The progress towards achieving universal health coverage
needs to remain on track

As finance minister Enoch Godongwana took to the podium for this year’s
budget address I knew healthcare would not take centre stage. The minister
had to contend with a multitude of issues, chief among them being the worst
energy crisis our nation has ever faced.

Yet it was encouraging to see a few healthcare touchpoints worked into his
address. But more than that, the full budget report illustrates continued
budgetary support for government’s health policy direction. Godongwana
touched on essential points poignant in our nation’s struggle against a
severely constrained healthcare sector.

We all know public healthcare has been struggling to keep up with
infrastructure decay, capacity issues and skills shortages. It is optimistic that
this fund allocation will help address service backlogs and alleviate critical
funding pressures in healthcare personnel, medicine, laboratory services,
medical supplies and other vital goods and services.

Though vacant posts in noncritical areas will not be filled in most cases,
government intends to recruit and retain personnel in key areas such as
healthcare, education and peace & security, mainly through the allocation of
additional funding.

An amount of R2.2bn over the medium term is allocated to the direct national
health insurance grant for provincial health departments to the contract
health professionals and healthcare services including primary health care
doctors, oncology services and mental health services.

The department also manages the national health insurance indirect grant,
which has three components and a budget of R6.9bn over the medium term:

• The non‐personal services component of R2bn over the next three
  years supports activities aimed at strengthening the health system,
  such as health information systems, quality improvement initiatives
  and the dispensing and distribution of chronic medicines.
• The personal services component is allocated R299.9m over the
  medium-term expenditure framework (MTEF) period and is aimed at
  piloting the establishment of contracting units for primary care
  through which public and private healthcare providers will be
  contracted.
• The third component of the grant, which seeks to revitalise health
  facilities, falls within the department’s infrastructure interventions.
  I’m pleased to see the additional commitment to help provinces deal with the
  accumulated backlog in core health services such as surgery, oncology,
  antiretroviral treatment and tuberculosis screening and treatment that
  resulted from disruptions to routine healthcare services due to the
  pandemic.

The Budget Review shows that healthcare functions have been allocated an
additional R23.4bn over the next four years. That is R7.5bn in 2023/24, R7.8bn
in 2024/25 and R8.1bn in 2025/26. However, the backlog and shortfall that
has marginalised so many South Africans remains. So, what about the
National Health Insurance (NHI) elephant in the room?

Last year I commented that the minister never mentioned the NHI in the
2022 budget address. This year the minister followed the same brief, though
how could we blame him given the prominence of the energy crisis? In the
detailed estimates of the national expenditure released alongside the budget
speech, the document mentions that the NHI sub-programmes will
increasingly focus on evolving health financing functions such as user and
provider management, health care benefits and provider payment, digital
health information, and risk identification and fraud management.

Revitalisation of SA’s health infrastructure with its shortcomings is the aim of
the Hospital Systems programme. A key objective of the programme includes
improving the financing and delivery of health care infrastructure by March
2026 by constructing or revitalising 58 primary health care
facilities, constructing or revitalising 50 hospitals, and maintaining, repairing
and/or refurbishing 600 public health facilities.

To this end, the department plans to invest a projected R26.9bn primarily for
health facility revitalisation, which includes the construction of the 488-bed
Limpopo Central Hospital in Polokwane. This public-private partnership
(PPP) project will establish the first central hospital in the province and form
part of the academic health complex attached to the University of Limpopo’s
medical school. The minister announced that the project is shovel ready and
that construction of the hospital will finally begin in March this year.

The NHI debate seems to have publicly entered a bit of a lull. However, the
immediate needs of national healthcare interests seem to be better served
with hospitals and skills, so we should applaud the minister’s healthcare
priorities.

Even though the energy crisis impacts our nation significantly, I believe the
progress towards achieving universal health coverage needs to remain on
track. I am hopeful that this can be done given this year’s budget address.
However, the proof will lie in the actions we see over the course of this new
financial year.

• Banderker is CEO of healthcare group AfroCentric.

ABOUT THE AFROCENTRIC GROUP

The AfroCentric Group is the most diversified healthcare company in Southern Africa, with more than 3.8 million lives under management (39% market share) serviced in the region. The Group is a majority black-owned, JSE-listed investment holding company with a focus on health administration, health risk management, pharmaceuticals, wellness and disease management as well as health-centric information and communications technology-based solutions.

Entities within the AfroCentric Group include AfroCentric Technologies, AfroCentric Distribution Services, Wellness Odyssey, AfroCentric Primary Care, Pharmacy Direct and Medscheme, its biggest subsidiary.

Medscheme is the largest health risk management services provider and is among the leading medical scheme administrators in South Africa, with more than 3.8 million lives under management. Its clients include some of the country’s major medical schemes, including Bonitas, Fedhealth, GEMS and Polmed, among others.

Website: www.afrocentric.za.com
LinkedIn: AfroCentric Group
Facebook: AfroCentric Group