Vote 18: Health Budget Debate
House Chairperson,
Honourable Minister and Deputy Minister,
Fellow MECs,
Honourable Members of the NCOP,
Fellow South Africans
It was Thomas Carlyle who said, “He who has health, has hope, and he who has hope, has everything.”
This truth underpins our work in healthcare. Because when we strengthen our healthcare system, we are doing more than delivering medicine or building clinics — we offer hope. Hope to the sick, to families and to entire communities.
If we want to build a thriving and inclusive South Africa, we must start with a healthy population. And while health and wellbeing stretch far beyond the walls of any facility, equitable, accessible, and dignified caremust form the foundation of our healthcare system.
To make this a reality, we must have the infrastructure to deliver care. These are spaces where hope becomes tangible.
I agree with the Minister that one of our key priorities must be to strengthen health infrastructure – both brick and mortar, and health technology.
In the Western Cape we are doing our level best to prioritise fit-for-purpose, patient-centred and climate resilient infrastructure. In this financial year alone, 18 infrastructure projects are in planning, 68 will move into design or tender, and 43 will be handed over to contractors.
29 construction projects will be underway, including Community Day Centres and clinics in Ravensmead, Hornlee, and Weltevreden; acute psychiatric units at Eerste River, Khayelitsha, and New Somerset Hospitals; and major refurbishments at Alexandra Hospital, Tygerberg, and Groote Schuur, including surgical theatres, emergency centres, and critical building systems. And last year, I’m proud to share with this House that the Western Cape built an Emergency Centre at the Robertson Hospital in just 10 months. And it’s beautiful. It compares with any excellent private sector facility of its kind, in both design, construction and equipment.
Chairperson, as the Minister noted, we find ourselves in challenging times, especially with the sudden withdrawal of international donor funding for HIV. We further welcome the announcement of the introduction of Lenacapavir into our HIV-fighting arsenal, once approved by SAHPRA and we trust that there will be an equitable distribution amongst provinces, according to need.
We welcome the R590 million committed to provinces in this budget for our collective and continued fight against HIV. In the Western Cape, we were ready. Our department has already completed proactive scenario planning to ensure that, when funding becomes available, we can respond swiftly and effectively.
We’ve asked: How do we get the maximum return for every rand spent? And how do we not just stabilise services, but strengthen them?
Our approach is pragmatic, evidence-based, and rooted in the local context.
Among our proposals:
- Digitising HIV and TB registers to improve care tracking.
- Expanding e-scripting and e-prescribing for better medicine access.
- Increasing community-based treatment pick-up points.
- Strengthening clinical management of HIV and TB.
- Focusing on high-burden geographic areas.
I want to assure this House that every rand allocated to the Western Cape will be used responsibly, strategically, and with the clear goal of delivering hope through healthcare.
The Western Cape Department of Health and Wellness has received six consecutive clean audits— a testament to fiscal discipline, responsible governance and a commitment to service delivery. And we hope to make it seven when the Auditor General releases audit outcomes later this month.
But no amount of fiscal responsibility can overcome national policies that are not fit for purpose. The DPSA’s recent regulations, intended to slow down recruitment, are doing real harm to large service delivery departments like Health. Staff retire or move on, and yet our system lacks the agility to replace them fast enough. This leaves remaining healthcare workers overburdened, and services strained.
Chairperson, these aren’t the only barriers we face.
Across the Western Cape, several NHI infrastructure projects have failed to launch. The Pacaltsdorp Clinic, first earmarked in 2017 and due in 2019, remains unfinished. So too do projects in Parkdene, Rosemoor, Blanco, Riversdale, Albertinia, and Oudtshoorn.
Where the provincial government could have delivered, the national process is slow and disconnected and I have written to Minister Motsoaledi to express my serious concerns.
Now Chairperson, turning to the NHI; in its current form, it is ill-defined, impractical and unaffordable. It will not address the immediate or long-term healthcare needs of South Africa.
The Western Cape supports the expansion of quality healthcare to all so that residents can access healthcare where and when they need it, without incurring catastrophic out of pocket expenses. But we do not support NHI as it stands.
As representatives of provinces, let me ask the honourable members of this House how they can support removing the health equitable share from your provinces and weakening provincial provision of healthcare?
Do you agree that district and central hospitals will no longer be provincially managed and will instead become national components? How will you justify this to the healthcare workers whose futures are uncertain?
We are getting dangerously close to a single, centralised fund that carries massive governance risks. And the consequences will fall on those who rely most on the public health system.
In Ghana, a model for our NHI despite more than 15 years of implementation, the NHIS still faces serious challenges: poor coverage, declining quality, corruption, ineffective governance, vague policy and political interference. Let this be a cautionary tale.
Instead of centralising power, we believe that better healthcare can instead be achieved through harnessing the strengths of both the public and private healthcare sectors. A more flexible model that expands choice, and addresses deficiencies will deliver a better healthcare system.
In the Western Cape, we have established a health sector think tank – including private and public sector, and academic leaders — to explore collaborative, innovative models that will deliver universal healthcare. No one should be left behind.
Because ultimately, what we’re fighting for — through every budget line, every clinic upgrade, and every patient interaction — is hope.
And Chairperson, here lies the difference:
The NHI will deliver a fragmented system.
The Western Cape delivers an integrated, unified system.
The NHI duplicates and complicates.
The Western Cape streamlines and strengthens.
The NHI ignores local realities.
The Western Cape responds to them.
The NHI delivers uncertainty.
The Western Cape delivers hope.
Thank you.