The KwaZulu-Natal legislature supports the health department's plan to increase daily operational ambulances and improve hospital efficiency with eHealth, despite a reduced budget for employee compensation and the recruitment of additional medical personnel.
That came up on Tuesday when health MEC Nomagugu Simelane delivered the department’s R56.2bn budget for the 2025/26 financial year at the provincial legislature in Pietermaritzburg.
Last month the premier said he would advertise 20 posts to address the growing unemployment crisis among healthcare professionals after unemployed doctors staged a sit-in outside the KZN premier’s office for several days.
The protesters gathered to express frustrations over the delay in advertising doctors' posts in the province despite promises earlier this year by the national government to fill new positions.
The department had no cuts on its baseline allocation, which was instead increased by 2.5%, for the first time in 19 years after losing more than R8bn in its baseline budget in the past six years.
Simelane said this deficit had resulted in the department struggling to meet some healthcare demands, including filling critical posts in nursing, medicine, administrative, and allied health professions, as well as hindering some of its infrastructure development, including a backlog of 250 clinics and routine maintenance in other facilities.
With the increased allocation, Simelane said, the department's priority was the long-standing issue of ambulance shortages.
“KZN’s vast and difficult terrain, coupled with budget limitations, has meant that we have only been able to replace ageing ambulances, not expand our fleet as much as we would have liked to. We have been transparent about this reality,” said Simelane.
She said that has put a strain on the Emergency Medical Services’ (EMS) response times when evacuating the sick and injured, as well as transferring patients between facilities.
She said the department is establishing a panel of licensed private EMS providers to complement its existing fleet and reduce response times. The panel will consist of the more than 300 licensed private ambulances that are already operating in the province.
Simelane said they have allocated the R81m EMS budget to fund the procurement of 50 new ambulances and 10 35-seater planned patient transport buses and use part of it for outsourcing EMS services from the private sector.
“This is a temporary measure for six months, while we fine-tune our procurement processes.”
How can a department facing a critical shortage of doctors, nurses, specialists possibly justify cutting its wage bill? The MKP refuse to support a budget that punishes workers for the department’s poor financial planning
— Ntombi Cele, MK Party MPL
The department is further planning to procure a total of 200 vehicles — made up of general fleet, mobile clinics, and EMS response vehicles — this financial year.
It will also introduce a roadside assistance programme to reduce turnaround times for minor repairs and maintenance, which will see the appointment of 12 artisan mechanics and the procurement of 11 vehicles to support district-level maintenance.
With regard to the public concerns over unemployed doctors, Simelane said they hoped to benefit from the national budget increase for health which includes the funding of 800 post-community service doctors.
She said the shortage also extended to other critical categories of healthcare workers — such as nurses, pharmacists, dentists, psychologists and other allied health professionals -which are equally vital to the overall functioning of healthcare system.
The majority of the KZN health portfolio committee accepted the budget but acknowledged that there were some worrying challenges.
Committee chair Imraan Keeka said provincial healthcare was overburdened and was struggling to meet the needs of growing population given its limits on existing resources and the withdrawal of foreign support such as USAID and Pepfar.
“For example, the department shared the need to absorb community health workers to help strengthen primary healthcare but this priority has not been funded precisely and the complicated budget cuts from the foreign donors has also complicated this matter,” said Keeka. “The unfunded mandates including nationally decided wage agreements then created a further challenge for the already overburdened budget.”
The committee expressed concerns over the budget for compensation of employees expenditure for the current financial year, noting that it had been reduced from R37.735bn in 2024/25 to R35.227bn.
“That means it is R458m less than what the department spent last year and this is excessively concerning. The committee believes that the further appointments should be accompanied by fiscal support or commitments from the provincial treasury.”
He highlighted that there were about 900 unfunded critical posts which will need other departments to give up some of their money to fund them.
Keeka noted that the department’s drive to improve efficiency has seen it install eHealth systems in 39 of its 69 hospitals which he said was not enough.
The MK Party criticised the idea of the private sector partnership to procure additional emergency services, questioning if the rural communities would be able to benefit from this.
“Will these ambulances serve the rural areas or will they circulate between urban hospitals in Umhlanga and Pietermaritzburg? The committee's own intervention study shows that EMS is critically underperforming but instead of stabilising the service with public investment, this department is trying to outsource its core responsibility,” said the party's MPL Ntombi Cele.
Cele also questioned the idea behind the reduction of the budget for compensation of employees amid staff shortages.
“How can a department facing a critical shortage of doctors, nurses, specialists possibly justify cutting its wage bill? The MKP refuse to support a budget that punishes workers for the department’s poor financial planning.”
The MK Party and the EFF were the only parties to reject the budget.
TimesLIVE
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