Western Cape Adjustments Appropriation Bill 2019: deliberations & approval

Health (WCPP)

27 November 2019
Chairperson: Ms W Philander (DA)
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Meeting Summary

The Committee deliberated on Vote 6: Health in the schedule to the Western Cape Adjustments Appropriation Bill. Consideration was given to the content, including the annexures, of the report on Adjusted Estimates of Provincial Revenue and Expenditure.

Concerns were raised about the high number of unemployed doctors. The Minister said that although there was a dire need for qualified doctors, the funds were not available. The high student failure rate was also highlighted as a problem. The inability of the Department to place all community service medical interns was discussed. Members expressed appreciation for the work done by community health workers but were worried that the cut in the HIV/AIDS budget might affect community health care workers. 

Meeting report

Dr Nomafrench Mbombo, the Western Cape Minister of Health, welcomed the increase of 0.4% to the current year budget. She said that while it was a minimal amount, it would have an impact on the lives of people who would be receiving it. The adjustment related to an increase in the uptake of medical interns and for additional services through extending the time of doctors, specifically in the West Coast and Central Karoo. Some of the adjustments related to expanding the time of community workers from half a day to a full working day of eight hours. National Treasury conditionally provided funding to assist with the building of the new level three Tygerberg Hospital. This meant that the original arrangements for all of the maintenance work at Tygerberg Hospital, needed to be revised and reviewed. The department discovered that some of the money, committed for maintenance, needed to go back to the pool.

The Chairperson tabled Vote 6 as documented on p105 to p122 of the Adjusted Estimates of Provincial Revenue and Expenditure 2019. She asked committee members to engage the Western Cape  Health Department on the content of the report.

Ms R Windvogel (ANC) welcomed the increase in the budget and stated that she would like to see practical programmes that would address the pressured services at hospitals. She was trying to understand the infrastructure backlog in the province as reflected in table 6.1 of the report. She was puzzled about the budget decrease as the health facilities were in a bad state. She asked for what purpose and where the money was moved.

Ms N BakuBaku-Vos (ANC) referred to table 6.1 and asked why the department did not cut on compensation of employees as was proposed for other departments.

Mr R Mackenzie (DA) noted the R1.9 million roll-over for Programme 6: Health and Sciences Training on p107 and asked what the department was doing to reduce the high student failure rate. He asked for an explanation of the statement; “the re-introduction of bursaries for such students, after they have successfully completed the failure year of study”. He asked if unemployed doctors could be accommodated in rural areas or appointed as a temporary measure to prevent them looking for greener pastures.

Ms A Bans (ANC) asked about the reallocation of funds in the main budget for the post of the Chief Director: Rural Health Services in sub-programme 2.1: District Management.

Ms Windvogel asked about the functional shift in the community health centres in the Khayelitsha eastern sub-structures. She asked if it meant that the four dental posts would be moved away from Khayelitsha.

Ms BakuBaku-Vos queried the reallocation of the budget for the Chief Director and asked where the Senior Manager Medical Services was deployed to.

Mr Mackenzie asked what the reasons were for shifting of funds as per p109 in relation to over expenditure in the Nursing Agency in sub-programmes 2.9. He requested more detail about the lower rate per bed in sub-programme 2.4.

Ms BakuBaku-Vos asked what the HIV/AIDS related challenges were in the province and if it was wise to cut the budget after the many battles for better working conditions for community health care workers who get paid a stipend of R3 500.

Ms BakuBaku-Vos asked how much of the budget of Programme 8 was shifted from the maintenance projects to other projects and what were the reasons. She wanted to understand if R142 million shifted to other programmes in addition to the R62 million that was shifted within the department.

Ms Windvogel asked what the National Health Insurance Grant in Programme 2 would be spent on and what accountability measures were in place to ensure that the grant is correctly spent. The DA was not supporting the NHI Plan.

Ms Bans asked about the R20 million expenditure to cover the additional costs of the new security framework for Metro Health Services. She requested a breakdown of allocation between rural and metro areas. She asked for details of the new security framework and if it included Emergency Medical Services (EMS).

Ms L Botha (DA) welcomed the increase for community health workers and said that they were doing a good job. She asked if the increase would also include the increase in the number of health care workers especially in the rural districts.

Mr Mackenzie noted that the budget of R223 million compared to the actual spending of R167 million in relation to Households in table 6.4 on p116 looked like under spending. The actual spending of 26% for 2018 for Payment for Capital Assets compared to the 96% for 2019 looked like over spending. He asked what the reasons were for the deviations.
Ms Windvogel asked the reasons for moving the Communication Centre Tygerberg Hospital and what it would cost.

Mr Mackenzie asked if the cash donation of R3.9 million from the University of Cape Town (UCT) was transferred to higher education for bursaries or for research and development.

Tabling of annexures
Ms Windvogel referred to Annexure B on p125 and asked how many posts were affected by the additional appropriation of R18 million.

Ms BakuBaku-Vos asked if it was wise to reduce the budget for District Health sub-programmes in table 6.9.2, given the many challenges faced by District Hospitals.

Ms Bans asked the reasons for all the budget cuts in the EMS for sub-programme 2, 3 and 4 in table 6.9.8.

Ms Botha mentioned that the Diazville Clinic burnt out recently.

Ms Windvogel asked a general question about funding for the rebuilding of the Jooste Hospital.

The Chairperson asked if students that failed would be covered by the roll-over amount. She asked for clarity about the savings at the TC Newman Community Day Centre in sub-programme 2.3.

Response by Western Cape Minister of Health
The Minister replied that the shift to the Department of the Premier, regarding the Western Cape College of Nursing, was not mentioned earlier. The bursaries referred to general bursaries and not to the human resource training grant. The Chief Director retired and the post needed to be filled but there were no suitable candidates in the first round of applications. The scope was therefore widened for the next advertisement.
The HIV/AIDS budget was a direct grant. The Minister explained that the money was shifted within the department and not taken elsewhere. An example was the allocation to Community Outreach Services for TB Control. The National Health Insurance (NHI) initiative is another point for debate but the department supported universal health coverage. Phase one, which related to General Practitioners (GPs), was introduced in the Garden Route. The National Department contracted directly with GPs in that area to assist with sessions at a clinic level. The systems were different but the department wanted to be part of the whole district instead of being managed from elsewhere. She expected that National Treasury would provide them with the money for the full contract in the form of a grant. The services were extended to the Central Karoo and the West Coast. Community health workers used to work four hours from Monday to Friday and earned about R1 200. The salary was increased to R3 500 after the Bargaining Council ruling. The donation from UCT was for Forensic Pathology services at the Salt River mortuary which was a level three institution. It was a joint project in terms of contributing to the mortuary. The funding for the Jooste Hospital formed part of the conditional grant from National Treasury.

The Minister said that there were always tensions towards the end of the year when medical interns needed to be placed. Some were not happy to be placed in areas other from where they come. This was a national competence and if the placement system was not working, it impacted on the provinces. In 2019, the Western Cape Health Department (WCHD) took more than 300 interns but the money did not follow. For the 2020 intake, the system was so delayed as National Treasury could not commit to the 2019 intake. WCHD was asked to take an additional 186 interns who needed to do community service as part of the two-year internship programme. The internship was a statutory requirement and for the students to become doctors, the provinces go out of their way to accommodate interns. Once the training was completed, they could apply anywhere for positions. WCHD was able to appoint only one-third of the medical officers. More than 500 medical officers were not yet employed. Some of them met with the National Minister and there were even court cases about this issue. Those with community service as environmental health officers had similar problems but not much was heard about their situation. She said that there was a dire need for doctors but there was no money.

Dr Keith Cloete, Deputy Director General: Chief of Operations, WCHD, explained that the R62 million was earmarked for the Tygerberg Hospital infrastructure project. It was not lost but returned to Treasury as the need for it was delayed. The department made bursaries available to students on the basis that they pass. Students who failed, forfeit the bursary and may request for reintroduction to the programme once they successfully repeated the failed year. He explained that Dr Renette Crous Chief Director: Rural District Health Services was overall responsible for five rural districts and for the George, Worcester and Paarl Hospitals. As the financial manager, she reprioritised the budget to assist in other areas. She sacrificed the money in her office to specifically fund the appointment of the Operational Manager Nursing post at the Citrusdal Hospital. Similarly, the Senior Manager Medical Services position at the Worcester Hospital was also funded as the hospital required the services of a Medical Services Manager for the clinics. It was the discretion of the financial manager to reallocate funding.

Dr Cloete said that the Dental Mobile Services provided services to the entire metro. Dr Gio Perez, Chief Director: Metro Health Services and his team asked the Oral Health Centre, situated next to Tygerberg Hospital, to take custodianship of the mobile services. The model that was being introduced allowed for some dental posts to be added to a central pool that would be able to service the entire metro. The posts were not lost to Khayelitsha but expanded across the metro. The money from across the metro was placed in a central pool and redistributed through the centralisation of the service. Overspending of the Nursing Agency in Khayelitsha was the equivalent to the case of the Chief Director Rural Services. The reprioritisation of the budget within the Office of the Chief Director was to help Khayelitsha Hospital with the shortage of staff. The reallocation was to fund the many staff members that were brought in by the Nursing Agency to assist at Khayelitsha Hospital.

A department official said that Tygerberg Hospital was given an estimated allocation for infrastructure. The department now had 23 programmes on the go but was unable to spend the money as programmes were in the planning phase. It was moved back to Provincial Treasury to be called up for use down the line. The R142 million was for delayed projects. The shift was done to the Medical Equipment sphere and once projects were identified, the plan to procure from Medical Equipment would take effect. The Intern Programme was underfunded and the department was given additional money to add to Compensation of Employees but it was not enough to cover the full expenditure. The cash donation from UCT was a contribution for the building of a forensic laboratory and for ICT infrastructure. The security framework was set up by the province and activated on 1 October 2019. There was an increase of 20% in security guards. They were placed in areas where safety concerns were raised for patients and staff at Groote Schuur, Tygerberg and Khayelitsha Hospitals. The average rate per guard decreased but due to the security situation, the number of security guards was increased and the department was given money in recognition of the additional security costs.

Dr Cloete explained that EMS was done in terms of a business case that was being considered between WCHD and the City of Cape Town. The issue was about efficiencies at the 107 Centre in Goodwood. The City had the infrastructure to take the 107 calls but the calls were currently being redirected to the Tygerberg Dispatch Centre. Combining the resources would save costs.

The Chairperson thanked the Minister and the Department.

The Western Cape Adjustment Appropriation Bill was unanimously adopted by the Committee.

Tabling of Annexures
The annexures were adopted by the Committee.

The meeting was adjourned.


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