Health - A shot in the arm

The attempt to curb obesity prevailed in the budget as Finance Minister Pravin Gordhan introduced a tax on sugar-sweetened beverages.

Financial Mail, 26 February 2016

According to National Treasury, this fiscal intervention is a tool to help counter the growing problem of obesity, which underlies many of SA's health problems. Laetitia Rispel, professor at the school of public health at Wits University, said that the tax disincentive to consume sugar will over time play a big role in combating obesity, which affects healthcare spending.

Mariné Erasmus, senior health economist at Econex, said the sugar tax could help people to follow a healthier lifestyle and result in changes to the health economy. The revitalisation of public healthcare services, the provision of specialised tertiary hospital services and the prevention and treatment of HIV/AIDS and tuberculosis account for the biggest share of the health budget.

National Treasury said that the R168.4bn health budget for 2016/2017 was allocated to these areas so that it was in line with the National Development Plan's vision of a life expectancy of at least 70 years and an HIV-free population under 20 years of age.  Of this budget allocation, R88.2bn will go towards hospitals, R31.9bn towards primary healthcare and R15.9bn to HIV treatment and prevention initiatives.

In the medium-term, R28bn will be invested in health infrastructure. Gordhan said that though the focus of the 2016 budget was fiscal consolidation, public health services and delivery improvements must be prioritised, as emphasised by Health Minister Aaron Motsoaledi, who is taking strides towards the National Health Insurance (NHI).

Gordhan said little about the financing of the NHI following the release of the White Paper in December. He admits, however, that its financing is a challenge as it has only been implemented in advanced, rich countries, and National Treasury will release further financing details in due course. Gordhan said health financing is complex because the demands are unavoidably exceeded by available funds. A new component has been added to the NHI indirect grant for the roll-out of the Ideal Clinic programme.

The programme will improve all 3 500 primary healthcare facilities nationally to reach the determined ideal status by addressing infrastructure backlogs, reducing queues, improving information systems, integrating services, and implementing uniform protocols, guidelines and staffing norms. Over the medium term, R90m is allocated to the programme.

HIV/AIDS and TB treatment programmes have made a marginal improvement. Over the past two years, government has developed a project that identifies a model to improve HIV and TB treatment as well as programmes for prevention of transmission. The Department of Health expects antiretroviral treatment to reach 5-million South Africans by 2018/2019, supported by an increase in the grant of R1-billion in that year. Motsoaledi said that Gordhan had "tried his best", so "under the circumstances, the department quite happy". On the issue of his new healthcare plans, Motsoaledi said there is no alternative but to plough ahead. R4.5-billion is budgeted in the medium term to revitalise the 11 NHI pilot districts. This grant will, however, end after 2016/2017.

In April 2012, the department launched several NHI pilot projects. One of the goals of the projects was to establish district health authorities and gauge their capacity to manage their own budgets and commission services for patients. Recruiting general practitioners for the NHI pilot sites is still a challenge. Erasmus said she welcomed the increased spending on hospital infrastructure, especially hospital information systems.

This, she said is a positive step towards the implementation of the NHI as it will require a centralised information system across provinces to co-ordinate the NHI. She expressed her disappointment that little to no mention of the funding mechanisms behind the NHI was made, but applauded plans to terminate funding for the NHI pilot projects because they weren't working.