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Robbing Peter to pay Paul — National government shortchanging healthcare in the Western Cape


Dr Nomafrench Mbombo is the Western Cape Minister of Health and Wellness.

The Western Cape Department of Health and Wellness faces a budget shortfall of more than R1.5-billion for 2023/24 and R2.1-billion for the following financial year as a direct result of national government’s funding cuts.

In the early 16th century, the abbey church of Saint Peter in Westminster was absorbed into the Diocese of London, England, when the Diocese of Westminster was dissolved. A few years later, many of the assets — once belonging to the Diocese of Westminster — were later expropriated in order to fund the repairs needing to take place at St Paul’s Cathedral.

While this event may seem irrelevant and from a distant era and far-off country, it is claimed to have given rise to a common and well-known proverb that we still use to this day: “To rob Peter to pay Paul.”

This saying couldn’t be more relevant in demonstrating what is happening to healthcare funding in the Western Cape. However, this robbing is not due to our provincial government. No, this lies solely at the doorstep of the national government.

For years, taxpayers’ money has been used to pay off cadres instead of being directed to bolster service delivery. This is an obvious fact and one that intensified during the national State of Disaster as a result of the Covid-19 pandemic.

And now the feasting has caught up. A combination of a shrinking economy, increased sovereign debt and widespread unemployment has led to the national government having to account for the consequences of its own actions and reprioritise funding to deal with the numerous crises facing our country.

All of this has resulted in health getting the short end of the stick.

In the Western Cape, we will now receive a decreased allocation in our Equitable Share and Conditional Grants. When considering the impact this has on cost of employment (CoE), goods and services, and transfers, the Western Cape Department of Health and Wellness faces a budget shortfall of more than R1.5-billion for 2023/24 and R2.1-billion for the following financial year.

While this amount is only around 5% of the department’s budget for the next financial year, it is still a substantial amount of money. Let me put this funding shortfall into perspective. If the province was not able to cover this deficit:

  • The impact of the R916-million shortfall on CoE translates to freezing approximately 1,694 posts, which would have disastrous implications for the health system;
  • The non-CoE shortfall of R393.5-million translates to scaling down service capacity equal to an approximate reduction in patient-day equivalent capacity of 282,634 in hospitals and a decrease of 598,602 primary healthcare encounters based on 2021/22 data; and
  • The total cut of R1.5-billion equates to more than the entire 2022/23 budgets for our three metro district hospitals — Mitchells Plain at R598-million, Khayelitsha at R464-million and Karl Bremer at R485-million.

The budget shortfall would also equate to the following:

  • A shortfall in the budget of the 10 clinics transferred from the City of Cape Town. The transfer of these clinics is a crucial component to service redesign within the Metro as well as the integration of progressive primary health care services;
  • The termination of the conversion of Brackengate and Sonstraal Hospitals to transitional care hospitals, which is also part of the service redesign to shift from in-patient care to more ambulatory and transitional care;
  • No provision for contingency reserves which are crucial, especially due to the unpredictable nature of medico-legal claims; and
  • A reduction in the National Tertiary Services Grant and Human Resource Training Grant. The decrease in these training components will have a significant impact on service delivery, especially for specialist services and registrar training at the Groote Schuur and Tygerberg central hospitals.

The combination of these factors would have devastating effects on our ability to deliver services to our residents.

The less money we are allocated from the national government, the less we are able to realise the principles of universal healthcare coverage. In doing so, we will be stuck with the historical cost allocations rather than moving towards decentralised budgets to geographic areas based on principles that allow more managerial autonomy and accountability.

Even though our province has had to dip into its reserves to partially pay for this deficit by allocating more than R1-billion to the department — which, if I may add, is more than four times the allocation for 2022/23 – it is not a tenable, long-term solution.

As such, these budgetary constraints emphasise our need to be innovative and further our service redesign.

We will continue to push forward with our community-based primary health focus, while also ensuring that our current services and infrastructure are able to meet the demands of our communities, given the socioeconomic climate.

Our province has a population of approximately 7.2 million people, of whom 75% are estimated to be uninsured. In fulfilling its constitutional mandate to progressively realise the right to healthcare, the department is going to have to do more with much less so that our 571 points of service are able to serve our residents well.

This is non-negotiable. No matter the maladministration in Pretoria and the effects its governance has on our country, we will not fail.

The Western Cape is South Africa’s hope and we must go above and beyond to succeed so that our country succeeds — no matter how much Peter is robbed to pay Paul. DM


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