HomeArticles#HealthBudgetVote: How will provinces spend their money?

#HealthBudgetVote: How will provinces spend their money?

  • Health Minister Joe Phaahla tabled his budget for the 2023/4 financial year in the National Council of Provinces on Wednesday afternoon.
  • On Tuesday the health minister tabled his budget in the National Assembly. Read his speech. Find Deputy Minister Sibongiseni Dhlomo’s speaking notes here.
  • Want a breakdown of Phaahla’s budget? Read our Twitter thread.

[WATCH] National Council of Provinces Plenary

What’s in the 2023/4 budget vote?

  • The national health department’s budget has shrunk: The 2023/4 budget allocation of R60.1-billion is R4.4-billion less than the R64.5 that was allocated in 2022/23. Why? Because COVID-19 conditional grants have been stopped. But, the health minister says, “the fact of the matter is that there is not even inflation adjustment and there are also reduction in allocations to existing programmes”.
  • The Treasury acknowledges that the national health department is under-funded by at least R11-billion.
  • Over 90% of the national health department’s budget goes to provinces: R56.2-million of the department’s R60.1 budget will this year be transferred to provinces or used to subsidise services in provinces.
  • R10-million per year will go to the no fault scheme (a fund pharmaceutical companies required the government to establish to cover possible injuries from COVID-19 vaccines — without establishing such a fund, Pfizer and Johnson & Johnson weren’t willing to sell jabs to any government). How does the fund work? We break it down. How do scientists link a death to a vaccine? Find out here.
  • Over the medium term expenditure framework (a plan that sets out three-year spending plans) R8.7-billion within the national health department’s human resources grant has been allocated to train specialists over the next three years — the public health sector has a huge shortage of specialists.
  • Also over the medium term expenditure framework, R7.8-billion will go to pay the salaries of medical interns (medical students have to do two-year internships) and community service doctors (health professionals such as doctors, physio, occupational and speech and hearing therapists have to do a year of community service at a government health facility before they are allowed to practice). How many medical intern positions did public health facilities have in 2022? The health minister says 2 625. In the same year there were 2 369 community service positions for doctors.
  • The medium term expenditure framework also allocates R7.2-million over three years for direct transfers to provinces with approved plans for the maintenance, refurbishment, upgrades and replacements of primary healthcare facilities.
  • Under South Africa’s National Health Insurance (NHI) scheme grants, the national health department has R1.4-billion to give to provinces to upgrade or build new clinics and hospitals (from primary healthcare to tertiary facilities). The Limpopo Academic Hospital, Zithulele and Bambisana Hospitals in the Eastern Cape and Dihlabeng Hospital in the Free State are part of this project.
  • The first year of the government health sector’s electronics health records system (EVDS) will be introduced this year — it will focus on electronically recording the data of HIV and tuberculosis (TB) patients. To make this happen, health facilities need internet. There are public sector clinics that have no internet — the health minister says all clinics will have connectivity by the end of the financial year.
  • R14-billion has been allocated to the tertiary services grant. This is money that is used for highly specialised medical services which are provided in 31 tertiary and central hospitals, mostly in cities.
  • The national health department has identified 100 health facilities in 17 health districts across the country that need extra help to retain HIV-positive people on treatment. Why? South Africa has not yet reached the United Nation’s 90-90-90 goals — these targets had to be met by the end of 2020. We currently stand at 94-76-92. The “90-90-90” goals mean 90% of people with HIV must be diagnosed, 90% of those who have been diagnosed must be on antiretroviral treatment, and 90% of people on treatment must be virally suppressed (this means they take their treatment regularly enough to allow the amount of HIV in their bodies to become so low, that it becomes impossible for them to transmit the virus to someone else through sex). The United Nation’s new targets, 95-95-95, need to be reached by 2025 and by 2030, the goal for Aids to be eliminated as a public health threat. South Africa is on track with the first and last “95” goal, but the middle “95” is a problem, because we struggle to retain people on treatment. That is why the 100 clinics and hospitals will receive additional support.

Watch the National Assembly recording

Want some context? We’ve got you.

  • On 22 February, Finance Minister, Enoch Godongwana, tabled his 2023/2024 financial year budget speech. Our Joan van Dyk broke down allocations to health in a Twitter thread. Want more background on Godongwana’s health budget? Find it here.
  • What did the health minister say in last year’s budget vote? Read it here.
  • What does the national health department’s 2023/2024 performance plan look like? Find it here.
  • One of the important issues in the health minister’s budget is how much money is allocated for the implementation of South Africa’s plan for universal access to healthcare, the NHI, and aspects, such as increasing the country’s number of health workers, improving infrastructure and both the health department’s and provincial health departments’ ability to curb corruption with tenders and pay suppliers on time.
  • Want to read the NHI Bill? Find it here.
  • South Africa has between 26 000 and 62 000 too few professional nurses (nurses who study for four years and get a degree), says the health department. Most nurses work in the private health sector, even though only 27% of South Africa can afford to pay for private healthcare. How do we change this — and how do we keep nurses in the health system? The Rural Health Advocacy Project at Wits University looks at solutions in this report, which was released on May 12.

A few budget-related stories

  • Does the health department have enough money to pay for more rural health workers? The health department’s deputy director for the NHI, Nicholas Crisp, told Mia Malan on Health Beat, our television programme, no — not as things currently stand, as provinces don’t have enough money. Watch the interview here and read it here.
  • What can the NHI learn from the COVID pandemic about getting the buy-in of the private health sector and managing budgets? Our Joan van Dyk breaks it down.
  • Has the NHI appointed any workers? In August, the health department told our Mia Malan that they’ll have 44 experts, such as economists, public health medicine specialists, actuaries and lawyers, appointed by January to advise them on the structure of the NHI. The health department, however, told Bhekisisa on Tuesday, that these appointments have not yet happened. “We received 1 955 applications,” Crisp said. “We shortlisted and have interviewed for many but several we had to re-advertise as there were no qualifying candidates.”

Catch up on our #HealthBudgetVote Twitter threads