Finance Minister Pravin Gordhan's 2014 budget speech was "disappointing", according to Daygan Eager of the Rural Health Advocacy Project at the University of the Witwatersrand.
He said that Gordhan's commitment to lowering the budget deficit leaves little space for improvements in healthcare service delivery.
"Government continues to take the stance of cutting the budget deficit and consolidating expenditure, which doesn't mean they're cutting expenditure; it means they're not significantly increasing spending particularly on non-infrastructure related social services."
Health was allocated R145.7-billion, which is R11.4-billion more than the previous financial year, for the 2014/15 financial year – R1.2-billion of which will be dedicated to contracting private general practitioners to work for the government’s National Health Insurance (NHI) scheme at 11 pilot sites.
"The department of health's white paper on the NHI and a financing paper by the national treasury have been completed and will be tabled in Cabinet shortly," said Gordhan in Parliament on Wednesday.
However, Eager said he would be "very surprised" if the documents are publicised this year.
"We've been waiting for this [financing] paper for at least two years and because it is an election year, there are other priorities high on government's agenda and it is unlikely that Cabinet will look at it in the near future," he said.
'Reluctant to come on board'
Eager said the health minister's vision for the NHI is not being matched by treasury, which is "reluctant to come on board" because of the large initial expenditure – which will delay investment in the project and any other significant reforms in the public health sector.
But it is not all bad: R43.5-billion has been budgeted for HIV and Aids programmes over the next three years. This is slightly more than the R41-billion that was allocated over the past five years. South Africa has 2.5-million people on the state-funded HIV treatment programme and, according to Gordhan, this figure will increase annually by 500 000 patients.
"Another positive point is that we have started to see is a commitment to improving how the money is being spent, particularly in the Eastern Cape," said Eager.
There have been improvements in the payment of doctors in the province and the appointment of a new chief financial officer is largely responsible, according to Eager.