By Peter Dickson
The Eastern Cape Department of Health, its hospital care services threatened with financial collapse within five years by an overload of Aids patients and its budget facing over-expenditure of R225- million this year as it struggles with a near billion-rand shortfall, went public this week on plans to rationalise state hospitals and seek private- sector partnerships.
Eastern Cape MEC for Health Dr Bevan Goqwana said his department’s budget for this financial year was R2,8-billion, but it needed R3,5-billion to make ends meet and rationalisation is the only way out of the provincial health care system’s costly mire of repetition and duplication of services.
Port Elizabeth’s three state hospitals – Provincial, Livingstone and Dora Nginza – and East London’s Frere and Cecilia Makiwane state hospitals are within a 30km radius of each other and a committee is investigating which hospitals will be rationalised.
Goqwana’s plan is to cut the average patient stay in hospitals – costing R400 per patient daily and with one out of every four patients being treated for Aids and Aids-related illnesses – from 11 to three days.
Goqwana said the provincial Aids rate had risen from 15,9% to 18% in only six months, according to the latest antenatal clinic survey, and was one of the reasons for the department overspending its budget this year. Port Elizabeth, Mdantsane and the Transkei area along the KwaZulu-Natal border have the highest infection record.
Other widely prevalent drains on the health care system were obesity – half the province’s women compared to 29% of its men are obese, Goqwana says – as well as chronic asthma (8%) and high blood pressure (12%).
He added that 45 out of every 1 000 Eastern Cape children died at birth, and that 59 out of every 1 000 would die before the age of five. He said the maternal death rate was 150 out of every 100 000 mothers, but this ratio would “increase drastically” as Aids began to take its toll.
Tuberculosis affected 311 out of every 100 000 people, half of them directly related to Aids.
Bisho legislators last week learnt that health department expenditure on its 33 000 personnel alone, due to unbudgeted and long-overdue promotion salaries, would exceed the budget by R625-million. Of the R1,9-billion personnel expenditure budget, the legislature’s health committee reported, R1,1-billion had already been spent in the first six months of the financial year.
The provincial treasury and the national Department of Finance last Friday promised a R400-million bailout, taking over- expenditure down to R225-million, but the Bisho health department will not be able to meet its R50-million revenue collection target despite a new patient billing system.
Goqwana says the department is experien- cing “transformation difficulties” among new and old senior officials, while the finance division is severely short-staffed at senior level.
Goqwana told a media briefing this week that rationalisation would not mean large- scale staff retrenchment or closure of casualty and outpatient departments, but hospitals would be honed to specialise in certain areas and patients transferred to the appropriate facility best suited to them after initial treatment.
State-aided hospitals, many situated close to each other and predominately in former “white” areas, would be downgraded to daytime health centres that outsourced chronic care, the two provincial drug depots cut to one and drugs bar-coded for specific clinics, district health department offices scrapped in favour of a few regional offices, and chief executive officers with sound business management skills brought in to run hospitals.