Presentation of the Budget Vote for the Western Cape Department of Health

by Aug 16, 2009All Articles

Western Cape Provincial Parliament
Tuesday, 23 June 2009

Mr. Speaker, Honourable Premier Zille, Leader of the Opposition, Members of the Diplomatic Corp,Honourable Members, Role Players from the Public and Private Health Sector, Media Representatives, Guests, Ladies and Gentlemen INTRODUCTION
Speaker, it is with pleasure that I rise to deliver the budget speech of the Western Cape Department of Health for the first time – a budget we inherited from the previous ANC-government.  Our new provincial government is committed to the principles of an open opportunity society that offer opportunities for all.   In my term as Provincial Minister of Health I intend to ensure that the Department of Health will indeed be opportunity-driven.  Many new initiatives will be investigated and implemented with major different emphasis on improving service delivery, problem solving and addressing the challenges we are facing.   

At the outset, let me say that I regard the Western Cape Department of Health as a well-functioning department with both competent and skilled clinical staff, many of which is amongst the best worldwide, and strong management, providing health services across the Western Cape under difficult circumstances – not only increasingly more difficult circumstances in South Africa and the Western Cape, but indeed worldwide.  I am supportive of the initiatives taken by the Department to restructure Provincial Health Services and acknowledge that in many areas the Department has led the country in this regard.  Nevertheless I acknowledge that there are many things in the health care sector that require urgent radical change, innovation and attention, and in my term I intend to focus on these.  I will not only be fine tuning the current budget expenditure, but I will also address the narrowing of the gap between current service delivery and expectations – I regard this as my main political challenge. 

First, let us look at the current status of health care in the province and the legacy that was left by my predecessors in the ANC. 

I must place on record my concern that the funds allocated for health services in the Western Cape are inadequate to meet the needs, and indeed the expectations, of the people of this province. 

Seven years ago, under the leadership of the then DA-led government, health services in this province was certainly in a much better state of affairs than it is now – and the previous ANC-government has to accept the responsibility for this.  I am specifically referring to the shortage and morale of doctors and nurses and the lack of capacity at various levels, such as the Emergency Unit at Tygerberg Hospital.   Our hospitals are understaffed and our doctors and nurses are leaving our hospitals and clinics for greener pastures.   The Occupational Specific Dispensation that should have been paid out to doctors since July last year, have been on hold, bringing about low morale.  With reason, our medical staff is unhappy about their working conditions, and compensation.  We have capacity problems as there are not enough beds, and the beds that we do have are occupied by sufferers of lifestyle diseases.  Examples of these are rife – teenage pregnancies, homicide, substance abuse, road-accidents, TB and HIV/Aids patients. 

In line with my priorities, I will emphasize those issues that are important to this new provincial government.  In saying this, I want to emphasize that I support the management and staff in their efforts to restructure the health care services, in line with the Comprehensive Service Plan.  I am impressed by the rigorous work done in its development and have noted that this plan, based on a model for health services developed within the department without the use of consultants, is regarded as a potential model for the country.

By the same token I must state on record my concern regarding the quality of health care as reflected by complaints of poor service reported either to the department, or directly to the media.   I acknowledge the good work of very many health workers and staff across the province under difficult circumstances, but I have directed the department to urgently address staff attitudes and all issues relating to the delivery of quality of health care.  I am aware that there are already innovative strategies being implemented by the department in this regard.  Health care is very expensive and therefore we have to concentrate and emphasize on the freebies in life, such as honesty, openness, friendliness, dignity and serviceability – or simply put – we have to treat our patients better!  The fact that people are poor and therefore entitled to free health care, can never justify poor treatment and service!    

I will also address the challenges resulting from inadequate infrastructure.  I will be engaging with my colleague, Minister Carlisle, regarding the poor performance of contractors that resulted in completely unacceptable levels of under-expenditure on construction projects during the past financial year.  This new provincial government will find effective solutions to prevent a recurrence of this unacceptable state of affairs.  

A particular issue of concern is the under-funding from the national conditional grant for HIV and AIDS, which includes anti-retroviral therapy, with a deficit in the previous financial year of R27 million.  This will escalate even further to a projected deficit in 2009/10 of around R60 million.

It is the Department’s task to drive an efficient programme within the allocated budget, and it is my duty, responsibility and challenge to re-strategize the department to address those needs and demands beyond the budgetary provisions.  I regard it as my political challenge and objective to narrow the gap between the available budget on the one hand, and the overall demand for Health care on the other!  To be able to succeed with this, requires innovative out-of-the-box thinking, management and leadership and business-unusual.  

Mr. Speaker, let me now turn to the key priorities of the Department of Health for 2009 as outlined in the Budget Statement and the department’s Annual Performance Plan.

Firstly, through the further implementation of the Comprehensive Service Plan, the department will address the important issue of the quality of health care delivery.  Media reports in recent months have focused repeatedly on quality issues and I give my commitment in this house that improving the quality of health care services across the province will be a priority of my term as Minister. 

Secondly, since Tuberculosis together with HIV and AIDS, poses a major threat to this province the department will strengthen the TB programs aiming to improve cure rates, which are the best in the country, still further and improve the management of people with in particular drug-resistant TB.  In respect to HIV and AIDS the department will embark on targeted, integrated prevention interventions and increasingly move to district-based treatment of people living with AIDS, building on the existing programs to prevent the transmission of the HI-virus from mothers to their newborn babies and treatment for people living with AIDS.

We will take the campaign against HIV and AIDS to a higher level, by developing with all stakeholders in the province a new strategic plan with the aim of reversing the prevalence trends across all age groups in the province and to expand the number of patients on ARV treatment.   Our previous DA-government in the Western Cape distinguished the Western Cape from the rest of South Africa with the introduction of ARV’s – it is my intention to build on the sound and commendable work that was done in the past, and to take the firm lead in South Africa in this regard. 

Thirdly, the department will address service pressures, which are the consequence of significant inward migration to the Western Cape and an increasing burden of disease resulting from in particular, trauma and substance abuse.  Here I would like to highlight the challenges posed to the department by TIK and alcohol abuse, which I might add are not only the responsibility of the Department of Health.  The department will during 2009 strengthen services in the areas of mental health, obstetrics and neo-natology, surgery and emergency care.

Fourthly, mechanisms will be strengthened to assess the burden of disease.  As I have already mentioned, many of the reasons for people needing health care are outside the health sector.  The department will be developing strategies, together with other government departments as well as individuals and organizations outside government, to begin to reduce the burden of preventable disease, thus freeing up resources for other much needed priorities within health. 

Fifthly, the department has attempted to increase the funding available for maintenance to address the major backlog estimated at around R800 million set against infrastructure with an estimated replacement value of R13,5 billion.  The construction of two new hospitals in Khayelitsha and Mitchell’s Plain is a priority, although the funding of the Mitchell’s Plain Hospital now poses a major challenge for the province.  This is due to the fact that the National allocation through the Hospital Revitalization Program is not available as initially indicated.   

Finally, particularly in the difficult financial environment in which we find ourselves, it is imperative for the department to strengthen the human resource and financial management capacity to improve performance in these key areas.  Effective service delivery is dependent on efficient appointment and procurement processes in the department at all times. 

Mr. Speaker, I will now deal with the details of the budget allocated to Vote 6, Department of Health, for the 2009/10 financial year.  The Department of Health receives the second largest budget, in total R9,892 billion of which R6,638 billion originates from the equitable share to provinces, and R2,819 billion from specific conditional grants to the province for health services.  The balance is made up of funding from the asset finance reserve, provincial revenue fund and departmental receipts.  Departmental receipts, of which the major proportion are from hospital fees, amount to R272 million.  The amount allocated is a 13% year on year increase in nominal terms, but in real terms, after taking into account salary adjustments – in particular the introduction of the Occupational Specific Dispensation for nurses and medical inflation, which is significantly higher than the CPIX inflator.  There is no increase year on year, despite increasing demands on health services in the Western Cape.

The budget is allocated between the eight programmes of Vote 6 with the major proportion, 86%, allocated to the four programmes dedicated to service delivery.  These programmes will fund activities in four areas, that is, acute services including emergency medical services and acute hospital services, ambulatory care including outreach and support, infectious disease management and de-hospitalized care, better known as home-based care.

Compensation for nearly 28 000 employees in the Department of Health is allocated R5,364 billion or 54,2% of the total budget, while goods and services receive R3,273 billion or 33,1%.  Transfers and subsidies amount to R505 million or 5,1% and expenditure on buildings, machinery and equipment is budgeted at R749 million or 7,5% of the total allocation to Health.

Administration (Programme 1) receives R313 million or 3,1% of the total Health budget. These funds provide for the strategic management and overall administration of the Department.  Included in this amount is R14,5 million to address cost pressures in information technology in the Department and a further R4 million for the shift of the internal audit function from the Treasury to the Department.

District Health Services (Programme 2) receives 35,4% of the Health budget at R3,503 billion to render primary health care (PHC) and a district hospital service which translates into a nominal increase of R374 million or 11% from the previous year.  The programme provides a wide range of health services in clinics, community health services, district hospitals as well as community-based services such as home-based care, care to abuse victims, chronic care and school health services.  This will allow the Department to handle more than 15 million PHC visits with a per capita utilization rate in the uninsured population of just under 4 visits per year, which will be the highest in the country.  In addition, district hospitals will handle over a million patient day equivalents and more than 690 000 outpatients during the 2009/10 financial year.
Key deliverables will be to strengthen and extend the district health system with the extension of the six district offices and the four Metro substructure offices to improve the efficiency and quality of services delivered.  The appointment of family physicians during this year will further enhance clinical governance and thus the quality of the services delivered.  The number of home-based carers will increase to 2500 enabling community-based services to achieve over 2 million visits to around 30 000 clients. Medication for chronic diseases provided through an alternative system of pre-packed medication to reduce waiting times within health facilities, will reach 2,2 million prescriptions during this financial year from the approximately 1,5 million dispensed during the previous financial year.

Tuberculosis remains a major health challenge for the Western Cape, despite the province having the highest cure rate in the country.  The implementation of the Direct Observed Treatment Strategy (DOTS) will be strengthened in high TB burden sub-districts while HIV positive TB patients and those with multi-drug and extremely drug resistant TB (M(X) DR) will receive special attention.

Despite the province having the lowest HIV prevalence, the provincial strategy based on the National HIV and AIDS and Sexually Transmitted Infections (STI) Strategic Plan (NSP) will focus on prevention through social mobilization, prevention of maternal to child transmission, voluntary counselling and testing and the provision of condoms for both men and women.  The province will continue to broaden the access of anti-retroviral therapy (ART) to those who require it.

Women, child and youth health will be addressed, with a focus on preventing unwanted pregnancies and for those women who are pregnant, ensuring that they register for antenatal care before 20 weeks gestation through the roll-out of the Basic Antenatal Care (BANC) program to additional facilities.  Immunization of children will be extended by increasing overall coverage and by the introduction of a vaccine to prevent pneumococcal infections.

Emergency Medical Services (EMS) (Programme 3) is allocated R488 million (4,9% of the provincial health budget) increasing nominally by 20% from the previous financial year. This programme renders road and air ambulance services, communications and special operations including rescue and events, which includes preparation for the FIFA 2010 World Cup Football tournament.

In addition, the program funds patient transport services (Healthnet) which is responsible for the transport of patients to and from outpatient services.  Funding (R44,8 million) has also been made available for EMS in Vote 1 Department of the Premier for the essential equipment, infrastructure and staff required for the FIFA 2010 World Cup which will be managed by a designated project manager from the Department of Health.

Provincial Hospital Services (Programme 4) receives the second largest slice (26,5%) of the health budget at R2,621 billion with a nominal increase of R263 million or 11% over what was allocated in the 2008/09 financial year.  This program provides for a wide range of hospital and other services delivered in general regional hospitals, tuberculosis hospitals, psychiatric hospitals, the Western Cape Rehabilitation services and the dental training hospitals.

This programme funds general specialist care in 2342 regional and central hospital beds, providing annually around 723 000 patient days of general specialist care to the people of the Western Cape.  These services have been under severe pressure over the last few years from increased patient numbers, as well as the severity of the conditions with which patients present to hospital.  During the 2009/10 financial year emergency units in the regional hospitals will be strengthened, services reconfigured, referral patterns for patients within the Metro rationalized and the acute emergency case load policy and triage system implemented to promote the most efficient utilization of available bed capacity.  The appointment of additional emergency medicine specialists in emergency units in regional hospitals will significantly improve the standard of care in these units.

In other activities funded by this program, tuberculosis hospitals will be strengthened by outreach from general specialist services and increasing management efficiency at these hospitals.  Particular focus will be given to the improvement of psycho-social element of care for patients in these hospitals, especially those suffering from multi-drug and extremely-drug resistant TB – M(X) DR TB.

Within the psychiatric hospitals the drive to de-hospitalize chronic patients will continue.  Ambulatory services, community-based services and the successful outreach initiative with assertive community teams to support discharged patients, will reduce the rate of readmissions.

The Western Cape Rehabilitation Centre will provide technical expertise to district health services to facilitate the development of community-based rehabilitation services in line with the Comprehensive Service Plan.  New initiatives in oral health will include a selective fissure sealant program for grade 1 children in four schools, together with the implementation of the primary oral care treatment package for both children and adults.

Highly specialized services are funded from Programme 5 and provide health services that require very highly trained and specialized medical specialists backed by sophisticated and often very expensive equipment.  These services are provided exclusively in the three central hospitals, namely Groote Schuur, Tygerberg and Red Cross War Memorial Children’s hospitals.  The program has been allocated R1,9 billion which is largely funded from the National Tertiary Services and Health Professional Training and Development conditional grants, with only a small component coming from provincial equitable share funding.  The program shows a very small nominal increase of R51 million or 2,8%, largely as a result of the fact that the major grants from which this funding originates, have not increased to the extent that they should have.  This creates major challenges for the hospitals that are faced with increasing numbers of patients of greater complexity with flat budgets that are decreasing in real terms.

These hospitals will handle over 600 000 patient day equivalents during the coming financial year and see around 480 000 outpatient visits.  The configuration of services within the hospitals will continue to be restructured in line with the Comprehensive Service Plan.  Beds will be redefined within the three hospitals according to the levels of care.  This will allow for the most optimal utilization of the available resources to meet the demand for services within a unitary tertiary highly specialized service.

Health sciences and training, which provides for the training of actual and potential employees of the Department of Health is funded by Programme 6, and is allocated R191 million or around 2% of the vote in 2009/10 which is a nominal increase of 6,8%.  The programme will fund 2210 nursing bursaries and 394 bursaries for other health professionals.  It is envisaged that around 300 nurses will graduate at the end of the academic year and be absorbed into the service to address some of the shortages of nursing personnel who make up the largest single component of health professionals within the Department of Health.

Health Care Support Services (Programme 7) largely provides funding for laundry, engineering and forensic pathology services and is allocated R178 million or 1,8% of the health budget.  The replacement of equipment within the provincial laundries will continue during 2009/10 and the laundries will strive for greater efficiency leading to lower costs per item laundered.  The department has again allocated an additional R10 million to begin to address maintenance backlogs, but this remains inadequate against the estimated total backlog of R800 million and alternative funding streams will have to be sought.  Further consolidation of forensic pathology services will continue during this financial year and to improve the integration of the service into the Department of Health, it will from 2009/10 reside managerially under the Chief Directorate Regional Hospitals, APH and EMS.

Finally, Programme 8, which deals with health facilities management and provides for new health facilities, upgrading and maintenance of existing facilities is allocated R685 million spread across all types of facilities on a project basis with the major share going to district and provincial hospital services.  The funding to this programme is derived from national conditional infrastructure grants for hospital upgrading and provincial infrastructure as well as the provincial equitable share amounts to almost 7% of the health budget and shows a 56% nominal increase of R246 million against the revised estimate for 2008/09, but a R77 million or 11% year-on-year increase.  There is an earmarked amount of R113 million for maintenance and a once-off amount of R40 million for the emergency center of Somerset Hospital which is required to bring it up to standard for the FIFA World Cup in 2010.


It remains uncertain as to why this project was initially approved by National Treasury, along with the Khayelitsha Hospital, and then fell to the wayside.  The lack of commitment from National Treasury certainly raises scepticism.  It is of utmost importance to ease the burden on the GF Jooste Hospital, and in terms of the implementation of the Comprehensive Service Plan, to proceed with both the Khayelitsha and Mitchell’s Plain Hospitals.  I made a proposal which was approved last week at Cabinet, to cancel the current tender and re-tender within 3 months – with an extended contract period from 36 months to 54 months.  This is subject to a legal administrative process to be undertaken in this regard.  Of importance is that this government accepted the challenge to overcome the budget shortfall from National Treasury for this hospital and will continue to build the Mitchell’s Plain Hospital with additional provincial resources.  This bears testimony to the commitment and innovation of our government to enhance health care in the Western Cape. 

It is by now common knowledge that the National Government envisages to implement the controversial NHI.  The DA as Official Opposition in South Africa, as many other important role players in the industry, has expressed its view, concerns and disapproval of this plan.  The DA has also communicated its alternative solution to the NHI.  I will not repeat this in detail again, but I will instead reveal many of the alternatives to the NHI that our provincial government will be investigating to implement in the Western Cape.  I will now explain in more detail our 10 main alternatives under the headings of:
1.    Private Health Sector and Representative Institutions
2.    Hospital Facilities Boards and Hospital Incentives
3.    Non-Essential Expenditure
4.    Sustainable Income Streams
5.    Social Responsibility and Awareness
6.    Asset Management
7.    Transparency
8.    Staff and Scarce-Skills Recruitment
9.    Medi-tourism
10.    Dashboard Oversight 

I will establish a much closer working relationship with the private Health care sector and representative institutions in Health care.  I find it extremely unfortunate that my predecessors neglected this relationship to the detriment of the people in our communities, especially those with the least opportunity for health care services.   I will rectify this situation and relationship and I will interact with the private Health care sector, and with as many as possible of the representative institutions in the Health care sector, such as the South African Medical Association (SAMA), the South African Hospital Association, the Treatment Action Campaign (TAC), and various other.  I will do this with the aim and objective of entering into strategic partnerships, joint ventures and co-operation, investigating the possibilities of outsourcing some of our core and non-core services, such as the preparation of meals to patients, laundry services and others.  I will also investigate the possibility and viability to invite private health care to tender to undertake certain routine surgeries and medical services and procedures.  We will certainly also explore the possibility of interacting with private sector investors and service providers to provide facilities such as hospitals or clinics or to tender for comprehensive public Health care services or as operators, as already suggested by Dr. Nkaki Matlala, member of the Medi-Clinic Board, and chairman of the South African Hospital Association.

I have little doubt that the only viable solution to our enormous challenge to provide and improve Public Health care can only be achieved with closer relationship, co-operation and joining of forces between public and private health care.  I will certainly explore every possible option and opportunity to co-operate, interact and transact with Private Health care.  I am absolutely astonished by the fact that a hospital in a small neighbouring country, Lesotho, has already undertaken this successfully with the Private Health care sector in South Africa.

I will re-address the current mandate and functions of Hospital Facilities Boards.  The aim will be to improve service ability, oversight and participation in the operation and functionality of our hospitals and facilities.  Innovative incentives will also be developed for individual hospitals through which they could become centers of excellence and be able to be more efficient and successful.

I will undertake an exercise, bearing in mind the current economic realities and challenges we are facing, to shrink non-essential expenditure without in any way compromising the delivery of core and essential health care services.  We will cut down on the expenditure of any unnecessary expenses relating to meals, wheels, deals and advertising.     

I am considering a variety of mechanisms to broaden and increase sustainable income streams for the Department of Health, not only by means of advocating and canvassing for increased National allocation to the Western Cape Health Department, but also through other avenues within our own ambit and competency of Provincial Government.   This will certainly also include a re-visit to the fee structures for private health licensing and the possibility to implement an annual renewal fee for these licenses. 

In order to address our dire need for additional income to enhance service delivery and striving for equality and improved quality in health care, I will be undertaking a comprehensive investigation into the possibility of a Health Levy in this province.  This investigation will comprise consultation with all relevant role players and stake holders, as well as investigation into the impact and nature of such levies in other countries.   This Health Levy could possibly be applicable to all those who pay for health services in the public and private sector.  The Levy could possibly be applicable to bed occupancy, consultation and medication prescription.  I believe that people will be prepared to contribute to a Health Levy if they had the assurance that the income generated by this will be dedicated towards specific health care initiatives and programs.  We need to work towards a more equal health care system narrowing the level of service between the rich and the poor, without compromising the high level and standard applicable in private health care.  This means we have to strive to improve the standard and level of service of public health care to match that of the private sector.  This is one of the most important differences in our proposal as alternative to the NHI.  The implementation of the NHI will result in reducing the quality and standard of private health care closer to the lower level in public health care – exactly the opposite.   This Health Levy would be similar to the previous initiative to implement a Fuel Levy and the current Tourism Levy.  Should it prove viable that such anticipated Health Levy could succeed in bringing better health care to the poorest of the poor, it would certainly become a very important contribution to equality, quality and opportunities for all in Health care.

Further to the strengthening of sustainable income I will embark on a commercialization exploration of trading with the names rights of some of our facilities, similar to the names rights attached to many sport stadia, as well as the marketing and advertising potential of various facilities – both inside and outside these facilities.  Many of our facilities and institutions, such as Groote Schuur, are internationally renowned, and this could possibly have an additional monetary value.  Many other health facilities are well positioned in terms of location and offer commercial potential.  I believe corporate institutions and commerce will be keen and willing to obtain the commercial value and opportunities, and simultaneously fulfilling their social responsibilities.    

The plan is to promote social responsibility in our communities, targeting and addressing the “up-stream” factors which increase the burden of disease and health problems of the people of the Western Cape.  This will be purpose-driven and geographically-aligned to be effective.  This government envisages embarking on private sector co-operational sponsorship with specific awareness and life skill enhancement to specific pre-targeted areas addressing specific burden of disease, as the conventional shot-gun approach is too expensive and ineffective.  I already had very fruitful discussions with interested parties in this regard.    

I will interact and collaborate with my colleagues in Finance and Transport and Public Works to undertake a comprehensive exercise to re-strategize the optimal utilization of all property and facilities currently occupied by the Department of Health, by means of a facilities / property audit with the aim of developing a re-utilization program to ensure optimum, adequate and most appropriate functionality of all health infrastructure, thus freeing up latent capital for urgent and critical health care infrastructure development to promote improved service delivery.  This will be a provincial initiative to create and form capital to address both maintenance and the backlog of much needed facilities and to finance other important programs to enhance our service delivery. 

We will open the procurement and staff appointment processes in the Department of Health to public scrutiny to promote the culture of accountability and transparency in government in the Western Cape.

Continuous assessment and support will be implemented and undertaken to assess management to ensure fitness for purpose.   We will embark on a purpose-driven exercise to recruit health staff nationally and internationally.  This Cabinet is preparing an inter-departmental resolution to this effect. 

We want to look into the expansion of a niche tourism market – medi-tourism – using existing international marketing structures to market packages that will include transport, accommodation, and medical treatment for overseas people, that will be more affordable for especially UK, USA and European visitors, given the favorable exchange rate, the popularity of the Western Cape and Cape Town as destinations.  The aim will be to enter into agreements with international medical insurance companies directly instead of canvassing individuals.  This is a market not yet fully researched and packaged, and offers income possibilities for health care facilities in both the public and private sector and simultaneously earning valuable currency for our Province.  .      

And finally, to ensure that the department and I deliver on these undertakings, we will implement the dashboard evaluation system to enhance delivery and management systems within the Department.  This will become a very important operational tool to ensure projects to meet deadlines and evaluate performance. 

Health services have undergone significant restructuring during the past few years, in line with the Comprehensive Service Plan of the department.  This has occurred in the face of the ongoing challenges of increasing patient numbers, increasing severity of the disease burden and a budget that has not matched these increases.  The Annual Performance Plan of the department spells out in detail the next steps in this process, and bears evidence to the fact that this department delivers health service far better than any other department in the country and in Africa.  I recognize this by realizing that the service in the rest of our country can certainly not be our benchmark – as we strive to render a service equal to the best in the world and according to the expectation and demand of those in need in our Province.  I am, however, determined to focus attention on issues such as the quality of the service we provide and how effective management can reduce wastage.  This will result in more resources being available to the sharp end of service delivery during this and future financial years taking this department to higher levels of performance.

I would like to express my sincere appreciation to health workers in the Western Cape who work hard, often under very difficult and unpleasant conditions, to provide health services across the length and breadth of the province every day and night of the year.  My sincere thanks and appreciation go to the management of the Department, Prof. Househam and his team, for the hard work in compiling this budget and the difficult choices that they have made in this process, particularly in this financially constrained times in which we find ourselves.  Thank you also to my Cabinet colleagues, the Chairperson and members of the Standing Committee and my office staff.  A special thanks to my family for their support.     

It is early days in my term as provincial Minister of Health, and I am sure that in time I may alter the emphasis in certain areas and make changes where appropriate, but I am satisfied that the budget as tabled in this House represents appropriate utilization of the funds available for health services in the Western Cape.

Thank you Mr. Speaker

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