1. Health 26

2. “ How to increase equal access to health care”
The Minister states clearly the social transformation visionary path for health by raising a fundamental and critical question for budgeting processes
“ How to increase equal access to health care”
This is an appropriate question to ask in making budgetary provisions towards the realisation provisions of Section 27 of our Constitution
The global call for Universal Health Coverage is predicated on this vision, and achieving that vision requires deliberate State intervention in reducing inequalities of access to quality health care services

3. Social protection
In summary of the Medium Term outlook, reference is made of :
Consolidated government expenditure increasing by 7.6% over the MTEF - above inflation adjustments.
With additional allocations for post school education, health services and social protection.
This is apposite given the need to maintain our social protection floor and protect the poor and vulnerable from further hardships associated with the prevailing tough economic climate
The burden of diseases is increasing, and disproportionately so amongst the poor, in a climate of rising health care costs – any such budget increases are likely to cushion the poor from further disability and financial hardships
Addressing post-school education will sure lead to better chances of finding employment – a key social determinant to health
Addressing Non-Communicable Diseases should be kept high in the priority list (sugar tax)

4. Prevalence of age stratified overweight or obesity in 12 countries in sub-Saharan Africa
Lancet 2016: SANHANES-1, 2014

5. Comorbidity
SANHANES-1, 2014

6. Pace of transformation and inclusivity of our growth path
It is quite significant that that the MTBPS takes into account the statutory and regulatory reforms such as National Health Insurance
This is fundamental to addressing;
First the budgetary provisions for such a crucial reform that are sensitive to the fiscal capacity of the state;
Second, inclusive development as the majority of the people get health coverage and social protection
Although “education and health services have been extended, the child support grant introduced, access to electricity, water and sanitation has been extended as well” achieving universal coverage in all these aspects remains a distant target that call for sustainable financing of these social services
It is therefore appropriate for the MTBPS to suggest that growth in social protection services including access to health services and social security promotes inclusivity and indeed social cohesion

7. Social Spending priorities
Increases in NHI conditional grant to continue the contracting of general practitioners, and bring professional capacity into the school health programme is commendable on a number of fronts:
The State alone cannot provide quality health care to all who need it, particularly at primary care level. So, GP contracting will enhance the service delivery platform and more importantly the quality of services
The health system is experiencing serious shortages in human resource at various levels – contracting provides the opportunity to bridge the human resources gap
Improving the school health programme will have immense positive effects on the quality of life trajectories of children especially in rural and disadvantaged communities