Western Cape Adjustments Appropriation Bill: Health and Wellness

Meeting report

Western Cape Provincial Minister of Health, Dr Nomafrench Mbombo said the health system was always subject to many crises such as the loadshedding, floods, the COVID-19 pandemic and the burden of disease, but despite this, the Western Cape Department of Health (WCDH) was trying to work with limited resources. The Department was working on pay-as-you-go budgeting. The budget of R29,7 billion increased from the previous year. At the start of the year, R28,8 billion was appropriated. This seemed like a huge amount, but Members should not be deceived by this. We are on a fiscal cliff as the health sector is underfunded. There was a baseline shortfall of R1,5 billion and while Provincial Treasury attempted to offer help sometimes, there was still pressure at emergency centres, particularly with the festive season approaching with cases of trauma, drowning and medical emergencies. On the unfunded wage bill, we welcome the 78% rescue to fund the wage bill, but this also means that not everyone will be funded by it and the shortfall must be sourced by WCDH. Much needed posts cannot be filled as WCDH must service the 20% shortfall. The Department has begun internal discussions with the private sector for assistance.

Dr Keith Cloete, WCDH Head of Department, said the mid-year appropriation amounted to R931.423 million in addition to the baseline budget. This was a net amount in the system and the biggest adjustment in the equitable share. This would partially cover the wage increase for healthcare workers. Some additional funding was from rollover funds from previous years, revenue generated and funds from the fiscus. A downward trend would continue over the next three to five years as part of the health allocation in the country and the health system in the Western Cape. We have done as much as we could, but more should be done given financial pressures. We are consulting with a range of stakeholders including civil society, private sector, universities and organized labour. The funds will carry us through to March 2024. We are also engaging all relevant departments and the municipalities.

Ms A Bans (ANC) asked about the R136 million in the infrastructure budget and said this was regrettable. She understood this was due to delays in projects, but wanted a list of projects and a report on how far they were. What was the status of rebuilding the JF Jooste Hospital? What tasks have been accomplished this year? What caused delays in the Central Hospital? Why were the computer replacements not budgeted for? She referred to Page 104 and the recent unfilled vacancies due to a lack of suitable candidates. What is the number of vacancies and which scarce skills are needed?

Discussion
Ms R Windvogel (ANC) welcomed the increase in budget allocation from the national government. How would the increase be used to fulfil the aim to provide equitable access to quality healthcare? How could people could be prevented from sleeping on the floor at hospitals? People strongly supported the NHI Bill in the province, but this was rejected by the DA. How could the budget be used to address the concerns of the people?

Ms Windvogel referred to page 99 and asked why WCDH would end the Health Non Emergency Transport (HealthNET) programme. She asked if the changes included assisting patients who for medical reasons could not use public transport to attend health facilities and those coming from rural areas? How would rural areas benefit from these changes? On page 102, could the City now order its own medicine in Subprogramme 2.2 and why was the R11 million shifted to fund the cost of medicine for the City? Funds were shifted to fund new posts. She asked for details on this.

Ms A Bans (ANC) referred to the R136 million in the infrastructure budget and said this was regrettable. She understood this was due to delays in projects, but wanted a list of projects and a report on how far they were. What was the status of rebuilding the JF Jooste Hospital? What tasks have been accomplished this year? What caused delays in the Central Hospital? Why were the computer replacements not budgeted for? She referred to Page 104 and the recent unfilled vacancies due to a lack of suitable candidates. What is the number of vacancies and which scarce skills are needed?

WCDH response
Dr Cloete replied that there was no increase as before the adjustment, WCDH was projected to overspend by more than R1,5 billion. The adjustment adds R900 million into the budget. The result is that R405 million is still projected to be overspent. It is against this background that we had to say the R900m comes in to offset that overspend. The R900m reduced over expenditure.

Dr Cloete replied that the Western Cape Department of Health supports the concept of universal health coverage and has the most active pilot in Knysna to prototype and find workable solutions for how healthcare can be divided between the public and private sectors. On the HealthNET discontinuation, this was only in specific areas and the ICT components will be improved. We are considering innovative ways of bringing services to people where they do not have to spend up to 36 hours travelling to a 15 minute consultation.

The City medicines fund shift was for services that we have assumed responsibility for from the City. There were 10 facilities which have approached us.

Dr Cloete said R136 million left the appropriation and was debited against the budget, but added to WCDH infrastructure. The posts were previously funded by NGOs and we have created posts in the Khayelitsha East Office. Consultants were appointed for the Klipfontein Regional Hospital and some equipment had to be imported which caused delays and resulted in funds being redirected. The unfilled posts are from the built environment such as engineers who are unwilling to work for the salaries offered in the public sector.

Mr Simon Kaye, WCDH CFO, referred Ms Bans to pages 129-142 which gave detail on the projects. For the JF Jooste Hospital, the Department of Public Works was the implementing agent and have appointed sub consultants for the design of the building. Draft plans and a government structure for Metro East and West service configurations have been circulated for Klipfontein. The posts are for an Audiologist, Dietician, Social Worker and an Auxilliary Worker. He referred Ms Bans to page 99 and said this was not an additional allocation, but was to fund the shortfall due to the wage agreement. R100 million worth of projects have been stopped to fund pressures in service delivery projects. There had been cuts to conditional grants and inflation has also had an effect. We have tried to mitigate so we can continue to pay personnel and suppliers for goods and services. Pages 102-107 detail where funds have been allocated.

Dr Laura Angeletti-du Toit, WCDH Chief Director, Infrastructure and Technical Management, replied that built environment skills had to be advertised a few times before finding people to fill the posts. Electrical and civil engineers were scarce. Klipfontein Hospital was at stage 2 and was progressing reasonably well.

Health MEC Mbombo said the general message WCDH wanted to convey was that this was the mid-year budget adjustment and the health sector was in trouble across the country. The health sector was robbed in terms of its national allocation. The Western Cape and Gauteng have been severely affected in the equitable share budgeting. No one could be against this in principle as there were 19-35 year-olds who were not at university or in employment. Conditional grants had also been cut. There was a population increase and many were medically uninsured who were coming to the cities. She had worked in the health space for an extensive time and the country had no money. It had limited resources from the equitable share and increasing staff. She emphasized that the demand was more than the supply.

Follow-up discussion
Ms N Bakubaku-Vos (ANC) asked for an update on staff at Brackengate temporary hospital set up during the COVID-19 pandemic. How many staff were retrenched?

Dr Cloete replied that the contracts of everyone at Brakengate had expired. The majority of people who had a contract there were interviewed and absorbed again into posts advertised for what was required. Others were encouraged to apply within WCDH and 34 people could not be accommodated. The Minister has explained that the mid-year budget allocation is to make up the shortfall of the allocation from the beginning of the year. Western Cape was asked to pay the increase for public servants, but no budget allocation was made for this.

Ms Windvogel said the fact remains the increase was money WCDH did not have. On Page 107, what progress has been made to establish the violence prevention unit and why have funds not been earmarked? Does it mean the funds are no longer needed by the unit?

Dr Cloete replied that the units have been established and the majority of posts filled. The part of budget not earmarked was for projected expenditure, but the capacitation of the units was not compromised.

MEC Mbombo explained that National Treasury allocated money to the sectors which included conditional grants and equitable share to provinces which had to be divided accordingly. The decrease in equitable share and conditional grants for WCDH amounted to R1.5 billion. The salary increase for the public service was also not budgeted for and the country could not afford this. There were strikes throughout the country by NEHAWU and we also went to court. A percentage increase was agreed on and provinces had to find money for this. Unfortunately, national government could now only offer 78% of funds for that salary increase. The R103 million increase from National Treasury also served as a cushion. WCDH was still collecting patient fees to cushion the services. JF Jooste and Klipfontein Hospitals have been allocated national fees to be reopened.

Ms Bans said that the Department should know that the Committee was not accusing it, but holding it accountable on plans which needed to be finalised by a specific date. It was not a matter of trying to be nasty.

Dr Cloete said the Klipfontein and Belhar Regional Hospitals were in progress and infrastructure development will not be stopped given budget pressures. We are also working with national government.

Mr T Klaas (EFF) asked if national government explained why it did not have any money? We need this question to be answered. Close to R1,4 million was redirected to the fiscus at the end of 2022/23. What amount of money had WCDH requested from national government and what budget cuts were made for 2023/24? There was a backlog of patients waiting to be assisted at hospitals. When will this be addressed?

Dr Cloete replied that WCDH asked for a R29,5 billion budget and was told R28 billion would be received. R900 million was given now. WCDH was told that the financial reality of the country did not allow the health sector to receive R29 billion. Complaints about the triage system will increase as yellow and green non-critical cases should not be in the hospital, but how can those who are not critically ill be turned away?

Dr Cloete made brief closing remarks and thanked Members for the manner in which WCDH was held accountable. Candid conversations were crucial. Everyone was proudly South African and we want to see the health system succeed.

The Chairperson thanked the WCDH delegation for all they had accomplished as this was a monumental task which was handled with the dignity it deserved.

Resolutions/Actions
Ms Windvogel said her question on the Violence Prevention Unit and its progress was not answered and this should be answered by the Department.

Ms Bans said a list of delayed hospital projects and reasons for this should be requested.

Committee Report on Health Vote 6 in Western Cape Adjustments Appropriation Bill
Mr C Fry (DA) said he supported the Vote 6 adjustment budget.

Ms Windvogel said the ANC notes the budget increase and does not support the Bill in terms of Rule 19.

Mr Klaas said he supported the Bill.

The Committee supported the Health Vote 6 and the minority view of the ANC was noted.

The Committee Report on Vote 6 was adopted.

The Chairperson thanked all present for their engagement and adjourned the meeting.