In his recent Medium Term Budget Policy Statement (MTBPS), Finance Minister Enoch Godongwana did not adjust allocations for South Africa’s health sector, sparking concerns among activists and trade unions who are apprehensive about the impact this will have on the country’s healthcare system in the upcoming year.
Russell Rensburg, director of the Rural Health Advocacy Project, emphasised that the lack of budget adjustment ignores the financial struggles nearly every province faces. “Almost every province has a shortfall in salaries. And they are handling it by “aggressively accruing expenses”. He said there is already pressure on goods and services – especially medicine.
Rensburg also pointed to the broader implications for South Africa’s healthcare structure, urging a shift from hospital-centred healthcare to prioritising primary care. He said we must focus on minimising hospital costs and expanding primary healthcare.
In his view, managing the healthcare budget efficiently means examining systemic inefficiencies and building a framework to improve healthcare services without relying solely on additional funding.
Godongwana warned of lower tax collection projections for the 2024/25 financial year, with revenue estimates reduced by R31.2 billion over the next two years. He noted that slow growth and external risks mean tax revenue will remain under pressure, necessitating difficult spending decisions.
Healthcare workforce at risk
The South African Medical Association Trade Union (SAMATU) raised concerns about the Health Department’s potential budget cuts. SAMATU General Secretary Dr Cedric Sihlangu warned that reduced funding could limit essential healthcare workforce and infrastructure investments.
He said the underfunding perpetuates the shortage of doctors and critical services personnel, further stressing the system. Sihlangu said patient care could suffer from longer waiting times and overstretched healthcare professionals.
A push towards digital health
Despite the lack of budget increases, Godongwana highlighted digital infrastructure initiatives, including digitising health records for the National Health Insurance (NHI) rollout. Additionally, he mentioned plans to attract public infrastructure funding for two new hospital projects, including a district hospital in Limpopo, as part of a broader strategy to increase funding sources for public infrastructure.
Dr Patience Mbava, chairperson of the financial and fiscal commission, emphasised the importance of a district-based health system to address inefficiencies in public hospitals. She said we must ensure the district health system is efficient and effective, especially as the government advances the NHI.
The lack of increased funding for healthcare in Godongwana’s MTBPS has left South Africa’s health sector in a precarious position. As the country moves towards implementing NHI and grapples with financial constraints, activists and unions are calling for a re-evaluation of spending priorities and an urgent focus on enhancing primary healthcare and workforce support.