Academics, activists and medical professionals have rung the alarm bell over the further deterioration of South Africa’s public health services if stringent budget-cutting measures are implemented immediately.

South Africa has been facing fiscal strain with increased interest rates and high debt repayments. It’s been reported that the National Treasury recently instructed provinces and departments to freeze vacancies and cut back on spending.    

Finance Minister, Enoch Godongwana, is expected to announce the cost-cutting measures in detail when he delivers the Medium Term Budget Policy Statement in November.

Major cuts are expected in departments such as social development, health, education and criminal justice. The government is already facing threats of social unrest and strike action from trade unions. 

But activists are calling for the exemption of social services including healthcare from the budget cuts as these will impact the vulnerable members of society.

Budget cuts entrench gender inequality

“Healthcare budget cuts adversely impact all South Africans but they further entrench gender inequality in the country,” says Matshidiso Lencoasa, a SECTION27 budget researcher and member of the Budget Justice Coalition steering committee – an alliance of civil society organisations. 

“Women rely more on the public healthcare system owing to our higher and  differentiated health care needs which include reproductive and maternal health services.” 

She says the anticipated cut in resources occurs in the context of a public health system that’s already under-resourced, understaffed and plagued with reports of corruption. 

“These budget cuts mean there is less money to hire and pay for nurses, doctors and community health workers. This, in turn, means that ordinary South Africans can expect fewer healthcare practitioners who are also severely overworked and underpaid,” says Lencoasa. 

The Sunday Times reported that a meeting took place a fortnight ago between President Cyril Rasmaphosa, finance minister Enoch Godongwana, South African Reserve Bank governor Lesetja Kganyago and Treasury officials who warned Ramaphosa against excessive government spending. 

Immediate impact

Earlier this week, the Progressive Health Forum (PHF) , a national health advocacy network made up of health professionals and patient advocates, wrote a letter to the president, and the ministers of health and finance. The group is warning that any reduction in resources for health will have immediate and catastrophic consequences. 

In the letter dated, September 12th 2023, the PHF argues that the national government should have foreseen the financial difficulties before agreeing to improvements in conditions of employment. 

Now  it is left to provincial health departments to “take drastic measures to avoid running out of funds during the 2023/24 financial year”, leaving the millions of people who rely on public health services in “great uncertainty”.  

“Rapidly implemented austerity measures introduced by weak provincial administrations will invariably compromise the quality of health services delivered. Any resulting impacts on patient care cannot be left to lie without a public response,” says the PHF in the letter.

“It is with this in mind that we call on the national government to reverse its abdication of responsibility, and actively initiate processes and policies that will fully mitigate any harm to public health services that self-induced profligacy has caused.”

South Africa’s budget conundrum is “a whole-of-government problem”. Thus the solution must involve “all relevant role-players”. 

Government has no choice 

Professor of Health Economics at the University of the Witwatersrand, Frikkie Booysen, says the government has no alternative but to impose cost-cutting measures to keep South Africa’s debt under control.

Booysen says the government should consider this an opportunity to revisit its allocation of resources across budget votes to ensure that expenditure on social services, including healthcare, is protected.

“What is most important now, more than ever, is to make ‘smarter’ decisions regarding how we utilise the available health budget. What should not be cut (in real terms) are the resources required to provide primary frontline health services in the public sector,” says  Booysen. – Health-e News