Western Cape Department of Health & Wellness mitigation efforts against load-shedding

Meeting report

Department of Health & Wellness on mitigation of load-shedding
Dr Keith Cloete, DH&W Head of Department, said the energy crisis was impairing DH&W’s capacity to provide health services because electricity was needed for medical equipment, computers and digital records, telecommunications and call centres, cold storage, safety and security systems, fire alarm systems, access control systems, lighting, and thermal comfort. The following ten hospitals were exempt from up to Stage Six of load-shedding: George, Groote Schuur, Karl Bremer, Mitchells Plain, Mowbray Maternity, New Somerset, Red Cross, Tygerberg, Victoria, and Wesfleur.

DH&W had a discussion with Eskom about installing a dedicated feeder for the Khayelitsha hospital and a final quote would be received the following week. If successful, the dedicated feeder would be installed by October or November 2023. The Khayelitsha hospital was so embedded in the grid that Eskom couldn't exempt the hospital from load-shedding. However, the dedicated feeder would resolve the matter.

Load-shedding has greatly affected staff morale and increased stress levels within DH&W. The DH&W has taken countless hits over the last five to ten years with the drought crisis, load-shedding, the COVID pandemic, and quite recently, the taxi violence. In the 2019/20 and 2022/23 financial years, DH&W had an average of 90 and 80 maintenance emergencies respectively. However, the emergencies spiked to 120 in only four months of the 2023/24 financial year, increasing DH&W infrastructure maintenance by 56%. Furthermore, DH&W had less than 20 electrical and generator emergencies in the 2022/23 financial year which more than doubled to over 45 emergencies in the 2023/24 financial year. That happened because generators in hospitals were not designed to be default providers of electricity. Generators were made available for essential power supply in only 193 facilities which included all hospitals, CHCs, Large CDCs, Observatory Forensic Pathology, and Tygerberg Forensic Pathology.

The generator operational implications include diesel availability and costs which from 01 April 2023 to 30 June 2023 amounted to R12 million, more frequent breakdowns, planned maintenance challenges due to load shedding, shortened life span of generators before requiring replacement, longer lead time for repairs due to limited availability of parts in the country, escalated cost of the repairs, rearrangement of maintenance team priorities, and a limitation in the health services provided which had an impact on surgical services. The DH&W’s newly implemented policy stated that surgical procedures could not be commenced in operational theatres when electricity was running on a generator. The policy was implemented to avoid putting people’s lives at risk as there was no backup electricity supply if generators failed.

The DH&W used UPS backup systems for its life support medical equipment, operating theatres, Emergency Medical Services (EMS) call centres, and Information Communications and Technology (ITC) equipment. Due to the limited financial and human resources, DH&W could not afford the installation and operation of standby generators in 278 of its facilities. DH&W now had two maintenance contracts in place. The breakdown of generators was logged on the maintenance portal and since the system was initialised in June 2023, 65 breakdowns had been logged.

On actions taken to support generator operations during load shedding, DH&W appointed a second contractor to support the maintenance of generators, the quality of oil used in generators was improved to ensure longevity by reducing friction and maintenance costs, the load was curtailed at facilities with the installation of dropouts on non-critical loads where the overloading of the generator was problematic in smaller facilities. In larger facilities, there had been an installation of intelligent demand management systems which managed the load automatically. Additionally, daily inspection sheets were shared with facilities to ensure that operational criteria were adhered to by monitoring the oil and coolant levels, diesel levels were reported on the maintenance portal for the procurement support of diesel, and generators were monitored for underload operations as it damaged the generators and, in that instance, the load was added to ensure longer life expectancy.

The cost per kilowatt hour (kWh) for electricity produced by diesel generators was four times the cost of electricity supplied by Eskom. To measure energy consumption, DH&W installed smart meters at 68 hospitals and large primary health care (PHC) facilities. This assisted with monitoring the consumption against benchmarks and international standards, planning engineering interventions, empowering facility managers, and managing municipal tariffs.

On DH&W reducing the electricity demand, the facilities exempted by the City of Cape Town (CoCT) and George municipalities were currently working on a load curtailment plan for reducing consumption during load-shedding as requested by Eskom. The facilities should manage the maximum demand such as hot water generation system, Central Sterilisation Service Department (CSSD) operating time, laundry operating time, and autoclaves. Energy saving has been incorporated into 20 projects by replacing where applicable, incandescent and florescent lights with Light-Emitting Diode (LED), wall-mounted units with inverter drive split air-conditioners, chillers and heating elements with heat pumps, roof insulation with higher efficient insulation with improved heat flow resistance, and colour of roof cover to be painted white to improve thermal transfer and decrease of need for air conditioning. Additionally, load curtailment plans had been drawn up by facilities that are exempted from load-shedding to reduce their power consumption during load-shedding. Inverter sizing calculator tools were available for facilities as a guideline to procure inverters and batteries without the need for technical input.

DH&W started the Energy Huddle during the COVID pandemic where it met three times a week with technical staff and operational managers, focusing on problem-solving, risk identification, risk mitigation, and dashboard monitoring. DH&W was rolling out its rural clinic inverter programme in two phases. In the current financial year, DH&W would roll out Phase One of its inverter programme in 51 clinics with a budget of R37 million. In 2024/2025, Phase Two would be rolled out to 87 clinics with a budget of R47 million. So far under Phase One, inverter systems had been installed in nine clinics with 42 clinics being in the planning and costing stages. Phase One would be completed by the end of March 2024. The clinics have been supplied with inverters and lithium batteries to provide essential power supply during load-shedding. Currently, photovoltaic panels had not been installed due to safety and security concerns such as theft and vandalism.

On the renewable energy programme, DH&W was planning the installation of solar photovoltaic embedded generators at 15 hospitals for a combined total peak generation of 5 MW. The installation was planned to be completed in three facilities in 2023/24, while the others would be completed in the outer years. The renewable energy produced would assist with the energy demand curtailment plan. The renewable energy programme would be expanded to all the other health facilities as resources became available.

DH&W has developed an electrical supply preparedness plan that outlined the activities to mitigate increasing stages of load-shedding, beyond Stage Six. The plan outlines the steps to be undertaken in maintaining key clinical services, internal resilience, particularly as pertaining to the essential supply of diesel, mitigation of risk related to external suppliers and other role-players such as pharmaceutical companies, National Health Laboratory Service (NHLS) and Western Cape Blood Transfusion Services, and maintenance of essential communication and command and control capability. The plan would be integrated with the activities of private healthcare providers, as well as the Provincial Disaster Management Centre (PDMC). Components of the plan were already active, and what has proven to be helpful was the cordial working relationship that existed between DH&W, Eskom, CoCT and other various municipalities.

Dr Nomafrench Mbombo, Western Cape Health and Wellness Minister, said while the presentation was on energy supply, DH&W was always a step ahead as its presentation on the supply of backup generators for hospitals was part of the Western Cape Climate Change Response Strategy (WCCCRS): Vision 2050. The DH&W was proceeding with its energy-saving phases which were initially commenced in 2017 when the three big hospitals in the Western Cape were exempt from load-shedding. The energy-saving phases ensured that electricity was not consumed unnecessarily in DH&W facilities and the Chief Director of Facilities and Infrastructure Management could attest to the savings made on Dorp Street in Cape Town. The DH&W strategy showed how energy was conserved following its energy-saving interventions in its laundry department and other areas.

DH&W has compiled a draft of the WCCCRS: Vision 2050. The focus was on electricity as an emergency response and moving towards having globally green and healthy hospitals. The conversation on energy would still be relevant even if load-shedding did not exist. While other sectors were busy with national responses and looking at fossils versus renewable energy sources, DH&W was already a step ahead in preparing for the issues caused by climate change. It was a major contributor to the issues around climate change through its waste and as a negative major contributor to climate change, it was taking the responsibility to save energy. DH&W also took the initiative to save on its water consumption by constructing some boreholes. If the Committee would like to engage further, it could make a presentation on its draft WCCCRS: Vision 2050 and the progress made thus far.

Discussion
Mr P Marais (FF+) commended DH&W on its informative and well-written presentation. The Committee, however, could not interpret the chart slides because the Committee’s slide deck was in black and white. Seeing that DH&W had the option to choose either from inverters, generators, solar energy etc to generate electricity, was a cost analysis performed on the cost-effectiveness of the different energy sources? Did DH&W perform an efficacy analysis of the various energy sources it considered? With boilers being the largest consumer of electricity in hospitals, how were they heating water? Were generators more effective than solar energy?  

Mr A Van Der Westhuizen (DA) said he was impressed by the innovations and steps taken by DH&W such as minimising the maximum electricity demand which not only decreased the municipal bill of the DH&W facilities but assisted Eskom and South Africans in availing electricity during peak hours for use by other consumers.

Presuming that the basic maintenance on generators was performed by the facility maintenance staff, did DH&W train the facility managers and maintenance staff on conducting maintenance and elementary fault tracing on the generators and inverter systems? Since DH&W said there was a greater awareness amongst the staff in the different facilities on the usage of electricity, it seemed that the energy consumption information was communicated to the staff. Was the same communication made to the ground staff to prevent the staff from using heaters or consuming electricity in other ways?

The provision of UPS backup systems to the staff played a huge role in achieving staff productivity. It also helped the staff to assist patients who would otherwise be turned away without assistance and subsequently incur additional personal costs. Has the savings made from providing UPS backup systems been quantified? After visiting a municipality which had a generator that failed to kick in during load-shedding, he was convinced that the investment in UPS backup systems would safeguard DH&W against losses.

Mr G Pretorius (DA) asked if there were any other hospitals which qualified for dedicated feeders like the Khayelitsha Hospital. Who was responsible for paying for the installation or supply of the dedicated feeder? The Committee was previously briefed by Dr Nicholas Crisp on the National Health Insurance (NHI). However, from the presentation given it was unclear how provincial budgets would be facilitated under the NHI. Who would pay for the generators and inverters if DH&W operated under the NHI?

Ms C Murray (DA) said she had heard of patients who opted for home care and used the assistance of an electrically powered breathing device such as a nebulizer but later passed on due to load-shedding. Was there anything that DH&W could do to assist in such cases? If so, what measures could be taken?

Ms A Cassiem (EFF) asked if there was an update on the status of the inverter programme in the remaining 42 rural clinics under Phase One which were currently in the planning and costing stage?

DH&W response
Dr Cloete replied that DH&W had a list outlining the progress of the inverter programme in rural clinics under Phase One and it would be shared with the Committee. DH&W has received several requests for assistance from home-based patients affected by load-shedding and it assisted such patients by redirecting them to nearby facilities which had electricity. While the resolution was not ideal, DH&W was not in a position to provide UPS backup systems to home-based patients. The situation was quite challenging and greatly affected the poorest individuals. However, the solutions that people come up with were amazing. DH&W noted the reported individual cases and tried to assist as much as it could.

One of the fundamental points for establishing a national insurance fund under the NHI was amending the legislation in such a way that the funds that came into provinces via the provincial equitable share from the national fiscus would be deposited directly into the NHI Fund and not the Provincial Treasury. As a provincial department, instead of getting its vote tabled in parliament and receiving its allocation of funds, DH&W would have to apply to the Fund to receive an annual allocation to run its operations in the province.

Dr Cloete explained that Dr Angeletti du Toit and Dr Smith were on a joint task team with the local Eskom head office. Minister Mbombo and DH&W senior management met with Eskom’s management about two months ago and were in constant communication with Eskom on its interventions. The Khayelitsha Hospital was prioritised for a dedicated feeder and DH&W was responsible for the payment. The installation of a dedicated feeder in Khayelitsha Hospital was an added financial pressure as it was not budgeted for. DH&W was looking at installing a dedicated feeder at Khayelitsha Hospital only but would look at other facilities.

DH&W had to implement a basic maintenance programme which had three levels and a standard training programme for its facility staff. The basic level of the maintenance programme had training and additional capacity was added for the other maintenance levels. The smart meter example in the presentation was broken down into ward levels and it indicated a particular ward’s energy consumption. Thus DH&W was able to communicate with specific users and compare the consumption levels of the various wards. DH&W’s target achievement was very impressive as its energy consumption levels were constantly at the green or dark green level which indicated that DH&W had the best efficiency level compared to the benchmarks. DH&W was able to further analyse the data into individual units and bring awareness in a decentralised manner.

DH&W would task Dr Angeletti du Toit and her team to determine the cost of multiple interruptions on productivity and determine why an uninterrupted supply of electricity was good for the efficient use of clinical services. If there were uninterrupted clinical services for expensive services such as surgical services, DH&W would be able to easily use its resources. The interruptions in the electricity supply have led to cancelled surgeries and wasted daytime. The analysis would be beneficial to conduct as it would determine how much was gained in efficiency and the appropriate comparisons would be made.

The cost of generating electricity using diesel was four times the cost of electricity produced by Eskom. Using diesel was a very inefficient way of generating electricity. Thus DH&W decided to use the inverters because they were efficient and served a different purpose. DH&W also looked at the contribution to the carbon footprint and a greener economy. DH&W has provided heat pumps for the boilers which were a huge cost saver.

Dr Laura Angeletti du Toit, DH&W Chief Director: Facilities and Infrastructure Management, replied that the cost of producing electricity with Eskom was R1.59/kWh. The cost for diesel generative electricity was four times more expensive and about R5/kWh. Solar power had a cost of R1/kWh. DH&W appointed a contractor who was currently working on improving the efficiency of DH&W in energy consumption. DH&W would not pay a capital investment for the 15 highlighted hospitals with solar panels on their roofs because the electricity-saving made would be shared between DH&W and the contractor over a contract period of ten years.

It was not financially feasible for DH&W to install small generators in the rural clinics. To reduce its carbon footprint, DH&W thought it would be more efficient to use inverters with lithium batteries. Perhaps when theft was no longer an issue and DH&W had the finances, it could install solar panels. Rural clinics did not have a lot of alternative energy sources and the choice was between generators and inverters. The cost between those two energy sources was the determining factor. Inverters were also a long-term solution as generators were not environmentally friendly and quite expensive.

DH&W conducted a cost analysis on the different technologies. There had been several technological advancements in the last few months such as changes in the technology of inverters and solar panels and DH&W was trying to keep up with those technological advancements in addressing load-shedding. DH&W had three coal-powered boilers situated in three of its hospitals. As a long-term plan to reduce its carbon footprint, DH&W was considering using biomass energy instead of coal to heat the boilers and it has already been exposed to biomass energy through one of its service providers. Unfortunately, DH&W could not get rid of the boilers in the hospitals because they produced steam which was required in its three biggest facilities.

The smart meters installed could be monitored on a phone through an app to determine a hospital’s energy consumption levels. The smart meter could be used by managers to monitor the energy demand and to determine how to improve the hospital’s efficiency. The engineering team could also use it for monitoring unique spikes or unusual activities in energy consumption and the appropriate interventions could be put in place to reduce high consumption levels. After the engineering team and Eskom looked at the 52 hospitals in the DH&W, they found that the only hospital that qualified for the installation of a dedicated feeder was the Khayelitsha Hospital. Other hospitals were deeply embedded in their communities so that Eskom did not advise the installation of dedicated feeders.

Follow-up questions
Mr Marais said it was apparent that South Africa would not rely on Eskom beyond 2026. The Western Cape had a rapidly growing population which increased the number of patients. The Western Cape currently had a population of 7.2 million people compared to 4.1 million people in 1994. Consequently, there would be an increase in the needs and energy consumption of the population. Was biomass an energy source that DH&W could recommend and depend on? Seeing that the energy crisis would continue for the next two or three years, was it enough time to compile a report that would give guidance on the five years starting in 2025 on what should be, and what could be done especially if the NHI was accepted and enacted as law, which would mean that the province's equitable share of the budget would not be allocated directly to the province but allocated through the NHI. If that happened, the province could lose a lot of things and its budget could be affected. Does DH&W want to venture an opinion, using its three years of experience, on whether a report should be compiled for the Risk Committee and the Premier’s Office on the advantages of solar energy and biomass

Mr A Van Der Westhuizen (DA) said he was impressed by DH&W’s innovation and the cost savings which were not only to the advantage of DH&W in the Western Cape but also to the broader community. He was aware that load-shedding has led to increased levels of vandalism and theft. Did DH&W have any experience with that? Many alarm systems were not designed to operate for extended periods as standby systems and the batteries of those systems did not have sufficient time to recharge because they had to be trickle charged. A minimum of six hours of load-shedding per day would result in the depletion of those batteries and negatively affect their lifespan. What has been DH&W’s experience with alarm systems in clinics? Has DH&W been able to overcome the limitations caused by extended load-shedding?

Mr Pretorius asked if the exempt facilities were equipped with inverters and generators if load-shedding beyond Stage Six was scheduled.

Mr C Dugmore (ANC) thanked DH&W for the informative presentation and for the work that it has done.

DH&W response
Dr Cloete replied that DH&W has faced battery-related challenges with its security systems. However, Dr Angeletti du Toit and her team have replaced the batteries. Security system incidents, vandalism and theft cases had to be reported on the system and Dr Smith would speak on the matter.

Dr Angeletti du Toit agreed that the frequent load-shedding prevented the re-charging of the batteries in the alarm systems. However, DH&W built some redundancy by setting up an inverter, similar to a household inverter, that could be connected to an alarm system. EMS facilities, forensic facilities and clinics were provided with alarms and batteries with an additional redundancy wired inverter which was not expensive.

DH&W was looking at all possible alternative renewable energy sources like wind, solar farms and biomass energy. It wanted to see if the energy from those sources could be converted to the big boilers. DH&W was not only looking into solar energy but all renewable energy sources and would conduct experiments to pilot the energy sources.

Dr Wayne Smith, DH&W Disaster Management Specialist, replied that DH&W became aware of vandalism and theft when the electricity did not return as scheduled. The criminals, being aware of the load-shedding schedule, stole the copper cables during blackouts. DH&W responded by using its mobile generators to keep the core and emergency systems running until repairs had been done. Eskom and the City of Cape Town responded immediately to assist with repairing or replacing the stolen copper cables. Eskom, CoCT and municipalities were looking at replacing the copper with aluminium, thus making it less attractive to criminals.

Dr Cloete said there were no load-shedding exemptions for the hospitals beyond Stage Six. If load-shedding went beyond Stage Six, the instability of the grid would most likely cause a blackout but DH&W had a detailed plan of contingencies to implement if that happened. Load-shedding-exempt hospitals had some of the largest generator capacities because there could be unforeseen power outages outside of load-shedding which have happened in the past. Tygerberg Hospital, being the biggest hospital, has one of the most sophisticated generator capacities and Dr Angeletti du Toit would give more information on that.

Dr Angeletti du Toit said DH&W had upgraded the Tygerberg Hospital medium voltage feed-in which went through to the substation and the CoCT and all the ring grid regulation around the facility. DH&W has two rings that created double redundancy and could generate electricity on two sides of the hospital. If one generator had a problem, the capacity to generate electricity still existed. Some generators were as big as a house which prevented the hospital from being blacked out if one generator failed. The generators were used for essential power supply and DH&W would be able to provide electricity if load-shedding went beyond Stage Six.

The Chairperson said the briefing from was important and thanked DH&W for the presentation

Minister Mbombo thanked DH&W for the comprehensive feedback. Its presentations were also about how the Committee could mobilise resources on DH&W's behalf because it did not receive additional funds for addressing load-shedding like it did not receive additional funds for the construction of boreholes when there was a drought in the Western Cape. After the budget cuts that happened when the year began, it was anticipated that there would be other budget cuts in the Medium Term Expenditure Framework (MTEF). The funds allocated to the infrastructure budget were insufficient.

Committee resolutions
The Chairperson asked if the Committee would like to make any resolutions on the DH&W presentation.

Mr Marais said the Committee should express its gratitude and full confidence in the competence of DH&W and its briefing. The Committee should resolve that it was satisfied with the DH&W comprehensive report, the state of readiness in delivering its services and addressing energy shortages caused by load-shedding. It should also communicate that it was encouraged by the DH&W efforts in its futuristic look into biomass and solar energy as alternate energy sources for the Western Cape in preparing for any future emergencies. DH&W’s futuristic outlook was important as there might be more emergencies in the future depending on the coal supply and the quality of coal. Could DH&W give the Committee an indication if it was in a state of readiness in terms of biomass usage, water energy, and solar energy which can be fed through inverters, and stored in batteries in the case of an emergency?

Mr Van der Westhuizen said the severe effects of load-shedding on health facilities should be reported. The report should also outline the operational risks of load-shedding such as the staff having to work in blackouts and medical equipment being dependent on the supply of electricity to work. It should also be noted that load-shedding has led to the health system incurring additional financial costs and the Committee was concerned about various department budgets, particularly for DH&W because the continuous supply of electricity was important and costs such as diesel procurement came at the expense of other services that DH&W could render to patients and their clients. The Committee should recognise the DH&W innovations, particularly in creating electricity consumption awareness which was important. The staff should not have the mentality that someone else would pay for the electricity they consume and the staff and hospitals were made aware that electricity was a scarce commodity and it was possible to save on consumption.

The Committee should commend DH&W for its technological advancements like the demand management systems installed in several health facilities which assisted the Western Cape when it came to huge electricity demands.

Mr Pretorius said the Minister of Finance should not reduce the funds allocated to health facilities. For instance, the fires incident in Hawaii could happen overnight in the Western Cape and consequently cause massive electrical faults. Thus all provincial and national hospitals, including private hospitals, had to be prepared.

Ms Maseko said the Committee should engage with National Treasury and enquire if it had considered increasing the equitable share based on the energy crisis faced especially by DH&W. It had to be prioritised to prevent the loss of lives.

The Chairperson said the Committee would ask Ms Baartman how to tackle Ms Maseko's resolution.

Ms D Baartman (DA), Budget Committee chairperson, replied that the Provincial Treasury was in the process of the Medium Term Expenditure Committee Hearing (MTECH) to determine the adjusted budget for the rest of the year as per the norm. The Committee should resolve that consideration should be given in the MTECH negotiations, particularly with DH&W, to ensure that a sufficient budget was put towards certain functions or line items. She was aware that the departments, after compiling their business plans, had to go into negotiations with Provincial Treasury. Since the equitable share was decreasing annually, it became more difficult to decide on which budgets to cut, retain or increase. Every person, committee and department would likely argue that they should receive an increased allocation. In such situations, the Provincial Treasury would be allowed to consider the respective departmental business plans.

The Chairperson announced that the next Committee meeting would be on 16 August 2023 where it would be engaging with the municipalities from the Cape Winelands District Municipality (CWDM).

The meeting was adjourned.