Revised health spending plan slated all round
R6.4bn cut in funds for on HIV/Aids met with disapproval
Civil society organisations have criticised the government for its plans to reduce expenditure on health and even on critical programmes such as HIV.
Documents released by the National Treasury on the budget show that consolidated government health expenditure is expected to surge from a revised estimate of R247bn in 2020/2021 to R249bn in 2021/2022, and then drop to R246bn in 2022/2023. It will fall to R245bn in the 2023/2024 financial year.
The HIV/Aids component of the HIV/Aids, tuberculosis, malaria and community outreach grant is to be cut by R6.4bn over the three-year period. The government has allocated R69.3bn to the HIV/Aids component of this grant over the medium term expenditure framework.
Treatment Action Campaign general secretary Anele Yawa said the move to reduce funding was ill-advised as over the past year there has been a disruption of government’s programme on HIV and TB treatment due to Covid-19.
He said the TAC estimates that about 30% of people on HIV treatment have defaulted over the lockdown period as clinics and other public health institutions prioritised fighting Covid-19 over testing and providing HIV treatment.
“If they are redirecting the money ... to other services, what does that mean for people living with HIV? It means that 2m people who have not been initiated on treatment will be allowed to go and die. It also means that those people living with HIV and TB who have defaulted on treatment we will not be able to bring them back to care,” Yawa said.
The TAC estimates that 7.8m people have HIV in SA. Of this number, 5m are on antiretroviral (ARV) treatment.
Yawa said the TAC will mobilise its allies in the sector in protest against the plans to reduce funding for such a critical health programme.
The Treasury also projects spending on maintenance of facilities to drop from a revised R14.4bn in 2020/2021 to R9.7bn in 2021/2022, to rise to R10.4bn in 2022/2023 and to rise again to R10.6bn in the 2023/2024 financial year. The national tertiary services grant is also expected to be cut by R3.5bn to R41.7bn while the human resources and training grant is trimmed by R1bn.
Angelique Coetzee, SA Medical Association chairperson, said the spending cuts would have a devastating impact on the number of health workers serving patients in the public sector.
“As it currently stands, there are not enough doctors and nurses permanently employed. This includes specialists, medical officers ... The more you cut on spending, the poorer your outcomes. This means poor clinical outcomes to the patient, [as well as poor] services to the patient at all levels. You cannot cut the healthcare budget. Our health care is in dire need of reform. Covid19 showed that to us,” Coetzee said.
She warned that while some doctors could emigrate elsewhere, some may consider having private practices to improve their income over the next few years. Coetzee also lamented the government’s projected cut in maintenance expenditure over the next three to four years, which she said would severely affect hospital infrastructure at old health facilities.
The health system has been stretched to its limits during the Covid-19 pandemic. This forced the government to reprioritise its budget to provide resources to fight the virus.
In his budget tabled on Wednesday, finance minister Tito Mboweni allocated R10bn for the purchase and delivery of vaccines over the next two years. He also allocated a further R8bn for provincial health departments to deal with Covid-19 and R2.4bn for provincial health departments to administer the vaccine programme.