12 December 2012


SECTION27 welcomes the Gauteng Premier’s announcement on Monday, 10 December 2012, that the Provincial Treasury will intervene in respect of some functions of the Provincial Department of Health (“Department”).

This announcement comes after the MEC for Health publicly stated last month that the provincial health budget is not sufficient to meet the needs of the province for the remainder of the financial year.

This problem is not new. SECTION27 and the Treatment Action Campaign have repeatedly raised concerns about the failure by the Department to put in place proper budgeting and financing systems and the dire consequences on the patients who rely on the public health system for their health care needs. These consequences include regular shortages of essential medicines, shortages of equipment and staff.

The Department has been overspending its budget for at least the past seven years. At the same time, the burden and costs of health care (particular the amount spent on personnel and salaries) has risen disproportionately to the budget. As a result, the Department has accrued debts every year and pays accrued debts out of the next years’ goods and services budget. The most recent Auditor-General’s report – in which the Department received yet another qualified audit – shows numerous breaches of the Public Finance Management Act (PFMA) by the Province, including fruitless and wasteful expenditure, unauthorised expenditure and other financial irregularities.

Section 18 of the PFMA requires the provincial treasury to exercise control over the implementation of provincial budgets and to assist departments in “building their capacity for efficient, effective and transparent financial management”. The Provincial Treasury’s intervention in terms of section 18 of the PFMA is therefore long overdue.

A rights-based approach

However, even in this fiscal environment, everyone’s right to have access to health care services must be respected in terms of section 27 of the Constitution, as well as the rights to dignity and equality in the delivery of those services. Section 27 of the Constitution requires government departments to progressively realise the right to have access to health care services, within its available resources. This responsibility includes the efficient, effective and equitable management of public resources for health care. The Provincial Health Department and Treasury must therefore ensure that the development of budgets and the implementation thereof do not limit access to health care, for example, through austerity measures.

Much money can be saved through stamping out corruption and eliminating waste and unnecessary bureaucracy. In short, we stress the importance of promoting a patient-centered approach in the implementation of the treasury’s intervention.

IST report recommendations on improving province’s budgeting and finances

The Treasury’s intervention can only be a short-term solution to the current crisis and work must be done to resolve the systemic weaknesses that have led to this situation. In doing this, the Department must make use of the Integrated Support Team (IST) reports to guide their interventions.

The IST reports on each of the 9 provinces were commissioned by the former Minister of Health, Barbara Hogan, in response to the massive budgetary shortfalls that over-whelmed provincial departments of health in the 2008/2009 financial year. The findings in these reports reveal fundamental failures in political and bureaucratic leadership, inappropriate financial management systems, inadequate monitoring and evaluation systems, and a failure to plan appropriately for human resources, amongst others.
The reports also contain detailed recommendations of what steps must be taken to resolve these systemic failings and assign responsibility to implement the recommendations to the Minister of Health, the National and Provincial Departments of Health, National and Provincial Treasuries, the Department of Public Service and Administration and external stakeholders. These recommendations are an important indication of what is needed to fix the problems in the Gauteng’s health system so that it is capable of achieving the right to have access to health care services guaranteed in section 27 of the Constitution.

We urge the Gauteng Provincial Treasury to consider the detailed analysis and recommendations in the Gauteng IST report in undertaking its functions in terms of the PFMA and to do so in an open and transparent manner that allows for community participation.


For more information please contact Daygan Eagar at 072 249 3873 or or Umunyana Rugege at 083 458 5677 or