May this year..

In relation to the construction of the Klipfontein Regional Hospital, we are making steady progress as a tender was awarded September last year for multidisciplinary professional service providers. Additionally, a town planner has been appointed to begin with the land application processes pertaining to rezoning and erven consolidation. Currently, the appointment of sub-consultants and other specialists is underway.

The public-private partnership (PPP) underway at Tygerberg Hospital has gathered speed with its developments. The Feasibility Study which commenced a few years ago has completed its consultation process with all relevant stakeholders last year after National Treasury issued a TA 1 Approval.

In total, there are 285 projects in our pipeline which will further capacitate our services as a Department. While we thank the Department of Infrastructure for being the implementing agent all of these years, we are excited for the opportunities that await us with the removal of Chapter 16B of Provincial Treasury Instructions. In doing, the delivery and maintenance of infrastructure will now be the responsibility of our Department. 
 

Violence Prevention Unit

Speaker, the Safety Plan has been debated many times in this House and despite our differing views on policy, we all agree that a whole-of-government and whole-of-society approach is essential to reducing violence in our communities. As the Department of Health and Wellness, we understand our role in this regard and are committed to doing our part: 

A violence prevention unit is being established within the Department after finally receiving the DPSA macro structure approval;
Area based teams are established in the hotspot areas and will work as the implementors of the VPU; and
A public facing dashboard is being developed and will give communities, law enforcement agencies,  and NPOs the data indicating the burden of trauma in localised geographic areas. 
 

Mental Health

As a Department and province, we have prioritised strengthening our mental health response to improve the wellbeing of all. An additional allocation of R30 million was made to bolster our mental health services last year and we have seen positive results on this front. But this is not enough. To truly make more headway, we truly need a whole-of-system response and we have been doing just that:

We have mental health steering committee of all relevant HODs;
In Klipfontein and Witzenberg, we are busy with a mapping exercise to map all mental health services in the respective regions;
Action plans had been drawn up to deal with mental health burdens and will be rolled out once finalised; and
Our psychogeriatric interventions have proven successful at Alexandra and Stikland Psychiatric Hospitals where currently piloted.

This year alone, R72.4 million has been allocated towards supporting mental health services in both the metro and rural districts. 
 

Surgical Backlogs

Last year we announced an additional allocation of R20 million to address the surgical backlog caused by the decision to reprioritise healthcare towards responding to the Covid-19 pandemic.

In doing so, there was a considerable increase in the backlog of elective surgical procedures. In June last year, the total estimated amount of surgeries needing to take place increased to 77 000 procedures. Due to dedicated management and staff, our hospitals have made great progress in reducing the current backlog. As of February this year, the outstanding procedures from 2020 stood at 20 849 – a decrease of more than 70%.

This has also been aided by our da Vinci surgical robots at Groote Schuur and Tygerberg Hospitals. Between their procurement and the end of February, 260 surgeries have taken place. These robots allow for quicker recovery periods and thus alleviate bed occupancies where they are being used.

We look forward to even greater progress being made in this regard. 
 

Joint Facilities

In 2022, with the City of Cape Town, we made the decision to provincialise joint facilities that were operating in the Metropolitan in order to rationalise the clinic network, which would reduce the financial burden and thereby improve service efficiency. This resulted in the handover of the 9+1 facilities. 

This is crucial to creating a more holistic and integrated healthcare package in line with the Provincial Department’s Healthcare 2030 plan to streamline the patient journey, create a person-centred approach and to improve the quality of healthcare.

It is for this reason that I am excited to announce the provincialisation of two further facilities in Atlantis. As of 1 July this year, Saxon Sea and Protea Park Clinics will be incorporated into Provincial Health Services. This will also improve burden and service pressures currently being experienced at Wesfleur Hospital. 
 

Climate for 2023/24

With us as a Department having delivered on our goals and promises, it is important that we lay the groundwork and contextualise the climate we will be weathering in the year ahead.

In total, we have more than 34 000 permanent employees and thousands more in contract staff working across our 571 service points in our province. That is a lot to fund, let alone to efficiently govern the only government service that is available 24 hours a day, 7 days a week, 365 days a year. Considering these facts, we need to contextualise the external factors which are becoming increasingly prevalent. 
 

Speaker,

the in-migration of people to the Western Cape is a well-known fact and has only been intensifying. As a province, we understand this – we are the home of hope for all South Africans. The Western Cape’s population is currently set at around 7.2 million, in which 75% use public health services, and it is expected to increase by another 800 000 people before the end of the decade! Even though we welcome with open arms anyone who wishes to call the Western Cape their home, the fact that our resource allocations from National lag behind this trend is of concern to us. 

This brings me onto our wellness priority, particularly the social determinants of health. 

As we all know, the wellbeing of any person is not solely dependent on the services its health system. Only 20% of the drivers of health are that of clinical care, with the rest being based off individual behaviour, one’s physical environment and socio-economic environment.

With our economy being pushed further into precarious waters, the direct socio-economic impacts are being experienced by residents who find themselves destitute and without hope. The consequences that follow are obvious. Coupled to the massive hikes in cost prices, food security for many has been undermined as a result and means that the general health of these affected residents is worse off. This is turn means that one’s immune system will be the first to be negatively impacted. This means that our fight against HIV, TB, childhood diseases and other conditions will have become much more difficult.

It is the above which also intensifies a vicious cycle in our communities. If diseases are more prevalent in our communities and food security is threatened, it begins to harm a child’s crucial first 1000 days of development. 

Speaker,

as you can see, the health system in our country is being pulled from both ends and means that the work we do has gotten even more complex. Health is the first point of contact for many of our residents and where many of their conditions are a result of inputs that could have been addressed through other means.

Despite the above, the Department of Health and Wellness has had to deal with another constraint impacting its service delivery. Speaker, I am of course referring to load shedding.

Our facilities and healthcare professionals need a constant and stable supply of energy in order to do their work efficiently. The electronic equipment used on a daily basis cannot be switched on and off like a light switch and runs the risk of being damaged overtime. Lives quite literally depend on them.

Speaker,

between April 2022 and February this year, we have spent more than R100 million on fuel supplies for our facilities. While this number might not seem that significant given the size of our budget, this is money that could have been used to hire more professionals to treat our patients, to procure more essential supplies or even to improve infrastructure. Load shedding simply steals from our residents.

However, we are not going to sit around and expect the situation to go away by itself! As we speak, we are rolling out inverters to 121 of our rural PHC facilities, surging ahead with our energy saving targets and are installing solar panels onto the roofs of 15 of our hospitals. Thanks to the talks with the City of Cape Town and Eskom, we were able to exempt five additional facilities from load shedding: Karl Bremer, Mitchell’s Plain, New Somerset, Victoria and George Hospitals. We hope in the future that a further 14 facilities will be added to this mix.

In total, the budget request for these projects is R196 million for this year alone. 
 

Budget

For the 2023/24 financial year, the R28 804 565 000 budget will be appropriated and structured according to the following:

Programme 1: Administration has been allocated R1 043 673 000
Programme 2: District Health Services has been allocated R11 764 375 000.
Programme 3: Emergency Medical Services has been allocated R1 316 456 000.
Programme 4: Provincial Hospital Services has been allocated R4 660 955 000.
Programme 5: Central Hospital Services has been allocated R7 685 197 000.
Programme 6: Health Sciences and Training has been allocated R404 624 000.
Programme 7: Healthcare Support Services has been allocated R623 456 000.
Programme 8: Health Facilities Management has been allocated R1 305 869 000. 
 

Speaker,

Over the next three years, the Department will invest R2.59 billion on maintenance and infrastructure. For any service to be properly rendered, it requires a stable and dependable platform upon which to do so. Our services need the solid foundations so that they can still be accessible for our residents. This is why we are increasing the allocation by almost 10% this year alone.

This is a budget of resilience, despite the odds which face it. Speaker, Honourable Members and residents of the Western Cape: I hereby table the 2023/24 Budget for the Department of Health and Wellness. Let us all support this so that we can push forward with quality healthcare services.

I thank you.

PART 2: 

RESPOND TO OPPOSITION AND SEGWAY INTO THE NEED TO BE INNOVATIVE 
 

E-vision

Speaker, innovation is key to the Department ensuring that is able to offer its services efficiently.

Last year, the Department emerged as a winner at the 20th Annual Centre for Public Service Innovation (CPSI) Awards for the ground-breaking HECTIS innovation – our hospital and emergency centre tracking information system. 

Currently operating in 41 health facilities in the Western Cape, it is the only e-innovation in the public sector that has built-in feedback from its end-users. This IT data system collects information from our emergency centres and follows the patient from the moment they are triaged to the point of treatment. In doing so, we are able to get real-time geographic information that informs us as to what is happening in our communities.

All of this forms part of the E-vision strategy we first implemented back in 2016 as we understand the importance of ensuring that healthcare is modernised and more accessible to everyone. Whether it be the digitalisation of our patient records or telemedicine, we are making a difference – so much so, that others are noticing! Earlier this month I had that opportunity to speak to the Lusaka Apex Medical University in Zambia about our ICTS strategy. The Western Cape is a place that is home to pioneers! 
 

Governance Strategy

In our efforts to be more impactful, we need to structure the Department so that it addresses the needs of our communities. Speaker, we have been doing this through our MEAP and Micro Design Process. This is something I have detailed in previous budget speeches. 

But for this to be effective, it needs a vehicle through which it can reap its benefits. This is why our organisational and leadership approach is crucial. As we move towards Community-Orientated Primary Care (COPC), we need to work across previous divisions in the healthcare sector to do even more. This is something that I highlighted at UCT’s Global Surgery programme, where I serve as its global patron.

The Global Surgery programme brings in stakeholders from across the world, both in the private and public sector, and provides these individuals with the necessary skills and of their fields. In doing so, they will be empowered and capacitated to bring about change needed in their communities and disciplines.

Speaker, we cannot continue to work in our silos; we have to work together in order to realise the change we envision today. This is because our work is driven by interrelated systems that are co-dependent on one another. If this concept is working on a global scale, we need to do more to ensure that it does in our communities. 
 

Conclusion

With National Treasury making more than R1.5 billion to our baseline funding, coupled to the downward adjustments made to the PES over the medium term, the Western Cape is going to have do much more with even less.

But this is the task we have always known. As a province, we understand that we have a long road ahead to improve dignity and wellbeing of all of our residents in our communities.

This, however, doesn’t scare us. No, this incentivises us to do even more! No matter the challenges that face us, the Western Cape has always been the province to showcase its brilliance through good governance and service delivery. This is something that is not only understood by the management of our Department, but also our many dedicated staff members on the ground.

This will not be possible without every single person working in the Department’s employ. It matters not whether you are a doctor, a nurse, a porter, an admin clerk or a director – we see every contribution and the impact it has on resident’s lives.

I would like to thank the Department under the leadership of Dr Cloete for being proactive and maintaining spirits after a very long period of no rest during the pandemic. Despite being pushed to your limits, your energy has never wavered. You and your officials are the heroes behind the scenes.

I am eternally grateful for our communities, clinic committees and hospital boards. These individuals work along side our staff with the same level of dedication to ensure residents receive health care services. We are also grateful for the work our mayors and councillors do to support our district healthcare platform – they truly embody the mantra “nothing about us, without us”. My thanks also goes out to the universities, public sector stakeholders and broader civil society for working with us on multiple fronts. Health is, without a doubt, everyone’s business.

Finally, I also am grateful for my office for the work they do to ensure that I am able to fulfil my duties and mandates without fail.

As we plot the course ahead and progress in realising our goal of true Universal Healthcare Coverage I am possible that this budget will make our lamp shine even brighter for all to see - even with the increasingly constrained fiscal climate. We must and will overcome.

We will leave no one behind. Ons sal niemand agterlaat nie. Asiyi kushiya mntu ngasemva!

I thank you.