UNIVERSITY OF CAPE TOWN

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UNIVERSITY OF CAPE TOWN
Presentation to Portfolio Committee
Faculty of Health Sciences
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Challenges Facing Health Care in the Western Cape

• The role of the Faculties of Health Sciences in
  the Western Cape
• Challenges facing health care in the Western Cape
• What are the potential solutions to the health
  care challenges?

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Committed to

• Education and training health professionals
  responsive to needs of country
• Provision of a healthcare service at most
  appropriate level of care
• Conducting essential national health research to
  improve the health of the nation

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Guiding principles

• Partnerships with others (Provincial and National
  DoH, other HEIs, MRC, NGOs and other sectors)
• Transformation (adoption of Faculty Charter,
  curricula transformation, sites of teaching)
• Equity in health (adoption of Primary Health Care
  philosophy as Lead Theme)

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Education and training

• We educate and develop quality health care
  personnel for the country (30 from the Western
  Cape)
• We train undergraduate (UG) and postgraduate (PG)
  students in audiology, dietetics and nutrition,
  OT, physiotherapy, speech language pathology and
  medicine
• 1742 UG students (1145 in medicine) and 1173 PG
  students (353 registrars/trainee medical
  specialists)
• Striving to ensure demographic profile
  approximates that of population

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Transformation of our Student Body (UG)
2003
1994
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Health care service

• Primary level of care
• Sites e.g., Vanguard, Khayelitsha, Retreat CHCs
• Services e.g., Medical, Audiology, Physiotherapy
• Secondary level of care
• Sites e.g., New Somerset, GF Jooste, and
  Victoria Hospitals
• Services General Specialist Care in Medicine,
  Surgery, OG, etc
• Tertiary level of care
• Sites e.g., Groote Schuur, Red Cross Hospitals
• Services Specialist and Super specialist care
  (e.g., Cardiology)
• Quaternary level of care
• Unique national services e.g., Heart and Liver
  Transplantation
• Relevant to public and private sectors (only one
  of a kind in Africa) e.g., molecular genetic
  testing for inherited heart disease

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Health care service challenges

• Increasing demand for health services
• Population growth
• Increasing disease burden HIV/AIDS, trauma, and
  disease of lifestyle
• Migration from other provinces N. Cape, E. Cape
  (228 increase in Xhosa-speaking patients in 3
  years)
• Refugees
• Underfunding of health services in the W Cape
• Historic budget cuts from 1990
• Healthcare 2010 Comprehensive Service Plan (CSP)
  promises further cuts
• No provision made for quaternary/national
  services (e.g., transplantation)
• Human resource shortages and inadequate career
  paths
• Nursing shortage
• Lack of adequate career path for other categories
  of staff

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Challenge 1 Increasing demand for health services
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Challenge 1 increasing patient numbers

• Overall, patient numbers have been growing by 6
  per annum
• Central hospitals grew by 8 in 2006/2007
  (measured by patient day equivalents)
• Regional hospitals grew by 4 in 2006/2007

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Challenge 1 Increasing number of deaths, mainly
due to HIV/AIDS
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Challenge 2 Underfunding Service Cuts since
1990
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• Loss of Service Posts since 1995

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Operations performed Case of Ear, Nose, Throat
Surgery
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Average waiting times for surgery

• Cardiac valve surgery ( 18 months)
• Cataracts (gt 1 year, gt 1000 cataracts)
• Joint replacements (gt3 ½ years, gt700 patients)
• Colon cancer (gt 2months)
• Breast cancer (gt 6 weeks).

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Challenge 2 Comprehensive Service Plan (2010)
Beds and Staff To Be Cut Further at the Tertiary
Level
19 reduction
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CSP - Funding
43 reduction
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Principal Specialists
39 reduction
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Specialists/Senior Specialists
51 reduction
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Registrars (Specialists in training)
43 reduction
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Impact on tertiary services

• Good Primary Health Care System has a strong
  primary, secondary and tertiary level services
  component
• More patients seen at primary level means more
  referrals up to, secondary tertiary care
• More pap smears at primary level more women
  requiring surgery (up to 30)
• Unethical to have patients referred upwards and
  not have personnel, resources to be able to treat
  them

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Impact of cuts on teaching

• Teaching and training dependent on adequate
  clinical platform
• Access to real patients in clinical settings
  backbone of clinical training in UG and PG
  contexts
• Clinical training begins in third year of MBChB
• 800 students from UCT need to accommodated on
  platform
• Total number of beds required 1480
• Many patients too ill to have students examine
  them

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Training of Registrars in Surgical disciplines

• Based on apprenticeship need to enhance skills
  in theatre
• Reduction in theatre time less time for
  training
• Reduction in numbers of registrars impact on
  services (patients with life-threatening
  illnesses cannot be treated in time) impact on
  numbers of specialist trained impact on medical
  students training
• High levels of trauma beds not available
  (specialists and registrars spend time looking
  for beds)

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Why is there a mismatch between demand and supply
of health services in the Western Cape?

• Western Cape serves 13.5 of patients in the
  country (based on Patient Day Equivalents) but
  receives 12.25 of national funding for health
  (including conditional grants)
• Growth in the W Cape health budget has not kept
  up with patient growth over the years
• Department of Health projects a R201 m over
  expenditure for 2007/2008
• Patient load divided by population is 50 higher
  in the Western Cape than for the country
• Population may be an inappropriate norm for
  measurement of budgets and costs

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Why is there a mismatch between demand and supply
of health services in the Western Cape?

• National Tertiary Services Grant has remained
  constant in real terms (i.e., no increase to
  cover the growth of patients)
• A costing study estimated the cost to the W Cape
  of providing highly specialised services to be
  R2.5billion, while the NTSG allocation is R1.3
  billion.
• Over the last 6 years to 2006/7, the Health
  Professionals Training and Development Grant has
  been reduced by R110m in real terms
• This province trains 30 of country's medical
  students, but it receives only 21 of the HPTDG
• A costing study indicated the cost to the WC of
  training of students of R450m, while the HPTDG
  allocation to province is only R333m

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Challenge 3 Human resources

• Flight of highly skilled nurses (pharmacists and
  others) to the private sector or overseas
• Limited career path for medical specialists and
  other categories of staff
• Lack of agreement on the concept of Joint Staff
  between universities and provincial government

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What is needed?

• Planning Development of a health service to meet
  the basic needs of the population
• Prescribed minimum benefits for primary,
  secondary, and tertiary care
• Funding Appropriate funding of the health
  services in the Western Cape and Nationally
• Adequate levels of the conditional grants
  National Tertiary Services Grant and Health
  Professions Training and Development Grant
  (HPTDG)
• Full implementation of the Modernisation of
  Tertiary Services Programme
• Framework for governance of Academic Health
  Complexes
• Implementation of the National Health Act
• Joint Agreements to benefit the country

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Conclusion

• Public health services are underfunded in the WC
  (and nationally)
• Progressive erosion of services at secondary and
  tertiary levels, in the face of rising demand,
  has impaired ability to provide adequate health
  service to the people of South Africa
• Right of access to primary healthcare impacted
  negatively
• Potentially irreversible destruction of major
  national healthcare assets
• Appeal for adequate funding of healthcare from
  national and provincial budgets