Health services too sick to mention

South Africa's health services crisis was ignored in this week's budget, healthcare activists say. Section27 executive director Mark Heywood said Finance Minister Pravin Gordhan's budget sounded more like an election manifesto, which focused on what had been achieved in health over the past five years instead of looking "honestly" at challenges in the sector.

Gordhan said improvement in that period was "best seen in our rising life expectancy, the reduction in infant, child and maternal mortality, and the changed lives of 2.5-million people who now have access to antiretrovirals [ARVs]".

South Africa has the largest state-funded HIV treatment programme in the world, and Gordhan said it would increase by 500 000 people every year.

Heywood said this misrepresented the state of health.

"The reason for improvement in life expectancy and other areas is purely due to the roll out of the ARV programme, about which we are extremely happy.

"But it doesn't tell you anything about the quality of healthcare services, neither does it tell you what is really going on in our country."

White paper
Gordhan announced that the white paper and financing paper on the National Health Insurance (NHI) scheme were complete, and would be tabled in Cabinet.

But civil society is doubtful about whether these documents will be published this year.

"We still don't actually know what's in the white paper or what's in the financing paper," said Heywood.

"NHI pilot districts were established in every province three years ago, and we know that most of them are health disasters, with very few successes to talk about."

Academics and civil society organisations say that the public health sector's troubles run much deeper than budget allocations.

Recommended spend
The government spends more than 8% of its gross domestic product on health, more than the 5% recommended by the World Health Organisation.

A total of R145.7-billion was allocated to health in the 2014-2015 financial year, up from R134.3-billion in the previous year.

"But if you look at the amount of money that's spent on health services, the performance of the health system is still suboptimal," said Laetitia Rispel, the head of the school of public health at the University of Witwatersrand.

The University of Cape Town's dean of health sciences, Wim de Villiers, said the real problem, which wasn't addressed in the budget, was the quality of services being delivered. "What we should be looking at is scaling up our healthcare leadership and management training."

Also presented to Parliament this week was the "people's alternative budget speech", compiled by a group of civil society organisations including Section27, the Rural Health Advocacy Project and the Public Service Accountability Monitor.

Absent issues
The document highlights key issues absent from Gordhan's speech. "Mismanagement of the health system and rampant corruption has meant that budgets are no longer sufficient to support the full range of healthcare services that provinces should provide," it says.

The group said that provincial health departments, especially those in the Eastern Cape and Gauteng, were failing to "deliver on their constitutional obligations".

For example, last year, then ­auditor general Terence Nombembe said Gauteng couldn't account for R12-billion, almost half of the health budget, and was unable to pay service providers timeously.

In September 2013, the Eastern Cape's inability to manage its finances to buy essential medical equipment resulted in a bail-out by the national health department for R15.3-million worth of supplies.


An actual Black Friday deal

Subscribe for R2/mth for the first three months. Cancel anytime.

Subscribers get access to all our best journalism, subscriber-only newsletters, events and a weekly cryptic crossword.

Amy Green
Amy Green reported on health issues at the M&Gs health journalism centre, Bhekisisa, from 2013 to 2016.
Ina Skosana
Ina Skosana was a health reporter at Bhekisisa, the Mail & Guardian’s centre for health journalism, from 2013 to 2017.

Related stories


Already a subscriber? Sign in here


Latest stories

It is right that audititing is under scrutiny, says Deloitte...

Deloitte has learned a lot about the importance of professional scepticism from its corporate mishaps, says incoming chief executive Ruwayda Readfearn

Impala Platinum re-enters Royal Bafokeng Platinum buyout bid

The announcement comes just weeks after competitor Northam inked a deal to acquire up to 33.3% of Royal Bafokeng Platinum

Brakes put on foreign truck drivers

New legislation aims to protect local jobs in the transport sector amid questions as to whether SA has enough willing and skilled drivers

SANParks shifts to solar and spekboom

Solar-generated pumps are pumping larger volumes of water for wildlife than diesel used to, and spekboom is helping offset carbon emissions

press releases

Loading latest Press Releases…