South Africa’s health budget is failing to respond to the realities facing women, particularly those living in poor and rural communities. The public health system, which serves 84% of the population, operates within at least three overlapping pressures: high unemployment and poverty, persistent gender inequality, and the increasing impacts of climate change. A new SECTION27 report, ‘South Africa’s Health Budget 2025/2026: Gender and Climate Responsiveness’, examines whether the health budget responds to the needs of those most affected by these pressures, particularly women.
The report finds that persistent underinvestment in health infrastructure and services is worsening inequalities in access to care, especially in rural communities. These failures affect marginalised genders most acutely. Long travel distances, unreliable emergency services, and deteriorating facilities disproportionately affect women, who are the primary users of healthcare services, are frequently frontline health workers, and are often caregivers.
Women sustain South Africa’s health system through both paid and unpaid care work. While 89% of professional nurses are women, funding remains insufficient to support health workers, expand services or reduce inequalities in access to care. As a result, gaps in the health system continue to shift the burden of care into households, where women and girls shoulder the majority of unpaid care work. Women spend an average of 30.5 hours a week on unpaid care and domestic work, compared with 12.2 hours for men.
Worse, climate shocks are intensifying these pressures. Floods, droughts and heatwaves are damaging already fragile health infrastructure, disrupting water and electricity supplies, increasing infection risks, and driving greater demand for healthcare services. Yet the 2025 health budget makes no commitment to climate-resilient health facilities or reliable backup water and energy systems, despite recurring climate-related disasters and service disruptions.
SECTION27 worked with the Eastern Cape Health Crisis Action Coalition (ECHCAC), whose members have experienced the devastating impacts of recent floods. Following the 2022 floods in Komani, many families lost their homes, identity documents and clinic cards, interrupting access to healthcare and treatment. “Women are primary users of healthcare services and caregivers; they experience barriers to maternal, reproductive and general healthcare services during floods,” said ECHCAC activists.
Although families were promised temporary accommodation for six months, many remain in overcrowded disaster centres three years later. “Families were moved to overcrowded disaster centres, exposing many people to contagious diseases such as multidrug-resistant tuberculosis (MDR-TB) and increasing demand for healthcare services,” the ECHCAC activists added.
The report finds a clear gap between government commitments and government spending. While government recognises gender inequality and climate change as urgent challenges, the health budget does not invest enough to address them. As a result, public healthcare remains underfunded, access to services remains unequal, and the burden of care continues to fall on women and families. The report calls on civil society and government to work together to advance a health budget that is fair, gender-responsive and resilient to climate change.
For media enquiries contact:
Pearl Nicodemus | nicodemus@section27.org.za | 082 298 2636
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