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Parliament steps in to shield South Africa’s health system after PEPFAR funding exit
South Africa’s long-standing reliance on foreign donor funding for critical health services has once again been thrust into the spotlight. This week, Parliament approved a Special Appropriation Bill designed to soften the blow left by the withdrawal of funding from the United States President’s Emergency Plan for AIDS Relief, better known as PEPFAR.
For communities that depend on public clinics and hospitals, the decision is more than a technical budget adjustment. It is about whether HIV treatment, TB programmes, and frontline health services can continue without interruption at a time when the system is already under strain.
Godongwana pushes self-reliance and faster NHI rollout
Finance Minister Enoch Godongwana framed the bill as a necessary step towards health system self-sufficiency. Speaking during the debate, he said the funding adjustment underlined the urgency of moving away from dependence on external donors and accelerating universal health access through the National Health Insurance.
Godongwana was candid about the challenges facing NHI. Ongoing court cases challenging the legislation, he warned, could delay implementation for years. While opposing parties in court claim to support universal health coverage, he argued that legal battles risk slowing down a system meant to benefit everyone. His call was simple. Settle the disputes and move forward.
Where the money will go
As part of his medium-term budget framework, Godongwana allocated an additional R750.4 million to the Department of Health. Of this, R590.4 million will be channelled to provinces through the District Health Programme grant to support comprehensive HIV services. A further R130.2 million has been earmarked for the South African Medical Research Council to continue critical health research.
In practical terms, this funding is intended to stabilise programmes that were heavily supported by PEPFAR, especially those linked to HIV, AIDS, and TB prevention and treatment.
A rare moment of cross-party agreement
Despite sharp political differences, the PEPFAR withdrawal triggered an unusually broad consensus in Parliament. Committee chairperson Mmusi Maimane said the central issue was sovereignty. Public healthcare, he argued, must serve ordinary people without turning personal health into a financial burden.
ANC MP Michael Segede described the PEPFAR exit as a deliberate political decision by the United States government under President Donald Trump’s administration. He maintained that the bill was vital not only for fighting HIV, AIDS, and TB, but also for protecting broader socioeconomic growth.
From the opposition benches, MK Party MP Sanele Mwali painted a grim picture of the consequences already being felt. He pointed to clinic closures, job losses among skilled healthcare workers, and reduced access to essential HIV services. While supporting the bill, he also criticised government failures, corruption, and maladministration that have weakened the health system over time.
Warnings against repeating old mistakes
DA MP Kingsley Wakelin said the debate exposed urgent questions about how South Africa sustains vital programmes when donor support disappears. The priority, he stressed, is preventing any slide backwards in life-saving services.
EFF MP Nonhlanhla Mkhonto took a harder line, arguing that decades of budget cuts and below-inflation increases have pushed public healthcare to the edge. Overcrowded clinics and understaffed hospitals, she said, are the result of deliberate underfunding.
IFP chief whip Nhlanhla Hadebe echoed concerns about donor dependence, warning that external funding has quietly subsidised services that should be fully funded through the national fiscus. ActionSA’s Alan Beesley and UDM MP Nqabayomzi Kwankwa both argued that reliance on foreign aid weakens sovereignty and leaves South Africans exposed to decisions made elsewhere.
More than a budget fix
Beyond the health bill, Parliament also passed several taxation and adjustment bills, some amid objections from opposition parties. Godongwana defended the Adjustment Appropriation Bill, saying it allows government to respond to unforeseen costs such as repairing infrastructure damaged by disasters. Without it, he said, vital repairs simply would not happen.
For now, the health funding bill heads to the National Council of Provinces for concurrence. But the broader debate is far from over. On social media and in policy circles, South Africans are asking the same question. Can the country finally break its dependence on donor funding and build a resilient public health system that stands on its own?
The approval of the bill does not solve every problem. What it does do is buy time and signal a shift in thinking. In a country where millions rely on public healthcare every day, that shift could prove decisive.
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Source: IOL
Featured Image: SABC News
