Civil society organisations provide budget inputs to parliament
Civil society organisations are sounding the alarm over South Africa’s underfunded public health system, warning that continued neglect is threatening years of progress in reducing TB cases and improving rural healthcare.
In presentations to the Standing Committee on Appropriations, the TB Accountability Consortium (TBAC) and the Rural Health Advocacy Project (RHAP) called for urgent political will, better planning, and targeted investment in vulnerable communities.
RHAP highlighted that despite the government’s planned R20 billion increase to the health budget, rural communities would continue to face dire health outcomes. Researcher and policy officer Celene Coleman noted that RHAP welcomed the hiring of 800 doctors. But she explained that most of this money will go to salary increases. This means there is very little left to fix clinics, improve services, or help patients in rural areas. She also warned that some of the roles for community service doctors might be removed. These doctors are often the only health workers in small towns and villages.
RHAP also shared new research showing that rural communities face serious health problems. Many girls in rural areas are falling pregnant at a young age and do not get the care they need during pregnancy. In some provinces, there are not enough contraceptives in clinics. Diabetes is also rising fast in rural areas, but very few people are getting treatment. The loss of support from international donors like PEPFAR has made things worse, especially for people with TB and HIV.
Coleman said that South Africa already has good health policies, but they are not always put into action in rural areas. “The budget is not just about money. It shows what we care about as a country. If we care about fairness and equality, then we must make rural health a top priority,” she said.
Similarly, TBAC returned to the Standing Committee on Appropriations for the second tabling of the Division of Revenue Bill, calling for immediate steps to protect the country’s TB programme. In its submission, TBAC highlighted that an estimated 56,000 South Africans continue to die of TB every year, a disease that is both preventable and treatable. It warned that without decisive action to address chronic underfunding, staff shortages and widening gaps in service delivery, the country’s ambitious End TB strategy faces serious setbacks.
“The government has a constitutional and legislative obligation to fund and expand TB services, especially for the country’s most vulnerable and underserved populations,” said Sihle Mahonga-Ndawonde, Project Coordinator at TBAC. “The reduction in TB incidence and mortality depends on fulfilling these commitments.”
Since the March budget announcement, conditions in the health sector have deteriorated further. Health allocations have declined in real terms over the past decade, while costs and demands have surged. Provincial health departments are grappling with strained conditional grants and the withdrawal of key overseas development assistance, including significant contributions from USAID.
As a direct result, South Africa lost approximately 15,000 frontline healthcare workers and 9,000 technical staff, including many involved in high-performing programmes such as the Central Chronic Medicines Dispensing and Distribution (CCMDD) service.
The R20 billion allocated to health over the next three years includes the equitable share increase, but TBAC argues that R6 billion per year is insufficient to address systemic challenges and prevent a rollback of HIV and TB programme gains.
“While South Africa’s TB programme has made important progress over the past decade by reducing TB cases and deaths, the End TB Campaign is now at risk,” Sihle noted. The campaign aims to test 5 million people in 2025/26 and diagnose 250,000 new TB cases, with the goal of cutting TB incidence by 29% and deaths by 41% by 2035. However, several challenges threaten these targets. At present, only 3 million TB tests are funded, leaving a shortfall of 2 million. There are also ongoing problems with medicine shortages, staff shortages, and uneven testing capacity between provinces. In addition, concerns have been raised that the little extra funding available will prioritise wage increases and new posts instead of scaling up TB services where they are urgently needed.
Responding to TBAC’s concerns, Wendy Fenoë of National Treasury acknowledged the seriousness of the crisis. She confirmed that Treasury had received costings from the Department of Health and was exploring options under the Public Finance Management Act to release funds before the adjustments budget, especially to provinces previously supported by USAID.
Also responding to RHAP’s submission, Fenoë acknowledged the severity of underfunding in areas that are underserved. She highlighted ongoing efforts to address these issues through a national benchmarking process in collaboration with the National Departments of Health and Basic Education.
“We indicate to provincial treasuries where we pick up gaps and areas of underfunding, and ask them to adjust the allocations to ensure that it’s properly funded,” she explained, emphasising the Treasury’s commitment to redirecting resources where most needed.
To protect lives and safeguard the country’s public health gains, TBAC put forward urgent recommendations. It called for provincial health departments to submit clear plans to prevent further TB deaths and for the National Department of Health to explain how it has reprioritised the District Health Programme conditional grant to ensure that essential TB services remain in place. It also recommended a joint sitting of Parliament’s finance, health and appropriations committees to ensure the TB response receives the necessary political attention and funding.
The full submission is available via TBAC’s website here: https://tbac.org.za/publications/
The RHAP full submission is available here: https://rhap.org.za/wp-content/uploads/2025/06/Health-care-in-Rural_-RHAP-June-Budget-Submission.docx