Extra R23bn for health ‘won’t fix systemic problems’

On Wednesday, Finance Minister Enoch Godongwana announced that R23-billion had been set aside to cover the shortfall in compensation budgets in the health sector and to improve public health services.

“In health, the funds are to hire new staff, address shortfalls in compensation budgets, retain additional health workers appointed during the pandemic, and clear the backlog in health services,” Godongwana said.

According to a written answer provided in October 2022 by the Minister of Health, Dr Joe Phaahla, 16,070 clinical posts and 4,764 administrative posts were vacant in South Africa’s public health system. These included funded and unfunded posts.

But while Godongwana announced an extra allocation for health posts, the department’s overall budget has still shrunk. 

In 2021, Treasury instituted massive reductions to the health budget, and the extra money in the new Budget will fail to offset these cuts, meaning the consolidated health budget will fall from a revised estimate of R259.4-billion in 2022/2023 to R259.2-billion in 2023/2024, and will then increase to R268.9-billion in 2024/2025 and R281.3-billion in 2025/2026.

Read more in Daily Maverick: “Budget in a box”

The dean of the Wits Faculty of Health Sciences, Professor Shabir Mahdi, said details on how the extra funds would be allocated strategically would determine their impact. 

“Employing more staff is not a solution to redressing crumbling infrastructure in most provinces. A blanket ‘employment’ of staff,  recruited for specific purposes during the pandemic, does not address whether the staff is fit for purpose,” he said. 

Mahdi pointed out that it would be more strategic to use the funds to address the skills shortage of specific categories of healthcare workers, such as specialist nurses in nephrology and intensive care. 

“Hopefully, the Minister of Health will provide details on how the funds will be allocated and what gaps in the health system will be addressed. Alternatively, it will be like pouring more money into addressing a lack of planning and management in most of our public facilities,” he added.

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Russell Rensburg, of the Rural Health Advocacy Project described public health challenges as “huge”, adding that “today was a tough day”. 

He explained that the provincial health budgets are funded from the equitable share provided for each province. The overall cut in budget when compared to last year “would mean that provinces will have to figure out how to provide public healthcare with a smaller budget. It erodes the ability to provide public healthcare”. 

“Budgets cannot fix structural problems,” he said. 

Rensburg also pointed out that the provincial health departments had an ageing workforce and not enough young nurses were being employed. 

“We are training more and more young nurses, making us a ticking demographic time bomb in some ways … the health department needs serious reform.”

He said diminishing budgets would accelerate the further decline of public services. “The poor will get access to fewer and fewer services.”

“Whatever increases we got during Covid, those contracts are now gone. We are back where we were. We haven’t learnt any lessons. In my mind, that means more than 300,000 people died in vain.”

He said for future pandemic preparedness, one of the best investments would be in primary healthcare. 

Mzi Nkata, from the trade union National Union of  Public Service and Allied Workers, said the union was still fighting with the Departments of Health to permanently employ all community health workers.

“Our fight is still on and will continue until we see community health workers employed permanently and not on a stipend,” she said. 

“This fight now includes pharmacy assistants, which we don’t have in our clinics, resulting in community members being given the wrong medication.”

While there is an international push for countries to start preparing for the next pandemic by, for example, strengthening research and development into diagnostics and therapeutics, Professor Glenda Gray, president of the Medical Research Council, said science was never allocated enough money. The MRC receives its budget from the National Department of Health. DM/MC