(Note to Editors: The following Debate was delivered during a Sitting of the KZN Legislature held today)
Healthcare is not merely another budget vote. It is the human face of government. During deliberations by the KwaZulu-Natal (KZN) Health portfolio committee there was careful scrutiny of this budget.
The Budget
We acknowledge the increase in the Department of Health (DoH) allocation, to R60.3 billion – approximately R4 billion more than last year. We further note the department’s intention to strengthen primary healthcare through contracting private practitioners, improving mental health services, expanding Emergency Medical Service (EMS) capacity and investing in infrastructure. These are welcome commitments.
KZN’s Government of Provincial Unity (GPU) inherited a healthcare system in need of help and it is improving. However, a larger budget, on its own, has never cured a patient. Money does not perform surgery, answer emergency calls or treat TB – people do. Systems either enable those people – or they frustrate them.
The greatest threat facing KZN’s healthcare today is not inadequate funding. It is inadequate governance systems. Specifically, policy made by those that occupy national office. In other words, there is money – but a dearth of solid policy.
Decentralisation/NHI
We need to talk about decentralisation and resilience within the heath sector built on solid infrastructure, improving quality care and safety, expansion of health services and promotion of prevention and wellbeing. These are the cardinal pillars in healthcare.
The DA’s beliefs are profoundly different from those who continue to champion ever greater centralisation. Universal Access to Healthcare does not require universal officialdom. The answer to a struggling health system is not another distant state-controlled bureaucracy deciding the fate of 12 million people. The answer is accountability, professional management, transparency and decentralisation. In other words, greater autonomy for districts and facilities.
The DA rejects the notion that Universal Health Coverage can only be achieved by concentrating unprecedented power into a single national structure under National Health Insurance (NHI). That is why we are in court. When power becomes concentrated, accountability disappears. When accountability disappears, corruption flourishes. When corruption flourishes, patients suffer.
The DA’s alternative is simple: strengthen what exists, fix governance, empower professionals, partner with the private sector where it benefits patients, and measure outcomes – not ideology.
Compensation of Employees
We heard during the portfolio committee stage of this budget that, despite the welcome increase in funding, the DoH continues to face immense pressure from Compensation of Employee (CoE) costs, operational shortfalls and growing service demands. That is why the DA has consistently maintained that the department must cut its cloth according to its means, while ensuring every available rand delivers maximum value for KZN’s people.
Fiscal discipline is not austerity. It is respect for the taxpayer. Every rand wasted through poor procurement, delayed payments, unauthorised expenditure or weak-kneed contract management is a rand taken from a sick child.
The DA believes that:
• Capable institutions begin with capable people;
• Professional appointments must replace political appointments;
• Competence must replace cadre deployment wherever this flourishes;
• Performance must replace patronage; and
• Performance must be measured.
Whether the Chief Executive Officer of a hospital, Chief Financial Officer or District Director, appointments must be based on merit and performance -not political proximity. Decision-making must also move closer to where healthcare is delivered. No hospital CEO should wait months for approval to repair critical infrastructure. Wherever we go, we hear this. No clinic manager should battle layers of bureaucracy before replacing essential equipment. We have seen this.
The DA believes in decentralising authority and simultaneously strengthening accountability. These go hand in hand. A healthy healthcare system will empower competent managers. It will give them authority, hold them accountable, reward excellence and it will remove persistent underperformance. That is how capable, ethical and caring states are built.
This notwithstanding, there is a temporary need in KZN to bring stability where centralisation has been supported. It seems to be bearing fruit in an ailing bad policy ridden system. Facilities must know that we are not here to defend bad managers. We are here to defend patients.
Technology
Technology should replace unnecessary bureaucracy. In 2026, paper files should not still determine whether patients receive treatment. Electronic patient records, real-time procurement tracking, integrated medicine stock management and transparent financial reporting are no longer luxuries – they are necessities.
Primary Healthcare
One of the most encouraging aspects of this budget is the intention to contract private practitioners into Primary Healthcare and strengthen multidisciplinary mental health services. The DA welcomes every initiative that expands patient access. We have consistently argued that public and private healthcare should complement one another – not compete against one another. The private sector is not the enemy of Universal Access to Healthcare. Poor governance is.
Public Private Partnerships
Practical priorities were also identified at committee stage, particularly within EMS. These now require urgent reworking and hastening towards implementation. Specialist vacancies also remain a priority. Infrastructure projects must also be completed where possible and a significant move towards maintenance must be ramped up. The DA’s visit to Northdale Hospital this week in this regard is encouraging, after many years.
EMS must continue rebuilding its fleet and the prioritisation of this area of work must remain active. Primary healthcare must be steered towards prevention. The state has trained thousands of doctors in Cuba with this model in mind and they are lost to the system. Mental healthcare must also receive the attention it deserves. The DA welcomes the project initiation in Port Shepstone and earmarking of R200million for a Northdale facility among others.
The DA commends the many dedicated people working within KZN’s health system, often under extraordinarily difficult circumstances. Many sacrifice family life and carry emotional burdens that no salary can compensate. They deserve a government that works as hard as they do.
As the GPU continues its work, the DA remains committed to constructive oversight. Where the department succeeds, we will acknowledge it. Where it falls short, we will say so without fear or favour. Because oversight is not obstruction – it is one of government’s greatest investments because it protects patients, taxpayers and institutions alike.
Universal Access to Healthcare will never be achieved through greater centralisation. It will be achieved through better governance, accountability, capable leadership, ethical public service, partnership, innovation and, above all, by putting patients before politics.