Calls to include patient voices for needs-based health budgeting

The budget tabled in Parliament this week, does not address a crumbling health system, certain civic organisations warned. Finance Minister Malusi Gigaba announced a R205 billion budget for health in the new financial year that is set to increase to R240,3 billion.

The total expenditure on health over the medium-term framework is set at R667,8 billion. Yet according to the Rural Health Advocacy Project (RHAP) Programme Manager Russel Rensburg this modest expenditure growth for Health may contribute to further deterioration of the public health sector. He also expressed concern over the R1,4 billion reductions in the equitable share. “Given the significant discretion enjoyed by provinces in allocating funding, district health budgets and critical health posts particularly in rural areas, could be at risk,” he warned. Rensburg said the “failure to explicitly protect critical frontline health posts”, is also concerning. There are already an estimated 40 000 vacancies in the public health sector. Chairperson of the Cape Metropolitan Health Forum Damaris Kiewiets shared this concern and said rural healthcare services are already poorly resourced. Kiewiets said the budget does not do enough to bring the services closer to the people especially to those in far-flung rural areas.

According to Rensburg increased VAT and the increase in the fuel levy will only “deepen inequality of access to healthcare in rural areas”. “There is talk of cost reductions which means less expenditure on goods and services like medicine, food for patients, cleaning materials and linen. These are inconsequential but still very important for the delivery of health services.” Rensburg said rural facilities are already under resourced. “Now we will find health service seekers in these poorer communities having to spend significant amounts just to get to health centres. Even when they get a referral from a clinic to a hospital it is problematic due to a lack of transport for patients.” RHAP in a statement prior to Gigaba’s budget speech called for a “socially just response to healthcare” that would consider all factors and try avoid further blows to people’s capabilities to live healthy lives.

Rensburg further stressed the importance of a needs-based budgeting approach and called on government to include patient voices in its planning. “They created a Joint Action Plan for health with national treasury, the health department and provincial ministries so government is actually just talking to themselves. We are very concerned that budget and other planning is happening in isolation, and one of the calls we make is for broader participation so that we can articulate the needs of ordinary health system users.” Gigaba in his budget speech said the increase in social grants and zero VAT on basic foodstuffs will mitigate the impact of the VAT increase on the poor but Rensburg is sceptical.  According to him this basket of VAT free items need to be revised. “We are already saying there is a need to talk about diet.  Maize meal may be VAT free, but it is still high in sugar and will help drive non-communicable diseases like diabetes which adds to the burden of disease and has its own price tag.

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