Section 27 of the constitution guarantees the right to healthcare which includes the rights to access healthcare services.

This right also includes access to healthcare facilities which comply with various health standards, including access to adequately trained healthcare staff.

Compared to the 2018/2019 health budget, the 2019/20 health budget appears more aligned with addressing the shortage of medical staff, lack of access to healthcare facilities and the weak management of healthcare workers.

While this is a commendable and welcome step in the government’s attempt to progressively realise the right to health, there needs to be more transparency and clear plans that detail the distribution of medical staff, and when and where community health workers will be incorporated into the national health system.

The budget for health sees an average annual increase of 7% in the medium-term expenditure framework, 0.8% less than estimates tabled in the 2018 budget.

This means that in the 2018/19 financial year, the health budget has decreased, which inevitably means less money available to meet service delivery objectives in the 2019/20 financial year.

One of the key issues affecting the healthcare sector and acknowledged during the 2019/20 budget speech is the shortage of doctors, nurses, and other critical posts.

To respond to this, a new human resources capacitation grant will be introduced and administered by provinces to ensure that critical posts are filled in health facilities.

A budget of R2.8bn has been re-prioritised from the personal service component of the National Health Insurance (NHI) indirect grant due to the slow spending of this grant in 2018/19 financial year.

Of the R2.8bn, R1.6bn has been allocated to provinces for the hire of health professionals.

The government must be cautious to reprioritise funds from grants that experience slow spending instead of investigating the reasons around the slow spending.

In cases where there is reprioritisation, this is a warning that grants are there for purposes of ensuring that certain conditions are met from plans put forward by provinces.

It is vital that provincial departments of health accurately and timeously determine how many critical medical posts need to be filled and must then submit costed plans to support funding requests.

Failure to do so will impact on healthcare facilities needing such staff, especially when the resource capacitation grant is distributed.

In June 2017 and February 2019, there were national and provincial complaints that doctors had not been paid and placed after their internships.

While the 2019 budget does not indicate whether the R1bn added to the provincial equitable share in 2021/22 is specifically intended to appoint doctors, providing employment beyond internship for various medical posts will assist in alleviating some of the staff shortages in the provinces.

Community health workers play a vital role in disease prevention, health promotion and linkage to care.

The government has increased the wages of community health workers to the minimum wage of R3,500 per month.

Many feel that this amount is inadequate considering that workers work under constrained conditions such as often having to travel over difficult terrain or long distances to bring healthcare to communities, and they tend to work in unsafe areas.

Given these factors alongside health care indicators, the R1bn budget to raise the workers’ wages should be revised upwards over the medium term.

Another issue identified by the government that requires addressing before NHI can become a reality is the condition of health facilities in SA.

In National Treasury’s estimates of national expenditure (available on the dire state of health facilities is recognised together with the need to maintain and refurbish these facilities or build new ones.

R19.2bn has been allocated to the health facilities revitalisation grant which goes to the provinces to fund 15,000 infrastructure projects during the medium term and R4.3bn has been allocated to the health facilities component of the NHI indirect grant.

While this is to be welcomed considering the condition often faced by impoverished communities in trying to access functional healthcare facilities, there is concern around the performance of the NHI grant for the repair or refurbishment of health facilities.

In 2015/16 this grant supported the repair/refurbishment/maintenance of 198 facilities, in 2016/17 the amount dropped to 67, in 2017/18 it went up to 107, while in 2018/19 it increased to 125.

However, it is projected that there will be a decrease to 45 facilities in 2019/20.

R80m is being earmarked for contingent liabilities relating to medico-legal claims against health departments.

The government rightfully acknowledged the pressure that the medico-legal claims were putting on service delivery and the fact there has been an increase in claims against the department from R28.6bn in March 2015 to R80.4bn in March 2018.

In outlining the reasons for the increase in medico-legal claims, the government failed to acknowledge inadequate quality of care as a factor for the increase in claims, and the extreme conditions that doctors and nurses often work under.

The reality is that public healthcare is in disarray and requires urgent government intervention.

The 2019 budget is a step in the right direction in attempting to address these issues, but more should be done, and is required by the constitution and National Health Act.

Rather than increase budget allocations to respond more meaningfully to widespread strain on the health system, the 2019 national budget has prioritised bailouts for mismanaged state-owned entities.

These decisions will delay the progressive realisation of healthcare rights.