WESTERN CAPE DEPARTMENT OF HEALTH

1
WESTERN CAPE DEPARTMENT OF HEALTH
PRESENTATION TO THE NATIONAL PORTFOLIO COMMITTEE
ON HEALTH
14 APRIL 2003
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 2003/2004PROGRAMME AND STANDARDITEMEXPOS
ITION
10
WESTERN CAPE DEPARTMENT OF HEALTHBUDGET
2003/2004PROGRAMME EXPOSITION

11
WESTERN CAPE DEPARTMENT OF HEALTHBUDGET
2003/2004STANDARD ITEM EXPOSITION
12
WESTERN CAPE DEPARTMENT OF HEALTHSTANDARD
ITEMS 2002/2003 VS. 2003/2004
13
Filled establishment as at 31 March 02 and 31
March 03 respectively
14
WESTERN CAPE DEPARTMENT OF HEALTHPROGRAMME 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 R51 500
million iro possible deferments.
15
WESTERN CAPE DEPARTMENT OF HEALTHPROGRAMME 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 HEALTHPROGRAMME 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 HEALTHPROGRAMME 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 HEALTHPROGRAMME 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 HEALTHPROGRAMME 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 HEALTHPROGRAMME 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 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 R6,00 million
Lentegeur Rehab. Centre R20,00 million R20,00 million
27
WESTERN CAPE DEPARTMENT OF HEALTHMTEF BUDGET
2003/2004 - 2005/2006
28
(No Transcript)
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 PlanGeneral issues

• Current capacity of existing facilities 15 000
  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 PlanRural 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 NGOs for
  step down facilities

34
Infrastructure PlanCape 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 Mitchells Plain and Khayelithsa as
  a district hospital but also incorporating level
  2 beds to facilitate outreach from the centrally
  located regional hospital

35
Infrastructure PlanTertiary 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 1 300
  beds
• TB hospitals rationalised to provide 1 100 beds
  increase of 300 from original estimate

36
Tygerberg Hospital In the region of 1300 beds
Academic Hospital
Regional Hospital
37
Red Cross HospitalSite Development Planaround
300 beds estimated cost R110 million
PEDESTRIANENTRANCE
MILNER ROAD
KLIPFONTEIN ROAD
VEHICLE ENTRANCE
38
GROOTE SCHUUR HOSPITAL In the region of 900
beds PPPs for remaining beds Disposal of
unwanted associated properties
39
Human Resource PlanStrategic 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 PlanPersonnel Shifts

• Personnel Plan
• Determine demand/availability gap
• Develop response strategies
• Primary Health Care
• Increase of approximately 1 300 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 PlanOverview

• 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 PlanInfrastructure

• 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
• 180 000 patients admitted to 36 district-level
  hospitals in the province and with 450 000
  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 166 000 patients
• DENTAL TRAINING HOSPITALS
• Dental care provided to 220 000 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 953 000
  patient day equivalents
• 118 000 patients admitted from the Western Cape
  and 94 000 patients admitted from other provinces
  for highly specialized health care in the Groote
  Schuur, Tyberberg and Red Cross Childrens
  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 Ministers 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.