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Daily Maverick
11-07-2025
- Health
- Daily Maverick
Closing the funding gap — how SA can respond to US aid cuts
South Africa still lacks an action plan after the withdrawal of US aid for HIV and related health services. But when funds do arrive, how will they be managed? The answer may lie in the District Health Programme Grant. The government's extended silence on how it plans to solve the funding crisis created by the withdrawal of US aid has thrown much of the health sector in South Africa into despair. It has been five months since the withdrawal of the aid amounting to about R7-billion per year. It covered the salaries for 15,000 health workers, of whom 8,000 are community health workers, 2,000 are nurses, and 300 are doctors working in 27 of South Africa's high HIV priority districts. As a result, volumes of high-risk populations have lost access to care, while overstretched healthcare workers are facing increased pressure amid ongoing staff shortages. Recently, the Global HIV Treatment Coalition and civil society organisations wrote a strongly worded letter to the government demanding action on a fully costed emergency plan. They accused the state of not taking concerted action. They are not wrong: The government has still not made a clear plan available to the public, although there is consensus on the urgent need to strengthen the emergency response. Plans have been developed internally in the National Department of Health, and a national technical support unit has been established in the office of the health department's director-general to support the integration of services. It is understood that several provinces are being supported to develop provincial transition plans that can be translated into concrete action. But ongoing discussions with the National Treasury have made little meaningful progress in closing the funding gap. The Treasury has indicated that any new funding will either be part of the adjustment budget or as an emergency allocation. At this stage, it is still unclear how much money, if any, will be allocated. There is another challenge that is yet to be considered. When the funding does arrive, there will need to be consensus on how the money is coordinated, incubated and managed. Here, the answer may already be in our back pockets in the form of the District Health Programme Grant. The grant is a mechanism for funding South Africa's public health efforts, particularly relating to HIV, TB and other communicable diseases. As an existing instrument, this grant programme could help address issues linked to the funding gap and lay the foundation for the sustainable integration of activities previously funded by the US President's Emergency Plan for Aids Relief (Pepfar). Why the District Health Programme Grant could work The District Health Programme Grant presents an ideal mechanism that can be used to strengthen governance and ensure that the funding, plans and activities, down to a district level, align with national campaigns and priorities. The grant would need to be amended to ensure that there is improved management of the conditionalities so that the funds invested meet their purpose. Conditional grants are funds allocated to provinces with the primary purpose of ensuring that national priorities are implemented consistently across the country. They facilitate targeted service delivery, equity, accountability and performance monitoring. The District Health Programme Grant, which has a budget of about R25-billion, already has a large HIV component, so additional funding for the HIV and TB services that are needed could easily be allocated to this grant. And if the health department amended the grant mechanism to allow for the contracting in of service providers, such as the Pepfar implementing agents, which are mostly South African NGOs previously funded by the US government, the country would be able to use the capacity built up over time in these organisations to strengthen the delivery of HIV and TB services. The concern, however, is accountability. In the current set-up of the grant, provinces can act more autonomously, and the grant's conditionalities are poorly managed. For the system to be more effective, there needs to be a greater emphasis on cooperative engagement, where two-way reporting between the national and provincial levels can take place. Amending the grant to include stronger accountability mechanisms would help the health department to better coordinate and manage it. The clock is ticking The funding gap comes at a time when the health department has launched two ambitious campaigns to tackle HIV and TB. The Close the Gap campaign aims to enrol a record number — an additional 1.1 million — of people living with HIV on life-saving antiretroviral medicine this year. Along with teenage girls and young women, the initiative prioritises an estimated 600,000 men who know their status but are not on treatment. This campaign aligns with the country's strategy to end TB by 2030. This year, the health department also hopes to accelerate TB case-finding by scaling up testing to five million TB tests to reduce the high rate of infections and deaths. The linkages between the campaigns make sense. TB is the leading comorbidity for people living with HIV. HIV is also the leading contributor to TB mortality, accounting for an estimated 55% of TB deaths, according to the World Health Organization's data on TB in South Africa. The campaigns are evidence-informed and well considered. However, the ambition is not matched by budgets that can support and ultimately enable its success. In addition to the R7-billion Pepfar funding gap, there is a funding gap of at least R600-million in TB to sufficiently fund the required five million tests needed for the campaign. Funding pressures at the provincial level are also constraining the scaling up of the capacity required to administer the tests. A recent analysis by the South African National Aids Council situation room, which every month evaluates the HIV response as part of the Close the Gap campaign, suggests that while there are increases in the number of people being initiated on HIV treatment, the pace is not fast enough to mitigate the losses SA experiences in retaining patients in care. This has resulted in negative growth in many high-prevalence districts. Similarly, in the first TB provincial managers' programme meeting coordinated by the national TB programme, reports of poor performance against the testing targets underpinned the underlying frustrations many are experiencing. South Africa has made incredible progress in expanding access to healthcare in the last 30 years. These include significant declines in maternal mortality, decreases in the under-5 mortality rates, and significant declines in the incidence of TB. Much of this success, particularly in the last decade, is the result of the mass rollout of lifesaving antiretroviral treatment to about six million of the estimated eight million people in SA living with HIV. The abrupt withdrawal of US aid has put at least some of this progress under threat. As we look to the mid-year adjustments budget, we don't just need new money to plug the gap; we also need a sensible framework for spending that money. Channelling the funds through a tweaked District Health Programme Grant is a financial solution that will both provide some quick relief and mitigate the impact that the funding gap will have on universal health coverage more broadly in the long run.
Daily Maverick
09-07-2025
- Health
- Daily Maverick
Putting a price on health — five key takeaways from Minister Motsoaledi's budget vote address
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
The Citizen
09-07-2025
- Health
- The Citizen
New Covid-19 variant: Public urged to remain calm
The National Department of Health has urged South Africans to not be concerned about the new Covid-19 variant, known as NB.1.8.1, which has mostly been detected in Asia. According to the department spokesperson, Foster Mohale, the department and the National Institute for Communicable Diseases (NICD) are working closely to monitor and detect any possible infections in the country. Currently, no cases of the new variant have been reported in South Africa. ALSO READ: Business seminar uplifts youth in Pienaar 'There is no need for the public to panic, as current data on this variant does not suggest any increased public health risk. However, people are urged to remain vigilant at all times and continue to observe non-pharmaceutical interventions such as regular handwashing with soap and water, and sanitising hands and surfaces,' said Mohale. At Caxton, we employ humans to generate daily fresh news, not AI intervention. Happy reading!
IOL News
06-07-2025
- Health
- IOL News
SA government condemns anti-foreigner protests at healthcare facilities
Residents of Atteridgeville, grouped under Concern Tshwane Residents, are protesting outside Kalafong Provincial Tertiary Hospital, calling for undocumented foreigners to be barred from receiving healthcare services due to the alleged strain on public resources. Image: Supplied. In a strong response to a rising tide of anti-foreigner sentiment that has erupted in Gauteng and parts of KwaZulu-Natal, the Gauteng Health MEC, Nomantu Nkomo-Ralehoko, along with the National Department of Health and the South African government, has condemned alarming actions that prevent foreign nationals from accessing essential healthcare services. This week, members of Operation Dudula in Gauteng and members of the March and March movement began their campaign of manning the gates of government clinics and hospitals, including Addington Hospital, Gateway Clinic and RK Khan Hospital in Chatsworth, in a bid to prevent alleged undocumented foreigners from accessing healthcare. In an interview with IOL, the spokesperson for the Department of Health, Foster Mohale, said while the department does not condone illegal migration, the actions of the activist groups are concerning. 'We have noted with concern illegal actions around some parts of Gauteng and KwaZulu-Natal, in which individuals and organised groups prevent healthcare users, especially illegal migrants from accessing health services,' said Mohale. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ Ad loading Mohale also condemned those who have come to the country illegally stating: "We also condemn people who illegally cross the border into South Africa specifically to access healthcare services. 'We urge those with concerns about this societal problem to raise them within the confines of the law instead of taking the law into their own hands because you cannot solve crime through illegal activities which may end you in jail,' he said. In a statement, the government indicated that it has noted with serious concern the reported incidents where certain groups and communities have blocked foreign nationals from accessing healthcare services at public facilities. "While the government understands the genuine frustrations of many citizens regarding the pressures on public services, including overburdened clinics and exhausted healthcare workers, members of the public are urged to raise such concerns through lawful and appropriate channels. Taking the law into one's own hands is unacceptable and undermines the values enshrined in our democratic Constitution. "Such actions stand in direct violation of the Constitution of the Republic of South Africa, which affirms the foundational values of human dignity, equality, and the advancement of human rights and freedoms. Section 27(1) of the Constitution of the Republic of South Africa, 1996, clearly provides that: 'Everyone has the right to have access to healthcare services'. This right is not subject to an individual's nationality or immigration status. Denying individuals healthcare based on their origin is a violation of our laws and values as a nation. Additionally, South Africa is a signatory to several regional and international agreements that aim to ensure access to healthcare for its citizens and, in some cases, for individuals within its borders," the government said.
IOL News
10-06-2025
- Health
- IOL News
New Covid-19 variant Nimbus raises concerns, but South Africa remains case-free
NICD says it's closely monitoring the emergence of a new Covid-19 variant, identified in several Asian countries. The National Institute for Communicable Diseases (NICD) says it's closely monitoring the emergence of a new Covid-19 variant, identified in several Asian countries. "The latest variant, Nimbus or NB.1.8.1, has been designated a SARS-CoV-2 variant under monitoring. "In South Africa, we have also not detected this lineage yet, and using our sentinel syndromic surveillance system, there are very few outpatient or inpatient respiratory illnesses caused by SARS-COV-2," the NICD said. According to the National Department of Health, the new variant is a descendant of the Omicron lineage.
