Deputy Minister Joe Phaahla: Health Dept Budget Vote 2025/26

Honourable Speaker/Chairperson of the sitting
Honourable Minister of Health, Dr PA Motsoaledi
Honourable Ministers and Deputy Ministers present
Honourable MECs present
Honourable Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo
Honourable members of the Portfolio Committee
Honourable Members of the National Assembly
Heads of Public Entities and Statutory Councils
Distinguished guests
Ladies and Gentlemen

Good afternoon, Sanibonani, Dumelang

Thank you very much Honourable Chair for this opportunity to participate in the Budget Vote 2025/26 of the Department of Health. This debate takes place on a sad week as we mourn the passing of a longstanding public servant, public representative, a leader in this house, our late Deputy President Hon DD Mabuza. We pass our condolences to his family. May his soul rest in peace.

Honourable Chair, we hold this debate on a very important year when we celebrate 70 years of the adoption of a document which became a loadstar during our struggle for freedom but also a base document for our democratic constitution and has remained a relevant reference point up to today, viz The Freedom Charter which turned seventy years on 26 June 2025. The Charter declares on health that “A preventative health scheme shall be run by the state. Free medical care and hospitalisation shall be provided for all, with special care for mothers and children.”

Honourable Chair, while we acknowledge that a lot still needs to be done, we also assert without any fear of contradiction that we have moved a long way in the attainment of these aspirations in terms of increasing access to services and removing barriers.

As I said on 13 June 2023 in the 6th Parliament when we passed the NHI, this was the next serious milestone towards the realisation of the Freedom Charter and we are well on our way to implementation of the Act despite the court challenges by those opposed to equity and transformation. When this Act is fully implemented, the aspirations of a preventative health scheme run by the state and free medical care at the point of service as espoused in the Freedom Charter will be realised in full.

Non-communicable diseases

Honourable Chair, while we must remain focussed on achieving elimination of infectious diseases such as HIV and AIDS, TB, malaria, children’s viral infections and water-borne diseases such as cholera and typhoid, we are also wide awake to the fact that non-communicable diseases are a rising menace to our population as is the case in other countries both developed and developing. It is for this reason that on 25 September this year, the UNGA will convene an unprecedented fourth High Level Meeting of Heads of States to discuss progress since the third high level meeting held in 2018 on NCDs.

As we are aware, the NCDs we are talking about are:

• High blood pressure and related complications such as strokes, cardiovascular diseases and kidney disease
• Diabetes mellitus and its complications including amputations and blindness
• Various cancers in women, men and even children
• Mental illnesses of all types including consequences of substance abuse
• Chronic respiratory diseases

Our overall strategy for NCDs is anchored on pillars of prevention, early detection and effective treatment where cure is possible, and retention on treatment and monitoring where it is a lifelong ailment.

As many of us are aware, the cornerstone of prevention of NCDs is managing our lifestyles through:

• Not smoking or using tobacco and related products
• Not taking alcohol or otherwise doing so in moderate amounts
• Eating healthy food rich in fibre, vitamins, minerals and other key ingredients beneficial to our bodies and avoiding high intake of sugar, salts and fats
• Regular physical activity

We have partnered with organisations such as Parkrun, which is led by our legendary Comrades Marathon multiple winner Bruce Fordyce, to use open parks for people of all ages to walk and run. This is done in various parks at 8am on Saturdays.

In terms of regulatory interventions, we have amongst others the Health Promotion Levy commonly called the sugar tax, regulations for control of trans-fats, and regulations to reduce salt in prepared foods to help reduce to less than 5g of salt per day.

In 2023, we published draft regulations to improve food labelling requirements which clarifies more explicitly food content. After public comments, we are about to conclude the amended regulations.

The next level of intervention is in early detection and treatment.

The detection, screening and treatment are key components of the response to NCDs. We continue strengthening screening services for early detection and prevention of high blood pressure and elevated blood glucose.

As a means of preventing and controlling NCDs, the Department is implementing a National NCD Campaign to improve early detection and link patients to care. This campaign aims to strengthen each district’s community-based response in line with the Integrated People-Centred Health Service approach.

The implementation of this campaign has led to an increase in the number of people screened for hypertension and diabetes, so that people diagnosed with these conditions can be initiated on treatment as early as possible.

I am happy to report that during the past five years we have been able to surpass the set annual targets of screening 25 million people for high blood pressure and elevated blood glucose respectively. During 2024/25, we managed to conduct a total of 44 602 922 screenings for high blood pressure and 44 069 005 screenings for elevated blood glucose.

This is attributed to increased uptake of screening services at community and facility levels which were supported by the training of community health workers and traditional health practitioners to conduct screenings in households, the procurement of HbA1c (which is a blood test that reflects your average blood sugar levels over the past 2–3 months) point-of-care testing machines, and the roll-out of the National NCD Campaigns in provinces.

For the next five years, we plan to conduct 45 million screenings for high blood pressure and 43 million screenings for elevated blood sugar per year. This will ensure ongoing surveillance and early disease detection and diagnosis.

The battle against NCDs is the responsibility of all in the country, therefore, continued collaboration among various stakeholders is key in our efforts to prevent and manage these diseases.

Honourable Chair, in terms of prevention of chronic respiratory disease, I leave it to members of the Health Portfolio Committee and their parties to support the current legislation on tobacco control which you are processing. By simply supporting that Bill, you will be saving millions of lives.

Cancer

Honourable Members, according to the South African National Cancer Registry, the top five leading cancers ranked by number of cases during 2023 include breast, prostate, cervical, colorectal and lung cancer.

Cervical cancer ranks as the second most frequent cancer among women in South Africa and the first most frequent cancer among women between 15 and 44 years of age. The number of new cervical cancer cases increased from 7 499 in 2022 to 7 644 in 2023.

However, cervical cancer is unique amongst other cancers in that its causative virus has been clearly identified and a vaccine has been developed, and therefore it can be prevented. It is for this reason that the WHO is leading member countries in a campaign to eliminate cervical cancer by 2030.

South Africa has made significant progress since the start of the HPV vaccination campaign in 2014. To date, 85%–89% of targeted girls in grade 5 and aged 9 have received one or more doses. During the February/March 2024 round of HPV vaccination against cervical cancer, 405 299 girl learners (88.6% of the target population) received HPV vaccination. The programme has since been extended to private schools.

The WHO has made coverage even easier by confirming that a single dose of the HPV vaccine provides adequate protection.

South Africa has committed to achieving the WHO Cervical Cancer Elimination targets, which focus on:

• Ensuring that 90% of girls are vaccinated against HPV
• Ensuring that 70% of eligible women are screened for cervical cancer using a high-quality test
• Ensuring that 90% of women with precancerous lesions or invasive cancer receive treatment

We have introduced HPV screening as a key component of efforts to eliminate cervical cancer through early detection and treatment of pre-cancerous lesions. HPV screening was introduced early in 2024/25, and by March 2025, 43 of the country’s 52 health districts had commenced HPV screening.

This number will be expanded further during 2025/26. The Department has conceptualised the mother/daughter pair as one measure to ensure that girl children receive HPV vaccination at nine years of age, while their mothers, aged 30 years and older, begin HPV screening.

This approach also prioritises HIV-positive mothers for HPV screening so that they can be started on treatment if diagnosed.

Mental health

Honourable Chairperson, there is growing global concern over the increasing burden of mental health conditions. In South Africa, mental health disorders are exponentially driven by substance abuse and are contributing to aggressive forms of mental disorders, leading to overburdening of health facilities and heinous crimes including GBVF.

During 2024, the National Planning Commission initiated a situational analysis of mental health to address the urgent need for mental health reform in South Africa. One finding was the disproportionately low allocation of resources for mental health services, with only 5% of the national healthcare budget dedicated to this critical area. This results in infrastructure inadequacies and staff shortages.

South African mental health legislation and policies are regarded as among the most progressive internationally. We have taken critical steps to strengthen our mental health system, including reforming the Mental Health Care Act 17 of 2002 and implementing a National Mental Health Policy Framework and Strategic Plan 2023–2030.

The vision is to achieve “comprehensive, high quality, integrated mental health promotion, prevention, care, treatment and rehabilitation by 2030.”

The Department continues to strengthen primary healthcare and community-based mental health services. Integration of mental health care into primary health care is key to preventing severity in communities and reducing expensive specialised care needs.

Currently, the Department is using a conditional grant for mental health services to contract private psychiatrists and clinical psychologists.

During 2024/25, a total of 261 mental health care providers were contracted. In the new financial year, we plan to develop a roadmap on strengthening resources and functionality of the Mental Health Review Boards.

Our Medium-Term Development Plan target is for 75% of Community Health Centres to have at least one mental health care provider by 2029. These include psychiatrists, medical officers with post-basic diplomas in psychiatry, psychologists, social workers, occupational therapists, registered counsellors and psychiatric nurses.

Malaria disease

Honourable Chairperson, South Africa embarked on a malaria elimination programme in 2012. We are part of eight SADC countries identified for near-term elimination, known as the “Elimination 8.”

Our Malaria Strategic Plan aimed for zero local transmission by 2023. However, 1 909 local malaria cases were recorded in 2022/23, and this goal was not met. Malaria cases rose from 7 330 in 2022/23 to 9 594 in 2023/24, though malaria deaths dropped from 90 to 82.

In 2024/25, malaria cases declined significantly to 3 520 with 28 deaths. Of the 2023/24 cases, 31% (2 660) were local and 69% (5 797) were imported.

To combat this, the Department implemented a malaria foci clearing programme in endemic provinces (KwaZulu-Natal, Mpumalanga and Limpopo). Ten subdistricts have implemented this programme, with four more to be added in 2025/26.

Two of South Africa’s nine endemic districts have not reported local transmission in the past four years—encouraging progress towards malaria elimination.

Public entities input

The Department of Health oversees six Schedule 3A public entities and six statutory health professional councils. These play a critical role in service delivery, regulation, research and oversight of health professionals.

National Health Laboratory Service (NHLS)
The NHLS is the largest pathology provider in South Africa, serving 80% of the population. It operates 233 laboratories and supports HIV, TB and COVID-19 diagnostics.

Point-of-care testing will expand access at community level. The NHLS has recovered from the 2023 cyberattack and now has stronger IT systems.

South African Medical Research Council (SAMRC)
The SAMRC will launch a landmark project to sequence 10 000 South African genomes and develop genomics capacity. R60 million has been earmarked for training researchers.

New programmes focus on Indigenous Knowledge, One Health, Artificial Intelligence, and pandemic preparedness.

South African Health Products Regulatory Authority (SAHPRA)
SAHPRA will strengthen medicine registration and digitalise regulatory processes. Projected revenue will grow by 12%, with R149.3 million in new transfers bringing its budget to R468.9 million over the MTEF.

MBOD and CCOD
These continue serving mineworkers. In 2024/25, over 6 200 claims worth R404 million were paid, and 17 700 medical certifications completed.

The Tshiamiso Trust has disbursed over R2 billion to nearly 22 000 silicosis and TB claimants.

Council for Medical Schemes (CMS)
CMS regulates 71 medical schemes serving 9.1 million beneficiaries. It managed an R6.73 billion post-COVID deficit and released findings on Low-Cost Benefit Options.

New regulations aim to reduce excessive co-payments and revise prescribed minimum benefits.

Office of Health Standards Compliance (OHSC)
In 2025/26, the OHSC will inspect 971 public and private facilities. It will enforce the NHI requirement for certification, and support quality improvements.

OHSC will also implement new inspection tools, modernise ICT, and assist EMS and psychiatric services.

Conclusion

Lastly, we continue to work with statutory health professional councils to ensure sound training, registration, and ethical healthcare. These bodies are foundational to a safe, functional health system.

I thank you.