BUDGET 2004 DEPARTMENT OF HEALTH

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BUDGET 2004DEPARTMENT OF HEALTH

• Ad Hoc Committee on Health
• National Assembly
• 9th June 2004

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Overview of achievements and challenges in
relation to the NationalTen Point Plan
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• Reorganisation of support services
• Health Information System (HIS) has been
  implemented in the three Academic Hospitals and
  is being rolled out to 5 further sites.
• Laboratory services Hospital laboratories have
  been transferred to the National Health
  Laboratory System (NHLS). A service level
  agreement has been signed with the NHLS.
• Transfer of the medico-legal mortuaries from SAPS
  to the Department of Health will occut from 1
  April 2005.

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• Improving quality of care
• Sub-directorate has been established to monitor
  and evaluate quality of care.
• Various initiatives
• External client satisfaction survey at selected
  sites
• A structured system for monitoring complaints and
  compliments has been implemented
• Development of a structured approach to motality
  and morbidity monitoring and review

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• Revitalisation of public hospitals
• Current projects include George, Worcester, and
  Vredenburg hospitals
• Preparatory planning for Paarl and Robertson
  hospitals completed and both projects are ready
  to go out on tender
• Business cases to motivate for funding have been
  submitted for the Khayelithsha-Mitchells Plain
  Hospitals and Victoria Hospital
• Developing business cases for Valkenburg,
  Tygerberg, Red Cross and Somerset West hospitals

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• Primary health care and district health system
• District health plans promoting intersectoral
  collaboration have been developed
• Services strengthened by cooperation with local
  government but consolidation of all personal
  primary health services under a single employing
  authority is seen as the solution to current
  service related problems

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• Strategic interventions to decrease morbidity and
  mortality
• Health programmes have been established to deal
  with
• HIV/AIDS, STIS and TB
• Womens health
• Mental health
• Chronic diseases
• Food strategies
• Violence against women and children

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• Resource mobilisation, allocation and management
• Strengthening planning, budgeting and inter- and
  intra-provincial equity
• Further developed by the quarterly Monitoring and
  Evaluation of Programme performance against the
  objectives stated in the strategic plan
• Performance agreements of senior managers are
  related to the strategic goals of their
  components
• Revenue generation and retention is a priority
  and receiving attention
• Public private partnerships (PPPs) are being
  promoted

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• Human resource development (HRD)
• HRD addressing identified needs to ensure an
  appropriate skills mix
• Implemented an Employee Assistance Programme to
  support staff
• Learnerships promoted
• Communication and empowerment of health service
  users
• Appointed Health Facility Boards in the Western
  Cape

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Vision, mission and key priorities next 3 years
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• Vision
• Equal access to quality care
• Better Care for Better Health, all Day,
  Everyday!
• Mission
• To improve the health of all people in the
  Western Cape and beyond, by ensuring the
  provision of a balanced health care system, in
  partnership with all stakeholders, within the
  context of optimal socio-economic development.

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Key priorities

• Implementation of Healthcare 2010 restructuring
  with underlying principles of
• Quality care at all levels
• Accessiblity of care
• Efficiency
• Cost effectiveness
• Primary health care approach
• Collaboration between all levels of care
• De-institutionalisation of chronic care

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Tertiary beds For the Western Cape
Tertiary beds for Other provinces
Adm rate 11.5 Staff/bed 4 Cost / PDE
R1641
Adm rate 64 Staff/bed 2.4 Cost / PDE
R730 Regional Hospitals
Admission rate 80 Staff/bed 1.77 Cost / PDE
R484 District Hospitals
Utilization rate 3.4 visits per year 1300
additional staff Cost per visit R62 Additional
funds for health promotion and home-based
care Primary level services in CHCs, clinics and
at home
SHAPE OF THE FUTURE HEALTH SERVICES in 2010
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Key general priorities

• Maximise overall efficiency
• Reduce personnel costs
• Improve staff morale
• General stringency measures throughout to remain
  within allocated budget

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Key priorities

• Primary Health Care
• Address the long queues and waiting times
• Improve the availability of medication
• Phased take-over of responsibility for funding of
  local government personal primary health care
  services with effect from 1st July 2004
• Transfer of the Emergency Medical Services
  personnel from the City of Cape Town and improve
  of the quality of EMS across the province

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Key priorities

• During 2005/06 the funding for hospitals
  currently classified as regional hospitals (in
  the Metro) and which will be reclassified as
  district hospitals will move from Sub-programme
  4.1 to 2.9
• Similarly during 2006/07 when 950 beds in
  Tygerberg hospital are classifed as regional beds
  funding will be moved from Programme 5 to
  Sub-programme 4.1

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Key priorities

• Tertiary services
• Rationalise duplication of services
• Restructure staffing establishments
• Revise Joint Agreements with the universities
• Resolve the conditional grant funding shortfalls

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FUNDING
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National Tertiary Services and Training and
Development Grants value in real terms
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Equitable Share real
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REVENUE
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BUDGET TRENDS
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PERSONNEL
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Personnel Numbers (6 years)
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Non PERSONNEL EXPENDITURE
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DISTRICT HEALTH SERVICES

• Program 2

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PROVINCIAL HOSPITALS

• Program 4

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CENTRAL HOSPITALS

• Program 5

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Triple burden resulting in pressure on the Health
budget

• Decrease in conditional grants without a
  concomitant decrease in patient load
• Phased take-over of responsibility for funding of
  Local government personal primary health care
  services with effect from 1st July 2004 without
  additional funds
• Increased cost of existing services particularly
  staff costs

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Implications of budget pressure

• Require to reduce personnel costs
• Require general stringency measures throughout
  the financial year
• Need maximum overall efficiency
• Need to resolve local government PPHC funding and
  conditional grant shortfalls

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Concluding remarks
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The need for change the four fundamentals of
Health care
INFRASTRUCTURE Well-designed, accessible and
secure facilities that are properly equipped
HUMAN RESOURCES The right people with the right
skills working in the right places
SERVICE PACKAGE Defining the type and quantity
of health services at each facility
FINANCE Securing a sufficient allocation of
funds that are used cost effectively and
generating maximum revenue
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Thank you