Despite some positives, the Budget falls short in dealing with South Africa’s health challenges

South Africa is one of the most unequal societies in the world. This inequality extends beyond mere income inequality and permeates all aspects of society, including our health system. It is not merely the competition for resources between parallel private and publicly funded health systems, but also within each system, as there is little correlation between the health services we provide and the broader healthcare needs of the population. 

The pandemic made these fissures more pronounced and gobbled up huge chunks of our resources for health. Now, as we transition to a different strategy in the management of the pandemic, the crisis and uncertainty that characterised the early stages may no longer be with us, but it will take time, resources and strategic refocusing for us to navigate our way through the devastation that Covid caused.

In March 2020, it was estimated that around 40,000 people would die from Covid-related complications. We knew at the onset of the pandemic that our disease burden characterised by a largely uncontrolled diabetes epidemic, a high burden of TB, as well as over eight million people living with HIV – exacerbated by 10 years of under-investment in our health system – would present a particular risk to our population. 

Two years later, the official death toll from Covid-related mortality is over 100,000. The unofficial or excess death rate is edging on 300,000. 

Wassila Jasatt and colleagues using hospital data collected as part of the Datcov project investigated hospital-based Covid deaths between March 2020 and March 2021 and found the leading comorbidities, as expected, included age, hypertension and diabetes. 

Further research is required on the distribution of excess deaths. 

Available testing data suggest that most tests were administered in private sector labs, which could indicate comparatively poor testing rates in the public sector clinics, with patients possibly choosing to not access treatment or accessing treatment too late. It raises questions about the extent to which health system responsiveness might have been the most significant driver of Covid mortality. 

Non-Covid related challenges 

The uncertainty and fear attached to Covid had an unintended impact on other routine healthcare services. TB is the leading cause of death even though 90% of TB-related deaths are avoidable. 

Sharp drops in TB screening and case-finding contributed to poor TB treatment outcomes and, for the first time in over a decade, HIV testing also showed sharp declines, while initiation into treatment showed a decline in the early stages of the pandemic. Routine immunisations are also reportedly down. 

Now, as we look to build up better, there was an expectation that the Budget would provide insight into the government’s plans and strategies to address these gaps left by Covid. 

Budgets are not just all about the numbers. The numbers on their own mean nothing. It is only when we consider the choices that underpin the numbers that we begin to see what government prioritises. 

Reading the news headlines a day after Finance Minister Enoch Godongwana delivered his Budget speech, there seems to be widespread approval of his commitment to stabilise public finance and implement structural reforms to facilitate inclusive economic growth. 

A primary surplus is pencilled in for the 2023/24 fiscal year almost a year ahead of schedule. 

Godongwana provided additional support to working South Africans in the form of tax rebates amounting to R13.5-billion. Big business benefitted from a 1% reduction of corporate income tax, with the government foregoing R2.5-billion in revenue. 

Government also forgoes a further R3-billion in revenue by not increasing the fuel levy. In total, the rebates amount to R17-billion rand. 

At what cost?

Fiscal policy and its relationship to government’s constitutional obligations to maintain and advance socioeconomic rights continue to be a site of struggle. 

It is the division of revenue that, under current policies, government can and must prioritise for the progressive realisation of socioeconomic rights. 

Finance Minister Enoch Godongwana delivers the national Budget speech at the Good Hope Chamber at Parliament in Cape Town on 23 February 2022. (Photo: Gallo Images / Jeffrey Abrahams)