The health sector was supported by 43% of companies and received an average of 7% of CSI expenditure in 2022. This is significantly down from 2010 when 64% of companies supported the sector and it received 17% of CSI spend.
The health sector has experienced a downward trend in support from companies, firstly due to the government improving its HIV/Aids response and, more recently, as the pandemic eases. Within the sector, support for primary healthcare has increased significantly, from 46% of average health expenditure in 2010 to 82% in 2022, with a corresponding decrease in support for secondary and tertiary healthcare. The share of funding dedicated to HIV/Aids has steadily declined, while spend on wellbeing initiatives and training was increasing pre-pandemic. Post-pandemic, we anticipate a return to that trend, and as the population ages, we anticipate greater emphasis on non- communicable diseases.
Level of healthcare
- Primary healthcare continues to account for the largest proportion of CSI healthcare spend (82%), the allocation in 2022 being the highest ever.
- The average healthcare spend allocated to secondary healthcare reduced to 6% in 2022, from 15% in 2021, while the spend on tertiary healthcare was unchanged (12%).
Type of intervention
- Covid-19-related interventions continue to receive the largest share of CSI healthcare spend (32%), though down from 39% in 2021.
- One-quarter of the CSI healthcare spend (25%) went to healthcare education, training and capacity building, an increase from 17% in 2021.
- Expenditure on infrastructure, facilities and equipment increased from 8% in 2021 to 14% in 2022.
- Funding for the other interventions declined in 2022 compared to 2021.
The changing health landscape in South Africa
– In the 1997/98 National Budget, R20 billion was allocated to health services, equating to 11% of national consolidated expenditure and over 3% of GDP.
– World Bank data shows life expectancy in South Africa was 58 years and the infant mortality rate was 47 per 1 000 live births.
– The total number of people living with HIV was approximately 1.8 million.
– The Department of Health established the Ministerial Task Team on Social Health Insurance to draft an implementation plan with concrete proposals on how to move towards National Health Insurance in South Africa.
– South Africa initiated its prevention of mother-to-child transmission (PMTCT) of HIV programme in 2002, in line with WHO guidelines.
– Life expectancy in South Africa had dropped significantly to 53 years.
– The total national and provincial health budget was R105 billion for 2010/11. Public funding for the health sector was approximately 4% of GDP and 14% of the total budget, with more than 40 million South Africans relying on public healthcare. – According to the Council for Medical Schemes, approximately 7.9 million South Africans were protected by medical schemes, comprising 3.4 million principal members and 4.5 million dependants.
– The total number of people living with HIV was approximately 5.24 million.
In mid-2011, the Department of Health released a policy 2011 paper titled ‘NHI in South Africa’ for public consultation. Following release of the 2011 policy paper, the NHI pilot projects, rollout commenced in 2012, with a focus on piloting of health system strengthening initiatives; establishing the NHI Fund and key institutions; and moving of central hospitals to the national sphere.
The Department of Health released a white paper titled ‘National Health Insurance for South Africa: Towards universal health coverage’.
The National Strategic Plan (NSP) 2017–2022 was launched in March 2017. The NSP outlined the strategic framework for a multisectoral partnership to further accelerate progress in reducing the morbidity (illness) and mortality (death) associated with HIV, TB and STIs in South Africa.
In August 2019, the National Health Insurance (NHI) Bill was introduced to National Assembly and is under consideration. Its aim is to provide universal access to quality healthcare for all South Africans as enshrined in the Constitution.
– World Bank data shows life expectancy improving to 64 years, and the infant mortality rate falling to 26 per 1 000 births. – On 5 March, the first case of Covid-19 was reported in South Africa, according to the National Institute for Communicable Diseases. – On 15 March a national state of disaster was declared, and a national lockdown commenced on 27 March, in an attempt to contain the spread of Covid-19.
– National Treasury allocated R9 billion in the medium term to roll out a free, government-run Covid-19 vaccination campaign. Between February and mid-November, more than 23 million doses had been administered, with 13 million adults fully vaccinated. – The total number of people living with HIV was approximately 8.2 million.
In the 2022/23 national budget, R259 billion was allocated to health, constituting 12% of consolidated government expenditure of R2.1 trillion.