Investing in healthcare infrastructure

While fiscal constraints remain, there is evidence of a shift in health expenditure that reflects the government’s recognition and importance of addressing these critical needs.

Recent budget allocations reflect a renewed focus on areas that support equitable access to quality healthcare, however, reduced funding in certain points of the value chain may impede these efforts. Understanding these key areas, as outlined below, is crucial for shaping future healthcare policies and investments.

1. Strengthening localised healthcare delivery: Provincial and district health services are set to receive proportionally higher allocations. This signals a commitment to decentralising care and addressing gaps in rural and underserved areas, ensuring that healthcare reaches those who need it most.
2. Disease-specific focus: According to the 2024 National Treasury Report, HIV,TB, Malaria and community outreach received a 10.1% growth in spending in 2020, but has seen negative growth in the 2021-2024 budgets. After years of stagnation, a 7.8% growth in spending is forecasted for grants addressing HIV, TB, malaria, and community outreach in 2025. This shift acknowledges the urgent need to address South Africa’s communicable disease burden as well as pandemic preparedness.
3. Reduced National Health Laboratory Services (NHLS) funding: The projected decline in NHLS funding is concerning, given its critical role in diagnostics and disease surveillance, especially with the increasing demands of the NHI rollout. Therefore, safeguarding adequate funding for NHLS is essential to maintaining a robust healthcare system.

The case for infrastructure investment

Healthcare infrastructure is the backbone of any successful health system. The budget’s increased attention to this area is promising, as modernising and maintaining infrastructure is essential for achieving NHI goals.

• Facilities management and maintenance: Many public hospitals and clinics are plagued by ageing and ill-maintained infrastructure. Enhanced investment in maintaining these facilities will improve service delivery and reduce operational inefficiencies.
• Water and sanitation: Reliable access to clean water and adequate sanitation in healthcare facilities is critical for infection control and overall public health. Addressing these gaps, particularly in the context of current and future expected water shortages, will enhance patient outcomes and boost public confidence in the health system.
• Broadband Connectivity: Digital infrastructure is a key enabler of modern healthcare. Access to connectivity followed by investment in systems and processes will support the effective and efficient implementation of NHI. Investments in broadband will allow for telemedicine, electronic health records, and remote diagnostics, especially in rural areas where access to care is limited.

Opportunities and predictions

Looking ahead, we would like to see the Minister making use of these three key opportunities to shape the success of South Africa’s healthcare transformation:

1. Infrastructure spending growth: We expect an increased focus on infrastructure spend to accelerate modernisation and create a foundation for more efficient and equitable service delivery. By prioritising infrastructure, South Africa can build a healthcare system that meets the needs of the population.
2. Workforce development: We are keen to see what measures are taken in retaining and developing skilled healthcare workers, as this should remain a top priority. Managerial training, skills development, and improving employee wellbeing will empower healthcare leaders to address system inefficiencies through strategic workforce planning.
3. Public-private collaboration: Deepening partnerships between the public and private sectors will help alleviate strain on public facilities, while leveraging private expertise to drive innovation and efficiency. Investment in infrastructure together with public-private collaboration will progressively build up the capacity of the public health care system to support universal health in a growing population.

A balanced approach to health system reform

The NHI represents an ambitious vision for South Africa, but its success hinges on smart investments in people, systems, and infrastructure. While the budget highlights promising trends in the 2024 Medium‐Term Expenditure Framework, sustained focus is required to address persistent challenges. By prioritising healthcare infrastructure, fostering workforce resilience, and encouraging collaboration, South Africa can build a health system that delivers on its promise of equity and innovation.

As we look to the future, the 2025 National Budget Speech presents an opportunity to take significant steps forward. What is needed is a renewed focus on basic infrastructure investments, and human capital training in order to leverage technological advancements and efficiencies. This the beginning of a long-term commitment to building a healthcare system that serves all South Africans.