Finance Minister Enoch Godongwana did not announce a budget allocation to plug the gap created by the termination of USAid funding to HIV/Aids organisations during his tabling of the budget speech in parliament on Wednesday.
In February, US President Donald Trump announced an end to funds from USAid which supports the President’s Emergency Plan for Aids (Pepfar) and TB treatments. USAid used to fund 44 health projects in the country.
Godongwana told journalists during a pre-budget briefing that, out of 275 000 people working on HIV, TB and sexually transmitted infections programmes, only 15 000 are reliant on Pepfar, adding that the Department of Health would be asked to assist with funding the shortfall. The treasury would only be able to provide more information at the end of the month.
The treasury allocated R298.9 billion to the 2025 health budget and, according to Health-e News, the shortfall resulting from the funding cut is R8 billion.
Health department spokesperson Foster Mohale told the Mail & Guardian that the funding freeze had not had much immediate impact on access to life-saving treatment because the government “procures 90% of the treatment or [antiretrovirals]”.
The funding cut is also slated to result in 14 000 to 17 000 job losses in the sector. This includes clinicians, counsellors, data capturers and researchers.
The minister said R28.9 billion had been added to the health budget, mainly to keep about 9 300 healthcare workers in hospitals and clinics, adding that it would also be used to employ 800 post-community service doctors and to ensure pharmacies did not run out of medicines.
According to budget documents, the health function is allocated R941.5 billion over the mid-term economic framework (MTEF) period to support the equitable provision of public health services, including free primary healthcare.
Of this, about 44.7% is directed to funding district health services, particularly
primary healthcare facilities such as clinics and community health centres, which also
provide outreach services.
“This level of care is recognised as the most efficient and effective due to its focus on disease prevention and proximity to communities. Almost 98% of the budget for this function is allocated to provinces, amounting to about R922.7 billion,” the budget review said.
As part of boosting the National Health Insurance (NHI) the Department of Health will fund the development of “a patient information system, a centralised chronic medicine dispensing distribution system and a facility medicine stock surveillance system”.
The indirect and direct conditional grants for NHI are allocated R8.5 billion and R1.4 billion, respectively, over the MTEF, according to the budget documents.
“Sustained allocations for direct and indirect infrastructure grants, including potential
additional funding through the budget facility for infrastructure, as outlined in the 2024 mid-term budget policy statement, will focus on new or replacement buildings, upgrades, rehabilitation and maintenance.”
The budget documents showed that the total health infrastructure allocation is R37.4 billion over the MTEF period. This consists of provisional allocations from the budget facility for infrastructure and new allocations for equipment for Siloam District Hospital in Limpopo and Tygerberg Hospital in Cape Town through a public-private partnership in 2027-28.
“It remains important to improve efficiency in expenditure, including in the areas of commuted overtime, public procurement and price benchmarking,” the minister said.
The recent termination of USAid to HIV/Aids and TB organisations in South Africa was a bone of contention in the 2025 budget
