Life, death and budget cuts: the tricky balancing act

When Western Cape Minister of Health Nomafrench Mbombo delivered her budget speech this week, it was clear poor people dependent on public healthcare in violence-prone areas like the Cape Flats should manage their budget and health-service expectations. The provincial Department of Health was allocated R24,8 billion for the 2019/20 financial year with a budget cut of R187 million. The total health budget cuts over the last three years amount to R1,2 billion whilst patient numbers consistently grew.

Given the high levels of interpersonal violence, mainly due to gangs and alcohol in the province, emergency health services need to be prioritised. It is within this context that the ANC in the Western Cape Provincial Parliament recently during deliberations on the health budget raised concerns over the impact of a shrinking budget on service delivery. ANC MPP Maurencia Gillion grilled the department for only budgeting for two additional ambulances amidst a growing need for emergency services, complaints over poor response times and not enough staff. The budget for emergency services increased by 4%, barely covering the annual inflation rate. A total of about R1,1 billion is allocated for emergency services for the 2019/20 financial year. ANC MPP Pholisa Makeleni also probed. “You say the department prioritises emergency services, but it doesn’t show in the budget. That is why our communities are frustrated because they call an ambulance and it is always late. The excuse is then that there are not enough ambulances.”

Head of department Dr Beth Engelbrecht agreed that more ambulances are needed, but that they should make the best of the resources available. “Every ambulance takes 11 staff members, so it is quite a significant financial investment to run ambulance services. I agree, we need more. For now, we must see how we can combine emergency services with our Healthnet (patient transport) service because not every case requires an ambulance.” Engelbrecht explained that despite budget cuts, emergency services are still a priority, but also one of many competing health service needs. Engelbrecht also told MPPs it is not just about Rands and cents, but also a bigger societal problem of violence and emergency-services personnel constantly under attack. A week ago, another ambulance was attacked in Khayelitsha and two emergency staff members were robbed at gun point.

According to chief director-general of Specialist and Emergency Services in the provincial health department Dr Saadiq Kariem, the impact of the high levels of violence in society is spilling over into emergency and pathology services. “On any given day we have on average 70 emergency services personnel booked off sick due to post-traumatic stress related to attacks and robberies of ambulances. The majority, which amounts to about 90%, is in the metro area. This means about seven vehicles are taken out of service daily.” There are 269 ambulances in the department’s service. In March this year, Emergency Services received 52 893 calls. EMS responded to about 30 000 in under an hour.

Kariem said violence in communities adds to EMS’ delayed responses. This is mainly due to certain hotspot areas of gang violence declared as Red Zones. EMS personnel will thus have to get a police escort before entering the area, which takes time. Therefore it is not just about getting more staff and vehicles, but a broader societal issue that must be addressed.  Kariem said that adding to this challenge is a severely stressed forensic pathology service. In 2018, almost 12 000 cases were admitted across the province.  “The Metro area has yet again seen a significant increase in admissions to the two large facilities with 8 437 cases admitted. December saw the busiest month in the history of the Tygerberg unit (morgue) with 435 cases admitted, and 367 admissions to Salt River (morgue). This leads to massive increases in the case load per pathologist.” Kariem explained the international norm is about 250 cases per year. Here the case load is 900 per pathologist. Mbombo said in her budget speech the department budgeted for two additional forensic specialists, six forensic officers and will increase the number of forensic assistants to 50 in the 2019/20 financial year to help ease the case load.

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