The Standing Committee on Community Development considered the Vote 6: Health in the Schedule to the Western Cape Appropriation Bill, 2018.
The Minister of Health said that the medium term expenditure framework (MTEF) allocation for 2018/19 was R23.1 billion, growing to R24 billion and R25.4 billion in the following two years. The projected population of the province was approximately 6.5 million, of which 75% was estimated to be uninsured. Due to the growth of the population, the demand for services was growing by about 1.5% per annum. However, the budget allocation did not allow for any real increase in service provision.
The 2018/19 comprehensive HIV/AIDS and tuberculosis (TB) grant allocation had been reduced by R113 million. The increase in population would add to the number of patients the Department would have to cater for. Coupled with the reduction in the budget in real teams, it was most likely that there would be a deterioration in the quality of service delivery, which would result in longer waiting times and treatment backlogs at the respective health facilities. In addition to this, the economy was not growing, prices were going up, people were becoming unemployed, and communities were becoming poorer. Poverty contributed to sickness. Poor people could not afford healthcare and the Department would not be providing them with the healthcare services they needed.
During consideration of the Vote 6: Health document, Members sought clarity on various issues. They wanted to know about the challenges related to forensic pathology, the measures taken by the Department to deal with the water crisis and the increased service demands. They also asked how the Department would address the impact of budget cuts, and the effects of poverty, unemployment and other socio-economic factors on the health and wellbeing of the population.
Representatives from community health forums also raised several issues, such as improving communication with communities, providing psychological assistance, and ensuring security was adequate to deal with the gangsterism and vandalism that threatened medical facilities and their patients.
Minister on increased demand for health services
Dr Nomafrench Mbombo, MEC for Health: Western Cape, said the medium term expenditure framework (MTEF) allocations for 2018/19, 2019/20 and 2020/21 were R23 063 703 000, R23 964 555 000 and R25 431 524 000 respectively. The projected population of the province for the 2018/19 fiscal year was approximately 6.5 million, of which 75% was estimated to be uninsured. The Department continued its endeavour to provide a quality, comprehensive and cost-effective package of health services to the people of the Western Cape.
Due to the growth in the population, the demand for services grew by about 1.5 % per annum. However, the allocation to the vote did not allow for any real increase in the general purpose of budget. Special purpose items were budgets where the department had a limited say over what the funds might be used for, such as the AIDS conditional grant and the Expanded Public Works Programme (EPWP) funds. The 2018/19 comprehensive HIV/AIDS and TB grant allocation had been reduced by R113 million.
The increase in population would add to the number of patients the Department would have to cater for. Coupled with the reduction in the budget in real terms, it was most likely that there would be a deterioration in the quality of service delivery, which would result in longer waiting times and treatment backlogs at the respective facilities. In addition, the economy was not growing. While the economy remained where it was, prices were going up, people were becoming unemployed, and communities were becoming poorer. Poverty contributed to sickness. Poor people could not afford healthcare and the Department would not be able to provide them with the healthcare services they needed.
She commented that she would appreciate members’ constructive inputs and engagements.
Vote 6 (Health): Western Cape Appropriation Bill, 2018
The Chairperson said that Vote 6 would be considered page by page.
Mr D Mitchell (DA) asked what the Department was doing with regard to forensic pathology, which was a national problem. He expressed concern over the water crisis, and asked how water scarcity impacted on health services.
Ms M Gillion (ANC) said it had been reported in the newspapers two weeks ago that there were patients who had been transferred from one hospital to another because there was no water. What was the Department of Health’s relationship with other departments? She was worried about some preventable diseases which could not be prevented due to economic and social problems. These were factors that contributed to ill-health, and she asked what the Department was doing to improve socio-economic conditions. There were people who were dying because of tuberculosis (TB). What was the Department to pressurise other departments to respond to socio-economic problems?
Dr Mbombo responded that the definition of the term “health” encompassed aspects relating to sanitation and water, and this made it everyone’s business. Health was about increasing the wellness of the population through effective and quality services. For example, health was not only about the immunisation of a child, but also about showing love, care and concern to that child. It was a must to collaborate with other departments. She gave the example of alcoholism, and said that alcohol could have implications such as aggravating chronic conditions or increasing road accidents. Once an accident happened, it would be a problem of the Department of Health. Referring to sanitation, she said that the health problem could be noticed at bus termini, where one would find them dirty, without water or without toilet paper in toilets, or with toilets that had not been cleaned.
Due to the water crisis, people should change their behaviour. Borehole water was an approach that was being utilised to change the behaviour of people in their use of water. Water impacted on everything. Healthcare needed water. Health facilities should use borehole water, unless there was no water underground. However, there were things that were out of her dDepartment’s control. Borehole water was not purified and, as a result, could come with certain communicable diseases.
Emergency situations were also recognised in planning. She had seen the disaster management plan, especially where they would be taking patients in cases of emergency. There were various health problems that could be addressed through collaboration with various departments. There was a need of national bill that would talk more about the competencies of certain departments. Besides, the national health obligations were divided among national, provincial and local governments. Sometimes a health problem might be environmental. It might be insufficient (or lack of) food or water. For example, food might be poisoned and this would end up being the problem of the Department.
Dr Mbombo added that several departments were working with the Department of Health in order to improve health of the people. They had agreed to work together so that they could support the municipalities, where a lot was being done to improve the lives in the communities. The borehole water was an approach used to support municipalities. There had been investment in the social development of communities. Health issues were not limited to socio-economic problems. Community safety and security was another important issue that affected health at the individual and community level.
With regard to forensic pathology, she acknowledged that there had been a decrease in service delivery because there had been a decrease in the budget.
She emphasised that regardless of the threat of “Day Zero,” municipalities would have water. Fire was also problematic. Communities and clinics were destroyed by fires. These clinics needed to be revamped, and besides that, there was a need to increase security in order to avoid break-ins and vandalism.
Ms D Gopie (ANC) asked whether the decrease in the budget would affect conditional grants.
Dr Mbombo confirmed that it would, and remarked that there a revised form had been prepared to make a request for conditional grants.
Ms P Makeleni (ANC) asked whether there would be a standard guideline to ensure that applications were treated equally.
Ms M Wenger (DA) asked for clarity on how the Department would deal with any cost of living adjustment, over and above what had been budgeted for.
Ms Gillion commented that if the population increased, service demands would also increase. It was true that the population was growing, and people were complaining about having to wait too long in queues as a result. She asked how the problem of queues would be addressed.
Dr Mbombo conceded that due to the growing of population and budget limitations, there would be long queues. There would be a reasonable time for waiting to be served. If a clinic was open, all patients should be attended to and no one should be turned away. The problem was that not all should have required equipment or medicines. If the budget did not meet the service demands, it would always be problematic. The Department would not be able to meet the needs of the increased population if insufficient budget allocations were received from the National Treasury.
Ms Gillion asked what plan was in place to respond to the needs of the increased population. She did not agree with the Minister’s response. How was the growth of the population measured? It had been stated that the average annual growth in population was between one and two per cent.
Dr Mbombo responded that her Department was working on the basis of the estimated population growth according to Statistics South Africa. The plan in place was to prioritise the primary healthcare.
Ms Gillion said that Vote 6: Health indicated that the budget per member of population, in real terms, decreased by 3% in 2018/19, and asked how the problem of financial constraints would be dealt with.
Dr Mbombo responded that the cut in the budget would have an impact on the quality of services delivered. Two years ago, the idea had been that each and every manager should take decisions on the basis of the budget. Actually, there should be a disproportionate cut in the administration. The main problem was that the Department could not wish away the national pressure to cut back expenditure. In the past, there had not been good collaboration between sections, but with the reduction in funds, there was increased collaboration to ensure that the health system functioned.
Ms Gopie asked what sophisticated services -- which were very expensive and the least cost effective -- had been reduced the most. Why had no funds been allocated to the University of Cape Town (UCT) for three consecutive years? Why was money being allocated to non-governmental organisations (NGOs)? Were they doing the work they were supposed to do? Was money going to them effective?
Dr Mbombo responded that the Department would monitor whether NGOs complied with their mandate. By and large, NGOs had their own funds. Money transferred to UCT had been for a neurology centre.
Ms Gopie asked for details on community health facilities that were being planned, designed, constructed, upgraded or refurbished.
Dr Mbombo responded that there was new infrastructure planned, and there were more than five clinics to be opened. She also referred Members to pages 280 to 306, which referred to expenditure for infrastructure.
Ms Rose Mabolo, Ravensmead Health Forum, asked questions about the annual performance plan (APP) for the 2018/19 financial year. Referring to the mission of the Department, she asked who the stakeholders partnering with the Department were. Was the community among the stakeholders? On prioritisation, she remarked that the Delft Clinic was no longer referring patients, and they should rather be referred to Tygerberg.
Referring to the “First 1 000 Days” initiative, she asked how communities would know whether there were successes or not. Had there been a report? If so, how could such a report be accessed?
Referring to the Tygerberg Project, she commented that they were aware that the primary focus had been on children under the age of five, but it should be on all children.
She said there were no psychologists included in the list of public health personnel, and asked if they were available. She gave an example of the Bishop Lavis community, which had been transformed by the University of the Western Cape (UWC) through psychological assistance, and said this should be duplicated elsewhere.
She also made some remarks on the wellness of employees, and asked whether there were intervention mechanisms to offer employees counselling with a view to managing their emotions.
She referred to entities involved in areas such as the Management of Complaints and Compliments; the National Care Standards (NCS) for health establishments, Infection Prevention Control (IPV), the Ideal Clinic Realisation and Maintenance (ICRM) programmes and Occupational Health and Safety (OHS), and asked whether these entities had committees and what their role was.
How many partnerships with NGOs were there? She sought clarity on the R10 million allocated to the Children’s Hospital Trust, and also asked if there were enough dieticians. With regard to public partnerships, she asked what the contingency plan for that was.
Ms Gafesa Jonathan: Bellville South Health Forum, urged that something should be done with regard to staff behaviour and community engagement. She felt that funds spent on workshops were wasted, as they did not achieve their objectives.
Mr Chief Galada, Langa/Bonteheuwel Health Forum, expressed concern about clinics that were being closed, like District Six. Did the Department think it had enough capacity to accommodate all patients if other clinics were being closed? There was a problem with security guards. Security guards carried no weapons -- only batons -- whereas thieves and gangsters carried guns. How could these security guards with batons in their hands protect facilities and facility users?
Dr Mbombo responded that without partnerships and collaboration with stakeholders, the Department could not carry out its work effectively. Each health facility had a committee which was composed of people from the clinic and the surrounding area. In the committees, people from the different strata of society should be included.
On the issue of psychologists, she responded that they were needed because there were pyscho-social problems. There was the Department of Social Development that needed to look at social matters. She said there had been an intervention, so Delft Clinic should refer its patients to Tygerberg Hospital.
In her closing remarks, the Chairperson commented that questions posed and not responded to should be responded to in writing. Responses ought to be communicated directly to the Committee. She thanked Dr Mbombo and her team for responding to all the concerns raised by Members. She urged members of the public to communicate their concerns to the Committee, and not just wait for meetings to be convened.
The meeting was adjourned.
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