Expert calls on Phaahla to ensure the health budget is used wisely, and departments are held to account

Health Minister Dr Joe Phaahla on Tuesday tabled an R64.5 billion budget for financial year 2022/23 – 86% (R55 billion) of which would be transferred to provinces as conditional grants – prompting an expert to call on him to ensure departments are held to account.

Failure by provinces to manage the grants could lead to consistency in the implementation framework not being achieved, according to Rural Health Advocacy Project director Russell Rensburg.

Delivering his maiden virtual budget vote speech before MPs – two years into the Covid pandemic – Phaahla said government has administered 35 182 million vaccine doses to just over 19 717 million adults, or 49.5% of all adults.

The department, said Phaahla, has been allocated R2 billion to procure vaccines in the 2022/23 financial year.

“While the virus is [still] among us, the best defence is vaccination,” said Phaahla.

Despite the health budget declining by 1.7% each year before factoring in inflation, Phaahla was bullish in announcing measures to strengthen health delivery, which included:

• Urging MPs to support the National Health Insurance (NHI) Bill to attain universal health coverage for all South Africans.
• Setting aside an amount of R1.5 billion to be managed by the health department – supporting various infrastructure projects in NHI pilot districts – with contracts already issued for the Siloam Hospital in Limpopo and the Zithulele and Bambisanani district hospitals, both in the Eastern Cape’s OR Tambo district.
• Issuing contracts towards the construction of a multi-billion-rand Limpopo Academic Hospital.
• Provinces sharing R6.8 billion in direct conditional grants, managed by them under the Health Facilities Revitalisation programme to construct, revitalise and maintain hospitals, clinics and other facilities. Reacting to the health budget, Rensburg urged Phaahla to hold provinces to account for the financial spending of the grants, totalling R55 billion.

“Historically, those conditions have not been well managed, with money merely transferred to provinces. We need new thinking; creating an environment for the recovery of strategic healthcare services,” said Rensburg.

“All those grants to provinces have conditions and if we don’t manage the conditions, we won’t achieve consistency in implementation.

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“Provinces are the main implementors of healthcare and decisions they make have an impact on how healthcare services are shared.”

Rensburg added that the minister had the power to provide that leadership through the implementation framework and a concurrent responsibility between national and provincial departments.

“With strategic programmes like district services grants – funding HIV/Aids and the community outreach – there is a big opportunity for the department to show leadership and coordinate the implementation of those programmes,” he said.

Sasha Stevenson, head of the Health Rights Programme at Section 27, said there has been a significant decrease in the health budget, which Phaahla has acknowledged – “something quite fatal, because we cannot achieve health outcomes”.

Stevenson said health facilities were short-staffed – affecting the quality of service to patients.

“No increase in compensation of employees means we can’t improve standards and access to services with insufficient staff,” she said.

“The employment of more community health workers is positive, because they play a significant role in providing homebased primary health services. We are also seeing a lack of a scale-up in mental healthcare services, which includes lack of infrastructure.”