Good morning, ladies and gentlemen, and a very warm welcome to Netcare Limited's interim group results presentation for the six months ended the 31st of March, 2024. Welcome to the Chair of Netcare, Mark Bower, members of the Netcare board, our executive committee, and our senior management teams. Let me begin by expressing my very sincere thanks to our management teams and Netcare staff across all of our divisions for their hard work, collective efforts, and commitment over the past six months, and also thank the board for their support and guidance. I'm going to begin with an overview of our group results and the operational performance of our various divisions before handing over to our Chief Financial Officer, Keith Gibson, who will unpack our financial results in more detail.
I will then conclude by providing more detail on the progress we have made on certain key strategic areas and present our guidance for the remainder of the year. Just a quick reminder of the extensive and growing array of facilities and services we provide within the Netcare ecosystem across 10 unique divisions. Looking at our overall results, despite a very challenging macroeconomic and inflationary environment, the past six months for Netcare have been characterized by a steady performance, notwithstanding lower volumes in the first half of 2024.
And yet, despite lower volumes, a robust operating leverage supported by ongoing efficiencies, maintenance of a strong balance sheet, and improved return on invested capital to 10.9%, the return of ZAR 613 million to shareholders in ordinary dividends and share buybacks, completion of the rollout of the electronic medical records across our entire ecosystem, with financial benefits meeting expectations, and our environmental strategy, which reduces reliance on the national grid and mitigates risks from the water supply challenges. This solid operational performance translates into our financial metrics. Revenue rose 4.3% to ZAR 12 billion, and we achieved good operating leverage, as evidenced by the 7.5% increase in EBITDA to ZAR 2.1 billion. The EBITDA margin, excluding strategic and generator diesel costs, was maintained at 19.1%.
Adjusted headline earnings per share rose by 5.8% to ZAR 0.49, and as a result of this performance, we are pleased to declare an interim dividend of ZAR 0.30 per share, representing 61.2% of adjusted headline earnings per share. And finally, our net debt to EBITDA ratio rose to 1.3 x versus 1.2 x in the comparative period. Let's unpack the operational performance of our respective divisions in more detail. Turning to the hospital and emergency services division, total patient days for the first half of 2024 declined by 0.8%, which comprises a 1.7% decline in patient days across our acute hospitals and 7% growth in mental health. However, inclusive of April, thus stripping out the timing impact of the Easter school holidays in March, total patient days rose by 0.4%.
In acute hospitals, the decline in patient days was only 0.3%. Average acute hospital occupancies declined slightly to 62.1% from 62.6% in the comparative period. However, occupancies recovered to 62.7% for the seven-month period to the end of April. Mental health occupancies also declined slightly for the six months to 69.3%, but improved to 69.7% for the seven months to the end of April. The decline in mental health occupancy is largely a function of new beds added. Thus far, occupancy for the month of May has been encouraging, with acute hospitals now at 72.3% and mental health facilities at 74.5%. Let's take a look specifically at our hospitals and emergency services segment in more detail.
Revenue grew by 4.3% to ZAR 11.7 billion, and we achieved excellent operational leverage, resulting in an EBITDA growth of 8.2% to ZAR 2.1 billion. Operating profit rose by 9.3% to almost ZAR 1.5 billion. Unpacking the elements that impacted revenue, acute revenue was impacted by a decrease in respiratory, maternity, and private cases and, to a lesser extent, low-cost networks. Acute hospital revenue per paid patient day grew by 5.7%. The acute length of stay increased to 4.5 days from 4.3 days in a comparative period, driven by the higher complexity of cases. EBITDA margin for the segment expanded 60 basis points to 17.9% from 17.3%, supported by efficiencies and stringent cost management, as well as lower strategic and generator diesel costs.
Excluding strategic costs of ZAR 87 million and generator diesel costs of ZAR 37 million, an EBITDA margin of 19% was achieved. Importantly, the hospital and pharmacy operations sub-segment achieved an EBITDA margin of 19.7%, excluding strategic and generator diesel costs, an increase of 60 basis points. Pleasingly, we have also grown our specialist base by granting admitting privileges in acute and mental health facilities to an additional 59 new specialists. Let's take a look at primary care. Revenue grew by 6.3% to ZAR 337 million. Medical and dental patient visits were 4.6% lower than the comparative period. However, again, stripping out the timing impact of Easter school holidays in March, medical and dental visits declined by a much lower 1.5% for the seven months to the end of April.
EBITDA declined 9% to ZAR 71 million from ZAR 78 million in the comparative period. EBITDA margin declined to 21.7%, excluding generator diesel costs and a ZAR 2 million capital profit, in H1 of 2023. Margins were largely impacted by lower activity, including seasonality and an increased contribution from the lower margin occupational healthcare business. I will now hand over to Keith to unpack our financial performance in more detail.
Thank you, Richard, and good morning, ladies and gentlemen. It's my privilege to talk you through Netcare's financial performance for the six months ended 31 March 2024. A combination of factors, including the mismatched timing of the Easter school holidays, lower respiratory, maternity and private cases, as well as the impact of low-cost networks, resulted in a reduction of 0.8% in total patient days for H1 2024. Lower activity within the business, against a high inflationary backdrop, meant that we had to keep a tight rein on costs, and it's pleasing that under these conditions, we were able to deliver operating leverage, also aided by lower strategic and diesel costs.
The business has maintained its healthy state into financial position and improved its return on invested capital, ROIC, marginally to 10.9%, and we continued our share buyback program, which commenced in the month of September 2023, and we have to date invested ZAR 684 million to repurchase 54.7 million shares in the market. This next slide sets out the performance of the business by half over the past 3.5 years, and it reflects the steady recovery of the business from the severe impacts of COVID-19. More recently, over the past 6 months, the business has faced headwinds, as just described in the previous slide, which have placed pressure on activity.
But notwithstanding these pressures, this graph reveals how a 4.3% growth in revenue has converted to a 7.5% EBITDA growth and an 8.7% growth in operating profit, which is more than 2x operating leverage. The last graph reflects the group's net debt, which has grown to ZAR 5.8 billion at 31 March 2024. Although less pronounced in H1 2023, looking back over the past three years reveals that there is usual seasonality in the March balances, which are historically higher than September balances, and in addition, the share buyback program has also contributed to higher net debt levels. Although these still remain comfortable with the net debt to EBITDA coverage of 1.3x.
This brings us to the group's statement of profit or loss for the six months ended 31 March 2024, and to aid comparability, the numbers reflected in this slide exclude the impact of exceptional items, unless otherwise indicated. Revenue for the period amounted to ZAR 12 billion, compared to ZAR 11.5 billion in the prior period, growing by 4.3%. EBITDA for H1 2024 grew by 7.5% to just under ZAR 2.2 billion, against ZAR 2 billion in the first half of 2023, despite a decline in patient days for the period, aided by tight cost management, the benefits of digitization, reduced strategic costs, and lower levels of load shedding. Strategic costs for the first half of 2024 amounted to ZAR 87 million, reducing from the prior period to ZAR 127 million.
The group experienced a 2.6 weighted average level of load shedding in the current period, which was better than the prior period's average of stage 3.5, and consequently, diesel costs dropped from ZAR 67 million to ZAR 39 million. The group EBITDA margin improved by 50 basis points, from 17.5% to 18%, and I'll unpack this in more detail on the next slide. Operating profit increased by 8.7% to ZAR 1.5 billion, compared to almost ZAR 1.4 billion in H1 2023. Other net financial expenses of ZAR 267 million increased from ZAR 223 million in the prior period, and this reflects the impact of higher interest rates as well as higher average net debt balances.
The IFRS 16 interest charge attributable to lease liabilities of ZAR 251 million increased from ZAR 220 million in the prior period. Profit before tax increased by 7.1% to ZAR 1 billion. The group's tax charge amounted to ZAR 284 million at an effective rate of 28.4%, marginally lower than the 28.7% in the prior period. Profit after tax, before exceptional items, amounted to ZAR 716 million, representing a 7.5% improvement from ZAR 666 million in the comparative period. Exceptional items comprise property impairments of ZAR 11 million, with an offsetting ZAR 3 million tax impact. This reflects the current softness in the property market, which is facing the dual challenges of a struggling economy and interest rates sitting at fourteen-year highs.
Profit for the period, inclusive of exceptional items, amounted to ZAR 708 million, being 6.3% higher than the prior period's profit of ZAR 666 million. As mentioned on the previous slide, the group's reported EBITDA margin for the period improved by 50 basis points from 17.5% to 18%. This is after absorbing operational costs of ZAR 87 million related to the implementation of various strategic projects, which was lower than the cost of the comparative period. So if excluded, this increases the underlying EBITDA margin to 18.7%, which is 10 basis points above the similarly adjusted EBITDA margin of 18.6% in the prior period.
Given the diesel cost burden that businesses carry from running generators when the national grid is load shed, it's also appropriate to unpack this impact on margins. The ZAR 39 million of diesel costs incurred in the current period, reduced from ZAR 67 million spent in H1 2023, and had a detrimental impact on EBITDA margin of 0.4%. If also excluded, the underlying EBITDA margin for H1 2024 increases to 19.1%, which is flat against the prior period, notwithstanding the fact that the business operated at lower activity levels during this time. The next slide sets out the CapEx investment made and the operating costs incurred across the three main categories of our key strategic projects.
Beginning with CapEx, the group has invested a cumulative total of over ZAR 1 billion in strategic projects up to the end of the last financial year. However, ZAR 624 million, or nearly 60% of this investment, relates to environmental sustainability projects, which date back ten years to the launch of our 2013 strategy and have yielded an IRR in excess of 40%. Our digitization initiatives across all business units make up the balance of this CapEx, with the majority attributable to CareOn. In the current year, we expect to invest a total of ZAR 124 million of CapEx on strategic projects. ZAR 40 million of this relates to CareOn, which was completed at the end of April 2024, at a modest total CapEx investment for the project of ZAR 321 million.
We continue to invest in environmental sustainability, with ZAR 78 million earmarked for FY 2024 on projects related to renewable energy, water conservation and waste reduction. In terms of OpEx, the total spent on strategic projects has reduced from ZAR 127 million in the comparative period to ZAR 87 million in the first half of 2024, of which approximately 60% relates to CareOn. As the CareOn implementation completed at the end of April, there are only minimal costs of ZAR 4 million left for the second half. While there are ongoing operating costs for the CareOn system, these will be absorbed into the operating base and are more than offset by the savings benefit that this automated way of working brings to the business. We continue to build up our new NetcarePlus business and to run our environmental sustainability projects.
Total strategic project OpEx for FY 2024 is expected to be ZAR 132 million, which is well down on the ZAR 258 million for the prior year, and these costs are expected to reduce further to approximately ZAR 60 million in FY 2025. Next, we move on to headline earnings per share or HEPS. As usual, we've presented the standard HEPS metric as well as adjusted HEPS, in which we strip out exceptional and unsustainable items. We note that adjusted HEPS is the primary measure used by management to assess performance. HEPS amounted to ZAR 0.489 for the first half, which is a 9.2% improvement on the ZAR 0.448 in H1 of 2023.
Adjusted HEPS for H1 2024 amounted to ZAR 0.49, increasing by 5.8% from the prior period's ZAR 0.463. The board has resolved to pay a dividend of ZAR 0.30 per share for the 2024 interim period, equating to 61.2% of adjusted HEPS. In addition, we've continued with our share buyback program, which we commenced in September 2023, and during the current reporting period, 11.2 million shares were acquired at an average price of ZAR 12.96 per share, amounting to ZAR 146 million. After the half- year end, we have to date acquired a further 19.1 million shares at an average price of ZAR 11.35 per share, at a cost of ZAR 217 million.
So collectively, since the commencement of the share buyback program, the group has repurchased 54.7 million shares on the market for ZAR 684 million, equating to an average price of ZAR 12.47 per share. Between the 2023 final dividend and the shares bought back in H1 2024, ZAR 613 million was returned to shareholders in the current reporting period. And if we add the shares bought back in the second half of the financial year, thus far, of ZAR 217 million, as well as the ZAR 394 million in respect to the 2024 interim dividend that will be paid on the fifteenth of July 2024, a grand total of ZAR 1.2 billion will have been returned to shareholders.
Moving on to the group statement of financial position, I remind you that Netcare's capital management policy is to maintain a strong statement of financial position and to retain an investment-grade credit rating while reducing the cost of capital with a safe level of debt. As at 31 March 2024, total assets amounted to just short of ZAR 28 billion, increasing marginally from ZAR 27.8 billion at September 2023. CapEx spend during the six months amounted to ZAR 510 million. ZAR 50 million relates to expansionary projects, and the balance of ZAR 460 million relates to replacement CapEx.
Total shareholders' equity increased marginally to ZAR 11.1 billion from ZAR 11 billion at September 2023, with the benefits of an improved operating performance being offset by dividend distributions and share buybacks of ZAR 613 million made during the period. Finally, since September 2023, the group has experienced a marginal improvement of ten basis points in ROIC to 10.9%. Next, let's review the group's debt position. Gross debt amounted to ZAR 7.4 billion at 31 March 2024, offset by cash balances of ZAR 1.6 billion. Therefore, net debt totaled ZAR 5.8 billion at the half- year end, increasing by ZAR 813 million from September 2023.
Remembering that ZAR 613 million was outlaid in the current period in dividends and share buybacks, along with ZAR 510 million of CapEx. Net debt to annualized EBITDA increased slightly to 1.3 x coverage at March 2024, from 1.2 x at September 2023. This metric is calculated on EBITDA, measured after the adoption of IFRS 16 and against bank debt only. Inclusive of lease liabilities recognized under IFRS 16, net debt to EBITDA coverage is 2.6 x, increasing from 2.4 x at September 2023. In line with our policy, we retained our credit rating of AA- for long-term and A1+ for short-term, as published by GCR in February 2024.
The cost of debt at 9.4% has increased by 50 basis points from 8.9% at September 2023, as a result of the rising interest rate environment, with rates currently at a 14-year high. If we compare this to the position a year ago at March 2023, the cost of debt has increased by 80 basis points, and this reflects in the ZAR 44 million increase in interest costs in H1 2024 when compared against the prior period. Currently, approximately 27% of the group's debt is at fixed interest rates, which is achieved with the aid of interest rate swaps. Netcare is compliant with its banking covenants, which firstly require the net debt to EBITDA ratio to be below 2.75 x, where EBITDA is measured excluding the impacts of IFRS 16 on a 12-month backward-looking basis.
The second covenant metric is EBITDA to net interest cover, which must be greater than 4 x, and both of these covenants have been met with ample headroom. Moving on to our debt facilities. At the half- year end, Netcare had cash balances of ZAR 1.6 billion on hand, and we also had committed, but undrawn debt facilities of ZAR 1.7 billion. We therefore have access to resources of ZAR 3.3 billion of cash on hand and committed debt facilities from which to fund our future needs. Our debt tenure reflects a manageable and appropriately staggered maturity profile, noting that there are no maturities in H2 2024, so the group therefore has sufficient capacity to manage its future capital needs.
Finally, from my side, just a quick word of recognition and appreciation to our finance staff across the group for their efforts and their energy in preparing the results and the related materials. I'm now going to hand you back to Richard, who will update you on the progress of our key strategic projects and the guidance for the remainder of the 2024 financial year.
Thank you very much, Keith. Let's now take a closer look at progress across some of our key strategic initiatives. In this section, I will give a brief recap of Netcare's strategy, specifically progress on our digital elements, and then discuss the launch of the next phases of the strategy, followed by updates on our other strategic initiatives. Our strategy is a ten-year journey to transform the way we deliver health and care. As you're aware, our strategy responds decisively to the three global healthcare megatrends of customer centricity, digitization, and data, and leverages off our unique ecosystem of assets and services to transform the way we deliver health care. We call this person-centered health and care that is digitally enabled and data-driven, and through this, we are intentionally committed to creating a sustainable, competitive advantage for the group.
As we will shortly demonstrate, over the past six years, we have completed the first phase of this strategy, and this has now enabled us to embark on the very exciting second and third phases. Our strategy is divided into three clearly defined but inextricably linked pillars or phases. This slide provides a brief overview, and I'll unpack each pillar in more detail in the slides that follow. The first phase, what we call digitally enabled, is now complete, and it entailed the implementation of electronic medical records across all of our operating platforms and services. This has taken us six years to achieve, having been delayed by the COVID-19 pandemic. The focus here has been on delivering operational efficiencies, and these have been achieved according to plan and budget every year.
We have already demonstrated the savings to you in a number of areas as we rolled out CareOn in the hospital division, and we fully expect these to continue. As the digital foundation of our ecosystem is now complete, we are now embarking on the next phases of person-centered engagement that will be digitally enabled and data-driven, providing improved access, ease of use, and engagement across our ecosystem. This will allow us to move away from the traditional, siloed, and episodic model of care towards an engaged and retention-led model of care over a person's lifetime. The second and third phases occur coterminously. The second phase, what we call data-driven, is currently being rolled out and will be completed over the next 2-3 years.
Here, the focus is on clinical efficiency, and this will be measured by our ability to substantially improve patient outcomes and safety, make a significant contribution to clinical research, both locally and globally, attract more clinicians to work within our ecosystem, and ultimately grow our market share. The third and final phase of our strategy, Person-Centered Health and Care, is currently in progress and will be completed over the next 3-4 years. Here, our focus is on patient acquisition, engagement, and retention, and this will be measured by our ability to retain patients within our ecosystem over their lifetimes, what we define as the patient-embedded value, as well as increasing their participation in our various service offerings and enhancing our digital engagement with them. Let's focus on the first phase or pillar of digitally enabled.
As this slide demonstrates, we've now completed the implementation of electronic records across all seven of our clinical delivery platforms. On the 28th of April, we completed the rollout of CareOn across our hospital division, and this slide gives you a sense of what is now in place and what has been achieved during this transformational first phase. 45 hospitals are now fully digitized across more than 9,500 beds. In doing so, we've connected over 14,500 medical devices to the electronic medical record. We have over 13,000 iPads in use, and there are more than 29,400 active users across our doctors, nurses, pharmacists, allied health professionals, and admin personnel. At any one time in our hospitals, there are more than 4,900 concurrent users of the electronic medical record receiving live clinical data.
To date, we've dispensed more than 5.8 million electronic scripts and issued over 2.6 million drug-to-drug alerts. In addition, we've digitally received over 8.5 million pathology and radiology results. The clinical data we produce and make available to our clinical teams has now exceeded 41 GB per day, a staggering amount of clinical data by any measure. Now, just to put this number into perspective from a layperson's point of view, 41 GB of data is equivalent to creating over 16,000 e-books per day, assuming each book contains over an average of 300 pages with an average of three hundred words per page, that would, in total, amount to 1.96 billion words a day. And most importantly, the benefits to patient safety, improved clinical outcomes, and patient engagement are rapidly emerging.
As I've pointed out before, as a result of all of this, Netcare is now Apple's largest single customer of iPads in Southern Africa. In terms of quantifying the costs and benefits of CareOn, and looking specifically at the CareOn project implementation, which was completed at the end of April this year, total CapEx of ZAR 321 million and cumulative OpEx rollout costs of ZAR 348 million have been incurred during the implementation phase. Efficiency savings of ZAR 204 million have been achieved over the past three years, inclusive of ZAR 63 million delivered over the past six months. CareOn remains on track to achieve an IRR in excess of 21%. The graph here demonstrates the break-even in the second half of the financial year.
As you can see, the ongoing cost to maintain CareOn will be comfortably offset by the growing efficiencies to be achieved. Let's turn now to our second pillar of data-driven. This phase encompasses utilizing the 41 GB of clinical data generated daily to firstly enhance patient safety, quality of outcomes, and care at the most appropriate cost. We're currently implementing a clinical data analytics platform, which will provide significant advantages for our clinicians, as well as our clinical and operational management teams. For clinicians in Netcare, the data analytics platform will allow them access to anonymized data on outcomes, clinical practices, and pathways, and provide them with the analytical tools to fully understand and interrogate data. It's also equipped with generative AI and natural language processing that will greatly assist them to publish their clinical studies on a large scale.
And most importantly, this is expected to have a fundamental impact on improving patient safety, appropriateness of treatment, and clinical outcomes. Now, for Netcare's clinical and operational management teams, the analytics platform has enabled a centrally coordinated clinical efficiency program with individualized programs at a hospital level to ensure we will achieve the most efficient cost per event. We're also aiming to introduce an electronic funder portal to allow seamless case management for our medical schemes. This will allow them access to all the relevant clinical information and authorizations in near real time, 24/7, as well as an electronic copy of the patient's summary of care. This platform will remove a significant administrative burden for both ourselves and medical schemes and enhance efficiencies and accuracy of the information shared.
One of the most exciting consequences and benefits of the large amount of rich clinical data now produced in real time is that the application of machine learning and predictive analytics is fast becoming a reality for us in Netcare and will inform clinician decision-making at the bedside in real time. We're partnering with a company to co-develop a suite of predictive analytic models, analytics models to augment clinician decision-making. The prediction models prioritized include those that can cause the most harm, such as sepsis or bloodstream infections, renal or kidney failure, acute myocardial infarction or heart attacks, and of course, mortality itself. The sepsis prediction model is currently in pilot phase. Now, let's turn to our final pillar and the end goal of person-centered health and care. By way of background, it's important to define what person-centered health and care means to us in Netcare.
In terms of ultimately transforming the care we deliver, we want to ensure a person-centered approach that puts patients first and at the center of everything we do, that recognizes them as individuals, and recognizes that every person's journey is unique, and also encourages them to actively participate in managing their own health and care needs. In terms of the health and care we deliver, we remain absolutely committed to providing high quality and compassionate care within our facilities, but also ensuring ongoing care during periods of wellness. Now, the most frequently asked question, as you can see at the bottom of the screen, which a healthcare practitioner puts to a patient is: What's the matter with you? But in a person-centered world, the question should rather be: What matters to you?...Let me give you a hypothetical example.
We are often confronted with patients who have significant and long-term conditions, which are often very debilitating. A patient might be diagnosed with major depression, schizophrenia, and perhaps some substance abuse, and is then given the diagnosis and treatment. Often, that's when engagement with the clinician ends. But is this what really matters to a patient? If we were to ask them, they might say the following: "What matters to me is that I want to restore my relationship with my partner or spouse or my children," or, "I want to be able to hold down my job and be a functioning member of society." And as a result, in a person-centered world, the diagnosis of what's the matter is only just the start of tackling what's really important to the patient.
And therefore, in Akeso, for instance, measuring functionality scores on admission and their improvement over time is absolutely critical to patients. In August last year, we launched the Netcare app. Phase I was aimed at improving out-of-patient convenience for our patients, with an array of benefits which are listed here on this slide. This phase has now been completed, and we are now embarking on the second phase. Over the next two years, we'll be rolling out various features within the app to improve our in-hospital ease of use. This slide demonstrates, on the left-hand side, those features that will be made available this calendar year, and on the right-hand side, those that will be completed next year.
At the heart of empowering patients to play an active role in their ongoing health and care, is the ability to provide them access to a full summary of the care they received from Netcare. The summary of care is available to all patients in Netcare 911, Akeso, Medicross, and Cancer Care, and we hope to complete the rollout in our hospital division this year. We'll also be applying generative AI to help de-jargonize complex medical technology and have just completed a proof of concept on this. Ultimately, over the coming 3-4 years, we'll be able to focus on what really matters to patients and improve their engagement and their compliance to the prevention and treatment of their health and care needs, particularly if they are at risk or already have chronic conditions. Turning now to some of our other strategic initiatives.
NetcarePlus, as we've spoken about before, was established to expand access to quality healthcare. NetcarePlus products provide increased access to private healthcare beyond traditional medical schemes and contribute to increased use of the Netcare ecosystem. This year, we have further enhanced our product offering within primary care. The graph on this slide demonstrates the encouraging growth we've experienced in NetcarePlus insurance products over the past years. As demonstrated previously, we're expanding access for those insured across primary, secondary, and tertiary care. Primary healthcare, through our various prepaid vouchers, secondary healthcare, through our range of prepaid surgical procedures, and in tertiary care, through comprehensive emergency care cover. Also, in order to enhance cover for medical scheme members, we have introduced NetcarePlus Gap Cover as a supplement to medical aid. We continue in Netcare to ensure we are an ongoing force for good.
Here are just two examples of the myriad of projects and initiatives we are actively involved in driving as part of our commitment to positive social development and change. In terms of our shoe project, My Walk Made with Soul, which converts intravenous drip bags into school shoes, has just crossed the 200,000 mark in terms of pairs of shoes produced and distributed free of charge to needy schoolchildren, which has been accomplished in partnership with numerous corporate and private sponsors. In doing so, we've also diverted over 100,000 kg of PVC waste from landfill. In terms of the worrying surge of mental health challenges in our society, Netcare has partnered with the South African Depression and Anxiety Group to provide mental health support services to communities and schools in Diepsloot and Ivory Park. To date, we've provided counseling to more than 62,000 members.
A quick reminder of our environmental sustainability program and where we currently are. We've successfully completed the first phase of our environmental sustainability strategy, achieving cumulative savings and cost avoidance of ZAR 1.5 billion, an IRR of 40%, and a 39% reduction in energy intensity per bed, surpassing our original ten-year target of 25% set in 2013. Our targets for phase II remain to reduce Scope 2 emissions to zero and reduce Scope 1 and 2 emissions by a combined 84% by 2030. Our strategy is aligned with the Just Energy Transition Investment Plan . We're aiming to achieve 100% renewable energy utilization, zero waste to landfill, and a further 20% reduction in water utilization by 2030.
Finally, we recently unveiled our first electric vehicle charging station at Netcare Waterfall City Hospital in partnership with Mercedes-Benz and Chargify, and we will now look to roll this out to all of our facilities over time. Significantly, our environmental strategy cushions the impact of both electricity and water supply disruptions. In terms of load shedding, private sector hospitals are not exempt from load shedding. However, we in Netcare have a number of measures in place to mitigate this, and they include: the majority of Netcare's hospitals have full island capacity and can operate independently of the grid in cases of extended load shedding. All of our facilities have uninterrupted power supply systems, and we have over 200 backup diesel generators in place. In addition, we have a sizable solar power base across 72 sites, capable of generating 18 GWh-20 GWh per annum.
As we've announced before, we've concluded a 20-year renewable wind-powered supply agreement for 6 Eskom-supplied hospitals, which will come into effect in the 2026 financial year. In terms of the ongoing water supply disruptions being experienced, we have a number of measures in place to mitigate water challenges. The majority of Netcare's hospitals have a 48-hour backup of water supply. We have a desalination plant at Netcare Christiaan Barnard Memorial Hospital that can supply all of Netcare's Western Cape hospitals with fresh water. We also have two very large water reservoirs for all of our Gauteng facilities, and in addition, we've planned a further 20 boreholes. As a result, we foresee no material impact on CapEx or earnings as a result of the current water challenges.
Finally, the graph at the bottom of this slide demonstrates the average load shedding we have had to contend with over the past 2.5 years. Finally, turning to our guidance for the remainder of the financial year. You will be aware that the President signed the NHI Bill on the 15th , May 2024. In terms of the policy objective itself, Netcare has always acknowledged that the inequities in healthcare access and delivery in South Africa need to be addressed, and we remain fully supportive of universal healthcare. Extensive and constructive inputs were made over several years by a wide range of stakeholders, including ourselves, which were motivated by a genuine desire to improve the NHI Bill, to ensure the practical and sustainable attainment of universal healthcare.
We believe very strongly it is essential to get universal healthcare right in the best interests of all South Africans. But we do have serious concerns, and in terms of some of those areas of concern, as you can see on the right-hand side of the screen, the bill was signed without addressing fundamental areas of weakness. The significant flaws in the bill and the legislative process followed in promulgating the bill will, unfortunately, likely result in the bill being challenged, again, unfortunately leading to further delays in implementation. And these potential delays in furthering the provision of universal healthcare could easily have been avoided had government engaged meaningfully with all interested parties. Nevertheless, we in Netcare welcome the President's statement in which he expressed the desire to now work with all interested parties.
Importantly, the concluding phases of Netcare's ten-year strategy to transform the way we deliver health and care will remain unaffected by this, and we expect it to actually further enhance our further participation in the provision of universal healthcare. Turning now to our guidance. As indicated in our trading update, we've revised our patient day guidance and are now guiding towards a total patient day growth of between -0.5% to 0.5% for the full year. Specifically looking at the hospitals, which had a 1.7% drop in patient days in the first half, we're expecting a period-on-period growth for the second half in a range of 0.5%-1%. Group revenue is expected to grow between 5%-5.5% versus the financial year 2023....
In terms of our strategic projects, we're expecting to spend ZAR 132 million of OpEx and ZAR 124 million of CapEx. Our normalized EBITDA margins will continue to benefit from ongoing efficiencies. And finally, we expect to spend ZAR 1.4 billion on CapEx in this financial year. Thank you, and that concludes the formal presentation of our results, and we're now happy to open the webcast to questions. Thank you very much.
Thank you, Richard. We have a question from Matrix Fund Managers: Can you please further elaborate why patient admissions are well below the pre-pandemic levels? Can you quantify respiratory disease admissions and maternity case admissions relative to pre-COVID, and how confident are you that these will return back to normal?
Thank you very, very much for that question. I'm going to ask the Acting Managing Director of the Hospital Division, Dr. Erich Bock, to answer that.
Good morning, and thank you so much, Richard. I think it's interesting to note that from an occupancy point of view, our occupancies have well recovered if you look at the seven months up to April. Thank you so much, Richard. It should be noted that, from an occupancy point of view, our occupancies have well recovered. If you look at till the end of April, where we've recovered to 95% and above of our 2019 figures. The largest impact on our lower occupancy still remain as the outmigration of lower margin day cases. From a maternity point of view, we note the global trends, of declining maternity cases, and obviously disposable income plays a role with regards to that.
We also see in our own medical scheme, more male members, smaller families, and an aging population on the medical insured, which has a negative impact on the births. With regards to respiratory, we've seen a decline in admissions since COVID, and obviously, we've seen the trend where people self-medicate at home. It should be noted, however, that even though the respiratory cases in general are down from an admission point of view, we are still left with a significant portion of the sicker, high acuity cases, as can be seen by the increase in our ICU and high care occupancies, to more than 10% versus pre-pandemic levels. Thank you.
Thank you. We have a further question from Jose at Melville Douglas. Thank you for the opportunity. The occupancy rate of 72.3% thus far in May is quite remarkable. Could you perhaps elaborate on some of the factors behind that performance?
Thanks, thanks so much. I'm gonna take that one as well. So from an occupancy point of view in May, May, in general, is a strong month for us. We've seen the recovery from a surgical point of view and from a case mix point of view, and definitely with regards to the activity in the May month, we've seen an uptake in our viral infections in the hospital as well, which started at the end of May, and that trend is continuing currently as well.
End of April.
Thank you. We have a question from Anusha from Standard Bank. Thank you for the presentation. Two questions from my side. Congratulations on a strong occupancy in May. Could you comment on how this compares to pre-COVID occupancy for May in 2019? Could you also provide some color on trends in Netcare's hospital occupancies by province, if the occupancies in some provinces are materially higher or lower than the group average occupancy?
Thanks, I'm so happy to take that one as well. So we've seen the general trends from an activity point of view, where we've seen a decline in the activity patient days versus pre-pandemic levels. We've spoken about the sector seasonality, if you take April into account, respiratory, maternity, and then also certain private cases, and then also some of the low-cost networks. So what's interesting, if you look at the different provinces, where in the coastal regions and predominantly in Gauteng, we have maintained good occupancy levels, very closely from a May point of view to about 99% of pre-pandemic levels.
We have seen in some of the provinces and some of the facilities where you are dealing with lower LSM groups that obviously migrate to the lower cost option networks from a disposable income point of view, that has a negative effect from an occupancy point of view.
Thank you, Erich. We have a question from Mergence: What is the benefit to Netcare in terms of having the EV charging point on their site?
There is no direct benefit from a financial point of view, but in terms of our commitment to environmental sustainability and in terms of where we see electric vehicles being introduced in South Africa, we want to make it as convenient as possible, and we want to be able to encourage the use of electric vehicles. So in short, no financial benefit, but certainly in alignment with our own environmental sustainability philosophy and strategy, and something we would like to assist Mercedes-Benz, Chargify, and other manufacturers to drive.
Thank you, Richard. At this stage, we don't have any further questions on the webcast. I'll hand back to Richard for some closing comments.
Thank you very, very much, everybody, for your time and attendance this morning. We remain available to answer any queries you may have over the coming days and weeks. Thank you very much to our team once again on the ground. These outstanding results could not have been produced were it not for the commitment of all 18,000 members of our team, teams in Netcare. Thank you very, very much.