Public health budget cut as demand soars

The government is instituting extensive cuts to public health budgets against a backdrop of soaring demand for services, fuelled by worsening social conditions and the after-effects of the coronavirus pandemic, Wits adjunct professor Michael Sachs warned delegates to the annual Hospital Association of SA (HASA) conference on Monday.

HASA is an industry association for private hospitals and its annual conference draws figures from across the public and private healthcare sector.

“We have seen a significant worsening of social conditions, increases in unemployment and disruption to education that are all going to have consequences for health. Because the economy is not performing we are looking at significant resource constraints in the very period when the system is recovering from Covid,” Sachs said.

The government was planning to institute the biggest fiscal shock to the public health system in 25 years, designed as a reduction in the salaries of healthcare workers, he said, referring to deep expenditure cuts announced by the Treasury in the February budget.

Consolidated government health expenditure will rise by just 0.2% in nominal terms over the medium term, which in February represented a 4.4% cut in real terms as the Treasury projected at that stage that inflation would average 4.6% over the period.

The health budget rose from a revised estimate of R256bn in 2021/2022 to R259bn in 2022/2023 but is projected to fall to R248bn in 2023/2024 before rising to R257bn in the outer year. The wage bill for health personnel will grow at only 1.1.% over the medium term, putting a damper on provincial health departments’ hopes of employing more front-line staff, or even replacing those who died from Covid-19.

Almost 1,500 SA healthcare workers lost their lives to Covid19, while those who remained were grappling with the effects of grief, trauma and burnout, Maverick Citizen editor Mark Heywood told delegates.

Despite the health department’s recent announcement that it would stop reporting daily Covid-19 figures, SA remained in the grip of the pandemic’s effects, he said. Covid-19 had not only led to extensive surgical backlogs, as elective procedures were delayed when cases surged, but the virus itself raised the risk of chronic diseases such as diabetes, increasing the future burden on the healthcare system, he said.

Improving the governance of public health facilities and the accountability of the people who ran them was essential if patient care was to improve, Heywood said.

VITAL ROLE

Business Unity SA CEO Cas Coovadia said the private sector had demonstrated its willingness and capacity to tackle the coronavirus pandemic and could do the same again to improve the public healthcare system.

The private sector formed an organisation called Business for SA at the outset of the pandemic to support the government’s response to the crisis. It played a vital role in procuring personal protective equipment and in the vaccine rollout, with senior figures providing their expertise pro bono.

“The private sector demonstrated it can come to the party in a situation of crisis in the national interest. We are still in a parlous state. We need to create an environment for investment, and an environment for private healthcare to play a role in the national interests, and be businesses [that] make a profit,” said Coovadia.

“Government needs to appreciate that we need to bring the best resources and capacity to bear to solve healthcare problems ... that is the message government needs to send out, and business will respond positively,” he said.

WE HAVE SEEN A WORSENING OF SOCIAL CONDITIONS … THAT ARE ALL GOING TO HAVE CONSEQUENCES FOR HEALTH

Michael Sachs Wits University, adjunct professor