UNIVERSITY OF CAPE TOWN

Academic Hospital Professional Staff 1990 - 2000

0

200

400

600

800

1000

1990/1991

1995/1996

1999/2000

- 39%

- * -

Loss of Service Posts since 1995

Western Cape Province Number of Health Services Posts Lost 1995 - 1999

0

1000

2000

3000

4000

5000

Academic

Regional

District

Other (metro)

PAWC Department of Health

- * -

Operations performed: Case of Ear, Nose, Throat Surgery

Theatre cuts

18

7

- * -

Average waiting times for surgeryCardiac valve surgery (~ 18 months);Cataracts (> 1 year, > 1000 cataracts);Joint replacements (>3 years, >700 patients);Colon cancer (> 2months);Breast cancer (> 6 weeks).

- * -

Challenge 2: Comprehensive Service Plan (2010) Beds and Staff To Be Cut Further at the Tertiary Level19% reduction

Tertiary Beds

(Tygerberg, Red Cross Children's and Groote

Schuur Hospitals)

1601

1290

0

500

1000

1500

2000

Current Total

Projected Healthcare 2010

Number

- * -

CSP - Funding43% reduction

Tygerberg, Red Cross Children's and Groote Schuur Hospitals Current Funding and Proposed Funding for Tertiary Services

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Current Total

Rands (million)

Projected Healthcare 2010

1737

986

- * -

Principal Specialists39% reduction

Principal Specialists at Tertiary Hospitals

(Tygerberg, Red Cross Children's and Groote Schuur)

49

30

0

10

20

30

40

50

60

Current Total

Projected Healthcare 2010

- * -

Specialists/Senior Specialists51% reduction

Tertiary Hospitals (Tygerberg, Red Cross Children's

and Groote Schuur) Senior Specialists/Specialists

235

115

0

50

100

150

200

250

Current Total

Number

Projected Healthcare 2010

- * -

Registrars (Specialists in training)43% reduction

Tygerberg, Red Cross Children's and Groote Schuur Hospital

Registrars

509

290

0

100

200

300

400

500

600

Current Total

Number

Projected Healthcare 2010

- * -

Impact on tertiary services Good Primary Health Care System has a strong primary, secondary and tertiary level services componentMore patients seen at primary level means more referrals up to, secondary tertiary careMore pap smears at primary level = more women requiring surgery (up to 30%) Unethical to have patients referred upwards and not have personnel, resources to be able to treat them

- * -

Impact of cuts on teachingTeaching and training dependent on adequate clinical platformAccess to real patients in clinical settings backbone of clinical training in UG and PG contextsClinical training begins in third year of MBChB800 students from UCT need to accommodated on platformTotal number of beds required 1480Many patients too ill to have students examine them

- * -

Training of Registrars in Surgical disciplinesBased on apprenticeship need to enhance skills in theatreReduction in theatre time less time for training Reduction in numbers of registrars impact on services (patients with life-threatening illnesses cannot be treated in time) impact on numbers of specialist trained impact on medical students trainingHigh levels of trauma beds not available (specialists and registrars spend time looking for beds)

- * -

Why is there a mismatch between demand and supply of health services in the Western Cape?Western Cape serves 13.5% of patients in the country (based on Patient Day Equivalents) but receives 12.25% of national funding for health (including conditional grants)Growth in the W Cape health budget has not kept up with patient growth over the years Department of Health projects a R201 m over expenditure for 2007/2008Patient load divided by population is 50% higher in the Western Cape than for the countryPopulation may be an inappropriate norm for measurement of budgets and costs

- * -

Why is there a mismatch between demand and supply of health services in the Western Cape?National Tertiary Services Grant has remained constant in real terms (i.e., no increase to cover the growth of patients)A costing study estimated the cost to the W Cape of providing highly specialised services to be R2.5billion, while the NTSG allocation is R1.3 billion.Over the last 6 years to 2006/7, the Health Professionals Training and Development Grant has been reduced by R110m in real termsThis province trains 30% of country's medical students, but it receives only 21% of the HPTDGA costing study indicated the cost to the WC of training of students of R450m, while the HPTDG allocation to province is only R333m

- * -

Challenge 3: Human resourcesFlight of highly skilled nurses (pharmacists and others) to the private sector or overseasLimited career path for medical specialists and other categories of staff Lack of agreement on the concept of Joint Staff between universities and provincial government

- * -

What is needed?Planning: Development of a health service to meet the basic needs of the populationPrescribed minimum benefits for primary, secondary, and tertiary careFunding: Appropriate funding of the health services in the Western Cape and NationallyAdequate levels of the conditional grants: National Tertiary Services Grant and Health Professions Training and Development Grant (HPTDG)Full implementation of the Modernisation of Tertiary Services ProgrammeFramework for governance of Academic Health Complexes: Implementation of the National Health ActJoint Agreements to benefit the country

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ConclusionPublic health services are underfunded in the WC (and nationally)Progressive erosion of services at secondary and tertiary levels, in the face of rising demand, has impaired ability to provide adequate health service to the people of South AfricaRight of access to primary healthcare impacted negativelyPotentially irreversible destruction of major national healthcare assetsAppeal for adequate funding of healthcare from national and provincial budgets

19% reduction