While Health Minister Dr Aaron Motsoaledi’s recent tabling of the 2025/26 Health Budget vote and the spending priorities showed efforts to plug some funding gaps left by the withdrawal of US funding, there is concern that it may not go far enough.
Daily Maverick reports the Minister had highlighted key priorities such as strengthening infrastructure, reversing the impacts of years-long austerity measures, and addressing the withdrawal of US aid funding for South African health programmes.
Reinforcing HIV/Aids, TB programmes
He said Treasury would allocate R753.5m to fill the gap left by the withdrawal of US funding for HIV/Aids programmes under Pepfar, which, with USAID, had been expected to provide R6.27bn in the 2025/26 fiscal year – about 13% of the R48bn HIV/Aids funding anticipated for the period, reports BusinessLIVE.
Additionally, the Gates Foundation and the Wellcome Trust had each pledged R100m, on condition each R100m is matched by R200m from Treasury, and that the money be dedicated to research. Treasury has agreed to the conditions.
“This means we will have a total of R600m offered to researchers despite Pepfar having pulled the plug from their work,” Motsoaledi said.
The Gates Foundation and the Wellcome Trust would immediately release the R200m while Treasury’s matching R400m would be released over three years, with the first tranche of R132m (included in the R753.5m) being allocated this financial year.
The research funding will be transferred to the SA Medical Research Council (SAMRC), which will disburse it to the various research institutions and universities.
Motsoaledi said that when, after the withdrawal of the Pepfar funding, the National Department of Health (NDoH) had approached domestic and global funders, National Treasury had asked it to prepare 10 plans – one for each province and the 10th for national level – as well as a plan for researchers who have played a major part in the fight against HIV/Aids and TB.
The R753.5m would thus be mainly spent as follows: R590.4m for service delivery in provinces to be allocated via the HIV/Aids component of the district health programme grant; R32m to the NDoH to support the central chronic medicine dispensing and distribution programme and pharmaceutical supply chain management; and R132m to be transferred to the SAMRC to support health research countrywide.
Infrastructure a major focus
Another priority in the Budget was infrastructure, which Motsoaledi described as “one of the biggest problems the public health system encountered”, citing the investigation by the Ombudsman into allegations of poor management at Helen Joseph Hospital, which found huge problems with infrastructure, among other things.
He said Limpopo Central Hospital was under construction in that province and already 26% complete, while other hospitals under construction are:
Siloam District Hospital in Vhembe, Limpopo – 90% complete;
Dihlabeng Regional Hospital in the Free State – 30% complete;
Bambisana District Hospital in the Eastern Cape – 82% complete;
Zithulele District Hospital in the Eastern Cape – 50% complete; and
Bophelong Psychiatric Hospital in North West.
He said the NDoH had, additionally, prioritised several key hospital projects to strengthen the public health hospital network, particularly in high-demand areas in Gauteng, but also in underserved areas.
“These include 17 major hospital projects that have been identified for development and which are in various stages of design and development.”
The Budget didn’t necessarily cover all of the funding needed for the “massive infrastructure injection”, Motsoaledi added, so officials were also speaking to international and local financial institutions about financing options.
Reversing austerity measures
On top of the R64.8bn allocation for Health, National Treasury had earmarked an additional R6.7bn to “reverse years of austerity measures which have crippled the public health system”.
The National Health Council (NHC), made up of Motsoaledi, Deputy Health Minister Dr Joe Phaahla, provincial Health MECs and representatives of the South African Local Government Association and the military, has elected to use the additional funds to:
- Hire 1 200 doctors, 200 nurses and 250 other health professionals at a cost of R1.7bn;
- Acquire 1.4m articles for public hospitals, including beds, mattresses, bassinets and new hospital linen at a cost of R1.3bn;
- Permanently employ 27 000 community health workers who have been in the system for close to two decades, but were supported through NGOs, at a cost of R1.4bn; and
- Start paying accruals that have accumulated over the years in oxygen supply, blood and blood products, laboratory services, medical equipment and pharmaceuticals.
The NHC originally announced its intention to fund an additional 1 650 public sector health worker posts in April.
Parties push back
Opposition parties, however, remain dissatisifed. Moshome Motubatse, an MK party MP, said the budget “fails to provide meaningful healthcare”, and that the allocation for the 2025/26 financial year was increasing by only 1% when accounting for inflation.
“It represents a cut in real terms, even as the demand (on health) continues to grow.”
Dr Karl du Pré le Roux, a former rural doctor who spoke for the DA, noted that while there was much justified criticism of the inequity between the public and private health systems in South Africa, there were also large disparities in the resourcing of different areas within the public health system.
He said managerial incompetence, poor leadership and corruption were among the largest problems.
“Though your aims are noble, most academics, analysts and ordinary South Africans recognise that the implementation of the NHI legislation by a government health system that is riddled with incompetence, mismanagement and corruption at every level, will be a complete disaster,” he said.
Reaffirming commitment to NHI
In their presentations, both Motsoaledi and Phaahla reaffirmed the NDoH’s commitment to implementing the NHI Act.
Motsoaledi said a priority was “to lay a strong foundation in preparation for improvement of the public health system, in preparation for the NHI”.
“There are people who believe we have no plans, nor inclination to do that. We want them to listen very attentively today.”
Phaahla said the department was well on the way to implementing the NHI Act, “despite the court challenges by those opposed to equity and transformation”.
There are currently six legal challenges to the NHI Act.
USAIDS report
Meanwhile, in a global update last week, UNAIDS indicated that the US funding withdrawal could potentially undo decades of progress and lead to millions of additional HIV infections and Aids-related deaths by 2030.
Although Treasury has agreed to release the R753m immediately, this is only about a tenth of the R7.5-bn Pepfar contributed to HIV programmes last year, writes Liezl Human for GroundUp.
The UNAIDS report warned that the cuts to Pepfar threaten to destabilise HIV programmes in low- and middle-income countries, including South Africa: it showed that by the end of 2024, major strides had been made worldwide, with the number of HIV infections and Aid-related deaths having dropped to their lowest levels in more than 30 years.
However, it estimates that if Pepfar funding is permanently suspended, there could be more than 4m additional Aids-related deaths and 6m new HIV infections by 2030.
At the report’s launch at Bertha Gxowa Hospital in Johannesburg on Thursday, Motsoaledi said the funding withdrawal was a “wake-up call”.
Clinics closed
Since the withdrawal of Pepfar funds, several clinics have closed down and healthcare workers have been retrenched. Civil society organisations and activists had urged the Presidency and Health minister to access emergency funding from Treasury.
In Parliament in May, the Global HIV Treatment Coalition presented to the Portfolio Committee on Health about the state of HIV programmes.
But Motsoaledi has downplayed the impact.
“I know that the withdrawal of Pepfar funding made some people believe our massive – actually the world’s biggest – HIV counselling, testing and treatment campaign has collapsed or is on the verge of collapsing,” Motsoaledi said in his budget vote.
“But I have noticed with regret that in South Africa we seem to like the word ‘collapse’ … The public health system suffers this tag quite a lot. It is said to have collapsed so many times that I do not know how many lives it has. There is no way we are going to allow the world’s biggest HIV/Aids Programme to collapse. Never.”
Hope for injection
The Minister noted that the Global Fund to fight Aids, TB and Malaria in Geneva had signed an access agreement with Gilead Sciences to procure lenacapavir, the long-acting injection for HIV pre-exposure prophylaxis.
SA has agreed to be one of the first countries in the starting blocks for lenacapavir.
“The first shipment is expected to reach at least one African country by the end of 2025 – we intend to be such a country and have already started putting the plan together,” he said.
Gilead and the Global Fund to Fight Aids, TB and Malaria recently concluded plans to supply lenacapavir to low-income countries, including South Africa, reports Reuters.
Under the agreement, Gilead will supply, at cost, enough doses to reach up to 2m people over three years in countries supported by the Global Fund.
Gilead signed royalty-free deals last year allowing six generic drugmakers to make and sell low-cost versions of the drug in 120 low- and middle-income countries, but those supplies will take time to get up and running.
The Global Fund said it will prioritise access based on HIV incidence and prevention strategies, including countries in sub-Saharan Africa that have expressed strong interest – notably South Africa, which will be among the first to roll out the drug among around 10 other nations.
The drug, under the brand name Yeztugo, has an annual list price in the United States of $28 218.
“The cuts have definitely hindered progress,” according to Khensani Chauke from the Gauteng Department of Health.
Chauke was among researchers presenting their findings last week at a press conference – hosted by the International Aids Society – on how the funding withdrawal affected the HIV response, reports Health-e News.
She noted that Johannesburg had been the recipient of the Accelerating Programme Achievements to Control the HIV Epidemic (APACE) award funded through Pepfar to support the achievement of 95, 95, 95, the targets being part of a UNAIDS goal to end HIV as a public health threat by the year 2030.
“The withdrawal of the (APACE) award in February this year had a huge impact on key healthcare workers, including the counsellors who were providing community-based HIV testing to vulnerable populations,” she said.
The study team assessed the impact of the award termination by comparing the HIV testing, HIV diagnosis and ART (antiretroviral therapy) initiations from 2023, 2024, and 2025, and found that testing dropped by 8.5% in the first quarter of 2025 when compared with the first quarter of 2024.
“There was also a 31% decline in HIV diagnoses and a 30% decline in antiretroviral initiations. HIV positivity declined from 3% to 2.2%,” she added.
Pepfar funding made up around 17% of the country’s HIV programme. Much of this funding went towards staff in 27 high HIV burden districts. Since the funding withdrawal, more than 8 000 people have lost their jobs. According to Chauke, the impact on Johannesburg’s health facilities has been huge.
“In facilities where Pepfar-funded staff were allocated, there was a massive reduction in ensuring clients get tested and are put on treatment,” she said.
The management of patients on ARVs has also taken a knock in the absence of Pepfar-funded staff, who only dealt with HIV management.
“And we have seen a huge drop in the viral load suppression, especially in the paediatric group where these children are caregiver-dependent. We were working on a family care model that focused on caregiver and child pairings to assist with disclosure and treatment adherence, which has since been affected,” she added.
Call for transparency
Activist and founder of the Treatment Action Campaign Zackie Achmat criticised the government’s lack of transparency in releasing the data on the scale of the impact of the Pepfar funding cuts.
“They must make the data accessible … because we need to know where to go and how to reduce the impact. And how the programmes are going to be dealt with. Our government has been neglectful in this regard.”
Health-e News – Joburg sees 30% decline in HIV diagnoses due to U.S funding cuts
BusinessLIVE article – HIV/Aids programmes get funding injection from Treasury (Restricted access)
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