BUDGET 2004 DEPARTMENT OF HEALTH

1. BUDGET 2004DEPARTMENT OF HEALTH Ad Hoc Committee on Health National Assembly 9th June 2004

2. Overview of achievements and challenges in relation to the NationalTen Point Plan

3. 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.

4. 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

5. 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-Mitchell’s Plain Hospitals and Victoria Hospital • Developing business cases for Valkenburg, Tygerberg, Red Cross and Somerset West hospitals

6. 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

7. Strategic interventions to decrease morbidity and mortality • Health programmes have been established to deal with: • HIV/AIDS, STI’S and TB • Women’s health • Mental health • Chronic diseases • Food strategies • Violence against women and children

8. 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 (PPP’s) are being promoted

9. 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

10. Vision, mission and key priorities – next 3 years

11. 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.

12. 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

13. 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 CHC’s, clinics and at home SHAPE OF THE FUTURE HEALTH SERVICES in 2010

14. Key general priorities • Maximise overall efficiency • Reduce personnel costs • Improve staff morale • General stringency measures throughout to remain within allocated budget

15. 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

16. 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

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

18. FUNDING

24. National Tertiary Services and Training and Development Grants – value in real terms

25. Equitable Share – real

27. REVENUE

30. BUDGET TRENDS

33. PERSONNEL

34. Personnel Numbers (6 years)

36. Non PERSONNEL EXPENDITURE

39. DISTRICT HEALTH SERVICES Program 2

42. PROVINCIAL HOSPITALS Program 4

47. CENTRAL HOSPITALS Program 5