The Treasury’s emergency allocation to health does not go far enough and is at risk of being diverted to pay off provincial debts to suppliers, parliament heard on Wednesday.
SA’s health sector was dealt a shock blow earlier this year after the Trump administration abruptly suspended foreign aid, including programmes supported by the US President’s Emergency Plan for Aids Relief (Pepfar). While the government provides most of SA’s HIV/Aids funding, the scale of SA’s epidemic means it has for the past two decades leant heavily on donor support. Pepfar contributed R6.59bn to SA in 2024/25, representing about 14% of its estimated HIV/Aids expenditure. Pepfar had been expected to contribute R6.3bn in this fiscal year.
In September, finance minister Enoch Godongwana tabled a special appropriation bill in parliament that provides an extra R754.5m to the health budget in the financial year. The lion’s share (R590.4m) is set aside as conditional grants to provinces to fund HIV/Aids programmes, while the remainder goes to the SA Medical Research Council (R132m) to continue clinical research and the National Health Insurance indirect grant (R32.1m) to strengthen SA’s health system.
The bill was tabled shortly before the Trump administration announced that some Pepfar funding is to be restored under a six-month “bridge plan” that will see SA provided with $115m (R2bn) to help maintain HIV/Aids programmes until end-March.
The new funding from Pepfar and the Treasury was insufficient as it represented barely more than a third of the money Pepfar had previously promised SA, Section 27 told parliament’s select committee on appropriations.
“Simple arithmetic shows this amount is not enough to cover the full gap left by the withdrawal of Pepfar funding. A significant number of HIV patients who relied on Pepfar-funded [treatment] programmes are at risk of losing access,” said Section 27 researcher Mduduzi Nkosi.
Cash-strapped provinces might divert the extra funds allocated by the Treasury to HIV/Aids programmes to other projects, he warned.
“Provinces are under severe financial pressure and the funds for HIV programmes are at risk of being swallowed up by existing debts or [other] expenditure priorities,” he said.
Provinces are under severe financial pressure and the funds for HIV programmes are at risk of being swallowed up by existing debts or [other] expenditure priorities.
— Mduduzi Nkosi, Section 27 researcher
His concern was echoed by the TB Consortium, which urged the committee to require provinces to present parliament with financing and implementation plans detailing how they intended to use the funds. Transparency would reduce the risk of the funds being absorbed into existing deficits, said TBAC project co-ordinator Sihle Mahonga, highlighting the huge accruals facing provincial health departments.
Accruals are debts to suppliers that are rolled over from one financial year to the next. The collective accruals racked up by provincial health departments stood at more than R24bn at the end of the 2024/25 financial year, a 10.4% increase on the total accruals of R21.5bn the year before, according to a national health department presentation to parliament last week. It shows Gauteng and the Eastern Cape were the worst offenders, with accruals of R8.1bn and R7bn, respectively, at end-March.
Trade union federation Cosatu said it was disappointed that it had taken the government so long to provide additional funding, given the financial crisis hit the HIV/Aids sector in March.
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