The Western Cape Health Department requires R1.5 billion to meet its needs and to keep up with the cost of living and inflation.
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This is according to Dr Keith Cloete, the provincial head of health, in response to the R807 million shortfall the department will face in the 2024/25 financial year.
Cloete says proactive planning should mitigate the impact of the shortfall compared to last year’s budget crisis. During that time, the department had to readjust its spending towards the end of the year due to ‘spending more money than we had’.
As a result, health services were pushed into ‘crippling austerity’, as stated by more than 1 000 health workers who signed an open letter addressing the practical consequences of the R1.5 billion mid-year budget cut.
The letter’s author, Professor Lydia Cairncross, head of surgery at Groote Schuur Hospital, says planning alone could not make up for the overall reduction in health resources.
‘Even if we use [it] as efficiently as possible, cutting the health budget means we cannot hope to meet this growing health need. The resultant reality is increased suffering and, in some cases, preventable deaths in vulnerable populations.’
This year, the province received R30.48 billion for its budget, a slight increase from the previous year’s R29.78 billion.
‘What we got was R753 million extra – R807 million short. The bottom line is that it is an increase, but not one that holds up with inflation,’ says Cloete.
Towards the end of last year, the province had to make spending adjustments as the department surpassed its budget.
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As per News24, one of the emergency measures was to stop filling essential posts. ‘It was painful,’ says Cloete. However, the department managed to direct the expenditure back to within its budget.
‘We then reset our system [so as not] to go back [to that situation] and work with what we have. We [now] have a whole year to do it, to work with everyone, monitor how well we’re doing, adjust, improve and try new things.’
‘On top of that, we are exploring relationships to potentially bring additional resources into our system outside of the money we get from the state,’ he adds. ‘We have started partnership conversations with the private sector, universities, NPOs and other government departments to possibly pool resources with external parties.’
Cloete adds that one of his initial tasks was to maintain the current staff levels. ‘We will maintain the number of posts going into the next financial year. But, at the same time, we will have to work smarter and wiser with the money we have.’
‘And for that, we need to involve everyone to help us make the choices to be able to live within budget while maintaining the good quality service that we need to give to our patients.’
‘What does that mean? It is unlikely that we will stop any big services, but we will prioritise and will have to limit – people might have to wait a little bit longer, there might be a little bit more discomfort for families, but we will do everything to make the wisest possible decision to serve the people to the best of our ability with the budget we have.’
Cairncross says she anticipated ongoing rotational cuts to theatre lists, stating that 200 theatre lists have been lost since the freeze on posts in November. This resulted in 800 cancelled operations. ‘In April and May, we will probably continue to experience this level of reduced theatre lists as it takes several months to recruit staff.’
She adds that it’s unlikely they’ll return to normal service levels until at least June. This will depend on whether they need to cut staff positions. ‘We do not know the quantum of the impact on Groote Schuur yet but have been advised to anticipate staff cuts.’
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Cairncross also noted that the budget essentially indicated a minimum 3% reduction in available healthcare resources, both provincially and nationally.
‘Last year, the “in year” cut generated an incredible amount of instability in a system which was already fragile. We continue to feel the effects of this as we are still struggling to advertise, recruit, and fill our posts as all human resources systems have been slowed down in anticipation of the release of the new budget.’
According to Cloete, there could still be an opportunity for a budget adjustment mid-year if the department continued to show pressures. ‘We will do everything in our power again to go to the provincial treasury, National Treasury, everybody.’
‘And if that adjustment does come in and we get additional money, then the projected R800 million shortfall gets less. Then, we work with all other partners to ask if they can help us with any shortfall to see how external funding can make up for it,’ he adds.
‘Our big thing here is to keep stability and make sure that the system functions without significant interruptions and disruptions.’
Cairncross urges healthcare workers to keep pushing for a review of the ongoing cuts to the health budget, which are planned for the next three years. ‘I believe we need to challenge the constitutionality of decreased health services when our country, through our Constitution, has committed to the progressive realisation of the right to health.’
‘In an election year, we need to be asking every single political party to state their views on the underfunding of health and education, and what they plan to do about this if they should find themselves in power,’ she adds.
‘Public health service cuts are not directly felt by the politicians who make these decisions as they, and their families, almost exclusively use the private health sector.’
‘And the communities served by our public health facilities are not always able to advocate for their services because, when you need healthcare, you are often at your most vulnerable.’
‘This puts a moral obligation on health workers in the system to stand up and speak out when we see the service deteriorating. We see the open letter as part of an expression of this imperative.’
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Also read:
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