What the TAC Want to See in the Health Budget

In his first term as Minister of Health Dr Aaron Motsoaledi oversaw the massive scale-up of antiretroviral treatment in South Africa. This scale-up has saved many thousands of lives and has pushed up life expectancy in South Africa to over 60 years. The Minister’s policy positions have been reasonable and he has been willing to engage with civil society. He has also not been afraid to stand up to strong industry lobbies when the public interest demanded it. For these reasons the Treatment Action Campaign (TAC) welcomed Dr Motsoaledi’s reappointment after May’s national elections.

However, we note with concern that Dr Motsoaledi often has to struggle against his own colleagues in government in order to make progress. While he has developed a number of good policies, many provincial MECs for health have failed to implement these policies by ensuring sufficient money is both allocated and spent from their provincial equitable share budgets. While Dr Motsoaledi has taken a progressive position on reform of South Africa’s patent laws, his counterpart in the Department of Trade and Industry, Rob Davies, has dragged his feet. The success of Minister Motsoaledi’s second term as Minister of Health might well be defined by how well he can bring his colleagues on board with his progressive vision and, in the case of MECs for health, to what extent he is willing to take political risks in order to have underperforming MECs for health challenged or replaced.

Below is a list of five key things the TAC would like to see in Dr Motsoaledi’s budget vote speech:

1.     Commitment to patent law reform: While Minister Motsoaledi has been very vocal on the need for patent law reform in the media, the Department of Health must play a more active role in the finalisation of South Africa’s Draft National Intellectual Property Policy. At present the draft policy is languishing in the Department of Trade and Industry. In his budget speech we would like to hear Minister Motsoaledi make a strong and clear argument for patent law reform that will ensure better access to medicines. We are also hoping for a clear indication that Minister Motsoaledi’s department will get more involved in the finalisation of the policy.

2.     Publication of NHI white paper: For over two years now the South African public has been promised the imminent publication of the white paper on National Health Insurance (NHI). Given the current budgetary constraints and the provincial health departments in financial crisis such as the Free State, Gauteng, Eastern Cape, and Mpumalanga it is high time that a national debate takes place on health system reform. We hope that the Minister will commit to a specific date for the publication of the white paper when he delivers his budget speech. Even better would be if the white paper and the often-promised Treasury paper on financing a National Health Insurance Fund is published concurrently with his speech. In order to address the financial crisis in many provincial health departments it is critical that we begin to look at the bigger picture and reform the allocation and expenditure of public funds towards health. 

3.     Declaring DR-TB a public health emergency: TB kills at least 140 people every day in South Africa. Most of these deaths are preventable. We call on Minister Motsoaledi and his cabinet colleagues to declare TB and DR-TB a public health emergency and in doing so ensure that there are sufficient funds available both at National and Provincial level to address this. Hopefully such a move could help catalyse a renewed national response to TB. While we know that Minister Motsoaledi is well aware of the problem of TB in the mines and in prisons, we hope to see clear indications that he will work more closely with his cabinet colleagues to address these problems. In our view, Minister Motsoaledi must make sure that the new Minister of Justice and Correctional Services Michael Masutha and Minister of Mineral Resources, Adv. Ngoako Ramatlh, work with him to ensure better TB control in mines and prisons.

4.     Taking on failing MECs for health: While Minister Motsoaledi takes good policy decisions at a national level, the public healthcare system is run and delivered primarily by provinces. A lack of commitment and political will from MECs for Health like Benny Malakoane in the Free State is undermining national policies, wreaking havoc on provincial budget allocations and contributing to the collapse of the healthcare system. While Minister Motsoaledi does not have the power to fire underperforming MECs like Benny Malakoane, he is nevertheless ultimately responsible for the healthcare system. We are hoping that Minister Motsoaledi will acknowledge the problem of underperforming MECs and the impact that this has on provincial budget planning, implementation and oversight. Such an acknowledgement will at least mean that the elephant in the room is no longer being denied.

5.      A workable plan to save the NHLS: The National Health Laboratory Service (NHLS) forms an essential part of the public healthcare system – it does most of the HIV and tuberculosis tests that we depend on for optimal management of patients. Yet, certain provinces have been chronically late in paying the NHLS. This situation has left the NHLS teetering on the brink of collapse. We would like for Minister Motsoaledi to share more details on how exactly he plans to safeguard the future of the NHLS. In our view, the NHLS should be paid through the National Department of Health, rather than by provincial departments. If this is done, the NHLS will not lack for funding as long as treasury allocates sufficient funds to this budget line. In addition while we welcome the introduction of the HPV vaccine, the benefits of this will not be immediate for everyone. In the meantime it is essential that women across South Africa have access to cervical cancer screening.

6.     Finalise a national policy on community health care workers: We are aware that the Department of Health has been engaged in a process of developing a national policy governing the training, employment and roles and responsibilities of community health workers across the country. We would like for Minister Motsoaledi, unlike the MEC for Health Benny Malakoane in Free State, to show political leadership by reaffirming the importance of community health workers. We call on the Minister to speak in concrete terms what the budget allocations are for the provinces to train and give formal employment with good conditions of services for community health workers. This will show that the Department is committed to delivering on the National Development Plan which identifies community health care workers, over 700 000 full-time and part-time, are the cornerstone of current government health policy. 

For more information contact:

Marcus Low — 082 962 8309