The ongoing struggles in South Africa’s public healthcare system, including staff shortages, poor infrastructure and surgery backlogs, came under the spotlight on Tuesday when parliamentarians raised their concerns with Health Minister Joe Phaahla. The minister was delivering his department’s budget vote.

Prioritising primary healthcare, mental health facilities and having a more preventative approach to healthcare were the main subjects of discussion. Phaahla hit back saying the healthcare system is not crumbling pointing out that healthcare workers were saving lives every day around the country.

“We acknowledge that there are issues and are dealing with them. We do not shy away from where we have challenges,”’ he says.

Phaahla added the National Health Insurance (NHI) Bill is the antithesis of privatisation and because a large amount of the population relies on public healthcare, the department does not take this lightly.

“85% of the population depends on public healthcare, making it a matter of life or death”, he says.

Learn from Cuba’s healthcare system

Last year 594 South African medical students from eight different provinces graduated in Cuba as part of the Nelson Mandela/Fidel Castro Medical Collaboration Programme

The programme aims to address the need for a new medical training model focusing on preventive and promotive healthcare services rather than the historical dominance of the curative healthcare system. He says this is key to dealing with the rise of lifestyle diseases, poor infection control, underdiagnosis of diseases and infant mortality rates. 

“We must embrace Cuba’s preventative healthcare approach to our country’s healthcare system”, he says.

Dhlomo: Partnerships working

Deputy Minister of Health, Sibongiseni Dhlomo, also appraised MPs of initiatives like the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme – which provides an alternative mechanism to facilitate access to medicine for stable patients.

“Instead of patients going to the clinic 12 times a year to get medication the CCMDD will assist them to get it four times a year. This does not only help the patient but it helps with overcrowding at healthcare facilities too”, he says.

Dhlomo says the department’s partnership with private schools to roll out the HPV vaccine is a positive step towards eliminating cervical cancer.


The 2023/24 budget allocation for the National Department of Health has declined by   R4,4bn from R64.5bn in 22/23 to R60.1 billion in 2023/24. Phaahla says this can be attributed to the discontinuation of conditional grants allocated for fighting Covid-19.

The minister says both the pandemic and loadshedding have hurt the economy. 

“The financing of public health is seriously negatively affected by this situation. The fact of the matter is that there is not even an inflation adjustment and there are also reductions in allocations to existing programs,” says Phaahla.


He says the treasury acknowledges the health sector is underfunded to a minimum of R11-billion. 

“We believe commutatively it is much higher. 89.2% of our budget is transferred to provinces and in the current budget the transfers and subsidies to provinces are at R56.2bn of the R60.1bn.”

The minister says now that Covid-19 is no longer a public health emergency, the department can now focus on improving services across the board from Primary Health Care to specialised care. 


Improving health services will require well-maintained facilities and new infrastructure. “To support provinces in this regard we have R7.2 billion over 3 years for direct transfer based on approved plans. Under NHI grants we have R1.4 billion which is implemented by the NDOH in provinces on agreed projects from primary health care up to tertiary services.”

He says the funds to build the Limpopo Academic Hospital comes from this budget. Construction on the Siloam Hospital in Limpopo started 10 months ago. Building of the Zithulele and Bambisana hospitals in Eastern Cape and Dihlabeng Hospital in Free State is also underway.

Phaahla says the department is looking at ways to ensure these facilities are delivered ahead of time and under budget. 

“Acquisition and maintenance of equipment are also under the spotlight where we are also looking at faster turnaround times and reliable maintenance plans,” he told MPs. – Health-e News