Healthcare is an issue that at some point touches everyone in South Africa. It is also an issue that will impact who people vote for on the 29th of May. To help voters understand just what parties are putting on the table when it comes to healthcare, Spotlight pin-pointed seven critical healthcare questions and put them to 10 political parties.

The seven questions we put to political parties were carefully formulated by the Spotlight editors and are based on years of reporting on healthcare in South Africa. The ten parties we approached are the seven largest parties (measured by representation in the current parliament) plus three that we selected at our discretion.

For the five parties that provided responses we present their answers as received, edited only for spelling and grammatical errors and to add clarification in brackets. For the five parties that did not respond to our questions after several requests, we studied their manifestos and other public statements and did our best to give readers as clear a picture as possible as to what the party's response is likely to be based on available public information.

Click or tap on a political party's name to see that party's answer to the related question. You can click or tap on it again to collapse the answer.

Question 1: If there is a motion in the new parliament to scrap the National Health Insurance (NHI) Bill, or if legislation is introduced that would have the effect of scrapping the bill, would your party support it? Please provide reasoning for your party's position in three or four sentences.

ActionSA

Yes, our party supports the scrapping of the National Health Insurance (NHI).

The NHI as proposed does not address any of the major problems in our health system, such as corruption, incompetence, maladministration, dilapidated infrastructure, and most importantly the inadequate number of well-trained healthcare professionals. It is going to become a third tier to the South African health system which is made up of public and private healthcare.

ActionSA ultimately opposes the implementation of the NHI Bill in its current form because the NHI is not aligned with the realities of South Africa's public healthcare system, and its implementation may destabilise the provision of healthcare across the country.

African Christian Democratic Party (ACDP)

Yes, we would support scrapping the NHI Bill. The NHI does not deal with the fundamental challenges in the public or private health sector.

In the public sector there are critical challenges such as poor infrastructure, systemic neglect, and poor governance. These will be exacerbated should the fundamentals or basics for a functional health system not be in place when the NHI becomes a reality.

The main issue is that the current Bill does not address the root causes or social determinants of inequality - the commercialisation of a fundamental human right is unethical and issues of pricing in private sector as an example must be addressed.

A national dialogue involving all sectors, and especially community-based organisations, are critical for the transformation of the health sector.

The NHI would turn the country even more into a free clinic for all, due to our poor immigration control. The influx of illegal immigration for health services places an undue burden on an overwhelmed system catering for over 70% of the population. This is the current reality in our country.

The most important component of change management, and especially the complete overhaul of a system is, trust in leadership, and any new administration must build trust through effective governance to introduce radical change, for without trust in leadership, there will be a massive exodus of skilled health professionals leaving the country.

Democratic Alliance (DA)

The DA stands for universal access to healthcare for all citizens. We believe the key to this, over the next five years, is not big policy developments but making the current district management model work.

The DA does not believe that a single-payer, single-purchaser model of the NHI will ensure Universal Health Coverage because it does not address the significant failures of the health sector (such as governance failures in the public sector). We do not support the NHI.

RISE Mzansi

Yes. RISE Mzansi supports Universal Health Coverage (UHC). We support the development of a public health system, which offers high-quality healthcare to all citizens.

We do not support the current National Health Insurance bill (approved by parliament and awaiting the president's signature to become law), because its funding model, the structure of the fund and implementation plan is flawed.

We note it has been heavily criticised by a wide range of expert health organisations.

To achieve UHC, South Africa needs the eventual convergence of the public healthcare sector (high patient volume, under-funded and sometimes bad outcomes) with the private healthcare sector (large resources for a small part of the population, at a high cost, and sometimes poor care).

This will require a partnership between the public and private health sectors, and initially focus on doing the basics correctly: better health promotion and disease prevention, maternal and early childhood health and then providing basic primary healthcare.

United Democratic Movement (UDM)

The UDM does not categorically dismiss the idea of the National Health Insurance (NHI), but we can understand why President Cyril Ramaphosa was [allegedly] reluctant to sign the bill into law before the 2024 elections, saying he was "looking for a pen" to do so.

South Africa has three major threats to the NHI and that is our crumbling health infrastructure, equipment and drugs shortages and the human resource dilemma, exacerbated by the brain drain.

The African National Congress raised expectations with the NHI and now they appear to be unable to deliver the goods. The UDM advocates for more robust interrogation of South Africa's budget capacity to absorb the NHI, our capacity to handle the total onslaught the already taxed healthcare system would have to endure upon implementation and wider consultation with private partners.

Parties who did not respond (write-ups by Spotlight based on public documents):

African National Congress (ANC)

The ANC did not respond to Spotlight's questions, however its manifesto states that if re-elected, it would "implement the National Health Insurance to reduce the cost of medical care, especially for the poor".

Alongside this, the party states that it would strengthen health infrastructure, train healthcare personnel and create a single electronic health record - all of which are considered necessary for a functional NHI scheme.

A single electronic health record would capture patients' personal and medical information from across health providers to monitor health coverage, patient outcomes and the performance of healthcare providers.

The manifesto does not state what the ANC would do differently in order to strengthen health infrastructure or train health workers.

Economic Freedom Fighters (EFF)

The EFF did not respond to Spotlight's questions and its manifesto doesn't directly address the NHI bill, however a statement released by the party in June 2023 called the bill's passing a "catastrophic development".

In an interview on the Sunday Times Podcast, EFF president Julius Malema said that his "biggest concern" was that the bill requires people to go to the health facilities that are nearest to them. The EFF's July statement argues that this requirement means "that people living in rural areas, townships and informal settlements will still be subjected to the diabolic state of public hospitals and clinics, whilst the affluent and those in cosmopolitan areas will have the utmost benefit due to their proximity to private institutions".

Freedom Front Plus (FF Plus)

The FF+ did not respond to Spotlight's questions, however the party's manifesto states that the NHI scheme would "not succeed in improving the quality of public healthcare" and would instead "put even more pressure on the dilapidated healthcare infrastructure".

It argues that the scheme wouldn't be viable as the government "does not have the funds to implement it" and also states that the NHI bill is "unconstitutional", citing in particular the Certificate of Need (CoN), which requires a person to acquire a certificate from the health department to develop or modify a health establishment.

The manifesto did not describe why the CoN, which is designated under the 2003 National Health Act, is relevant to the NHI bill. (Editor's note: the notion that the CoN is necessary for the NHI to work has been widely reported though a legal expert that Spotlight consulted argued that this was not the case, and the bill itself makes no reference to the CoN).

Inkatha Freedom Party (IFP)

The IFP did not respond to Spotlight's questions, however its manifesto states: "An IFP government will... lead a process to review the National Health Insurance (NHI) to address its funding model while clearly defining the role of public and private health service providers and that of medical aid schemes."

It does not elaborate, and the IFP appears to have released contradictory statements about the scheme. In December 2023, News24 quoted the IFP president, Velenkosini Hlabisa, as saying that the "NHI Bill is a recipe for disaster for our health sector in South Africa".

Additionally, after the NHI bill was passed in the national assembly in June 2023, IFP representatives told reporters that the party had serious concerns about the potential for NHI funds to be mismanaged by the government.

However, in a Portfolio Committee on Health meeting a month earlier (in May 2023), the IFP representative, Magdalena Hlengwa, stated that "the IFP supports the [NHI] bill because there are many people... who are suffering [and] have no money... therefore the NHI will assist them to get their medication and everything that is necessary for them".

uMkhonto weSizwe (MK)

The MK party did not respond to Spotlight's questions, however its manifesto states it will "implement the National Health Insurance scheme as an instrument to redistribute resources in the healthcare system away from the expensive private healthcare system".

The MK's leader, former President of South Africa and leader of the ANC Jacob Zuma, announced during his first State of the Nation Address in 2009 that the NHI would be implemented (though the ANC had been promoting the idea before then). He was subsequently criticised by proponents of the NHI, including ANC members and trade union leaders, for failing to introduce the scheme while he was President.

Question 2: According to South Africa's Human Resources for Health Strategy 2030, the country is facing worsening shortages of several categories of healthcare workers. Please explain in three or four sentences what your party will do in the next five years to address shortages of healthcare workers in South Africa.

ActionSA

ActionSA plans to reopen nursing colleges to increase the number of nurses working in our public health system.

We will reduce administrative expenditure to 10% or less, to ultimately increase expenditure on frontline healthcare workers. We will ensure that 75% of all compensation goes towards doctors, nurses, and other frontline healthcare workers.

We will prioritise the improvement of working conditions in South Africa's public health facilities to retain talented professionals in the system.

We will reduce burnout among healthcare professionals by reviewing the working conditions in public health facilities to identify systematic issues that need to be addressed.

In addition, we will increase security measures for clinics, hospitals, and ambulances to protect healthcare professionals and patients from criminality.

ACDP

Repeal the unsuccessful BEE policies across all sectors of the economy in order to attract top talent to rebuild the health sector, especially in critical technical health executive and senior roles.

Community and health worker investment focus - community workers are worth their weight in gold because they understand the context in communities and provide critical support to upscale health services.

"Leave it to the professionals in healthcare and not the politicians" - ensure the practice of good governance and efficient systems, with no political appointments or cadre deployment but rather a focus on the basics: competence and capacity to build an environment that attracts and retain top talent, and drives excellence.

The health sector is a highly specialised environment and greater investment in attracting the best technical skills - invest in health sector staffing in critical skills such as innovation, technology, and general management skills.

Improve security in hospitals and emergency services with investment and partnering with the private sector and communities.

Focus on training, and the revitalisation of nursing colleges.

DA

The DA plans to overcome the challenge of health workforce shortages by:

Eliminating regulatory obstacles that prevent private institutions from participating in the training of doctors and nurses (introducing a certificate of non-placement; details can be found in our manifesto).

Incorporating the foreign health workforce in South Africa's health system.

- Ensuring that medical professionals are included in Home Affairs' "scarce skills" list.

- Attracting doctors to South Africa: This can be done by offering 2-4 year working visas for medical professionals. These visas need to be expedited so that visa delays do not deter medical professionals from choosing to migrate to South Africa.

Developing an integrated data source to enable HRH (human resources for health) planning. This will be done by establishing a technical workforce planning unit which will encompass the appropriate capabilities. This unit would establish real-time tracking of all key health professionals in South Africa, whether working in the public or private sectors. This will be done by developing an integrated, publicly available, regularly updated HR system. The system would be an integrated HRH data source that would be accessed by all relevant stakeholders in HRH. This would allow for policy makers and entities to better understand the workforce shortages and would guide improved development of supply plans for HRH.

RISE Mzansi

The public health system must be rapidly reformed to improve its governance, financial sustainability and infrastructure.

The healthcare workers are at the centre of the health system but their working conditions are very difficult and they leave for the private sector (or leave South Africa entirely).

The healthcare budget must be scrutinised to remove wasteful spending and eliminate corruption, and the savings be directed to hiring newly qualified doctors and nurses and investing in healthcare facilities to improve their working conditions.

Implement and budget for the Human Resources for Health 2030 plan that has been developed by public health experts.

UDM

The primary focus should be on investing in the education and training of new healthcare workers, which should extend beyond universities to include nursing colleges and vocational training programmes.

Alongside this, the United Democratic Movement believes that it is crucial to implement strategies aimed at retaining talent within the country and preventing burnout among existing healthcare professionals. This includes timely filling of vacancies with local talent.

Additionally, training and deploying community health workers to deliver basic healthcare services and health education in local communities can help address healthcare gaps effectively.

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC's manifesto does not explicitly address staff shortages in the healthcare sector, though it does state that it would "move decisively toward... training [health] personnel".

Dr Joe Phaahla, the current minister of health and an ANC National Executive Committee member, indicated earlier this year that budgetary constraints remain an obstacle to employing more workers in the public sector but that the health department has had several engagements with National Treasury to "find creative ways to shield the healthcare service and the frontline workforce". He didn't specify what these methods were.

EFF

The EFF's manifesto states that the party would "increase the number of nurses and doctors in South Africa's health care system" through "[e]stablishing at least one health care training facility per province and ensuring that there is no province without a health sciences campus, inclusive of nursing school and medical school".

It goes on to say under the EFF, the government would "ensure for both undergraduate and postgraduate students a clear and efficient pathway to qualifications recognition, professional registration, licensing, and employment for those trained outside of South Africa". It does not detail how it would restructure the existing pathway for students, or how it would be made more efficient.

FF Plus

The FF+ manifesto states that "the biggest challenge in public healthcare is not a lack of money but a lack of expertise and sound management".

It states that "the obsession with transformation means that even more expertise is forced out of the sector - so much so that thousands of South Africa's healthcare practitioners are working abroad".

The manifesto does not state how it plans to address this, though a separate section states that public service appointments should be "solely based on merit".

IFP

The IFP manifesto states that the IFP will "address the shortage of healthcare professionals, including doctors, nurses and support staff... by employing unemployed trained healthcare providers".

This proposal differs from many other party manifestos in that it places the emphasis on employing existing health workers as opposed to expanding training. It does not elaborate on how much increasing employment would cost or how this would be funded.

More broadly, the manifesto states that it would "fund its programs" through several measures which include "[cutting] Government Ministries and their lavish spending".

MK

The MK's manifesto does not address healthcare worker shortages directly, though it does state that the party will "[e]xpand the capacity and intake of medical schools and ensure that all universities have medical schools". The manifesto doesn't elaborate on how the new graduates would be absorbed into the public healthcare system, where posts often go unfilled due to budgetary constraints.

The party also states that it would advocate for expanded access to traditional healers. For instance, it states it would ensure "that people have a choice to access alternative and traditional African healthcare and healing in public/private facilities".

Question 3: Most of South Africa's provincial health departments are facing severe budget constraints. Will your party advocate for increasing health budgets in the new parliament and provincial legislatures? Please explain your party's position in this regard in three or four sentences.

ActionSA

We will start by reducing the administrative budget to 10% and redirecting funds towards frontline healthcare services.

In select cases, we have seen that budgetary constraints are not the reason for the poor performance of health departments - rather poor management of financial resources and corruption must be addressed. We advocate for efficiency and appropriate human resources. Responsible financial management of departmental budgets is needed to ensure that public health facilities are adequately maintained, resourced, and staffed with frontline healthcare workers.

On the other hand, ActionSA would reduce government expenditure on non-essential services and reprioritise expenditure on basic service delivery, including healthcare.

ACDP

Austerity in health and social services is short sighted. Health investment is always amplified over time. The ACDP would strongly support an increase in health budgets for the sake of our health professionals and population!

The health sector is a highly specialised environment that requires investment in attracting the best talent to our country to create an environment of innovation and technical expertise and best treatment for the sick and ailing. Our investment should be to retain and attract the best, capacitate community primary healthcare for prevention and effective disease management.

Investment in community healthcare workers to scale up the value add in human resource spending.

Invest more in disease prevention and healthcare promotion: education, awareness and agency.

Prioritisation of health reform focused on prevention and capacitation of community-based programmes.

DA

The DA's alternative to NHI will enhance quality healthcare in both the public and private sectors while remaining fiscally neutral. Implementing the DA's policy recommendations, as found in the DA manifesto, can enhance quality healthcare within the current budgetary framework.

Key to this is ensuring fit-for-purpose individuals in key positions, removing politicians from getting involved in health administration, reducing fiscal leakages (such as fruitless and wasteful expenditure) and ensuring enhanced accountability mechanisms. Our manifesto provides further details and additional recommendations.

RISE Mzansi

We will end austerity funding for the health system immediately. It is vital to remove wastage and corruption in public healthcare procurement as this would save the fiscus billions of rands annually.

Health budgets need to be focused to the greatest need and where the greatest long-term health gains are: maternal and early childhood healthcare.

Also, we recognise the need for much more effective health promotion to prevent disease, including through stringent regulation of alcohol, tobacco and food stuff that cause ill health. This could significantly reduce the burden of non-communicable diseases on the health system and its cost.

Lastly, RISE Mzansi will use its public positions to advocate for the protection of healthcare spending, including budget increases to ensure that South Africans receive the best possible healthcare, within the public healthcare systems constraints.

UDM

The UDM firmly believes in advocating for increased health budgets in both the new parliament and provincial legislatures.

Adequate funding is essential to address the pressing healthcare needs of our population, including improving healthcare infrastructure, ensuring sufficient staffing levels, and providing essential medical supplies and equipment.

By prioritising increased health budgets, we can work towards achieving better health outcomes for all South Africans and mitigating the challenges faced by provincial health departments

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC's manifesto does not directly address this question. Under the current ANC-led government, the country's total health budget for 2023/2024 stood at R267 billion, and is projected to increase to R295 billion by the 2026/2027 financial year.

This means that on average the health budget will increase by 3.5% a year for the next three years. This is below projected inflation (which is 4.7%), meaning that in real terms, the health budget will shrink.

EFF

The EFF's manifesto states that it "will ensure adequate, equitable domestic funding for health and will proactively ensure sustainability and will not allow austerity or deficits to impact the health system efficiency". No further elaboration is given for what constitutes adequate spending or how this will be achieved.

The section on the party's fiscal framework gives an indication of how the party plans to raise revenue for government spending more broadly. It states that it would ensure "a 100% increase in current annual tax collections" through measures like "aggressively tackling tax avoidance", "expanding the tax base to include e-commerce", "a wealth tax on the ultra rich", and "maximizing the collection of VAT from small-scale traders who are not registered but are responsible for the distribution of goods and services to large section of society"

FF Plus

The FF+ manifesto does not directly address the health budget, however more broadly, the party states that it would "limit state expenditure" and that governance would be defined by a "small, effective government".

Concomitantly, it states that "personal and company tax need to be lowered" and that the government "should not be allowed to spend more than it collects through taxes".

The manifesto asserts that "state hospitals and clinics should be run by private service providers". It does not detail how such providers should be regulated.

IFP

The IFP manifesto does not address whether it would increase the health budget, though does list poor funding as one of the reasons for the "collapse and dysfunction of many [health] facilities".

More broadly, the manifesto states that it will "restructure" fiscal spending and that it will spend government money "more wisely", rather than explicitly stating that it will expand the budget.

In a 2022 statement about the finance budget, the IFP stated that "it is time to tighten things and get a grip on our country's finances" and that "we cannot fall prey to countries and banks that are willing to assist us, while exploiting our current debt-ridden economy".

MK

The MK's manifesto states that it will "ensure that appropriate budgets are available for all healthcare facilities to operate for 24 hours, 7 days a week, and are adequately resourced with ambulances". It does not provide further details on what this would cost or where the money would be sourced from. The party also states that it would "end austerity and neoliberalism".

Ultimately, the party seems to hold that increased government spending would be fueled in part by increased government ownership of the country's assets. For instance, the MK advocates nationalising the South African Reserve Bank (SARB), "major banks", "strategic mines" as well ArcelorMittal (the country's major steel producer) and SASOL (which makes chemicals).

Question 4: Reports of the Auditor General, the Zondo Commission, and the Special Investigating Unit have shown corruption to be rife in the public service, and particularly in the health sector. In three or four sentences, explain what concrete steps your party will advocate for to reduce health sector corruption under the next administration.

ActionSA

We will advocate for banning cadre deployment to ensure that all appointments to the civil service are based on merit rather than loyalty to a political party.

We would establish an independent selection panel, free from political interference, to oversee the interview processes for all senior positions in the health sector.

We plan to provide training to ethical state officials, financial managers, and decision-makers on how to detect corruption in the health departments.

We would reform preferential procurement regulations to reduce corruption and procurement inefficiencies by focusing solely on efficient service delivery criteria.

We want to improve the financial management of public healthcare institutions through the implementation of financial control protocols that enable the effective utilisation of resources.

ActionSA will advocate for the implementation of surveillance and monitoring systems to proactively identify corruption, bribery, and illegal transactions in the health sector.

ACDP

Implement strategic procurement in the Department of Health with oversight by a mainly private sector committee.

Implement the health market enquiry report from the Competition Commission.

End to "non-disclose agreements" in procurement, and improved parliamentary oversight on the department and health's entities, to head on confront "political protectionism", and truly standing for "without fear or favour" (an often-abused political phrase).

Improvement in payment systems - anyone responsible for decision making or with spending power in public health should be made to use the public sector for health in the area that they manage, and without preferential treatment.

DA

The DA will address corruption and enhance accountability by:

Separating politicians from administrations, regulators, and all public entities responsible for the delivery of healthcare services. This measure will prevent harmful conflicts of interest in the appointment of personnel and procurement processes from getting in the way of good governance and service delivery.

Establishing an investigative structure to address fruitless, wasteful and irregular expenditure. Given the lack of financial controls in place, irregular expenditure amounted to R4.5 billion, and fruitless and wasteful expenditure across all entities amounted to R3.3 billion.

Establishing an Independent Watchdog for Health Entities (also known as supervisory structures). The independent watchdog will supervise all regulators, all key hospitals, key health services and health districts. They will have the powers to supervise procurement processes, oversee human resource matters, and appoint and remove the relevant chief executives.

The relevant chief executive or equivalent of health entities will report to the watchdog. They will be responsible for all aspects of their organisation, including finance, procurement, human resources, equipment, all administrative functions, and all capital expenditures.

Establishing an independent National Health Appointments Authority (NHAA) to guarantee the autonomy of the watchdog (supervisory structures). The NHAA will handle supervisory structure members' nomination, appointment, and removal processes, moving these responsibilities away from the executive.

RISE Mzansi

Public health procurement must be competitive and transparent. Public healthcare leadership must be competent and ethical, and be held to account by the Office of the Auditor General and other institutions.

The existing protection mechanisms - the register for tender defaulters and National Treasury's database of restricted suppliers - must be rigorously monitored and adhered to.

Provincial-level procurement tenders should be centralised on a single national portal. This will allow for effective oversight on what national and provincial health departments spend on procurement, and if it is being spent in line with the department's mandate, in accordance with the principles of fairness, equitability, competitiveness and cost-effectiveness.

RISE Mzansi advocates for publicly reporting on expenditure above R50 000, on a monthly basis, in all provinces.

UDM

The UDM is committed to holding those found guilty of corruption accountable, ensuring that there are significant consequences for their actions, unlike the leniency often observed with the ruling party.

To combat corruption in the health sector, our party will champion the establishment of robust oversight mechanisms, conducting regular audits and investigations through independent bodies.

We will advocate for stringent anti-corruption measures, promoting transparent procurement processes and enforcing strict adherence to ethical codes of conduct among healthcare professionals.

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC manifesto states that it will "strengthen financial management and supply chain management in public health institutions".

More broadly, it states that the party "has taken decisive measures to prevent corruption within its ranks. We have required ANC members charged in a court of law to step-aside [sic] from organisational and state responsibilities until the case is finalised".

It also states that "action is being taken against alleged perpetrators of state capture and funds are being recovered".

EFF

The health chapter of the EFF's manifesto doesn't refer to political corruption in the healthcare sector specifically though it does state that it would "decentralise procurement for health services and goods" to individual facilities.

It also includes a reference to theft by nurses: "The EFF government will implement strict measures, including punitive actions, against nurses who breach patient confidentiality or engage in the theft of medications, upholding the highest standards of professional conduct and trust in healthcare settings."

On the issue of corruption more broadly, the manifesto states: "All EFF public representatives found to be involved in corruption and secret relations with other political parties and businesses will be immediately suspended and face disciplinary measures." The manifesto also states that it would make the National Prosecutions Authority (NPA) "accountable to Parliament in order to stop selective prosecutions and fight corruption".

FF Plus

The FF+ manifesto states that "mismanagement and corruption have destroyed our public healthcare institutions".

More broadly, it states: "Corruption should be actively eradicated through the political will to prosecute individuals who are, or have been, involved in corrupt practices. This should apply to high-ranking politicians as well, and not be limited to officials - as is currently the case.

IFP

The IFP manifesto states: "Essential equipment and medical supplies never reach those who need them, due to corruption, tender fraud and operational mismanagement."

The manifesto states that the IFP will "[c]lamp down on corruption within the healthcare system while rooting out fruitless, wasteful and irregular expenditure".

More broadly, it states that the party will "strictly implement and enforce a zero-tolerance policy towards corruption, including the prompt dismissal and prosecution of corrupt officials irrespective of rank or political affiliation".

It also states that the party would "ensure a strong, capable, capacitated and funded National Prosecuting Authority".

MK

The MK manifesto doesn't address corruption in the healthcare sector specifically, however it states that on policing it would "[strengthen] the fight against corruption by increasing the funding and capacity of the investigative directorate".

This may be a reference to the National Prosecuting Authority's Investigating Directorate. At a press conference, Zuma reportedly stated that the MK would not tolerate corrupt behaviour.

Question 5: While tuberculosis (TB) and HIV rates in South Africa are coming down, this is happening slowly, and these rates remain extremely high compared to most other countries. Please explain in three or four sentences what concrete interventions your party will advocate for in relation to TB and HIV after the elections.

ActionSA

To address HIV/AIDS in South Africa, ActionSA will advocate for:

Expanding access to anti-retroviral therapy and reducing the rate of new transmissions by increasing access to pre-exposure prophylaxis and encouraging regular testing. Additionally, we will advocate for the implementation of programmes aimed at preventing mother-to-child transmissions and increasing sexual health education. We would enhance educational programmes aimed at improving people's understanding of HIV/AIDS and destigmatising the disease.

To address TB, ActionSA will advocate for:

Expanding early diagnosis efforts with mass screening programmes in high-risk areas. We would implement public awareness and education programmes to empower the public to understand the symptoms and prevention of TB. We will also advocate for the wide roll-out of BCG [Bacillus Calmette-Guérin] vaccinations at birth and partner in international research programmes for improved vaccines.

ACDP

Build a comprehensive community social care system and community oriented primary care system. Partnership between communities and healthcare services to address from birth to death, health and wellness.

Health reform focused on prevention and capacitation of community-based programmes.

TB is a solvable problem in South Africa in one generation. It requires a multi-pronged approach, involving improved linkages to care through a community-based, community health worker or community oriented primary care programme.

Pushing back on pricing of TB and HIV pricing - continuing investment in preventive strategies TB and HIV.

Develop a strong network of healthcare at a community level, linking NGO's and primary care with home-based care and awareness programmes at grass roots level.

DA

We will address the persistent issues of stigma and discrimination that hinder progress in HIV prevention and treatment. Access to healthcare services, particularly in rural areas, remains a concern, and the government must do more to ensure that all citizens, regardless of their location or socio-economic status, can access quality healthcare.

The DA will enhance access to crucial medication by establishing a single prescription registry that will allow patients to collect repeat prescriptions at any pharmacy nationally. A single pharmacy registry will allow the patient to go to any pharmacy should their original pharmacy of choice be out of stock. This prevents issues arising when patients cannot access their medications due to shortages or stockouts at facilities.

Furthermore, we will ensure greater transparency in the allocation of resources dedicated to HIV/AIDS programmes and a comprehensive review of current policies to identify gaps and inefficiencies, ensuring that every rand is utilised effectively to combat this epidemic. The under-expenditure of R62 million during 2022/23 on the National Department's HIV, AIDS and STIs programme is very problematic given the persistence of the epidemic and the strides that still need to be made towards achieving the UNAIDS 95-95-95 strategy. [Editor's note: These targets are also part of South Africa's National Strategic Plan for HIV, TB, and STIs 2023-2028. This means that 95% of people living with HIV should know their status, 95% of those who know their status should be on treatment, and 95% of those on ARVs should be virally suppressed.]

RISE Mzansi

Two million people still need to be on ARVs. There is a need for a targeted, monitored campaign to access hard to reach and vulnerable groups as well as to reinvigorate the promotion of HIV testing, treatment, and adherence.

HIV prevention needs to be fully resourced again, especially targeting young people for male and female condom use and other barrier methods. This needs to be linked with greatly improved access to sexual and reproductive healthcare services.

We recognise that TB treatment and detection can be dramatically improved, with better social mobilisation, monitoring and ensuring state of the art diagnostic and treatment regimens.

UDM

The UDM will prioritise concrete interventions to accelerate the decline of TB and HIV rates in South Africa.

We will advocate for increased funding and resources for comprehensive prevention, testing, and treatment programmes, focusing on vulnerable populations and underserved communities.

Additionally, we will push for expanded access to essential medications, robust public health campaigns to raise awareness and reduce stigma and strengthened healthcare infrastructure to ensure effective delivery of services at all levels of care.

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC's manifesto does not address TB, though it does mention HIV.

It states that over the next five years, the ANC will work "with young people, their organisations and institutions, with families and sectoral formations" to tackle a range of issues including HIV.

It does not specify what organisations and institutions the party would work with or what the specific strategies will be.

EFF

Generally speaking, the EFF's manifesto focuses on expanding primary health services as a means of increasing health coverage.

The EFF's manifesto also states that it would increase funding for research on a range of diseases, which include HIV and TB.

FF Plus

The FF+ manifesto does not address TB, HIV or any other communicable disease. In parliamentary engagements, FF+ representatives have frequently focused on the fact that poorer communities are more vulnerable to TB and have pushed for primary prevention measures.

In 2022, the FF+ released a statement laying the blame for high rates of HIV on the ANC (for instance highlighting ex-president Thabo Mbeki's baseless position that HIV did not cause AIDS). The statement does not address what the FF+ would do to reduce HIV transmission or how it would change current government policy.

IFP

The IFP manifesto does not state what policies it would introduce to address TB, HIV or any other communicable disease in the country. It does however state that in 2002, the provincial government of Kwazulu-Natal, which was then led by the IFP, distributed ARVs to clinics in spite of national ANC policy at the time (some of these details are discussed in a British Medical Journal article from the period).

The IFP states that this "demonstrated the power of provincial autonomy", which the IFP argues is essential to "run health institutions effectively".

MK

The MK's manifesto doesn't state how it will address TB or HIV. It does state that the MK would "make it mandatory that every citizen undergo a health screening once a year". It does not elaborate on what citizens would be screened for.

Question 6: In Spotlight's reporting, we've often encountered the allegation that politicians exert undue influence over the day-to-day affairs of provincial health departments and that the lines are often blurred between the roles of MECs and heads of departments. Please unpack in three or four sentences what steps, if any, your party would advocate for under the new parliament to prevent undue political interference in the day-to-day affairs of provincial health departments.

ActionSA

We will advocate for banning cadre deployment to ensure that all appointments to the civil service are based on merit rather than loyalty to a political party.

We would establish an independent selection panel, free from political interference, to oversee the interview processes for all senior positions in the health sector.

We will establish a culture of leadership excellence and service with pride in the public service by adopting high standards based on the values of education, professionalism, and ethical leadership.

We will additionally implement an oath of office for senior managers that commits them to serve residents and not political parties.

ACDP

Limit political overreach - reduce the powers of the [Health] Minister at all levels. Ministers to be responsive and consult with their health departments at all levels. [Editor's note: Provincial MECs for Health are sometimes referred to as Ministers. In addition to the National Department of Health, South Africa also has nine provincial departments of health.]

Focus on effective, meaningful community engagement as a critical part of oversight by both the political and departmental heads.

Delegate decision making and authority to health officials and communities that are closer to the issues affecting healthcare.

DA

[Editor's note: Here the DA responded "Please refer to the answer provided under point 4." Accordingly, we reproduce that answer here.]

The DA will address corruption and enhance accountability by:

Separating politicians from administrations, regulators, and all public entities responsible for the delivery of healthcare services. This measure will prevent harmful conflicts of interest in the appointment of personnel and procurement processes from getting in the way of good governance and service delivery.

Establishing an investigative structure to address fruitless, wasteful and irregular expenditure. Given the lack of financial controls in place, irregular expenditure amounted to R4.5 billion, and fruitless and wasteful expenditure across all entities amounted to R3.3 billion.

Establishing an Independent Watchdog for Health Entities (also known as supervisory structures). The independent watchdog will supervise all regulators, all key hospitals, key health services and health districts. They will have the powers to supervise procurement processes, oversee human resource matters, and appoint and remove the relevant chief executives.

The relevant chief executive or equivalent of health entities will report to the watchdog. They will be responsible for all aspects of their organisation, including finance, procurement, human resources, equipment, all administrative functions, and all capital expenditures.

Establishing an independent National Health Appointments Authority (NHAA) to guarantee the autonomy of the watchdog (supervisory structures). The NHAA will handle supervisory structure members' nomination, appointment, and removal processes, moving these responsibilities away from the executive.

RISE Mzansi

RISE Mzansi believes that budgeting and management powers should be vested with the heads of large provincial hospitals. On-site managers are best placed to know what the hospital requires.

At a national and provincial level, leaders must be appointed on the basis of their experience and competence, not their political party affiliation.

UDM

The UDM remains committed to combating undue political influence on accounting officers at both provincial and national levels.

We advocate for the separation of powers in this regard and will swiftly investigate any accusations of impropriety involving UDM MECs or ministers.

Our party believes that the Public Service Commission should appoint directors-general and heads of departments to ensure continuity in administration and retain institutional knowledge, preventing wholesale staff changes with each new ministerial appointment.

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC's manifesto does not address this specific question. It does state that it "will ensure that its public representatives and deployees are held accountable for the basic services to communities that form part of their responsibilities".

It states that it "will track implementation through the ANC Local Government Monitor and act against public representatives who are not performing, which may include their recall."

It also states that critical vacancies will be filled by "qualified people". The ANC has in recent years pushed, and cabinet has adopted, the Framework Toward the Professionalisation of the Public Sector, but to what extent the party remains committed to the ideals of this framework is not clear from its manifesto.

EFF

The EFF manifesto doesn't directly address this question with regards to the healthcare sector, though more broadly it plans to change the constitution to ensure the "abolition of the provincial sphere of government". This would be "accompanied by a mass restructuring, and strengthening of local government spheres".

It also states: "No EFF public representative or their immediate relative will conduct business with the national and provincial governments that they serve in due to their direct or indirect influence."

FF Plus

The FF+ manifesto does not directly address this question though it does state: "Sound management practices should be implemented at all hospitals and clinics.

Only people with managerial experience should be appointed as chief executive officers at hospitals." More broadly, the party states that it would abolish cadre deployment and Black Economic Empowerment policies so that hiring decisions are based on merit.

IFP

The IFP manifesto does not address this issue directly however it states: "An IFP government will... ensure the devolution of powers to provinces and municipalities to run health institutions effectively. Responsibility for ensuring delivery should be devolved to the lowest appropriate and competent level of government.

More decision-making powers will be devolved from provincial departments to district managers and health facility managers." It does not explain what specific powers would be devolved to district and health facility managers or how national health programmes would be coordinated under this system.

MK

The MK's manifesto does not address this question. Provincial governance would however likely change under the party, which advocates for reducing the number of provinces from nine to four.

More broadly, the manifesto imagines that governance would be transformed so that decision making would rest with an upper parliament made of "indigenous kings and queens as well as other traditional leaders", and a lower parliament made of elected representatives. It also states that a referendum would be held to decide on scrapping the Constitution.

Question 7: Rates of non-communicable diseases (NCDs) such as diabetes and hypertension are rising in South Africa. Please describe in three or four sentences what your party believes government should do to address NCDs? As part of your answer, please indicate whether your party supports NCD interventions aimed at the private sector, such as the "sugar tax".

ActionSA

We believe that the government should establish healthy environments to reduce NCDs. Public access to recreational facilities should be expanded to promote exercise. In addition, high water and air quality should be maintained to minimise the effects of environmental pollution on public health.

Community-based programmes that focus on the screening, prevention, and early detection of diseases should be implemented.

The expansion of health-related content in the education curriculum should be prioritised to ensure that children are taught about NCDs, healthy lifestyle choices, and nutrition.

We advocate for the implementation of data-driven regulatory controls that responsibly limit the production, sale, and consumption of harmful substances.

ACDP

Yes, for an increase in price but equally, a loud yes for a reduction in price of nutritious food, with incentives for wholesome and environmentally sustainable food production.

Build a comprehensive community social care system and community oriented primary care system. Partnership between communities and health care services to address from birth to death health and wellness.

Support price reduction on essential nutrient rich goods, and support of small-scale community farming in both urban and rural areas.

Prioritisation of health reform focused on prevention and capacitation of community-based programmes.

DA

To effectively tackle the challenges faced by our health sector, collective action is required, which cuts across a variety of sectors and requires effective policies to meet the basic needs of the population. These encompass areas such as housing, education, employment, and social security.

The DA has developed a range of policies, offering credible policy recommendations to improve the conditions within these sectors and ultimately improve people's lives. When areas such as education fail or when individuals grow up in high-risk communities, it can result in poor life choices such as substance abuse or poor diets.

Addressing these challenges requires a whole-of-society approach. Nonetheless, below, we propose policy recommendations to address NCDs specifically within the health sector.

The DA will address NCD's by:

Ensuring laws related to addressing behavioural risk factors are enforced.

Scaling up Community Health Services for Non-Communicable Diseases through Community Health Workers.

Ensure strong referral pathways between health facilities and other social services.

The DA does not support the sugar tax as there is little evidence that the tax has improved health outcomes. To date, the Health Committee has failed to produce a report that demonstrates how the tax has addressed health challenges, such as diabetes and obesity, in South Africa.

RISE Mzansi

South Africa is estimated to have the second highest number of people living with type 2 diabetes in Sub-Sahara Africa. In 2021, more than 4 million people were living with diabetes in South Africa.

The 'sugar tax' is one way to help curb sugar consumption and thereby potentially reduce the incidence of type 2 diabetes. However, South Africans must make wholesale lifestyle changes to significantly reduce the risk.

The risk factors include: being overweight, inactivity and a family history. We recognise that eating habits etc. are not just individual choices but heavily influenced by marketing, food "desserts", affordability of nutritious food. This is why we will implement the formation of a National Health Commission (which has been gazetted but never effected) to try to improve health promotion and regulation.

Early and regular screening of the at risk population is vital for early detection and treatment. RISE Mzansi will advocate for the faster adoption of nutritional labels on food to explicitly state the amount, in grams, of sugar and salt contained in the product.

UDM

The UDM advocates for a comprehensive approach to addressing non-communicable diseases (NCDs) in South Africa. This includes implementing public health campaigns to raise awareness about the risks of NCDs and promoting healthy lifestyles.

We support interventions targeting the private sector, such as the "sugar tax", as part of broader efforts to reduce the consumption of unhealthy products.

Additionally, we believe in investing in healthcare infrastructure to improve access to screening, diagnosis, and treatment for NCDs, particularly in underserved communities.

Parties who did not respond (write-ups by Spotlight based on public documents):

ANC

The ANC does not address non-communicable diseases in its manifesto.

It does state that it would "lower the cost of food through VAT exemption on essential items, support food security through land reform, support for community and home gardens, and act against price fixing". This is relevant as diabetes often goes hand in hand with poor nutrition.

The manifesto does not mention the sugar tax though the party has historically supported the levy.

EFF

The party's manifesto states as follows: "The EFF government will adopt front-of-package nutrition warning labeling on food and beverages containing excessive amounts of salts, sugar and fats, following the best available scientific evidence free from conflicts of interest by industry."

Also noteworthy is the following: "The EFF government will ensure screening for food insecurity by health professionals is adopted into clinical care in order to improve patient care and to support patients in managing their health communicable and non-communicable conditions." It does not address the sugar tax in its manifesto.

In a parliamentary discussion prior to the implementation of the sugar tax, an EFF representative reportedly said that "there was no way that a hike in price in [sugar-sweetened beverages] would lead to a drop in consumption".

In another parliamentary discussion after the implementation of the tax, an EFF member said the levy should be raised to "minimize sugars in foodstuffs".

FF Plus

The FF+ manifesto does not address non-communicable diseases. In 2020, the party released a statement saying that it had "asked the Western Cape Department of Health and Social Development to launch an awareness and testing campaign for diabetes".

The same year, the official twitter page of the FF+ tweeted: "The FF Plus is calling on the provincial and national governments to increase their health budgets to effectively combat #diabetes and promote awareness among communities."

It's unclear how this accords with the position presented in the manifesto that government spending should be curtailed, and that the core functions of the state should be the police force, the military and the justice system (the health sector is listed as one of three 'secondary functions').

IFP

The IFP did not address diabetes, hypertension or any other NCD in its manifesto.

In 2019, the IFP reportedly told Health e-news that it supported the sugar tax. Somewhat confusingly, it also reportedly said that "companies shouldn't be taxed on their products. It's the role of government to inform the public of the dangers in consuming too much sugar".

Spotlight failed to find any other publicly available documents which provides concrete policy proposals from the IFP on NCDs.

The party's former leader, Prince Mangosuthu Buthelezi, was public about the fact that he had diabetes and several news reports quote him as saying that he responded by making strict lifestyle and dietary changes.

MK

The MK's manifesto does not directly address non-communicable diseases. It does state that the MK would "increase the Child Support Grant to the food poverty line of R760". More broadly, it states that the party would "institutionalize the research and development for standardization and regulation of traditional African medicines to improve its safety standards".

This is in line with a concern noted elsewhere in the manifesto which states that despite the widespread use of traditional healers, "little effort has been made to integrate traditional healing into the mainstream health system".

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