RHAP Press Statement
25 February 2016
2016 Budget Speech Provides Commitment and Guidance on the Protection of Critical Health Posts
Following our repeated calls for the protection of critical health posts, the Rural Health Advocacy Project (RHAP) welcomes the clear message sent by the Minister of Finance Pravin Gordhan in his Budget Speech and National Budget Review of the 24th of February that frontline service delivery personnel are to be protected in the current climate of “fiscal consolidation.”
While Minister Gordhan announced the need to “curtailing personnel expenditure”, this refers to non-critical posts across government departments. We furthermore applaud the agreement between Provincial MECs for Finance to protect, and exclude, health service staff from the announced cost containment measures, as mentioned in the Budget Speech.
This is an important shift compared to Treasury’s previous announcements, such as in the Medium Term Budget Expenditure Framework in October 2015, when it stated that “Departments that had planned to expand headcount or fill vacancies need to postpone their plans.”
With “non-critical posts” Treasury refers to “administrative posts”, whilst with “critical health posts” Treasury refers to “front-line health professionals” including but not limited to doctors and nurses.
This is significant in the context of the recent abolishment of rehab posts and unemployed Clinical Associate bursaryholders. It must be clear to all that Primary Health Care, a Government priority, can only be delivered by a comprehensive team of health care workers, which also include rehab professionals such as occupational therapists; radiographers; community health workers; public dentists; pharmacists and clinical associates, over and above doctors and nurses. We nonetheless note with concern Treasury’s reported decline in doctors posts, from 20 042 in June 2014 to 19 352 in September 2016.
Despite the commitment to protecting health posts, it remains evident that the expansion of health care workers to improve access to health care will continue to be under pressure.
Therefore, health need, equity, and existing levels of understaffing, must be decisive factors in the distribution of scarce human resources between and within provinces. As we have stated before, the RHAP recommends that critical posts are defined locally and the consequences on patient care should be the determining factor on deciding whether post A in facility B is critical under the given circumstances.
Rural areas should be considered critical service areas for their high levels of deprivation; long distances to facilities and existing levels of understaffing. Outreach services to poor and remote households by community health workers, rehab professionals and other cadres, need to be protected and resourced, in line with the Primary Health Care approach.
Minimum levels of staffing need to be protected across facilities. Whereas the “WISN” staffing model was developed to provide the minimum norms, these norms now appear unaffordable and alterative models need to be applied.
The current fiscal climate calls for nuanced approaches. The National and Provincial Departments of Health will take forward the Minister of Finance’s commitments to protecting health posts in their own budgets and strategic plans for 2016/17. As RHAP and our partner organisations, we will closely follow developments and will continue supporting the Government ‘s efforts to ensuring the progressive realisation of access to affordable health care services to all.
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Programme Manager: Rural-Proofing
Rural Health Advocacy Project
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 http://www.rhap.org.za/press-statement-the-rhap-welcomes-the-health-ministers-statement-on-staffing-moratoria-and-calls-for-the-protection-of-critical-health-posts-in-times-of-austerity/ ; http://www.rhap.org.za/causes-implications-and-possible-responses-to-the-implementation-of-staffing-moratoria-in-the-public-health-system-in-south-africa-during-times-of-budget-austerity-2/ ; http://www.rhap.org.za/press-release-the-rhap-calls-for-the-protection-of-critical-health-services-whilst-the-north-west-department-of-health-is-put-under-administration/
 2016 Budget Speech, National Treasury, page 23
 http://www.treasury.gov.za/documents/national%20budget/2016/review/Annexure%20a.pdf , page 125