oa South African Health Review - Health financing

Volume 2011, Issue 1
  • ISSN : 1025-1715



An overview of healthcare financing in South Africa (SA) is presented, reviewing policy developments and expenditure trends with a focus on the public sector. Despite SA spending around 8.6% of Gross Domestic Product on health, overall health outcomes of South Africans remain inadequate. Although the private-public differential reveals a narrowing trend, with provincial health spending overtaking medical scheme spending for the first time in 2009, inequity in health access, quality of care and spending remain major challenges. It is envisaged that current policy developments, including National Health Insurance (NHI), the Negotiated Service Delivery Agreement and re-engineering of primary health care, will narrow the health equity gap.

There has been a significant increase in spending on primary care and health infrastructure, with a steady rise in human resources for health in the public sector. Spending on expanding HIV-related services through the HIV and AIDS conditional grant has grown by 46.4% per annum over the past three years. It is projected that the total number of antiretroviral therapy clients will increase to 3 million from the current 1.4 million by 2015/16. With the phased rollout of GeneXpert®, more resources will be required for the treatment and management of tuberculosis (TB) and multidrug-resistant TB patients as the detection rate increases.
On average, hospital spending has increased by 15.4% per annum over the last three years. NHI will significantly change the landscape of health financing over the decade ahead, with increasing levels of funding, greater access and equity and improved quality being key objectives.

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