1 / 28

UNIVERSITY OF CAPE TOWN

Presentation to Portfolio Committee. UNIVERSITY OF CAPE TOWN. Faculty of Health Sciences. 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

Download Presentation

UNIVERSITY OF CAPE TOWN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Presentation to Portfolio Committee UNIVERSITY OF CAPE TOWN Faculty of Health Sciences

  2. 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?

  3. 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

  4. 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)

  5. 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

  6. Transformation of our Student Body (UG) 1994 2003

  7. 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, O&G, 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

  8. 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

  9. Challenge 1: Increasing demand for health services

  10. 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

  11. Challenge 1: Increasing number of deaths, mainly due to HIV/AIDS

  12. Challenge 2: Underfunding = Service Cuts since 1990

  13. Loss of Service Posts since 1995

  14. Operations performed: Case of Ear, Nose, Throat Surgery

  15. Average waiting times for surgery • Cardiac valve surgery (~ 18 months); • Cataracts (> 1 year, > 1000 cataracts); • Joint replacements (>3 ½ years, >700 patients); • Colon cancer (> 2months); • Breast cancer (> 6 weeks).

  16. Challenge 2: Comprehensive Service Plan (2010) Beds and Staff To Be Cut Further at the Tertiary Level 19% reduction

  17. CSP - Funding 43% reduction

  18. Principal Specialists 39% reduction

  19. Specialists/Senior Specialists 51% reduction

  20. Registrars (Specialists in training) 43% reduction

  21. 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

  22. 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

  23. 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)

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

More Related