Finance minister Pravin Gordhan's "careful control of the wage bill" and expenditure on goods and services that he announced in his mid-term budget speech on Wednesday will impact negatively on health service delivery, said health economist Daygan Eager from the Rural Health Advocacy Project at the University of the Witwatersrand.
"If measures aren't taken to deal with the provincial management crisis, it could mean that the health department might not be able to appoint enough health professionals within a short time frame for its National Health Insurance [NHI] scheme. The department will also face restrictions with the purchase of medical supplies," Eager said.
Eager added that it's not clear where the additional funds needed for the NHI and upgrading of health facilities in particularly rural areas such as the Eastern Cape will come from.
"The Rural Health Advocacy project fights for increased resources in such areas so that services can be improved. The current economic climate is therefore of concern to us."
R491 893-million was budgeted for the NHI for the current financial year – Gordhan's mid-term budget adjusted this amount to R488 865-million.
Drawing up budgets
In the coming weeks, provincial health departments will draw up budgets based on the Gordhan's review. "We're likely to see that provincial budget expenditure won't increase sufficiently," Eager said.
The review shows that the health department is falling behind on its cure rate target of 85% for lung TB patients per year – for the first half of the current financial year the rate stands at 75.2%. The performance is, however, an improvement compared to previous years.
The expansion of the government's antiretroviral treatment programme for people with HIV is showing a strong performance with 221 498 of the annual target of 500 000 patients initiated on treatment for the first six months of the financial year.
According to the review, the late start of antenatal care remains a challenge; just more than half (52.5%) of pregnant women accessed antenatal care during the first four weeks of pregnancy, compared to an annual target of 60%.
"The health department is addressing this challenge through the appointment of ward-based outreach teams that will improve access at community level," the review states.
In the first four months of 2013/14, 2.7 of babies born to HIV positive mothers tested positive for the virus – slightly above the target of 2% of the state's prevention of mother to child transmission of HIV programme.