Provincial healthcare is in crisis, with a R70-million overspend and projections that it will overshoot the budget by R120-million by the end of the financial year, new health MEC Theuns Botha has confirmed.
And, given that there are 6 000 vacancies, mostly of doctors and nurses, Botha has indicated he will move quickly on what he called a top-heavy administration, saying he would not rule out the possibility of freezing administrative posts in an attempt to boost medical staff numbers.
The admission vindicates chairperson of the SA Medical Association Dr Mark Sonderup, who was accused of "blowing things out of proportion" when he raised concerns about projected over-expenditure last month.
He said Groote Schuur Hospital alone was expected to overspend by R22-million in 2009, warning that the last example of similar overspending in 2007 led to bed cuts at Groote Schuur and Tygerberg hospitals.
Sonderup came in for flak from provincial health department spokeswoman Faiza Steyn, who has for weeks denied suggestions of over-expenditure.
Confirming the fact that the department faced "severe financial constraints", Botha admitted there were huge challenges ahead for public healthcare in the province, including a critical shortage of doctors and nurses.
He promised to make the filling of operational posts a priority, even if this meant scaling down on administrative and support staff.
"We need to determine how we can scale down on the administrative and support staff, and expand on the operational side of things.
"The staff component is too high and takes about 54 percent of the budget. We need to get a balance. If it means freezing those posts then that's what we are going to do," he said.
On the department's over-expenditure, Botha said it was too early for him to offer solutions, saying he would have discussions with Premier Helen Zille and Finance MEC Alan Winde.
But he offered the assurance that the solution would not involve compromising service delivery.
"We can't afford not to fill operational vacancies just to maintain our administration. I will do everything possible to make sure that critical posts are filled and beds are not cut. We can't let service delivery be hampered by not filling positions. It is something we can't run away from, otherwise people will die," he said.
Botha said he would also not let equity legislation stand in his way of recruiting people with scarce skills.
"We will do everything possible to adhere to equity legislation, but I'm not going to let that stand in my way," he said of a campaign to attract South African medics working overseas back to the country.
He also did not rule out recruiting foreign doctors to fill vacant positions.
The department was also looking at forging private-public partnerships where private agencies would be encouraged to invest in the province's healthcare.
Botha said he was in discussions with an overseas donor about a turn-key project, which could see the building of a fully-equiped 400-bed, hospital run by an agency for the province for the first few years.
The province would buy the hospital when it could afford to do so.
"As a province we will have to think out of the box and find other solutions to address the backlog of services at our facilities. We can't depend solely on national government for funding as the current health budget can't keep pace with our needs," he said.