Budget takes steps in the right direction but we need more details Mr Finance Minister

22 February 2024

The Rural Health Advocacy Project acknowledges the efforts of Finance Minister Enoch
Godongwana in delivering his 2024 budget vote this week.

As champions of the most marginalised health users in the country, it is encouraging to see the
minister make direct references to health, introducing budgeting initiatives that will tackle some
of the most pressing challenges. But this is only the first step – and in general more detail is
needed to ensure that people’s constitutional health rights will actually be realised.

Godongwana this week announced that health would be allocated a total of R848 billion over
the next three years. This included R11.6 billion to address the 2023 wage agreement, R27.3
billion for infrastructure, and R1.4 billion for the NHI grant over the same period.

In addition, Godongwana announced above-inflation excise duty increases (of between 6.7 and
7.2 per cent) on alcohol products. Excise duties on tobacco duties will, however, only increase
by 4.7 per cent for cigarettes and cigarette tobacco. Godongwana also tabled an excise duty on
e-cigarettes and vapes.

RHAP welcomes these above inflation increases for alcohol and the new e-cigarette excise tax.
But given the public health impact of tobacco use, we are disappointed by the limited increases
for conventional tobacco products.

The National Health Insurance also received a notable mention in the budget. While we
welcome the deliberations around the NHI, we recognise the phased implementation of the NHI
will take several years. It is unlikely to impact on our most immediate challenges in providing
healthcare now.

We are also concerned by the continued trend of below inflation adjustments to allocated
budgets. This calls into question the extent to which these budgets are sufficient to meet the
requirements of the programmes it funds at a national level.

Among the largest line items in the National Health budget are the communicable and
non-communicable disease programmes, which was restored to R25 billion in this budget.
This programme is responsible for the coordination of the district health programme grant,
which partially funds SA’s HIV programme. In October 2023, the district health programme
grant, which primarily funds the provision of antiretrovirals was cut by over R1 billion to support
the payment of unbudgeted salary increases. While RHAP is satisfied that this has been
corrected, we are deeply concerned with the performance of this programme. The Health
Department’s reports reflect that as of November 2023 only 5.5 million people have been
retained in care – a shortfall of 500 000 people. This comes after reports of increased HIV
prevalence among older people in rural areas. As the response to HIV /AIDS matures, there is a
need to reflect how we use existing resources to end HIV AIDS as a public health threat.

We also welcome increases to the provincial equitable share items and specifically the
increases to rural provinces as result of the adjustments to the health component of the
provincial equitable share formula. But we are deeply concerned by how these additional
allocations will support the employment of additional healthcare workers as suggested by the
minister. The challenge is that these allocations would also need to cover the negotiated
increase that provinces have to meet. More information must be provided explaining how these
allocations will be used.

Health is a shared struggle across society. To meet our Constitutional obligations to healthcare,
greater priority must be given to addressing the broader health needs of a community in
transition. Publicly funded healthcare must meet the needs of all who live here.

For more information, contact RHAP Director Russell Rensburg on 076 309 4261 or