Last week’s Budget presented by Finance Minister Enoch Godonongwana has been criticised by Dr Patrick Ngassa Piotie, chairperson of the Diabetes Alliance, as “disconnected from the scientific and clinical evidence emerging daily from public health facilities”.
Piotie warns that while Treasury had allocated R21.3bn to support the hiring of doctors, and R26bn for HIV/Aids programmes, there was no dedicated funding stream to tackle the non-communicable disease (NCDs) crisis burdening the country.
In Health-e News, Piotie writes:
South Africa’s health profile has changed fundamentally over the past decade. NCDs have been the leading causes of death since 2010. We are no longer confronting an infectious disease-dominated mortality pattern. We are confronting multimorbidity, where people with HIV are now increasingly developing diabetes, hypertension and cardiovascular disease.
Diabetes mellitus is the leading underlying natural cause of death in SA, claiming more lives than HIV, TB and other infectious diseases, according to Statistics South Africa’s latest Mortality and Causes of Death report.
Yet our financing frameworks remain structured as if this transition has not happened.
A disappointing silence
For the 5.6m diabetic South Africans, this Budget is a profound disappointment. Despite the momentum generated by the 2025 Diabetes Summit and a clear call from civil society for ring-fenced funding, the Minister’s speech was silent on NCD-specific allocations.
One of the most glaring omissions was the failure to reference or strengthen the Health Promotion Levy (HPL), known as the “sugar tax”. Since its introduction in 2018, the HPL has proven to be an important tool in curbing sugar consumption and reducing obesity – a massive driver of NCDs. Yet, over several budget cycles, it has effectively stagnated, eroded by inflation and policy hesitation.
Civil society and health experts recommended an increase in the HPL from the current 11% to 20%, in line with World Health Organisation guidance. Instead, the Minister maintained a conservative approach.
This approach extends to taxes on other products that burden our health system. For example, increases in tobacco and alcohol largely track inflation rather than reflecting the rising burden of disease and the heavy toll of commercial determinants of health.
By failing to act decisively on this, the government has missed a critical opportunity to protect public health, particularly in poor communities that are disproportionately targeted for marketing by big food corporations.
The true cost of inaction
The Minister spoke of “spending better” and “stabilising debt”. Yet a Budget anchored in fiscal consolidation cannot afford to ignore the single condition driving escalating long-term health expenditure, disability claims and productivity loss.
The total cost of managing diabetes is projected to reach R35.1bn by 2030, with nearly half of that amount spent on preventable complications like amputations, kidney failure, and blindness.
When we fail to invest in policy reform and stronger regulation of Big Food, we are not saving money; we are merely shifting the cost. The burden moves from industry to our primary healthcare facilities – already under pressure – and to families who must absorb the financial and emotional cost of chronic care.
The human toll
Diabetes is also a major threat to South Africa’s workforce. It affects people in their prime working years, leading to lost productivity, increased disability and premature death. In a country grappling with economic stagnation and high unemployment, failing to address NCDs will inevitably further undermine economic resilience.
As chairperson of the Diabetes Alliance, I carry the frustration of millions who feel increasingly unprotected in environments shaped by powerful commercial interests.
Behind every statistic is a human story: the anxiety of parents whose children have Type 1 diabetes and struggle to access essential care; the worker whose income disappears after losing a limb to a preventable complication; or the “missing millions” who remain undiagnosed and unsupported because early detection systems and disease surveillance are fragile.
A call for visionary leadership
Godongwana’s Budget may please credit rating agencies, but it does not adequately reflect the health reality confronting South Africans.
We do not need fiscal discipline that overlooks the leading cause of death. We need fiscal leadership that aligns economic planning with epidemiological evidence.
We call on the government to:
- Ring-fence funding specifically for NCD prevention and management at the primary healthcare level;
- Increase the Health Promotion Levy to 20% to deter consumption of harmful products and generate sustainable revenue for public health; and
- Implement urgent food policy reforms, including strict regulations on the marketing of ultra-processed foods to children.
South Africa cannot afford to wait. Every budget that sidelines the diabetes epidemic is a budget that normalises avoidable amputations, strokes and broken families.
A nation cannot secure its economic future while neglecting the chronic disease epidemic eroding its workforce, its communities and its public finances.
The 2026 Budget missed an opportunity to align financial planning with epidemiological reality.
Piotie is a co-Founder of the University of Pretoria Diabetes Research Centre and the Chairperson of the Diabetes Alliance
See more from MedicalBrief archives:
NHI setbacks delay implementation further
Concern as NCDs rise in young South Africans – Limpopo study
SA facing diabetes ‘pandemic’ as cases soar among young people