Health minister Joe Phaahla says it is “indisputable” that public hospitals need infrastructure maintenance and investment, the anticipated cost of which the health department has quantified at close to R200bn.
The dilapidated state of many public hospitals has frequently been highlighted.
In a written reply to a parliamentary question by EFF MP Sophie Thembekwayo the minister said the R200bn “is clearly not going to be available in the short- to medium-term. There are nonetheless projects that are being attended to within the limits of available budget.”
The cost of addressing the backlog comes within the context of budget cuts to meet Treasury’s objective to achieve fiscal consolidation and the need to improve hospital infrastructure ahead of the introduction of the national health insurance scheme which will see the provision of healthcare shift from the private to the public sphere.
Replying to a question by the DA’s Michele Clarke, Phaahla noted that there was a current national infrastructure backlog of R7.9bn with the total estimated cost addressing it between 2022/23 and 2024/25 estimated at R23.9bn.
The biggest current infrastructure backlog of R1.5bn was in the Eastern Cape followed by KwaZulu-Natal (R1.4bn), North West (R823m), Western Cape (R797m), Limpopo (R781m), Gauteng (R758m), Free State (R733m), Northern Cape (R427m) and Mpumalanga (R316m).
Phaahla said the cost of addressing this backlog was R7.6bn in 2022/23, R6.8bn in 2023/24 and R9.6bn in 2024/25.
Asked by Thembekwayo whether he has considered not rushing the implementation of the National Health Insurance Bill and rather address the infrastructure challenges facing SA, Phaahla said “the department (of health) is not implementing the National Health Insurance (NHI) Bill in a rushed manner.”
The system would be phased with the health system being strengthened while the legislative process is finalised and the institutional arrangements for the NHI Fund are undertaken. The system would be gradually phased in depending on the availability of financial resources.
Initiatives to strengthen the health system such as addressing of infrastructure challenges will be undertaken during the transitional period.
Replying to a question by DA MP Wendy Alexander on what the NHI has cost to date, Phaahla said the expenditure that has been ascribed to NHI money had been used to fund efforts to strengthen the health system’s performance in preparation for NHI and not on the actual functions of the NHI Fund.
“This funding has been allocated through the NHI grant and has been used to develop and test provider payment mechanisms, expanding the national insurance beneficiary registry, and purchasing and providing a prioritised set of health services. The funding has also been allocated for quality improvement initiatives within the non-personal services component of the NHI indirect grant with the aim of helping facilities meet the envisaged standards required for NHI accreditation,” the minister said.
An amount of R480m was allocated to all provinces for the NHI grant in 2021/22, with the allocations for 2022/23, 2023/24 and 2024/25 being R694m, R695m and R717m respectively.
Replying to a question by Clarke on health staff shortages, the minister said that as of the end of October the current overall shortage in the public sector for all health workers who provide both health related and administrative support functions was 34,523. There were 9,271 vacant posts for professional nurses, 3,768 vacant posts for medical science and support personnel, 1,385 for nursing and support personnel and 2,075 for nursing assistants.
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