Four healthcare priorities for South Africa’s budget

Tito Mboweni is sworn in as South Africa's new finance minister on 9 October 2018. Photo: Leila Dougan, Daily Maverick

By Russell Rensburg, Rural Health Advocacy Project

The president in his recent “state of no action” address outlined five major areas that in his approximation articulates the road that lies ahead. The priority given to the restructuring of the country’s security services notwithstanding, there was one particular priority that stood out and that was the rebuilding of the capability of the state to address the needs of the people. It was tacit acceptance that without a supportive state we will not be able to deliver on our promise as a nation.

The tabling of the national budget this afternoon will give us a sense of the extent of our fiscal crisis. How will we achieve the difficult task of addressing the risks posed by the potential collapse of ESKOM which requires in excess of R200 billion just to meet its immediate needs. With over R400 billion in state guaranties the ESKOM bailout is a fait accompli.

The bigger question posed to the minister is how will we mitigate the impact of the looted purse on the millions of South Africans who rely on the state to meet their most basic rights. None more than the millions of people living in rural areas particularly those in former Bantustans, whose long walk to freedom is far from over.

As the Rural Health Advocacy Project, we call on the minister to respond to the crisis in our health system by.

Fixing the way we fund healthcare

The National Health Insurance (NHI) bill, though imperfect, provides an important framework through which to implement the reforms needed to fix our broken health system. Its success will depend on a strong publicly funded health system. We can begin this reform by consolidating the more than R220 Billion spent on health into a single financing stream managed by an independent National Health Fund.

Addressing our Human Resource Crisis

The advertising of over 5 500 critical health posts in December was an important first step but it cannot end there. The National Department of Health estimates that there are more than 40 000 vacancies across all nine provinces. Despite this, between 2002  and 2010 less than 40% of health professionals trained were retained in the public healthcare system. RHAP reported in 2016 how provincial departments delayed or failed to fill vacancies merely to save costs without any consideration of the resulting impact on quality of care. To effectively address the Human Resources for Health crisis we need a comprehensive assessment of where our health workers are. Using this assessment, we can begin to develop a plan that ensures that our available resources are distributed in an equitable manner prioritising those most in need of care.

Strengthening Primary Health Care

Since the dawn of our democracy we have invested heavily in improving access to healthcare services and currently there are 4 000 primary healthcare centres scattered across the country. In the recently published district health barometer budget analysts from National Treasury reported two interesting findings. The first was that despite the talk of a system in crisis primary health care expenditure has actually gone up.  Similarly, the percentage of patients without referrals also trended downwards suggesting that people were accessing care at the appropriate level. On further inspection, the rise in primary healthcare expenditure is actually a result of fewer people visiting primary health care clinics despite an increasing burden of disease. Which begs the question, if the people are not going to clinics or district hospitals, are they delaying health seeking because they have lost trust in the system? District management in one deep rural district report to us that they are operating with vacancy rates of up to 80%.

Prioritising Rural

The challenges in the health system are amplified in Rural districts plagued by inadequate staffing levels, inconsistent availability of medicines and poor physical infrastructure – despite the fact that rural communities often bear a greater burden of disease. Women in rural districts are 30% more likely to die from complications related to pregnancy. While we have almost eliminated mother to child transmission of HIV we continue to struggle with under 5 mortality including malnutrition. Rural populations account for close to 38% of the population of which more than 50% are below the age of 35. Failure to prioritise rural populations for the delivery of good quality health can no longer be acceptable.

So, dear minister, lets reflect on the goal of our ongoing struggle, as expressed in the preamble of our Constitution, above all else to “Improve the quality of life of all citizens and free the potential of each person”.

Let’s hope the budget you present today is a step towards realising that ambition.