Putting a price on health — five key takeaways from Minister Motsoaledi's budget vote address

Daily Maverick

2 days ago

Minister of Health Dr Aaron Motsoaledi's budget vote address laid out spending priorities for the 2025/26 financial year, including infrastructure, National Health Insurance, and gaps left by Donald Trump's canning of Pepfar funding.
Health Minister Dr Aaron Motsoaledi tabled the 2025/26 health budget vote in Parliament on Wednesday, 9 July, laying out the spending priorities for the current financial year.
His speech centred around strengthening infrastructure, reversing the impacts of yearslong austerity measures, and addressing the withdrawal of US aid funding for South African health programmes.
Wednesday's proceedings followed a tumultuous 2025 Budget process, which saw Finance Minister Enoch Godongwana's Budget speech delayed twice and only finalised on 21 May.
'This [health] budget is being presented at a very challenging time in the history of our country, including geopolitical events of recent days,' said Motsoaledi. 'However, I must assert that challenging as the moment is, there is a lot we should be excited about.'
A National Department of Health budget of R64.8-billion was presented to the National Assembly for consideration.
Below are five key takeaways from Motsoaledi's address.
1. Strengthening infrastructure
Motsoaledi spent a significant portion of his 15-minute time allocation on infrastructure, saying it was 'one of the biggest problems that the public health system encountered'.
He referenced the health ombud investigation into allegations of poor management at Helen Joseph Tertiary Hospital in Gauteng, which found problems with infrastructure and human resources at the facility.
He noted that South Africa's eleventh academic hospital, the Limpopo Central Hospital, was under construction in Limpopo and was 26% complete.
Other hospitals under construction are:
Siloam District Hospital in Vhembe, Limpopo — 90% complete;
Dihlabeng Regional Hospital in the Free State — 30% complete;
Bambisana District Hospital in the Eastern Cape — 82% complete;
Zithulele District Hospital in the Eastern Cape — 50% complete; and
Bophelong Psychiatric Hospital in North West.
'In addition to the hospitals currently under construction, the National Department of Health has prioritised several key hospital projects placed strategically to strengthen South Africa's public health hospital network, particularly in high-demand areas in Gauteng, but also in underserved areas,' said Motsoaledi.
'These include 17 major hospital projects which have been identified for development. They are in various stages of design and development.'
While the budget didn't necessarily cover all the funding needed for the department's 'massive infrastructure injection', Motsoaledi said officials were also speaking to international and local financial institutions about financing options.
2. Reinforcing HIV/AIDS, TB programmes
The loss of US foreign development assistance, particularly funds provided for HIV programmes through the US President's Emergency Plan for AIDS Relief (Pepfar), has been a major concern in the health sector over the past few months. Experts and activists have called on Motsoaledi and the National Department of Health to develop an emergency funding plan to prevent a loss of ground in the fight against HIV/Aids.
'In the aftermath of the withdrawal of Pepfar, we presented our plans to National Treasury and asked for help. At the same time, we approached other funders, both domestic and globally,' said Motsoaledi.
He said the National Treasury had 'come to the party' by allocating R753.5-million. These funds will be used to provide:
R590-million for provincial departments of health;
R32-million for the National Department of Health; and
R132-million for the South African Medical Research Council (SAMRC) to support health researchers around the country.
The R132-million allocation for the SAMRC is part of a R400-million budget the Treasury has designated for health research over the next three years.
Motsoaledi said the Gates Foundation and the Wellcome Trust had each pledged an additional R100-million to South Africa.
'This means we are going to have a total of R600-million offered to researchers, despite Pepfar having pulled the plug on their work,' said Motsoaledi.
'These amounts are intended to cover the most urgent needs, and further allocations may be considered later.'
3. Reversing austerity measures
On top of the R64.8-billion budget allocation for health, the National Treasury had earmarked an additional R6.7-billion to 'reverse years of austerity measures which have crippled the public health system', said Motsoaledi.
The National Health Council (NHC), made up of Motsoaledi, Deputy Health Minister Dr Joe Phaahla, provincial health MECs and representatives of the South African Local Government Association and the military, has elected to use the additional funds to:
Hire 1,200 doctors, 200 nurses and 250 other health professionals at a cost of R1.7-billion;
Acquire 1.4-million articles for public hospitals, including beds, mattresses, bassinets and new hospital linen at a cost of R1.3-billion;
Permanently employ 27,000 community health workers who have been in the system for close to two decades, but were supported through NGOs, at a cost of R1.4-billion; and
Start paying accruals that have accumulated over the years in oxygen supply, blood and blood products, laboratory services, medical equipment and pharmaceuticals.
The NHC originally announced its intention to fund an additional 1,650 public sector health worker posts in April.
4. Reaffirming commitment to NHI
In their presentations before the National Assembly, both Motsoaledi and Phaahla reaffirmed the National Department of Health's commitment to implementing the National Health Insurance Act.
Motsoaledi said one of the main objectives in the health budget was 'to lay a strong foundation in preparation for improvement of the public health system of our country, in preparation for the National Health Insurance (NHI). There are people who believe that we have no plans, nor inclination to do that. We want them to listen very attentively today.'
Phaahla said the department was well on the way to implementing the NHI Act, 'despite the court challenges by those opposed to equity and transformation. When this Act is fully implemented, the aspirations of a preventative health scheme run by the state and free medical care at the point of service, as espoused in the Freedom Charter, will be realised in full.'
There are currently six legal challenges to the NHI Act.
5. Parties push back
While the ANC expressed its support for Motsoaledi's health budget vote, not all parties were satisfied with the minister's priorities. Key among those raising objections were the uMkhonto Wesizwe (MK) party and the DA.
Moshome Motubatse, an MK party MP, said the party opposed the health budget vote.
'This budget fails to provide meaningful healthcare for the people of South Africa,' said Motubatse, noting that the allocation for the 2025/26 financial year was increasing by only 1% when accounting for inflation.
'It represents a cut in real terms, even as the demand [on health] continues to grow.'
Dr Karl du Pré le Roux, a former rural doctor, spoke for the DA, the ANC's largest partner in the Government of National Unity. He said that while there was much justified criticism of the inequity between the public and private health systems in South Africa, there were also large disparities in the resourcing of different areas within the public health system.
He said managerial incompetence, poor leadership and corruption were among the largest problems facing the public health sector. Du Pré le Roux added that NHI was not the best way to achieve universal healthcare in the country.
'Though your aims are noble, most academics, analysts and ordinary South Africans recognise that the implementation of the NHI legislation by a government health system that is riddled with incompetence, mismanagement and corruption at every level, will be a complete disaster,' said Du Pré le Roux. DM