Addressing fiscal constraints in South African healthcare
The National Budget should be used as a catalyst to modernise healthcare delivery – aligning infrastructure, workforce, technology and partnerships to deliver sustainable, high-quality services.
While the increase in health budget allocations in last years’ budget speech was a positive signal, the sector continues to operate under significant fiscal constraints. Such constraints include R22 billion in health debt from the preceding year for services provided and R28.9 billion earmarked for infrastructure projects. But even with a significant increase in funding, this alone will not deliver system reform. For example, for the National Health Insurance initiative to become a reality, sustained focus is required on upgrading healthcare infrastructure, ensuring medicine availability as well as retaining a motivated and capable workforce.
Provider satisfaction, workforce stability and service quality are deeply interconnected for overall client satisfaction. Furthermore, an increased prioritisation of value-based, high-quality care must sit at the centre of health system planning and digital infrastructure development. Investments in additional healthcare posts for community service doctors – among other job opportunities – are a step in the right direction. When Health Minister, Aaron Motsoaledi, revealed his 2025/26 healthcare budget last year, a significant investment in skills marked a significant shift towards strengthening healthcare systems. This included the appointment of 1,200 doctors, 200 nurses and 27,000 community health workers permanently, offering meaningful employment for newly qualified professionals and stability for those under contract.[1]
However, these appointmentsmust be paired with more effective human resource management models to translate funding into measurable improvements in care delivery and professional retention into medical officer, residencies and specialist positions.
US funding cuts have left South Africa in a challenging position, where professionals previously funded by these programmes are now available in the local labour market.
South Africa can use this as an opportunity to bring experienced managers and system builders to fix inefficiencies in the public health system to enable new innovative public-private partnerships by utilising digital tools and artificial intelligence to modernise planning, procurement, workforce management and service delivery.South Africa has an opportunity to move beyond business as usual by leveraging innovation, digital transformation, and stronger public–private collaboration to improve system efficiency. By introducing public health and management expertise, alongside South Africa’s established medical technology and pharmaceutical footprint, there is room to optimise supply chains, strengthen governance and improve cost efficiency across the health system. Subtle but targeted partnerships can support provinces facing financial and operational challenges without undermining accountability, while protecting continuity of care.
Ultimately, the budget should be used as a catalyst to modernise healthcare delivery – aligning infrastructure, workforce, technology and partnerships to deliver sustainable, high-quality services.
____________________________________________________________
