Presentation of the Budget Vote for the Western Cape Department of Health
WESTERN CAPE MINISTER OF HEALTH, THEUNS BOTHA
Western Cape Provincial Parliament
Tuesday, 23 June 2009
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INTRODUCTION
Our new provincial government is committed to the principles of an open opportunity society that offer opportunities for all. In my term as Provincial Minister of Health I intend to ensure that the Department of Health will indeed be opportunity-driven. Many new initiatives will be investigated and implemented with major different emphasis on improving service delivery, problem solving and addressing the challenges we are facing.
At the outset, let me say that I regard the Western Cape Department of Health as a well-functioning department with both competent and skilled clinical staff, many of which is amongst the best worldwide, and strong management, providing health services across the Western Cape under difficult circumstances – not only increasingly more difficult circumstances in South Africa and the Western Cape, but indeed worldwide. I am supportive of the initiatives taken by the Department to restructure Provincial Health Services and acknowledge that in many areas the Department has lead the country in this regard. Nevertheless I acknowledge that there are many things in the health care sector that require urgent radical change, innovation and attention, and in my term I intend to focus on these. I will not only be fine tuning the current budget expenditure, but I will also address the narrowing of the gap between current service delivery and expectations – I regard this as my main political challenge.
CURRENT STATE OF AFFAIRS
I must place on record my concern that the funds allocated for health services in the Western Cape are inadequate to meet the needs, and indeed the expectations, of the people of this province.
In line with my priorities, I will emphasize those issues that are important to this new provincial government. In saying this, I want to emphasize that I support the management and staff in their efforts to restructure the health care services, in line with the Comprehensive Service Plan. I am impressed by the rigorous work done in its development and have noted that this plan, based on a model for health services developed within the department without the use of consultants, is regarded as a potential model for the country.
I will also address the challenges resulting from inadequate infrastructure. I will be engaging with my colleague, Minister Carlisle, regarding the poor performance of contractors that resulted in completely unacceptable levels of under-expenditure on construction projects during the past financial year. This new provincial government will find effective solutions to prevent a recurrence of this unacceptable state of affairs.
A particular issue of concern is the under-funding from the national conditional grant for HIV and AIDS, which includes anti-retroviral therapy, with a deficit in the previous financial year of R27 million. This will escalate even further to a projected deficit in 2009/10 of around R60 million.
FURTHER ANNOUNCEMENTS
MITCHELL’S PLAIN HOSPITAL
It remains uncertain as to why this project was initially approved by National Treasury, along with the Khayelitsha Hospital, and then fell to the wayside. The lack of commitment from National Treasury certainly raises scepticism. It is of utmost importance to ease the burden on the GF Jooste Hospital, and in terms of the implementation of the Comprehensive Service Plan, to proceed with both the Khayelitsha and Mitchell’s Plain Hospitals. I made a proposal which was approved last week at Cabinet, to cancel the current tender and re-tender within 3 months – with an extended contract period from 36 months to 54 months. This is subject to a legal administrative process to be undertaken in this regard. Of importance is that this government accepted the challenge to overcome the budget shortfall from National Treasury for this hospital and will continue to build the Mitchell’s Plain Hospital with additional provincial resources. This bears testimony to the commitment and innovation of our government to enhance health care in the Western Cape.
NATIONAL HEALTH INSURANCE
It is by now common knowledge that the National Government envisages to implement the controversial NHI. The DA as Official Opposition in South Africa, as many other important role players in the industry, has expressed its view, concerns and disapproval of this plan. The DA has also communicated its alternative solution to the NHI. I will not repeat this in detail again, but I will instead reveal many of the alternatives to the NHI that our provincial government will be investigating to implement in the Western Cape. I will now explain in more detail our 10 main alternatives under the headings of:
1. Private Health Sector and Representative Institutions
2. Hospital Facilities Boards and Hospital Incentives
3. Non-Essential Expenditure
4. Sustainable Income Streams
5. Social Responsibility and Awareness
6. Asset Management
7. Transparency
8. Staff and Scarce-Skills Recruitment
9. Medi-tourism
10. Dashboard Oversight
1. PRIVATE HEALTH SECTOR AND REPRESENTATIVE INSTITUTIONS
I will establish a much closer working relationship with the private Health care sector and representative institutions in Health care. I find it extremely unfortunate that my predecessors neglected this relationship to the detriment of the people in our communities, especially those with the least opportunity for health care services. I will rectify this situation and relationship and I will interact with the private Health care sector, and with as many as possible of the representative institutions in the Health care sector, such as the South African Medical Association (SAMA), the South African Hospital Association, the Treatment Action Campaign (TAC), and various other. I will do this with the aim and objective of entering into strategic partnerships, joint ventures and co-operation, investigating the possibilities of outsourcing some of our core and non-core services, such as the preparation of meals to patients, laundry services and others. I will also investigate the possibility and viability to invite private health care to tender to undertake certain routine surgeries and medical services and procedures. We will certainly also explore the possibility of interacting with private sector investors and service providers to provide facilities such as hospitals or clinics or to tender for comprehensive public Health care services or as operators, as already suggested by Dr. Nkaki Matlala, member of the Medi-Clinic Board, and chairman of the South African Hospital Association.
I have little doubt that the only viable solution to our enormous challenge to provide and improve Public Health care can only be achieved with closer relationship, co-operation and joining of forces between public and private health care. I will certainly explore every possible option and opportunity to co-operate, interact and transact with Private Health care. I am absolutely astonished by the fact that a hospital in a small neighbouring country, Lesotho, has already undertaken this successfully with the Private Health care sector in South Africa.
2. HOSPITAL FACILITIES BOARDS AND HOSPITAL INCENTIVES
I will re-address the current mandate and functions of Hospital Facilities Boards. The aim will be to improve service ability, oversight and participation in the operation and functionality of our hospitals and facilities. Innovative incentives will also be developed for individual hospitals through which they could become centers of excellence and be able to be more efficient and successful.
3. NON-ESSENTIAL EXPENDITURE
I will undertake an exercise, bearing in mind the current economic realities and challenges we are facing, to shrink non-essential expenditure without in any way compromising the delivery of core and essential health care services. We will cut down on the expenditure of any unnecessary expenses relating to meals, wheels, deals and advertising.
4. SUSTAINABLE INCOME STREAMS
I am considering a variety of mechanisms to broaden and increase sustainable income streams for the Department of Health, not only by means of advocating and canvassing for increased National allocation to the Western Cape Health Department, but also through other avenues within our own ambit and competency of Provincial Government. This will certainly also include a re-visit to the fee structures for private health licensing and the possibility to implement an annual renewal fee for these licenses.
In order to address our dire need for additional income to enhance service delivery and striving for equality and improved quality in health care, I will be undertaking a comprehensive investigation into the possibility of a Health Levy in this province. This investigation will comprise consultation with all relevant role players and stake holders, as well as investigation into the impact and nature of such levies in other countries. This Health Levy could possibly be applicable to all those who pay for health services in the public and private sector. The Levy could possibly be applicable to bed occupancy, consultation and medication prescription. I believe that people will be prepared to contribute to a Health Levy if they had the assurance that the income generated by this will be dedicated towards specific health care initiatives and programs. We need to work towards a more equal health care system narrowing the level of service between the rich and the poor, without compromising the high level and standard applicable in private health care. This means we have to strive to improve the standard and level of service of public health care to match that of the private sector. This is one of the most important differences in our proposal as alternative to the NHI. The implementation of the NHI will result in reducing the quality and standard of private health care closer to the lower level in public health care – exactly the opposite. This Health Levy would be similar to the previous initiative to implement a Fuel Levy and the current Tourism Levy. Should it prove viable that such anticipated Health Levy could succeed in bringing better health care to the poorest of the poor, it would certainly become a very important contribution to equality, quality and opportunities for all in Health care.
Further to the strengthening of sustainable income I will embark on a commercialization exploration of trading with the names rights of some of our facilities, similar to the names rights attached to many sport stadia, as well as the marketing and advertising potential of various facilities – both inside and outside these facilities. Many of our facilities and institutions, such as Groote Schuur, are internationally renowned, and this could possibly have an additional monetary value. Many other health facilities are well positioned in terms of location and offer commercial potential. I believe corporate institutions and commerce will be keen and willing to obtain the commercial value and opportunities, and simultaneously fulfilling their social responsibilities.
5. SOCIAL RESPONSIBILITY AND AWARENESS
The plan is to promote social responsibility in our communities, targeting and addressing the “up-stream” factors which increase the burden of disease and health problems of the people of the Western Cape. This will be purpose-driven and geographically-aligned to be effective. This government envisages embarking on private sector co-operational sponsorship with specific awareness and life skill enhancement to specific pre-targeted areas addressing specific burden of disease, as the conventional shot-gun approach is too expensive and ineffective. I already had very fruitful discussions with interested parties in this regard.
6. ASSET MANAGEMENT
I will interact and collaborate with my colleagues in Finance and Transport and Public Works to undertake a comprehensive exercise to re-strategize the optimal utilization of all property and facilities currently occupied by the Department of Health, by means of a facilities / property audit with the aim of developing a re-utilization program to ensure optimum, adequate and most appropriate functionality of all health infrastructure, thus freeing up latent capital for urgent and critical health care infrastructure development to promote improved service delivery. This will be a provincial initiative to create and form capital to address both maintenance and the backlog of much needed facilities and to finance other important programs to enhance our service delivery.
7. TRANSPARENCY
We will open the procurement and staff appointment processes in the Department of Health to public scrutiny to promote the culture of accountability and transparency in government in the Western Cape.
8. STAFF AND SCARCE SKILLS RECRUITMENT
Continuous assessment and support will be implemented and undertaken to assess management to ensure fitness for purpose. We will embark on a purpose-driven exercise to recruit health staff nationally and internationally. This Cabinet is preparing an inter-departmental resolution to this effect.
9. MEDI-TOURISM
We want to look into the expansion of a niche tourism market – medi-tourism – using existing international marketing structures to market packages that will include transport, accommodation, and medical treatment for overseas people, that will be more affordable for especially UK, USA and European visitors, given the favorable exchange rate, the popularity of the Western Cape and Cape Town as destinations. The aim will be to enter into agreements with international medical insurance companies directly instead of canvassing individuals. This is a market not yet fully researched and packaged, and offers income possibilities for health care facilities in both the public and private sector and simultaneously earning valuable currency for our Province. .
10. DASHBOARD OVERSIGHT
And finally, to ensure that the department and I deliver on these undertakings, we will implement the dashboard evaluation system to enhance delivery and management systems within the Department. This will become a very important operational tool to ensure projects to meet deadlines and evaluate performance.
Issued by the Western Cape Ministry of Health
Tel 021 483 5417
Fax 021 483 4143
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