Tamar Kahn: Business Day,
BUDGET constraints have forced the Western Cape provincial government to cut 90 beds at Groote Schuur and Tygerberg hospitals, two of the province's top academic facilities, as it tries to boost services to poor township communities. The Western Cape health department's redistribution of scarce resources highlights the difficulty facing officials across the country as they grapple to find the appropriate balance between investing in primary healthcare facilities without eroding the services offered by tertiary facilities beyond repair.
The issue shot into the spotlight two weeks ago after doctors at Groote Schuur alerted the press to looming budget cuts at Groote Schuur and Tygerberg hospitals, which were to lose R19m and R11m respectively out of their R900m budgets. Earlier this week Groote Schuur's head of medicine, Bongani Mayosi said that doctors supported the notion that most care must take place at the primary healthcare level. But for a balanced system, all the parts must hold together. He added that any further budget cuts would render the academic hospitals unable to train specialists. Yesterday, Western Cape finance MEC Lynn Brown announced that health would get 34% (R7,095bn) of the province's R20bn budget for 2007-08. While the figure is second only to education’s R7,68bn, and represents a nominal increase of 9,6%, it still falls short of what the province believes it needs to spend on public healthcare.
The province's health budget has three main funding sources: R2,18bn in conditional grants from the national treasury, earmarked for specific programmes such as refurbishing hospitals and HIV/AIDS; R4,56bn from the provincial coffers; and R363m from revenue generated primarily from hospital fees. Western Cape's head of health, Craig Househam, said officials had failed to persuade the treasury to allocate an additional R419m to the province for healthcare spending, money it believed it had the capacity to spend. He said the department was clearly faced with difficult decisions regarding the best way to spend limited resources.
Brown emphasised the province's aim was to improve the quality of people's lives where they lived and worked. The province would invest in 100 new beds at Lentegeur Psychiatric Hospital in Mitchell's Plain to take strain off GF Jooste Hospital, which could not cope with the large numbers referred from clinics and community health centres in Khayelitsha and Mitchell's Plain, Househam said. This allocation forms part of the R2,44bn budget set aside by the province for district health services, an increase of R464m, or a 23% rise in nominal terms on this year's budget.
The increased allocation will also boost services at other district hospitals such as Karl Bremmer. Househam confirmed media reports that R30m was to be cut from Groote Schuur and Tygerberg's combined budgets. He said this was largely because the total allocation for the "central hospital services" - Red Cross Children's Hospital, Groote Schuur and Tygerberg - had increased by a mere 1,8% in nominal terms to R2,175bn. It was also because the R1,335bn national tertiary services grant, a conditional grant for improving hospital equipment such as radiology machines, had decreased in real terms by R12m. The province based its calculations on an inflation rate of 5,5%, he said.