For two decades, South Africa has been waging a war on two fronts: against the twin epidemics of HIV and Tuberculosis. It’s been a gruelling fight, marked by hard-won progress and millions of lives saved. But now, a chorus of the nation’s most respected health advocacy groups is raising a unified alarm: without a radical overhaul of how we fund our health system, that progress could be completely undone.
The warning comes as Parliament’s select committee on appropriations considers a Special Appropriation Billa short-term fix to plug a R754 million hole in the health budget. This gap was ripped open when the Trump administration froze funding from PEPFAR (The US President’s Emergency Plan for Aids Relief), a crucial donor that has been a cornerstone of South Africa’s HIV response.
A Stopgap, Not a Solution
While health groups like the Treatment Action Campaign (TAC), Section27, and the Rural Health Advocacy Project (RHAP) support the emergency funding as a necessary lifeline, they are adamant that it’s a dangerous illusion to see it as a solution.
This Bill, and the larger R2 billion “PEPFAR Bridge Plan,” are merely stopgaps. They are band-aids on a deeply wounded system, masking a fundamental structural crisis in how South Africa finances its public healthcare.
The Financial and Fiscal Commission (FFC), an independent advisory body, welcomed the funds but delivered a sobering fiscal reality check. Redirecting money from the National Revenue Fund, they warned, “adds strain to limited fiscal space and may reduce funding for other social priorities.” They pointed to a damning inefficiency: in the 2023-24 financial year, health programmes across the board underspent by 3%. Pouring more money into a leaky bucket, they cautioned, may not be justified.
“Without a Plan, HIV and TB Goals Will Fail”
The most stark warning came from the Rural Health Advocacy Project. Their submission cut to the heart of the matter: “Without a plan, HIV and TB goals will fail.”
This isn’t just bureaucratic noise. This is a direct prediction from the front lines. It means that the very programmes that provide life-saving antiretroviral therapy to millions and manage TB treatment could begin to crumble. Clinics in rural and vulnerable communities, which rely heavily on this funding, would be the first to feel the impact, potentially reversing decades of painstaking work to build trust and extend care.
The message from civil society is unified and urgent. The temporary bailout is a chance to avert immediate disaster, but it must be used as a catalyst for what we truly need: decisive, transparent, and long-term reform. We cannot keep patching up a broken system. The health of the nation, and the legacy of our fight against HIV and TB, depends on building a new one.
