There is no doubt in anyone’s mind that all healthcare workers are an integral part of South African society. Yet, the healthcare system is plagued by an unforeseen crisis caused by budget cuts imposed on healthcare provisions.

We take a look at how budget cuts can impact the health care system and everyday South Africans.

The announcement of budget cuts by the National Treasury has sparked concerns among various groups, governments and the broader South African health community as a whole.

An open letter signed by more than 16 academics - all of whom are heads of departments at various universities, and close to 1,000 senior clinicians, nursing leaders and health workers in the Western Cape - has highlighted the impact that the “catastrophic” budget cuts are having on the province’s health system and how it will affect South African members of the public.

The letter was released publicly and is addressed to Minister of Finance Enoch Godongwana, Western Cape Premier Alan Winde and Provincial Minister of Finance and Economic Opportunities Mireille Wenger.

They highlighted that the budget cuts have affected healthcare services in the entire country.

The health professionals said a reduction in posts means fewer nurses, doctors, general assistants, cleaners, clerks, physiotherapists, radiographers, porters, occupational therapists, dentists and specialists to deliver desperately needed healthcare to the population.

They put a spotlight on how it affects those who are in need of urgent care.

“For patients who need access to surgical and anaesthesia services, it has forced a reduction of theatre lists, which means postponing or cancelling essential operations for patients who have often waited months or years for these procedures.”

They highlighted that there are women, men and children who are waiting for various surgeries, including cancer surgery, surgery to restore sight and hearing, surgery to treat chronic pain, surgery for brain tumours, surgery to remove infection and improve breathing, surgery to treat urinary retention and bowel conditions and life-saving heart surgery.

Budget cuts can also mean decreased access to beds in hospitals and longer waiting times.

They added that for many of the above conditions - and more - time is of the essence and delays may result in progression to the point of irreversible organ damage.

Patients who need access to oncology services, service cuts mean a delay in reaching multi-disciplinary oncology services.

“A delay in their biopsy or surgery due to pressure on those services. It means that cancers are (at a) higher stage at diagnosis, and therefore there is less chance of cure.”

Staff shortages can also place an additional strain on the existing staff, leading to burnout and increased staff resignations.

When it comes to mental health services, service cuts will lead to reductions in the quantity and quality of care for both serious mental disorders such as schizophrenia and bipolar disorder, as well as for common mental disorders such as depression, anxiety disorders and substance use disorders.

Delayed diagnoses due to understaffing will result in increased hospital costs and hospital stays.

“We urgently call on you to re-examine your budget spreadsheets, realign your fiscal priorities to Health, Education and Basic Services, and put the well-being of our people first.”

A recent joint statement by Winde and Wenger, cited the open letter and said the impact of nationally-imposed budget cuts on healthcare provision is “simply devastating”.

“The implications of the nationally-imposed cuts go beyond health care services and have hit education and social development services - and every other provincial department,” said the Western Cape government in the statement.

It said it vows to use “all available levers” to mitigate the effects.

“However, the hard truth is that the quantum of the budget cuts is now so large that it will be almost impossible to fully mitigate the loss of funding from the national purse” said Premier Winde.

Wenger said that although they will try to mitigate it, provincial governments cannot control the budget cuts.

“The fact is that these budget cuts are beyond the control of the provinces because we rely almost entirely on funding from the nationally-collected tax revenue. This is then allocated to each of the nine provinces by the National Treasury through the Provincial Equitable Share (PES), to fund the core constitutional mandates of providing, among others, health care, education and social development services,” she said.

In a statement released last December, the South African Committees of Dental Deans (SACODD), Healthcare Sciences Deans (SACOHSD) and Medical Deans (SACOMD) expressed concern about the implications of these cuts on the already strained health system in South Africa.

The budget cuts are expected to exacerbate existing challenges within the health system, including staff burnout, compromised quality of care, and inadequate training opportunities.

They said the situation could disproportionately affect vulnerable groups, such as women and children in rural areas, worsening gender inequity in healthcare.

The Deans emphasise the urgent need for government intervention to address systemic failures in the health system. They call for the protection of the health sector from austerity measures and advocate for fully-funded placements for graduating health professionals, including those from the Mandela-Castro Medical Collaboration programme.

Furthermore, the Deans urge the Minister of Health to engage with the National Treasury to safeguard the health sector and convene discussions on employment of health workers and joint workforce planning between the health and higher education sectors.

They stress the importance of ensuring access to quality healthcare for all South Africans, emphasising the role of civil society in advocating for this cause.

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