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Coetzee emphasised that without proper accountability measures, increased funding would not solve the healthcare system's problems.
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In Wednesday’s budget speech, Minister of Finance Enoch Godongwana announced a substantial R277 billion allocation for healthcare in the 2024/25 fiscal year, projected to increase to R329 billion by 2027/28.
However, a medical expert has raised serious concerns about whether these ambitious targets are achievable given the systemic challenges facing South Africa’s healthcare system.
“Health spending will grow from R277 billion in 2024/25 to R329 billion in 2027/28 to support the equitable provision of public health services, including free primary healthcare,” Godongwana stated in his speech.
“R28.9 billion is added to the health budget, mainly to keep about 9 300 healthcare workers in our hospitals and clinics.
“It will also be used to employ 800 post-community service doctors and to ensure that our pharmacies do not run out of medicines.”
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Dr Angelique Coetzee, vice-chairperson of the Unity Forum for Family Practitioners, voiced scepticism about the government’s healthcare improvement targets despite the significant budget allocation.
“I don’t think the government’s targets for healthcare improvement are realistic. I don’t really think so,” Coetzee stated bluntly.
“There are no proper stats that we can use currently to say in the community acts: the primary clinic is seeing so many patients, we need so many doctors, nurses, and allies to service specific communities.”
She stated that the real ratio of healthcare professionals to patients, hospitals and clinics is not reflected publicly.
The budget allocation comes in response to a critical situation in healthcare staffing that Godongwana himself acknowledged in his speech.
“In the last year alone, public sector health system lost close to 9 000 health workers. We did not have the money to retain or replace them even after reprioritising funds budgeted for consumables and medicines,” the minister explained.
Coetzee pointed to the severe staffing crisis that continues to plague the system: “We have been seeing posts that have been not filled, and then they become redundant and then that post disappear.”
She cited Rahima Moosa Mother and Child Hospital as an example: “We know just looking at Rahima Moosa Mother and Child Hospital that there’s about 300 only nursing posts that are vacant. So if you really go and start looking at what is the need, the HR need, and what is being allocated for health care personnel, I think it’s [the budget is] going to have a shortfall.”
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A major concern for effective implementation is the decentralised nature of healthcare funding management.
Godongwana said provinces will receive R2.4 trillion over the MTEF period.
“This budget includes additional allocations to support critical provincial functions related to health and education. We trust that the allocations will be used for their intended purposes.”
However, Coetzee expressed doubt about provincial accountability: “You can allocate these monies to the various provinces. Remember, the National Department of Health is not going to have oversight of the monies. These monies will be allocated to the various provinces where the premiers and the MECs would then decide how they’re going to use these money.”
She added: “It’s not to say that the provinces is going to use that money exactly for what it’s been benchmarked for.
“And a lot of these provinces don’t have good track records,” said Coetzee while further emphasising that “no amount of money would help” a system that is rigged with corruption and lacks accountability.
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Coetzee emphasised that without proper accountability measures, increased funding would not solve the healthcare system’s problems.
“If we want to make sure that the health, to improve the healthcare system and ensure that the proposed budget is used effectively, we need to put checks and balances in,” she stressed.
“There must be open and transparency process with accountability.”
She pointed to existing corruption issues: “We’ve seen a lot of waste, we’ve seen a lot of fraud, we have seen a lot of people in positions they shouldn’t be in. So we need to start holding people accountable.”
The budget aims to address the concerning issue of accruals, which Godongwana described as having “ballooned to nearly R22 billion”.
This represents money owed by departments to vendors for services already provided.
“This means that the money allocated to departments ends up paying for previous services and goods rather than for the current needs, setting off a vicious cycle of budget shortfalls, unpaid invoices, and a crisis in cashflow and the planning and predictability of budgets,” the minister explained.
“This is an untenable situation that we could not leave unresolved.”
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The budget speech also announced a Value Added Tax (VAT) increase, which will rise by half a percentage point in 2025/26 and another half-percentage point the following year, bringing it to 16% by 2026/27.
Coetzee warned about the consequences for healthcare access: “The proposed VAT increase will definitely impact the cost of living, especially your low-income households. And that might also be that when there’s stock out at the local public clinics, and patients need to buy out of pocket”
Coetzee added that while patients would be required to buy some of their own medicine, some wouldn’t be able to do so due to low or lack of disposable income.
She elaborated: “The economy is not growing. We do not have a thriving economic economy and therefore the average patient that is ill, your chronic patients is mostly your older patients, your elderly patients and they only live from Sassa, or well, most of the time they will depend on Sassa.”
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Coetzee highlighted crucial gaps in the current healthcare budget and planning.
“There was nothing said regarding the training of specialists. So it was only mentioned about 800 post-community service doctors,” she noted.
“What happens next year when there’s the next bunch of community services doctors that need to get into the sector? When will there be funding for them?”
She also mentioned the absence of funding to compensate for lost international support: “The absence of allocations to compensate for the loss of international funding for HIV AIDS programs introduce uncertainty here. And this gap could potentially affect the continuity of services for individuals relying on these programs.”
Coetzee also warned about the potential impacts if healthcare targets aren’t met, saying unmet targets could increase waiting times in clinics and hospitals, while resulting in medicine shortages.
She concluded with a stark warning: “At end of the day, you will either get a patient coming into hospital with a crisis, costing a lot of money, or patients would just die at home. So we need to make sure that the ratio of the correct staffing against the patient load is correct.”
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Coetzee advocated for greater collaboration between sectors: “We need to fix the primary healthcare at ground level. We need to start working together with the public and private sector. We need to stop this thing of the government doing everything for public sector and we do not include or very seldom negotiate with the general practitioners.”
She emphasised the need to prioritise healthcare over politics.
“Politics should get out of health. Healthcare should be [centred] around the health of people, not what political party is having the most vote or what [party] is in charge of that specific province.”
Despite her numerous concerns, Coetzee acknowledged some positive aspects of the budget.
“The overall sentiment from my side might be cautiously positive. The government’s commitment to increase health expenditure demonstrates at least a recognition of the sector’s critical needs, especially in retaining the healthcare personnel and ensuring the availability of medicines.”
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