Presentation to Portfolio Committee Faculty of Health Sciences
- Slides: 28
Presentation to Portfolio Committee Faculty of Health Sciences UNIVERSITY OF CAPE TOWN
Challenges Facing Health Care in the Western Cape • The role of the Faculties of Health Sciences in the Western Cape • Challenges facing health care in the Western Cape • What are the potential solutions to the health care challenges? -2 -
Committed to • Education and training health professionals responsive to needs of country • Provision of a healthcare service at most appropriate level of care • Conducting essential national health research to improve the health of the nation -3 -
Guiding principles • Partnerships with others (Provincial and National Do. H, other HEIs, MRC, NGOs and other sectors) • Transformation (adoption of Faculty Charter, curricula transformation, sites of teaching) • Equity in health (adoption of Primary Health Care philosophy as Lead Theme) -4 -
Education and training • We educate and develop quality health care personnel for the country (30% from the Western Cape) • We train undergraduate (UG) and postgraduate (PG) students in audiology, dietetics and nutrition, OT, physiotherapy, speech language pathology and medicine • 1742 UG students (1145 in medicine) and 1173 PG students (353 registrars/trainee medical specialists) • Striving to ensure demographic profile approximates that of population -5 -
Transformation of our Student Body (UG) 1994 2003 -6 -
Health care service • Primary level of care : – Sites: e. g. , Vanguard, Khayelitsha, Retreat CHCs – Services: e. g. , Medical, Audiology, Physiotherapy • Secondary level of care: – Sites: e. g. , New Somerset, GF Jooste, and Victoria Hospitals – Services: General Specialist Care in Medicine, Surgery, O&G, etc • Tertiary level of care: – Sites: e. g. , Groote Schuur, Red Cross Hospitals – Services: Specialist and Super specialist care (e. g. , Cardiology) • Quaternary level of care: – Unique national services: e. g. , Heart and Liver Transplantation – Relevant to public and private sectors (only one of a kind in Africa): e. g. , molecular genetic testing for inherited heart disease -7 -
Health care service: challenges • Increasing demand for health services – Population growth – Increasing disease burden: HIV/AIDS, trauma, and disease of lifestyle – Migration from other provinces: N. Cape, E. Cape (228% increase in Xhosaspeaking patients in 3 years) – Refugees • Underfunding of health services in the W Cape: – Historic budget cuts from 1990 – Healthcare 2010 Comprehensive Service Plan (CSP) promises further cuts – No provision made for quaternary/national services (e. g. , transplantation) • Human resource shortages and inadequate career paths: – Nursing shortage – Lack of adequate career path for other categories of staff -8 -
Challenge 1: Increasing demand for health services -9 -
Challenge 1: increasing patient numbers • Overall, patient numbers have been growing by 6% per annum • Central hospitals: grew by 8% in 2006/2007 (measured by patient day equivalents) • Regional hospitals: grew by 4% in 2006/2007 - 10 -
Challenge 1: Increasing number of deaths, mainly due to HIV/AIDS - 11 -
Challenge 2: Underfunding = Service Cuts since 1990 - 12 -
Loss of Service Posts since 1995 - 13 -
Operations performed: Case of Ear, Nose, Throat Surgery - 14 -
Average waiting times for surgery • Cardiac valve surgery (~ 18 months); • Cataracts (> 1 year, > 1000 cataracts); • Joint replacements (>3 ½ years, >700 patients); • Colon cancer (> 2 months); • Breast cancer (> 6 weeks). - 15 -
Challenge 2: Comprehensive Service Plan (2010) Beds and Staff To Be Cut Further at the Tertiary Level 19% reduction - 16 -
CSP - Funding 43% reduction - 17 -
Principal Specialists 39% reduction - 18 -
Specialists/Senior Specialists 51% reduction - 19 -
Registrars (Specialists in training) 43% reduction - 20 -
Impact on tertiary services Good Primary Health Care System has a strong primary, secondary and tertiary level services component • More patients seen at primary level means more referrals up to, secondary tertiary care – More 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 - 21 -
Impact of cuts on teaching • Teaching and training dependent on adequate clinical platform • Access to real patients in clinical settings backbone of clinical training in UG and PG contexts • Clinical training begins in third year of MBCh. B • 800 students from UCT need to accommodated on platform • Total number of beds required – 1480 • Many patients too ill to have students examine them - 22 -
Training of Registrars in Surgical disciplines • Based on apprenticeship – need to enhance skills in theatre • Reduction 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 training • High levels of trauma – beds not available (specialists and registrars spend time looking for beds) - 23 -
Why is there a mismatch between demand 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 R 201 m over expenditure for 2007/2008 • Patient load divided by population is 50% higher in the Western Cape than for the country –Population may be an inappropriate norm for measurement of budgets and costs - 24 -
Why is there a mismatch between demand 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 R 2. 5 billion, while the NTSG allocation is R 1. 3 billion. • Over the last 6 years to 2006/7, the Health Professionals Training and Development Grant has been reduced by R 110 m in real terms – This province trains 30% of country's medical students, but it receives only 21% of the HPTDG – A costing study indicated the cost to the WC of training of students of R 450 m, while the HPTDG allocation to province is only R 333 m - 25 -
Challenge 3: Human resources • Flight of highly skilled nurses (pharmacists and others) to the private sector or overseas • Limited career path for medical specialists and other categories of staff • Lack of agreement on the concept of ‘Joint Staff’ between universities and provincial government - 26 -
What is needed? • Planning: Development of a health service to meet the basic needs of the population – ‘Prescribed minimum benefits’ for primary, secondary, and tertiary care • Funding: Appropriate funding of the health services in the Western Cape and Nationally – Adequate 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 Programme • Framework for governance of Academic Health Complexes: – Implementation of the National Health Act – Joint Agreements to benefit the country - 27 -
Conclusion • Public 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 Africa • Right of access to primary healthcare impacted negatively • Potentially irreversible destruction of major national healthcare assets • Appeal for adequate funding of healthcare from national and provincial budgets - 28 -
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