1. WESTERN CAPE DEPARTMENT OF HEALTH
PRESENTATION TO
THE NATIONAL PORTFOLIO
COMMITTEE ON HEALTH
14 APRIL 2003
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2. PROVINCIAL BACKGROUND

3. Provincial Background
Social sector constitutes 79,8% of the total expenditure with real term increases of 3,5% to 2003/04, 2,59% to 2004/05 and 0,54% to 2005/06 if weighted average is taken into account
Improved quality of services – medical equipment R125,930 million
Provincial equitable share inflation adjustments
5,6% 2003/04
5,1% 2004/05
4,4% 2005/06

4. Provincial Background
Health conditional grants, specifically NTSG and HPTDG comprise 61,25% of the total provincial conditional grants
Reduction of health conditional grants nominal R50 million but in real terms (adjusted for CPIX) reduction is R180 million
Year on year change is:
NTSG 2002/03 to 2003/04: +2.8%
HPTDG 2002/03 to 2003/04: -0.53%

5. Provincial Background
Health Vote – at R4,29 billion 10,85% against estimated actual expenditure in 2002/03, lesser increases, 4,96% and 4,03% in the outer years respectively
Health constitutes 26,17% of the 2003/04 budget
Personnel expenditure consumes 60,98% versus 63,3% of the 2002/03 estimates
Equipment allocations of R40 million 2003/04, R42,04 million 2004/05 and R43,9 million 2005/06

6. Provincial Background
HIV/AIDS combined totals of conditional grants and exclusive allocations from the equitable share amount to R54,8 million (2003/04), R66,8 million (2004/05) and R69,4 million (2005/06) respectively
Increased own revenue collection allows additional R11,7 million for equipment in 2003/04 and beyond
Decentralized end-user IT equipment R38,5 million (2003/04), R22,8 million (2004/05) and R17,6 million (2005/06)

7. OWN REVENUE

8. OWN REVENUE

9. BUDGET 2003/2004 PROGRAMME AND STANDARD ITEM EXPOSITION

10. WESTERN CAPE DEPARTMENT OF HEALTH BUDGET 2003/2004 PROGRAMME EXPOSITION

11. WESTERN CAPE DEPARTMENT OF HEALTH BUDGET 2003/2004 STANDARD ITEM EXPOSITION

12. WESTERN CAPE DEPARTMENT OF HEALTH STANDARD ITEMS: 2002/2003 VS

13. Filled establishment as at 31 March 02 and 31 March 03 respectively

14. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 1: ADMINISTRATION
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
- Pers: ICS, pay progression, workstudy reports and UWC claims
- Equip: R40 million iro critical medical equipment.
- Misc: R million iro possible deferments.

15. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 2: DISTRICT HEALTH SERVICES
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, pay progression, critical posts, incr conditional grants
Inv: Inflation, medicine prices
Prof & Spec: Laboratory tests, new security contracts, L/A Backlogs
Transfer: increase in AIDS and INP conditional grants
General: Eerste River Hospital opened

16. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 3: EMERGENCY MEDICAL SERVICES
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, paramedics salary adjustments
Prof & Spec: L/A backlogs.
Transfer: Decrease due to provincialization

17. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 4: PROVINCIAL HOSPITAL SERVICES
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, pay progression
Inv: Inflation
Transfer: Suspension from Social Services, New Kings
General: Conradie Hospital, Nelspoort Hospital

18. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 5: CENTRAL HOSPITAL SERVICES
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, pay progression
Inv: Allocation according to available funds
Equip: Shift of IT budget
Prof & Spec: Shift of IT budget, NHLS
General: Pers reduction to fund Inventories

19. Budget 03/04 AAH versus Conditional grants

20. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 6: HEALTH SCIENCES AND TRAINING
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, reduction of paid nursing students
Admin: Bursaries to students at WCCN, transport
Prof & Spec: Payment to Cape Technicon for EMS Diploma courses.
Transfer: Additional bursaries allocated

21. WESTERN CAPE DEPARTMENT OF HEALTH PROGRAMME 7: HEALTH CARE SUPPORT SERVICES
INCREASES/DECREASES CAN BE ATTRIBUTED TO:
Pers: ICS, pay progression
Inv: Inflation
Prof & Spec: Earmarked day-to-day maintenance allocation.
Transfer: Capital augmentation (CMD)

22. CAPITAL WORKS

23. CAPITAL WORKS: BY PUBLIC WORKS
Hospital
Voted 2003/4
New construction
R20,50 million
Rehabilitation/ Upgrading
R36,32 million
Revitalisation Programme
R81,93 million

24. CAPITAL WORKS: MAJOR CONSTRUCTION
Hospital
Total project cost
Voted 2003/4
Eerste River:
Casualty & OPD
R4,90 million
Valkenberg:
Admissions Ward
R12,65 million
R4,80 million

25. CAPITAL WORKS: REVITALISATION
Hospital
Total project cost
Voted 2003/4
Vredenburg
R46,16 million
R15,28 million
George (Ph 2C)
R35,00 million
R26,45 million
Worcester
R127,90 million
R40,20 million

26. CAPITAL WORKS: MAJOR REHABILITATION/UPGRADING
Hospital
Total project cost
Voted 2003/4
Mowbray:
Upgrading
R6,00 million
Lentegeur:
Rehab. Centre
R20,00 million

27. WESTERN CAPE DEPARTMENT OF HEALTH MTEF BUDGET 2003/2004 - 2005/2006

29. Provincial Background
Healthcare 2010 plan approved by Provincial Cabinet
Adjustment estimates for 2003/04 will reflect appropriate shifting of financial resources within the vote and consequently the outer years of the MTEF period

30. Strategic Approach to Healthcare 2010
Vision
“Equal access to Quality care”
Mission
“Change the shape and increase the efficiency of the health service platform to achieve improved quality of care and health status”
Implementation Plans
Service Delivery
Infrastructure
Human resource
Financial

31. Strategic Approach Focus during the first three years
Locate – and relocate – services within existing and upgraded facilities with the focus on key facilities
Address equipment backlogs according to priorities – ensure maximum “gain” from equipment acquired
Develop uniform protocols for patient treatment, guidelines for smooth referral and upgrade patient transport system
Train, retrain and retain health staff in health facilities and workers at community level in support of home-based care
Key promotion and prevention strategies to improve health status
Improved revenue generation

32. Infrastructure Plan General issues
Current capacity of existing facilities beds
9 600 beds needed for 2010
Considerable scope for funding new capital infrastructure from HRP, PIG, Asset Swaps and PPP
Active involvement of the Works Department will be a key enabler

33. Infrastructure Plan Rural Regions
Rural District Hospital utilization not optimal
Except for Vredenburg, Robertson and Hermanus, rural district hospitals will have fewer beds
George, Worcester and Paarl be upgraded as regional referral hospitals
Excess beds could be made available to NGO’s for step down facilities

34. Infrastructure Plan Cape Metropole
Recommend
One Regional Hospital – situated within the current Tygerberg Hospital facility
At least eight district hospitals with specialist outreach improving accessibility
Includes a new hospital on the Cape Flats accessible to Mitchell’s Plain and Khayelithsa as a district hospital but also incorporating level 2 beds to facilitate outreach from the centrally located regional hospital

35. Infrastructure Plan Tertiary and Specialized hospitals
Tertiary hospitals retained to provide the required 1285 beds with a new configuration
All tertiary hospital beds will have associated level 2 beds to provide for the inevitable 20% overlap of inpatient care
Psychiatric hospitals rationalised with beds
TB hospitals rationalised to provide beds – increase of 300 from original estimate

36. Tygerberg Hospital
In the region of 1300 beds
Academic Hospital
Regional Hospital

37. Red Cross Hospital Site Development Plan around 300 beds
Red Cross Hospital Site Development Plan around 300 beds estimated cost R110 million
PEDESTRIANENTRANCE
MILNER ROAD
KLIPFONTEIN ROAD
VEHICLE ENTRANCE

38. GROOTE SCHUUR HOSPITAL
In the region of 900 beds
PPP’s for remaining beds
Disposal of unwanted associated properties

39. Human Resource Plan Strategic Approach
Ensure that the workforce meets the challenges of service delivery
Key focus areas:
Consultation with labour
Recruit, train, retain and retrain staff
Nurses, mid-level workers, home based carers
Attract clinical staff to rural/underserviced areas and facilities

40. Human Resource Plan Personnel Shifts
Personnel Plan
Determine demand/availability gap
Develop response strategies
Primary Health Care
Increase of approximately personnel
Hospitals
5000 plus staff to be relocated or reskilled
Reduction of less than 100 posts
Annual attrition of approximately 1000 staff allows for restructuring of the staff establishment without retrenchment being envisaged

41. Financial Plan Overview
Progressive shift to cost effective service will release up to R500 million per annum for further investment in efficiency gains
Impact of migration on provincial health funding must be discussed at national and inter-provincial level
Increased attention needed for revenue generation
Effective billing and collection
Road Accident Fund
Preferred provider network

42. Financial Plan Infrastructure
Incremental improvements matched to availability of funds
Capital requirements of R1,23 billion will be funded from HRP, PIG, asset swaps and PPP
Equipment backlog in 2001 was R333 million
Current allocation is R126 million by 2005/6
Additional R12 million per year allocated from increased revenue

43. WHAT DOES THE BUDGET BUY?

44. Background
The 2003/2004 health budget is a “holding” budget preparatory to moving towards Healthcare 2010

45. WHAT DOES THE 2003/2004 HEALTH BUDGET BUY?
DISTRICT HEALTH SERVICES
Nurse-driven primary health care services in 242 fixed and 130 mobile clinics to over 3 million residents of the Western Cape (80% of patient contacts seen by a nurse)
Medical doctor supported primary health care services in 64 community health centers with over 12 million patient contacts per year
Health services provided by provincially-aided hospitals and municipalities through the transfer R249 million to these institutions and local government structures

46. WHAT DOES THE 2003/2004 HEALTH BUDGET BUY?
DISTRICT HEALTH SERVICES
Home-based care and visits to old age homes
Reduced prevalence of HIV/AIDS through various programs including the PMTCT and VCT programs
Increased cure rate of Tuberculosis to 75%
All eligible children in primary schools fed for 170 days during 2003/2004
patients admitted to 36 district-level hospitals in the province and with outpatient visits

47. WHAT DOES THE 2003/2004 HEALTH BUDGET BUY?
EMERGENCY MEDICAL SERVICES
Emergency medical services provided by fully equipped EMS vehicles and trained staff covering 14 million kilometers per annum
PROVINCIAL HOSPITAL SERVICES
Specialist care provided in 9 regional general, 6 tuberculosis and 4 psychiatric hospitals which will admit patients
DENTAL TRAINING HOSPITALS
Dental care provided to patients and 130 oral health professionals trained per year

48. WHAT DOES THE 2003/2004 HEALTH BUDGET BUY?
CENTRAL HOSPITAL SERVICES
Highly specialized care provided to patient day equivalents
patients admitted from the Western Cape and patients admitted from other provinces for highly specialized health care in the Groote Schuur, Tyberberg and Red Cross Children’s Hospitals

49. WHAT DOES THE 2003/2004 HEALTH BUDGET BUY?
OTHER PROGRAMS and ACTIVITIES
Training of health professionals in the three Faculties of Health Sciences in the province supported through a conditional grant
450 nurses trained per year
27 million pieces of laundry laundered per year both within own laundries and outside
3500 prosthetic devices supplied to people with disabilities
R14 million worth of bursaries allocated
Central Medical Depot (CMD) trading capital augmented by R2 million

50. Ikapa Elilhumayo – Growing Cape
The Department of Health will support the iKapa Elihlumayo initiative through infrastructural projects and Public Private Partnerships that have the ability to unlock significant resources and promote the development of people in the Western Cape.

51. CONCLUSION
The Department of Health faces significant challenges with the 2003/2004 budget
The Department will take the first steps towards the vision of Healthcare 2010 through a series of “turnkey” events during 2003 that will be announced durng the Minister’s budget speech
The Department is totally committed to financial discipline and “living within our means”
The Department is committed to “Equal access to Quality Care” in all State facilities throughout the province.