Budget cuts imposed by the Treasury left the health department unable to fill a quarter of its posts in 2023/24, including dozens it considered critical to delivering on its mandate, MPs were told last week.
“It really has had an impact on how we function,” health director-general Sandile Buthelezi said during a presentation in parliament on the department’s 2023/24 annual report on Thursday night.
The Treasury imposed unprecedented in-year budget cuts in the medium-term budget policy statement last November. These cuts were only partially reversed in this year’s February budget, leaving the sector’s budget set to shrink in real terms over the medium term.
The Treasury set aside a revised estimate of R267.3bn for consolidated health expenditure this year, rising to R271.9bn in 2024/25. The consolidated health budget then increases to R281.1bn in 2025/26 and R295.2bn in the outer year.
This represents a nominal increase of 3.4% compared with the Treasury’s forecast inflation of 4.7% over the period. Health department officials described to members of the portfolio committee on health how the budget cuts had affected hiring at national and provincial level, with far-reaching effects.
The national health department had 1,122 posts in the year under review, of which 24.1% stood empty. It was able to fill only 60 of the 101 posts it had identified as priority positions, said Buthelezi.
At the provincial level, thousands of community health workers had not been replaced after their contracts ended or they resigned, hampering the provinces’ efforts to provide community outreach services, said the department’s chief director for monitoring & evaluation, Thulile Zondi.
The budget cuts hobbled polio surveillance programmes, which ran in just eight of the 42 health districts that had originally been planned, she said.
The cash crunch had led to a shortage of surveillance staff and limited their ability to travel, said Zondi.
Budget constraints had led to the loss of about 18,000 posts over the past two to three years, said CFO Phaswa Mamogale. In September, health minister Aaron Motsoaledi said in parliament that all the provinces were struggling to deliver services with fewer staff as budget cuts left them unable to fill critical positions.
Vacancy rates for doctors ranged from 22.4% in the Free State to 5.5% in the Western Cape, while those for nurses ranged from 28% in the Free State to 5% in the Eastern Cape, he said at the time. There were extensive vacancies at senior managerial level, he said.
Zondi also drew attention to problems with SA’s tuberculosis (TB) programmes during 2023/24. Large numbers of patients were not treated. For a variety of reasons people with confirmed TB did not start treatment, she said. These reasons included lack of transport, money and food.
The treatment success rate for patients with drug-susceptible TB was only 71.5%. while that for drug-resistant TB was 60.7%. Many of the patients who died from TB had advanced HIV/Aids, said Zondi.
“TB positive patients with unknown HIV status have poor treatment outcomes. HIV/Aids patients that have disengaged from care come back with advanced disease, and when tested and diagnosed with TB die within few weeks of starting treatment.”
The health department received an unqualified audit from the auditor-general.
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