Baragwanath Chris Hani Hospital. Picture: BUSINESS DAY
Baragwanath Chris Hani Hospital. Picture: BUSINESS DAY

President Cyril Ramaphosa has injected a new sense of urgency into the government’s efforts to tackle the crisis in public health care, promising to increase funding and convening a high-level summit to chart a plan for tackling the sector’s ills.

The healthcare industry will be closely watching finance minister Tito Mboweni’s medium-term budget policy statement on Wednesday for details of how the government intends to give effect to the commitments the president made when he delivered his economic stimulus package in September. They include undertakings to fill 2,200 critical posts, improve the supply of linen, beds and other essential items and establish a R400bn infrastructure fund, which, according to deputy president David Mabuza, will include an allocation for health.

“Wherever you look, there is a systematic breakdown. Not a month passes without someone calling to tell me there is a hospital whose theatre roof is falling in, or the boilers are not being maintained,” says Mzukisi Grootboom, chair of the SA  Medical Association. “Public-sector doctors are reasonably well paid these days. There is a lot of goodwill, but they can’t get the job done when there isn’t equipment or medicines.”

Public-law advocacy group Section 27 says the crisis is in part due to the government prioritising reining in public debt and narrowing the budget deficit since 2016, leaving less money available for spending on social services.

The February budget showed health expenditure increasing by an average 7.8% annually, rising from R191.7bn in 2017-2018 to R240.3bn in 2020-2021, but analysis by Section 27 and its partners submitted to the UN Committee on Economic, Social and Cultural Rights shows the 2018-2019 budget was cut by 0.1% in real terms compared with the previous year. They note that with an estimated 740,000 additional people entering the public health system through births and migration, per-capita spending on the uninsured has decreased.

“Provinces have dealt with the expenditure ceiling imposed by Treasury by not hiring doctors, nurses and administrators,” says Section 27’s budget analyst Daniel McLaren. 

Trade union federation Cosatu, whose affiliates include state health-care worker unions, estimates 148,000 funded posts are not filled. “We have asked Treasury to do a physical verification, because we get reports of ghost workers in provinces and municipalities — in the Eastern Cape, North West and Free State  — and the usual suspect municipalities flagged by the auditor-general,” says Matthew Parks, Cosatu’s parliamentary co-ordinator.

With growth and tax revenue likely to undershoot the February budget projections, and the government under pressure from ratings agencies and investors to stick to its expenditure and deficit targets, the Treasury has little scope to source additional funds for public health care.

To fund former president Jacob Zuma’s promise of free higher education, the government cut school infrastructure budgets and raided the National Skills Fund. Provincial health departments may have to do the same juggling to meet  Ramaphosa’s undertaking to fill critical health-care posts.

Money may be shifted to the health department from other departments, or within the health vote, says Russell Rensburg, the Rural Health Advocacy Project’s programme manager for health systems and policy. 

“The funding needs are vast. There is a chronic shortage of staff, particularly in rural areas; poor financial management; and provinces are collectively carrying over R14bn in accrued expenditure along with significant over- and irregular expenditure,” Rensburg says.