Health care

As part of drawing up the Budgetary Review and Recommendations Report for the Department of Health and its entities, the Portfolio Committee on Health considered various source documents and received inputs from a number of entities, including the Financial and Fiscal Commission (FFC).

The FFC reported that the public sector continues to carry the highest burden of health care delivery with limited resources. Health outcomes are not comparable with the level of spending and with peer countries.

South Africa has a total of 4 200 health facilities each serving 13 700 people on average. An average citizen visits health facilities 2.5 times per annum. More than 90% of the population can access a health facility within a five kilometre radius. There are over 170 000 health care professionals countrywide.

Public health care funding accounts for 12% of consolidated national spending and is growing. Growth in health spending is driven by the implementation of the universal test and treat policy on HIV.


On challenges facing the health sector, there are disparities in access to healthcare professionals between the public and the private sector. Health personnel are gradually declining amid concerns of staff shortages especially in rural areas – this is compounded by a bureaucratic process in appointing healthcare professionals. Provinces are also reluctant to delegate human resource functions to health facilities.

On infrastructure, the FFC noted that health infrastructure is funded through the Health Facility Revitalisation Grant which is characterised by inconsistent spending performance. Provincial health infrastructure programmes are faced with numerous challenges ranging from slow progress in filling posts for infrastructure units, delays in procurement processes and approval of projects, lack of operational budget for newly built facilities and delays in closure of completed projects and transfer to asset register.

The FFC reported that health negligence and malpractices are rife within the sector and a concerning trend of growing medical claims as these place huge contingent liability on provincial health budgets. The FFC assumed potential abuse of the system by legal professionals.

On private health care sector, spending accounts for 51% of the total national spending while the sector only caters for 17% of the total population. The large financial muscle enables the private sector to attract qualified and experienced doctors and other professionals to the disadvantage of the public sector.

With regard to health reforms, the National Health Insurance (NHI) implementation is set to enter a second phase of implementation from 2017 to 2020. The newly revised White Paper makes notable strides in addressing concerns raised in the first draft. The FFC, however, noted that many details remain outstanding on the ultimate design of the NHI.

Health outcomes are improving but not at a rate consistent with the capacity or level of the economy. Maternal mortality ratio and infant mortality show slow improvement. Overall, the Department appears to have achieved planned performance targets especially on HIV, TB and school health, however, performance targets for infrastructure related strategic objectives remains a problem.

When discussing the Department’s annual performance for 2016/17, the Committee expressed concern that staffing levels at primary health care facilities were not in line with the Workload Indicators of Staffing Need (WISN) Report recommendations. The Committee was concerned that not all chronic patients are enrolled for receiving medicines through the Centralised Chronic Medicine Dispensing and Distribution programme. The Committee raised its concern on the lack of intergovernmental collaborations in addressing cross-cutting issues, for instance malnutrition, with other Departments such as Social Development, Agriculture, Forestry and Fisheries and Basic Education.