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3 June 2009 


There are some positive signs in President Zuma’s State of the Nation Address, foremost that he renewed the state’s commitment to meeting some of the key targets laid out in the NSP and to the revitalisation of the health service in general. However, there is little indication in the address as to exactly how these projects will be achieved. The President’s words must be followed by action to protect the health of South Africans. Evidence-based means of preventing HIV must be pursued by the state to reach the target of a 50% reduction in HIV transmission by 2011. The ABC programme in schools must be overhauled and replaced by a sound programme of treatment literacy and HIV education in the mould of TAC’s treatment literacy programme. ARV access, condom distribution and circumcision – the best biomedical means available for reducing HIV transmission, must be comprehensively implemented.

Summary of the State of the Nation Address

After Zuma discussed his plans for the economy and job creation, the development of infrastructure (housing, sanitation, transport) and education, he addressed health directly. He began by voicing his concern “about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease”. He made specific mention of government goals to:


  • Reduce inequalities in health care provision
  • Boost human resource capacity
  • Revitalise hospitals and clinics


  • Step “up the fight against the scourge of HIV and AIDS, TB and other diseases”
  • Work together to improve implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS including the commitment to reduce the rate of new HIV infections by 50% by the year 2011 and to reach 80% of those in need of ARV treatment by 2011.


  • Introduce NHI in “a phased and incremental manner” by urgently rehabilitating public hospitals through “Public-Private Partnerships”.

In his closing remarks on his discussion of healthcare, Zuma acknowledged that the remuneration of health professionals is an urgent issue. He also emphasised the need to work together to promote quality healthcare in line with the UN Millennium Development Goals to halve poverty by 2014.

Zuma continued by discussing plans to fight crime and continue the “transformation” of the judiciary. He spoke of the value of sport and outlined his vision of South Africa’s international role.


It is important that the Presidency has recommitted the government to the NSP targets and that prevention and treatment of HIV/AIDS were specifically mentioned. It is positive that the issues of human resources and inadequate salaries in the health care system were raised. However, it was disappointing that there was no specific mention of the shortage of essential medicines, especially in light of the recent crisis in the Free State. There was also no mention of the problems of lack of adequate equipment and unacceptably long waiting lists. A commitment to PMTCT was also glaringly omitted. In addition, no specific time frame for implementation of NHI was mentioned. Government must bring the plans around NHI into a public forum.

Furthermore, although overall the content of the President’s speech was positive, there was no specific indication as to how the Presidency and government will tackle the current crisis in the health care system. For example, government is R1 billion short to fund ARV access for the targeted number of people for 2009 – as set out in the NSP. Where will the money be found to make up this short fall? How exactly is the President going to reduce the rate of new HIV infections by 50% by 2011? How is government going to ensure that 80% of people who need ARVs will be receiving them in 2011?

Plans for the realisation of Zuma’s other commitments were similarly vague. He mentioned improving transport systems, providing adequate sanitation, and building more houses – all of which are vital in the fight against HIV/AIDS and TB. He also committed the government to protecting girls at school from sexual abuse and to fighting crimes against women and children (although rape was not specifically mentioned). However, it is not clear from the speech how these goals are to be achieved.

Zuma’s statements on social grants was disappointing. He acknowledged the role that social grants play in society but emphasised the need not to create social dependency. As social grants are central to eradicating poverty and improving healthcare, TAC was dismayed that this subject was not more extensively addressed and supported. While job creation is important, this must be coupled with the introduction of vitally important grants such as a Chronic Diseases Grant and a Basic Income Grant. Grants such as these can help prevent the spread and ill effects of disease.

In his closing comments Zuma spoke of the need “to act prudently – no wastage” in the current economic downturn. Zuma must ensure that resources and budgets are allocated in a way that guarantees life and dignity, in keeping with the requirements of the Public Finance Management Act.


The President recommitted the government to certain important targets and acknowledged the need to provide more resources for health. However the address did not give details as to how this would be achieved. TAC will continue to monitor the performance of the government to ensure that the commitments established by the NSP and re-emphasised in the State of the Nation address will be fulfilled.



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