2013-14: A successful health story in Western Cape

Healthcare 2030 which sets out the vision, values and principles guiding the Western Cape Government Health has been endorsed by the Western Cape cabinet, forming the compass for the Department over the next two decades in guiding its health service development.

It will now be converted into sets of priorities that will be incorporated into the annual plans and the new five year term.

The need for public and private health services is ever increasing, not only in South Africa, but all over the world, and it is impossible for government funding to cover the growing demand in the public sector. Instead public health systems require funding from everyone who has a stake in the well-being of communities.

Read: Healthcare industry undergoing transformation

The Health Foundation, a non-profit organisation that facilitates donations and partnerships with government, and the strengthening of the business development unit to manage contracts with the private sector will play an important role to “Increase Wellness” and underwrite our government slogan “Better Together”.
 
One of the highlights in 2013/14 was certainly the opening of Mitchell’s Plain Hospital by premier Helen Zille. This hospital, together with the Khayelitsha Hospital, will make a significant difference to health service provision in the Metro over the forthcoming years.

However, at the same time, the annual report reflects the service pressures that continue to impact on expenditure, and staff capacity, especially in the large district and central hospitals of the Metro.
 
Highlights

• Opening of the new Mitchells Plain Hospital, a facility with 230 new beds
• Launch the pilot of 16 Wellness Centres in collaboration with the private retail pharmacy sector. This will improve access to the screening of common chronic diseases.
• Roll out of Ministerial SMS complaints line to improve patient responsiveness. More than 1000 complaints during the 2013/14 financial year were resolved via this system.
• The Department reached the milestone of 150 000 patients on ART (total of 156 703)
• The Department maintains its 10 year track record for an unqualified audit
• “Walk for Health” – transversal initiative to promote employee wellness
• Launch of an innovative change management programme at 38 facilities to ensure that departmental values translate into positive actions and behaviour to enhance patient-centred care.

 
Service delivery outputs

Utilisation:

• Serve a population of 6.0 million of which 78% (4.7 million) are uninsured.
• Primary health care (PHC) services are rendered through 284 fixed facilities and 169 non-fixed facilities. Fixed facilities include 9 community health centres, 50 community day centres and 92 clinics managed by the City of Cape Town Municipality while non-fixed facilities refer to satellite clinics and mobiles.
• There were 14.3 million patient visits at PHC level at a cost of R167 per visit (each person in the province visited a PHC facility approximately 2.4 times during the year).
• About 2.2 million (15%) of the PHC visits were children under the age of five years (each child under five years visited a PHC facility approximately 3.8 times during the year).

Community based services

• 3 536 home carers were employed by non-profit organisations.

Read: Talking to your doctor
 
Child Health:

• 53 347 children under 5 years were treated for diarrhoea.
• 35 475 children under 5 years were treated for pneumonia.
• 89 202 children under the age of one were fully immunised (80.4% coverage).
• Transmission rates from HIV-infected mothers to their babies dropped to 1.9% amongst those tested.
• Introduction of human papilloma virus (HPV) vaccine for Grade 4 girls (9 years old)

Maternal and women’s health:

• Only 6.3% of deliveries were women under 18 years of age.
• 87 397 women over the age of 30 were screened for cervical cancer.

 
Acute hospitals:

• Acute general hospital services are rendered by 34 district hospitals, 5 regional hospitals (which include a specialised maternity hospital), 2 central hospitals and 1 tertiary hospital.
• These hospitals admitted 529 430 patients and had 2.38 million outpatient visits.
• 7 692 cataract surgery operations were performed.

Specialised hospitals:

• There are 6 TB, 4 psychiatric and 1 rehabilitation hospitals in the Western Cape.
• Jointly these hospitals admitted 10 613 patients and had 59 197outpatient visits.

 
HIV and TB:

• 986 223 people were tested for HIV.
• By the end of the financial year 156 703 people were on anti-retroviral therapy (ART).
• 816 ART chronic clubs have been established in the Province.
• The cure rate amongst 13 614 new, smear-positive adult TB cases was 83.7% and 7.5% defaulted.

Emergency medical services (EMS)

• EMS functioned from 52 ambulance stations and operated 251 ambulances.
• 514 901 patients were transported.
• In 70.9% of cases, EMS responded within 15 minutes to priority 1 calls in urban areas and in 85.3% of cases within 40 minutes to priority 1 calls in rural areas.
• Fabian Higgins (EMS recue diver) and Constable Heino Uhde (SAPS rescue diver) received an international award on 25th of November 2013 for their courage and bravery during the Miroshga incident in Hout Bay.

 
Forensic Pathology Services (FPS)

• FPS operated from 18 forensic pathology facilities.
• 9 984 post mortem examinations were conducted to establish the cause of death.

Infrastructure:

• Mitchells Plain Hospital was commissioned in 2013/14.
• Main capital projects completed in 2013/14: Hermanus Hospital (new ward, outpatients department and administration), Malmesbury Ambulance Station, Swartland Hospital (extensions and alterations to emergency centre), Brooklyn Chest Hospital (new drug resistant TB unit), Lentegeur Regional Laundry (upgrade) and Karl Bremer Hospital (emergency centre).

Human resources:

• 30 931 employees on 31 March 2014.
• Personnel expenditure for 2013/14 was R9.2 billion.
• Overall vacancy rate of 4.70%
• 3 643 staff exited the Department (majority due to expiry of contract, resignation and retirement.
• 4 245 employees recruited.
• 1 219 employees promoted.
• 6 122 performance rewards paid out at a cost of R46 million.
• 1 857 misconduct and disciplinary hearings finalised (majority due to absent from work without permission, failed to comply with or contravened acts, improper / unacceptable conduct and insubordination).
• 25 055 training opportunities provided.

 
Finance:

• The Department had a budget of R16 030 billion. Its expenditure was 99,3% of its budget.
• Revenue to the amount of R598 million was generated during the year (R111 million more than the target set). R419 million was from hospital fee accounts paid.

 
Information and communication technology:

• Commenced installation of a new EMS software solution for its communication centres
• The Primary Health Care Information System (PHCIS) has been rolled-out to 176 facilities of which 97 are actively using the appointment module.
• The pharmaceutical management system (JAC) has been rolled-out to 48 sites.
• The Hospital Information System (HIS) was implemented at Swartland and Lapa Munnik Hospitals in 2013/14.  
• Commenced implementation of the Enterprise Content Management (ECM) system at Mitchells Plain Hospital, George Hospital and the Directorate: Information Management at Head office.
• A tender has been awarded for the roll-out of the Picture Archiving System/Radiology Information System (PACS/RIS) to regional and certain large district hospitals.

Read: How the funds of medical schemes are spent
 
Quality of care:

• 9 604 complaints and 24 598 compliments were received directly at health facilities.
• In recent client satisfaction surveys 88% of patients surveyed were generally satisfied with the level of service.
  

However, waiting times, cleanliness of the toilets and the cost to get to health facilities remain challenges.

The link to the full Western Cape Government Health Annual Report 2013/2014 can be found at their website.

Read More:

More underprivileged SA families to receive healthcare at home
Zuma: SA to get free, quality healthcare
Medical records worth more than credit cards on black market

Image: Stethoscope and calculator symbol for health care from Shutterstock.