Finance Minister Enoch Godongwana has described the state of public hospitals in South Africa as a serious concern that requires the collective efforts of all political parties and levels of government.
Delivering the third iteration of the 2025 budget speech on Wednesday, Godongwana announced targeted budget allocations to improve public health infrastructure, including hospitals and clinics.
The health department’s total budget will increase from R277 billion in the 2024/25 financial year to R296 billion in 2025/26.
Before presenting the health budget, Godongwana read an emotional open letter from Sarah Stein, a young medical student at the University of Cape Town. Her letter highlighted the dire conditions in public hospitals and the emotional toll on healthcare workers.
Stein wrote:
Working in a public hospital with way too few resources punches you in the face every day. It’s not just the trauma of seeing your patient die; it’s having no gloves in a delivery room, no alcohol swabs to clean wounds, and knowing that nurses stop at shops on their way to work to buy their gloves and masks because the clinic has run out. Waiting times for a scan stretch for months, and surgery delays let disease progress to the point of being inoperable. Limited beds in high care mean doctors are regularly forced to decide whose life is worth saving more because there’s only space for one.
Godongwana says the situation Stein describes reflects the heartbreaking reality faced by healthcare workers and patients alike, a reality the government is determined to change.
He says the budget seeks to address this emotional and systemic crisis by maintaining the expenditure trajectory outlined in the March 12 budget.
“Addressing the persistent spending measures to restore critical frontline services and invest in infrastructure is essential for improving access to basic services and lifting economic prospects,” he says.
The increased health budget is expected to support the procurement of medical supplies, improve hospital infrastructure, and reduce staffing shortages.
Health budget breakdown
The provincial health sector budget has been set at R845 billion over the medium term.
As part of this allocation, the health budget will be increased by R20.8 billion over the next three years to:
- Employ 800 post-community service doctors
- Procure essential goods and services
- Reduce accruals, which have placed a major strain on service delivery
In his previous budget speech, Godongwana highlighted a severe cash flow crisis within provincial health departments, noting that they currently owe R22 billion to vendors for services already delivered.
A step in the right direction
Dr Peter Baur, from the School of Economics at the University of Johannesburg,, tells Health-e News that employing 800 doctors is a positive development.
“While it’s hard to determine if all needs will be met, the government is striding towards filling some of the gaps,” he says.
However, he cautions that the sustainability of this initiative beyond the initial three-year window will depend heavily on South Africa’s economic growth prospects which are linked to trade, investment, and both international and political developments.
On the issue of accrual reduction, Baur emphasises its critical role in improving service delivery.
“Reducing accruals provides more confidence in the industry and allows for ongoing service delivery.”
Civil society welcomes budget, raises concerns
Civil society organisation Section27 welcomes the targeted allocations to public hospitals and clinics but says the scale of infrastructure collapse and the healthcare system’s burden may render these funds insufficient.
In a statement, the organisation expresses concern about specific cuts in the budget.
“The -3.1% cut to HIV services and -2.4% cut to emergency medical services are deeply concerning. While the HIV budget reduction reflects savings in the cost of producing antiretroviral treatment (ART), we urgently call on the Treasury to reconsider this in light of USAID’s recent decision to reduce support to South Africa. Any savings must be reinvested in strengthening the HIV response, including treatment literacy, support systems, services for key populations, and improved health information infrastructure.”
Godongwana acknowledges that the withdrawal of PEPFAR funding through USAID is a spending pressure that may require further allocations later in the year.
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Tight budget landscape
Baur says the country is operating in an extremely tight fiscal environment, which limits flexibility.
“The government has the responsibility to cover numerous areas such as education, infrastructure, and development initiatives. This makes it extremely difficult to determine where spending should be prioritised,” he says.
He adds that rising unemployment is increasing pressure on the public healthcare system, as fewer people can afford private medical aid.
“This places additional pressure on public medical services to meet growing demand. The reduction in USAID support has already created a funding gap, and filling that gap may prove very difficult.” – Health-e News
