Health Budget: Western Cape Submission

Meeting report

HEALTH AD HOC COMMITTEE
9 June 2004
HEALTH BUDGET: WESTERN CAPE SUBMISSION

Chairperson: Mr L Ngculu (ANC)

Documents handed out:
Western Cape presentation
Western Cape Budget Statement

SUMMARY
In line with Vision 2010 the Western Cape Department of Health has changed its focus from tertiary health care to primary health care. The total budgeted amount allocated for the 2004/05 financial year was R 4,7 billion which showed an increase of 8,4%. The presentation was an overview of achievements and challenges in relation to the national Ten Point Plan and outlined key priorities for the next three years, funding and personnel trends. Pressures on the budget were brought about by cuts in conditional grants without decreases in patient loads and an increase in costs, particularly staff costs.

Topics covered in the discussion included:
· long queues
· tuberculosis treatment.
· balance between staff reduction and service delivery
· vacancies rates for nurses
· Hospital Board
· mobile clinics and home based care services
· transfer of Emergency Medical Services from Local Government
· number of HIV/AIDS patients in the province.
· the issue of primary versus tertiary health care

MINUTES
Introduction by Western Cape MEC for Health
Mr Pierre Uys (Western Cape MEC for Health) said that the increase of 8% judged against inflation showed a negative increase in the budget. The budget as allocated would be nurse-driven and primary health care-focused. Compensation to employees would amount to 60% of the budget. About 200 000 people would receive specialised treatment at the three specialised public hospitals whilst the antiretroviral (ARV) treatment would be expanded to serve 6000 people. A request would be made to the Minister for a Special Conditional Grant for upgrading at Tygerberg Hospital.

Western Cape presentation
Prof Keith Househam (HOD Health) conducted the presentation. He highlighted the challenge of reducing long queues and waiting times and the increased availability of medication as two of the key priority areas that formed part of the Premier's 100-day delivery target. In order to facilitate equitable redistribution of resources to other provinces, the Western Cape budget has, since the 2001/2002 financial year, consistently been increased below the national average.

Discussion
Dr Luthuli (ANC) asked how the province would deal with the challenges of long queues and availability of medicines.

A Committee member asked how many health care nurses were trained over the past 10 years and whether the DOTS programme was used in the province.

An ANC committee member asked how the province would respond to traumatic and acute cases if tertiary care were to be reduced and whether the province experienced patient compliance in relation to TB treatment.

Mr Pierre Uys responded that the Department's target was to wipe out the patient waiting period at the nine worst community health care he specifically identified Primary Health Care Centres. Special queues would be set up for specific activities and signage to facilities would be improved to better direct patients. Shelter for patients from rain would be built such as the one at Delft Clinic. Independent groups would be used to survey clients of Health Care Centres so as to ascertain service delivery levels.

Prof Househam commented that Clinics, Home Based Carers and District Hospitals would deal with 90% of patients. Trauma centres would deal with violent trauma and accidents, as these were general and not specialised needs areas. The TB Direct Observation Treatment Strategy (DOTS) programme was included on page 276 of the Budget Statement number 2 document. The province's TB cure rate was between 70 and 75% and had a target cure rate of 85%. The Tuberculosis treatment completion rate was very high due to careful monitoring systems in place.

Ms C Dudley (ACDP) asked whether the Department were accessing the number of nurses they needed and what systems were put in place to help the province attract the numbers they need.

Ms Rajbally (Minority Party) asked how the reduction in personnel expenses would impact on delivery of service and in what areas would personnel be reduced.

Ms R Masienyana (ANC) asked what for the Department's personnel numbers, their vacancy rate and the disabled employment rate.

Ms Manana (ANC) asked how many Primary Health Care Schools and nurses there were, how many nurses were trained in the past ten years and whether the Emergency Medical Services were still under the Local Government.

Mr Pierre Uys responded that 780 nurses had been trained under the current Bursary Aid system and that 1800 vacancies existed. The supply of medicines would also be streamlined. The figure of disabled persons employed in the Department was not at hand, but was below one percent. Cape Technikon and Peninsula Technikon would do the training of Community Health Care workers.

The Chairperson commented that requests for figures covering the past ten years were unfair, as the MEC had not been informed beforehand to provide such figures.

Prof Househam commented that a sensitive balance between needs and resources would be reached in a caring manner. No patients would be turned away from a hospital. The fine balance between staff reduction and service delivery would be maintained in a manner that would be in the best interest of the province. Funded vacancies existed for nurses, pharmacists and doctors of certain categories. The province had the most specialists per capita than any other province. The training of 500 nurses per annum forms part the Western Cape 2010 Vision, which was to have an adequate supply of nurses. The transfer of Emergency Medical Services (EMS) had been handled efficiently.

Dr Sebeko (National Department: Director of Hospital Services) commented that the Department views the exit of nurses out of South Africa in a very serious light. He urged the province to focus not only on training and recruiting primary officers, but also mid level officers as the National Strategy were the introduction of a Clinical Officers category.

Mr. Nobo asked what role the Hospital Board played in the improvement of health care services and how the issue of patient transport was handled. What was the Department doing to keep nurses that received Department bursaries in the public health sector and were all clinics open 24 hours per day?

Mr Tswete asked how many mobile clinics there were in the province.

Mr Tsikilana (ANC) asked to what extent organised labour practices had impacted on the improvement of health care services and what the province's Affirmative Action and Broad Based Black Economic Empowerment track records were.

Mr Pierre Uys responded that the transfer of staff relating to the transfer of the Emergency Medical Services from Local Government to the Health Department was still a problem and that the Department would finalise the EMS transfer by 1 July 2004. There were 130 mobile clinics in rural areas and most community health care clinics were open 24 hours per day.

Prof Househam responded that Hospital Board members played an advisory role and were instrumental in the promotion of the institution. Part of the Board's activities were fundraising and buying of equipment. Nurses that left the public health sector before completing their contract term, paid back the amount owed to the Department. Fixed clinics were open during normal working hours whereas Community Health Care Facilities were open for 24 hours per day. Where no clinics were open, a District Hospital filled their place and was open 24 hours per day.

Prof Househam said that gender representivity at senior management level was 65% male and 35% female. The Employment Assistance Programme was successful and had been outsourced. Healthy robust relationships existed with organised labour. Regular interaction and consultation occurred between the Department and organised labour on issues of restructuring. The Department was revising its Affirmative Action Plan to enable it to reach reasonable levels of representivity.

Mr Tswete asked whether the 125 Home Based Care service providers were the only service providers in the province. He questioned whether there were only 6 000 HIV/AIDS patients in the province.

A Committee member asked what arrangements were in place to assist disadvantaged patients of other provinces.

Dr Luthuli asked how international patients were handled in relation to health care cost.

Prof Househam responded that it was very difficult to identify whether patients were from other provinces or not. Provinces that referred patients to Western Cape for treatment carried the cost for treatment.

Dr Cupido (Department spokesperson) commented that Home Based Care Services were reviewed and approved by the National Department of Health. Home Based Care Coordinators were appointed throughout the entire province. The Department preferred the use of satellite clinics to the use of mobile clinics, as satellite clinics were more humane.

Prof Househam commented that 6 000 patients would receive ARV treatment by the end of the year. Current pilot projects in the province treated about 2 700 patients. Overseas patients that made use of state hospitals were only admitted on a needs basis and were billed on a different scale to that of local patients.

The Chairperson asked why there was an under spending of R 22 million.

Dr Sebeko commented that mechanisms were needed through which the province would be able to assist the rest of Africa. Numerous medical aid schemes in Africa could not afford to pay the fees structure of private hospitals.

Prof Househam responded that the amount shown as under spent was spent on other needs. The R4.3 million under spent amount would be rolled over and used to purchase equipment.

The Chairperson commented that only 79% of funds earmarked for HIV/AIDS programmes had been used.

Prof Househam responded that most of the funds allocated had been spent.

The Chairperson commented that the Department should not de-emphasise specialised health care services whilst promoting primary health care. He urged that there be a re-look at the issue of primary health care versus tertiary health care. Due to time constraints, issues of morbidity, mortality, immunisation levels, Human Resources matters were not covered at this meeting. The Committee would like to visit some of the health care projects in the province.

The meeting was adjourned.