Health: National Context

  • The national health budget increased by 8%, from R205 billion in 2018 to R222 billion in 2019. This constitutes 11% of the total national budget. More than R98 billion was allocated to district health services and nearly R80 billion went to central and provincial hospital services.

  • Spending on the National Health Insurance programme is set to increase from R1.2 billion in 2018/19 to R3 billion in 2021/22, with allocations continually reviewed in relation to policy and legislative developments, and expenditure trends. This spending was financed through limiting increases to the medical tax credit, which allows people to claim back taxes on their medical expenses.

  •  Findings from the Global Burden of Disease Study 2017 showed that, contrary to global trends, tuberculosis remains the number one non-natural cause of death in South Africa (it is ranked 11th globally), followed by diabetes and heart disease.

  • According to the South African Depression and Anxiety Group, 16% of the adult population has a mental health disorder.

Guidelines for Effective Funding in Health

  • As a disease that cuts across many other health concerns and has vast psychological and emotional implications, HIV/Aids is best addressed through approaches that enlist the cooperation of the authorities and leverage different skills and experience. Funders are advised to consider initiatives that actively engage or partner with government health structures, NPO service providers and businesses that meaningfully address the pandemic.
  • Consider supporting community-based HIV/Aids initiatives, such as home-based care and antiretroviral adherence clubs, which do not necessarily fall within government’s budget allocation.
  • More funds should be channelled into research in the health sector, as well as into initiatives that aim to increase South Africa’s health worker capacity.

National Directives in Health

Quality in Healthcare for South Africa, 2007
This policy aims to improve the quality of care in the public and private health sectors, by addressing
access to healthcare; increasing patients’ participation and the dignity afforded to them; reducing
underlying causes of illness, injury and disability through preventive activities; expanding research on
evidence of effectiveness; ensuring the appropriate use of healthcare services; and reducing healthcare
errors. These improvements generally reflect the needs of various vulnerable populations.
Integrated School Health Policy, 2012
To deal with past injustices, democratic South Africa has had many school health policies, including
this most recent one which aims to improve existing school health services, as well as to strengthen
collaboration between key roleplayers such as the Departments of Health, Basic Education, and Social
Development. This policy focuses on addressing health issues that cause barriers to learning, morbidity
and mortality among learners during childhood and adulthood. The provision of health services (as
opposed to screening and referral) in schools is prioritised.
National Health Insurance (NHI), 2017
This policy aims to promote equity and efficiency in the health sector, and to ensure that all South Africans
have access to affordable, quality healthcare services regardless of their socioeconomic status. The NHI will
be phased in over 14 years and derives its mandate from South Africa’s Constitution, which states that the
state should ensure healthcare for all. The implementation is underpinned by the National Development
Plan, which envisions that, by 2030, a common fund should enable equitable access to healthcare,
regardless of what people can afford or how frequently they need to use a service.
National Emergency Care Education and Training Policy, 2017
After 1994, the need to increase geographical reach meant that emergency care personnel were required
to operate independently and provide an increased level of clinical care. This necessitated a higher level
of training. This policy therefore aims to facilitate the alignment of emergency care education and training
with current education legislation and national training needs. Similar to other health professions, the
Emergency Care Qualification Framework would have three tiers consisting of an entry-level, mid-level, as
well as a professional qualification allowing access to postgraduate studies.