Budget doesn’t address SA’s crumbling health system — activists

The budget tabled in Parliament last week, does not address a crumbling health system, some civic organisations have warned. Finance Minister Malusi Gigaba announced a R205bn budget for health in the new financial year that is set to increase to R240.3bn. The total expenditure on health over the medium-term framework is set at R667.8bn.

Yet according to the Rural Health Advocacy Project (RHAP) programme manager Russel Rensburg this modest expenditure growth for health may contribute to further deterioration of the public health sector. He also expressed concern over the R1.4bn reductions in the equitable share. “Given the significant discretion enjoyed by provinces in allocating funding, district health budgets and critical health posts particularly in rural areas, could be at risk,” he warned. Rensburg said the “failure to explicitly protect critical frontline health posts”, is also concerning. There are already an estimated 40,000 vacancies in the public health sector.

Chair of the Cape Metropolitan Health Forum Damaris Kiewiets shared this concern and said rural healthcare services are already poorly resourced. Kiewiets said the budget does not do enough to bring the services closer to the people especially to those in far-flung rural areas.

According to Rensburg increased VAT and the increase in the fuel levy will only “deepen inequality of access to healthcare in rural areas”. “There is talk of cost reductions which means less expenditure on goods and services like medicine, food for patients, cleaning materials and linen. These are inconsequential but still very important for the delivery of health services.” Rensburg said rural facilities are already under resourced. “Now we will find health service seekers in these poorer communities having to spend significant amounts just to get to health centres. Even when they get a referral from a clinic to a hospital it is problematic due to a lack of transport for patients.” RHAP in a statement prior to Gigaba’s budget speech called for a “socially just response to healthcare” that would consider all factors and try avoid further blows to people’s capabilities to live healthy lives.

Rensburg further stressed the importance of a needs-based budgeting approach and called on government to include patient voices in its planning. “They created a Joint Action Plan for health with national treasury, the health department and provincial ministries so government is actually just talking to themselves. We are very concerned that budget and other planning is happening in isolation, and one of the calls we make is for broader participation so that we can articulate the needs of ordinary health system users.”

Gigaba in his budget speech said the increase in social grants and zero VAT on basic foodstuffs will mitigate the impact of the VAT increase on the poor but Rensburg is sceptical. According to him this basket of VAT free items need to be revised. “We are already saying there is a need to talk about diet. Maize meal may be VAT free, but it is still high in sugar and will help drive non-communicable diseases like diabetes which adds to the burden of disease and has its own price tag.”

Health accounts for 13.9% of government spend and priorities include National Health Insurance, the antiretroviral programme for HIV/Aids treatment and the establishment of a regulatory authority for health products. Fin24 reports that according to the National Budget, government will spend R191.6bn on health in 2017/18 and R205bn in 2018/19. This will grow to R240bn by 2020/21. Revised estimates for 2017/18 amount to R191.6bn.

The report says an additional R4.2bn will be allocated to the national health insurance, which is a policy priority, according to the budget review. Over the medium term R368m will be allocated towards a public awareness campaign to complement the health promotion levy on sugary beverages and to establish a health technology assessment unit. The unit will analyse the cost effectiveness of various health interventions, the budget review explained.

Government will allocate R66.4bn to support HIV/Aids prevention and treatment. The antiretroviral treatment programme reaches 3.9m people. An additional R1bn will be made to the comprehensive HIV/Aids and TB grant in 2021 to expand the programme. A total of R4.4bn has been reprioritised within the grant over the next three years to support the programme.

The South African Health Products Regulatory Authority will be established as a public entity in 2018/19. The authority will receive R396.9m in transfers. The regulatory body will have oversight of registration, licensing, manufacturing and importing of active pharmaceutical ingredients, medicines and medical devices. It will also regulate clinical trials in line with national policy. The body will generate feeds from the pharmaceutical and health products industry, Treasury stated.

The report says the health facility revitalisation grant and indirect health facility revitalisation grant will be cut by R820m over the medium term. The budget will be reallocated towards infrastructure programmes.

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