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An overview of the achievements and challenges in the health sector, including improvements in support services, quality of care, hospital revitalization, strategic interventions, resource management, and human resource development.
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BUDGET 2004DEPARTMENT OF HEALTH Ad Hoc Committee on Health National Assembly 9th June 2004
Overview of achievements and challenges in relation to the NationalTen Point Plan
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.
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
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
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
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
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
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
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.
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
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
Key general priorities • Maximise overall efficiency • Reduce personnel costs • Improve staff morale • General stringency measures throughout to remain within allocated budget
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
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
Key priorities • Tertiary services: • Rationalise duplication of services • Restructure staffing establishments • Revise Joint Agreements with the universities • Resolve the conditional grant funding shortfalls
National Tertiary Services and Training and Development Grants – value in real terms
DISTRICT HEALTH SERVICES Program 2
PROVINCIAL HOSPITALS Program 4
CENTRAL HOSPITALS Program 5