Last week Health Minister Zweli Mkhize presented to Parliament what could well be dubbed his Catch-22 budget. The Minister recognised that the COVID-19 pandemic had delivered an unmistakable lesson: only “investing in the long-term resilience and sustainability of the health system” would enable nations to withstand future health crises better. However, the economic devastation of COVID-19 and resulting public debt has seen the health budget subjected to fiscal discipline along with the rest of government. “Needless to say, the backlog, current and future needs for health services far exceed the current allocation of resources and all indications point to chronic underfunding of this sector,” Minister Mkhize said.

The Minister presented a budget totalling R62.5bn, which represented a 0.8% increase on the previous year. Fully 85.9% of this amount is distributed to provinces in the form of conditional grants. Provincial health services are also funded from the general allocation to provincial governments, which is distributed to departments through their budgetary processes.

He indicated that a substantial HIV programme had been sustained against the odds in 2020/21, with 14 million HIV tests conducted, five million people on antiretroviral treatment, and more than 500 million condoms distributed. However, there was a concerning 50% decline in TB testing and treatment success for TB was “sub-optimal” at 78%.

There were also declines in contraceptive coverage, antenatal visits and childhood immunisation rates. Targets were almost met in respect of chronic diseases: a total of 22.8 million people were screened for hypertension and 21.7 million for diabetes, while 4.3 million patients now collect chronic medication from convenient sites outside public clinics.

The 2021/22 Health Vote acknowledges the need for a continued response to the coronavirus epidemic for at least two years. A total of R9bn has been allocated over the two-year period for the purchase and administration of vaccines.

The Minister formally announced the appointment of Dr Nicholas Crisp as Deputy Director-General for National Health Insurance (NHI). In recent years Dr Crisp has consulted to the department on NHI. He managed the establishment of the National Health Laboratory System some years ago.

The medium-term expenditure framework (MTEF) has earmarked R121.3m over three years for the NHI Unit in the national Department of Health, while R7.5bn is envisaged for the NHI Indirect Fund, which will be replaced – in time – by the NHI Fund. This amount is to be used for upgrading health facilities (R4.4bn over three years), strengthening of health systems (R2bn) and contracting health services (just under R1bn). Minister Mkhize said the establishment of the NHI Fund would follow the passing into law of the NHI Bill.