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DEPARTMENT OF HEALTH – BUDGET

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Shape up or ship out, warns MEC

Mase Monapule

THE NORTHERN Cape Department of Health has seen a massive rise of medico-legal litigations, with the potential financial liability (contingent liability), increasing from R151 million in 2015 to R1.5 billion by March 2019 – a figure equaling almost 30% of the total 2019/20 budget.

This was revealed in the Northern Cape Provincial Legislature during the budget speech of the Northern Cape MEC for Health, Mase Monapule, who presented the department’s R5.1 billion budget allocation for the 2019/20 financial year.
During the presentation, Monapule indicated that South Africa was experiencing a sharp rise in medico-legal litigations in the public health sector.
“Nationally, the potential financial liability that may be incurred, also known as the contingent liability, rose from R20.6 billion in 2015 to R98 billion by March 2019. In the Northern Cape, we have seen an increase from R151 million to R1.5 billion in the corresponding period,” Monapule stated, adding that strict management of patient files and confidential departmental records would be introduced.
“A project has been launched for the clean-up and reorganisation of patient files and the filing of records. In this process, the sequential unique number for the referencing of patient files will be reviewed in favour of a more efficient system. In addition, I have established a task team to investigate allegations of breaches in patient confidentiality and unethical behaviour.
“This task team will provide me with a preliminary report within four months, with recommendations on how to mitigate the potential risks in this regard,” Monapule said.
The MEC noted that the department’s budget baseline for 2019/20 showed a growth of 7.1% from the adjusted budget of 2018/19.
Personnel costs, which constitute 60.3% of the total budget, remain the main cost driver in the department. The budget for compensation of employees grew by 11.8% when compared with the adjusted budget of R2.8 billion in 2018/19. The budget for goods and services shows a small growth of 4% when compared to the adjusted budget of R1.6 billion in 2018/19. The budget for transfers and subsidies shows a growth of 5.6%. The budget for payments of capital assets shows a negative growth of 14.7% compared to the R376 million in adjusted budget in 2018/19. 
Monapule indicated that this significant reduction was due to reprioritisation within the Health Facility Revitalisation Grant to scale down on the capital allocation for construction of new facilities and prioritise the repair and maintenance of the existing health facilities. The maintenance budget falls with the goods and services allocation.
The budget allocation to each programme in 2019/20 is as follows:
• Administration – R219 million or 4.2%, District Health Services – R2.4 billion or 46.3%, Emergency Medical Services – R362 million or 6.9%, Regional and Specialised Hospitals – R409 million or 7.9%, Tertiary Hospitals – R1.1 billion or 22.1%, Health sciences and training – R140 million or 2.7%, Health care support services – R123 million or 2.4% and Infrastructure health facilities management – R390 million or 7.5%
This gives a grand total budget allocation of R5.1 billion in 2019/20.
Monapule said that the sixth administration in health would be marked by “bold steps” in the sanitisation of senior management – in a paradigm shift she explained that “would bring the revitalisation of staff and the radical transformation of management practices”.
“The perpetuation of silo operations and turf mentality continues to put at risk the efficiency and efficacy of our services . . . it has led to dysfunction, duplication, negligence of duty, blurring of reporting lines, and often a sense of entitlement. A meticulous process of change management, organisational re-alignment and integration of services will be implemented to eradicate this phenomenon once and for all – before the end of the current financial year.
“In other words, it is my firm opinion that if the management of the department has gone reprobate, then it must be thoroughly overhauled in order to allow for new thinking, and to inject new commitment and vigour. We need managers who are prudent with state resources, forward-thinking and solution-orientated. Our posture this time around is ‘Shape up or ship out’,” Monapule warned.
She said that the department had embarked on the establishment of a Health Advisory Board to guide the department in its transformational undertakings.
“The fundamental task of the board is to scrutinise the root causes of chronic under-performance in the department, and to develop the necessary interventions to address them. The Advisory Board will also be instrumental in assisting my office in instituting consequence management measures regarding irregular, fruitless and wasteful expenditure in the department,” she said.
Monapule added that the governance structures of the department had “degenerated” over the years, “despite all efforts to empower them in implementing their mandate”.
“As a result, governance structures show poor commitment, many of them do not hold regular meetings and in some instances have collapsed. As part of addressing this, we are reviewing the status of all governance structures, and putting in place measures to ensure that beyond induction, governance structures are properly trained, monitored and held accountable for their activities.
“The provincial induction and training will be completed before the end of this calendar year,” she stated.
Turning her attention to human resource management, Monapule noted that since the start of this financial year, the department had appointed 194 health professionals in various categories of nurses and medical doctors.
“In June I also extended a call for all retired or unemployed medical doctors, nurses, and emergency medical practitioners who still desire to work in the public health service to bring their CVs to our district health offices across the Province.
“In this regard, we greatly appreciate the positive response that we have received so far from our medical professionals, and we will work tirelessly to fight the plight of staff shortages in our facilities,” she said.
She also announced that the department would have an intake of 120 nursing students at the Henrietta Stockdale College of Nursing. This will comprise of 60 nursing students for the Diploma in Nursing, 30 midwifery students for the Diploma in Midwifery and 30 Bridging Course Students
Monapule also indicated that the number of emergency care officers in the Province had increased from 742 last year to 791, and added that the medium-term plan was to increase personnel to 1 200 as part of a plan to reduce response times, especially for urgent and emergency care.
The MEC indicated that Tuberculosis remained one of the leading causes of deaths in the Province.
“The case finding of TB patients in the province is in the order of 7 000 patients per annum. Despite this, the department is aware of 4 189 known TB patients who have been lost to the system after diagnosis. If not found and treated, these patients increase the risk of TB transmission. An additional complication to this is that about 400 patients each year develop Drug Resistance, reducing the chance of achieving timely cure. The death rate among Drug Resistant TB patients is very high, at 28%.
“This financial year R31 million rand has been allocated from the HIV Conditional Grant to help fight the scourge of TB. This budget will be used to help find the 4 189 defaulting TB patients, thereby ensuring that all patients are linked back to the health system and started on treatment,” Monapule noted.
She also indicated that a breast imaging machine, known as a Mammography unit, was being procured for Dr Harry Surtie Hospital in Upington, and a local radiographer from Upington had been trained at Robert Mangaliso Sobukwe Hospital to specialise in mammography.
“Once installed, this equipment will allow approximately 50 patients each month who are currently being referred to Kimberley, to be scanned in Upington,” she said.
Monapule also said that she had engaged some partners in the mining sector and the JTG Trust, with the express purpose to mobilise support and resources for the construction of two district hospitals, one in John Taolo Gaetsewe District, and the other in Frances Baard District.
“The operationalisation of the two hospitals will curb the influx of patients to Robert Mangaliso Sobukwe hospital. The department is undertaking a phased approach to transfer most of the Community Service Medical Officers from the Robert Mangaliso Sobukwe Hospital to the health facilities in the districts.
“Currently the department has two infrastructure upgrade projects underway at Robert Mangaliso Sobukwe Hospital, funded by private sector donors. The first is a project to upgrade the Burns Ward, in partnership with the Smile Foundation. In the first phase, which started last year, the Smile Foundation raised R1.8 million.
“The hospital is facing a shortage of front-line clinical staff in the form of doctors, nurses and allied health professionals. This will be addressed by filling all vacant posts over the next few months. 
“The hospital aims to improve the multidisciplinary team approach in order to reduce the lengthy inpatient stay, to reduce the incidence of hospital-acquired infections and to generally improve the quality of healthcare. 
“The average length of stay in the hospital remains high at just over seven days compared with the national average of just over five days. This results primarily from patients waiting for Orthopaedics and general surgery and will be addressed through the appointment of critical clinical staff.
“A new facility for the Renal Centre has been developed at the hospital. In the next two weeks the renal dialysis service will move into a modern facility that is dedicated for renal patients.
“This move will not only increase dialysis stations from ten to 12, it will also provide more space for each patient, as well as an isolation room for any patients with an infection. This will be a major improvement in terms of patient confidentiality, comfort and infection control,” Monapule stated.
She added that the second project was a significant upgrade of cancer services funded by the Bristol-Myers Squibb Foundation (BMSF) over three years.
“The lung cancer project is worth R25 million. A major part of this project involves adapting the property at 34 Memorial Road so that it will become the Cancer Centre for the hospital, providing provincial cancer tertiary services. The strategic goal is to be able to provide and support lung, breast and cervical cancer services, including awareness, screening, referral, patient navigation, treatment adherence and palliative support.
“The long-term aim is to construct a radiotherapy bunker and linear accelerator facility behind the Cancer Centre. Whilst this business case is being developed, the short-term solution sees the procurement of services from Equra Health, who run a radiotherapy cancer service at the LenMed Royal Hospital in Kimberley.
“The Robert Mangaliso Sobukwe Hospital sees over 500 new cancer patients and over 8 000 existing cancer patients every year. It provides over 2 500 chemotherapy treatments per annum locally and refers 600 patients each year to a hospital in Bloemfontein for radiotherapy.
Each trip lasts up to six weeks. The long distance from home and the extended waiting time before being accepted for treatment makes this option difficult for many cancer patients. The service level agreement entered into with LenMed will allow more than 70% of radiotherapy treatments to be provided locally,” Monapule explained.
She also stated that the construction of the Mental Health Hospital in Kimberley was complete, and that the department would open this hospital next month, with the transfer of mental health patients from the West End Hospital.