MEC Monyatso Mahlatsi
By Thabo Mosia
On Friday, 25 April 2025, Honourable Monyatso Viceroy Mahlatsi, the Member of the Executive Council (MEC) for Health in the Free State Province, delivered a powerful Budget Vote speech at the Fourth Raadsaal in Bloemfontein. Presenting a total allocation of R14.187 billion for the 2025/26 financial year—a modest 2.84% increase from the previous year’s R13.796 billion—MEC Mahlatsi outlined an ambitious plan to transform the province’s healthcare system. This budget, though constrained by inflation rates exceeding 5%, aims to enhance service delivery, upgrade crumbling infrastructure, and promote wellness for all Free Staters. With a focus on equity, innovation, and community involvement, the speech highlighted key initiatives to address pressing health challenges and build a resilient healthcare future.
A Vision Rooted in Dignity and Hope
MEC Mahlatsi opened his address with a poignant Swahili proverb: “To fear a big (or important person) is futile; when will he ever be small?” This wisdom set the tone for a speech that encouraged facing challenges head-on, rather than shying away from them. He reflected on April’s historical significance, marking 31 years since South Africa’s first democratic elections following Chris Hani’s assassination. This legacy, he stressed, must inspire the province to protect and strengthen its healthcare system.
The timing of the speech also coincided with Africa Vaccination Week (24-30 April 2025) and World Malaria Day (25 April 2025). Although malaria is not endemic in the Free State, MEC Mahlatsi emphasized vigilance due to climate change and travel-related risks. The province is intensifying its immunisation efforts under the theme “The Big Catch-Up—Protecting Everyone, Everywhere,” ensuring no child is left behind. This commitment aligns with the Premier’s sobering reminder that people visit health facilities out of necessity, not choice, placing a heavy responsibility on the department to deliver care with dignity and empathy.
Tackling Key Health Priorities
The R14.187 billion budget is strategically allocated across eight core programmes to address diverse needs:
• Programme 1: Administration – R406.9 million
• Programme 2: District Health Services – R6.28 billion
• Programme 3: Emergency Medical Services – R995.8 million
• Programme 4: Provincial Hospital Services – R1.997 billion
• Programme 5: Central Hospital Services – R3.386 billion
• Programme 6: Health Sciences & Training – R322.5 million
• Programme 7: Health Care Support Services – R175.7 million
• Programme 8: Health Facilities Management – R623.7 million
These funds will support critical interventions, from staffing shortages to infrastructure repairs. A significant focus is on child and teenage pregnancy, a national concern that MEC Mahlatsi has placed on the agenda. Promoting abstinence as the safest option, the department also provides access to safe, medically approved preventative measures. He posed a stark question: Should a ten-year-old girl seek preventative care, a termination, a dangerous backstreet abortion, give birth, or face maternal death? Open conversations at home, he argued, are vital to prevent such outcomes, urging communities to address reproductive health proactively.
Another pressing issue is the vandalism of public health infrastructure. Targeted break-ins and theft of small items like copper pipes have caused extensive damage, pointing to a market for scrap metal. MEC Mahlatsi called for community ownership and accountability from unscrupulous dealers to safeguard these essential facilities.
Innovative Solutions and Infrastructure Revival
The budget addresses long-standing challenges, including a rising demand for eye care services. With cataract surgery waiting lists extending to 2028, the Free State School of Nursing (FSSON) will introduce specialised ophthalmic nursing training in 2027. Similarly, the removal of midwifery from the four-year nursing programme has weakened primary healthcare, prompting urgent action to restore this training.
Infrastructure remains a priority, with projects like Boitumelo and Pelonomi hospitals stalled for years due to historic accruals. MEC Mahlatsi announced a revitalised infrastructure unit to improve planning and execution, alongside a verification process that may reduce estimated accruals from R500 million. A dedicated maintenance campaign will transform facility conditions and operational efficiency.
Water security is another focus, with crises affecting facilities due to illegal connections, natural scarcity in areas like Masilonyana, and ageing infrastructure at hospitals like Elizabeth Ross and Parys. Partnerships with Vaal Water, Sedibeng Water, and others have shown promise, as seen in the Qwaqwa case, and will be extended to other struggling regions.
Advancements in Technology and Specialised Care
The Free State is embracing cutting-edge technology to enhance healthcare. The introduction of the Versius Surgical Robotics System at Universitas Academic Hospital marks a leap in precision surgery, reducing risks and improving recovery. Nuclear medicine is also making strides, with case studies showing improved outcomes in cancer and neurology care. Innovations like the DEXA and PeaPod, which analyse body composition to predict future health risks, underscore a shift toward preventative care, supported by collaborations with the University of the Free State.
Specialised programmes are gaining momentum. The Renal Transplant Programme at Universitas, revived with a successful 2023 transplant, reduces dialysis costs and improves patient quality of life. Smile Week offers free reconstructive surgery for children with facial abnormalities, restoring dignity and hope. Orthopaedic outreach from Pelonomi Tertiary Hospital will address implant shortages and surgeon deficits, while the Thuthuzela Care Centre at Elizabeth Ross Hospital—the 66th in South Africa and fifth in the province—supports gender-based violence (GBV) survivors.
Strengthening Human Resources and Partnerships
Human resources are a cornerstone of the budget. The recruitment plan targets 106 critical clinical posts by August 2025, including 91 nurses and 17 doctors, alongside non-clinical staff like cleaners and security officers. COVID-19 contract workers are encouraged to apply for permanent roles. A Ministerial Advisory Committee on Human Resources is reviewing overtime policies and the Remunerative Work Outside Public Service (RWOPS) framework to ensure accountability and fairness.
Public-Private Partnerships (PPPs) are being re-evaluated. The 23-year partnership with the Community Health Management (CHM) consortium at Pelonomi, deemed financially burdensome, will transition to full public control, with constructive discussions underway. Future partnerships, like potential use of underutilised sections at Senorita Ntlabathi District Hospital, will follow strict guidelines for sustainability.
National Health Insurance and Universal Coverage
The Free State is a leader in implementing the National Health Insurance (NHI), with Thabo Mofutsanyane District as the pilot site. Developments include a Centralised Chronic Medicine Dispensing Unit in Dihlabeng, infrastructure upgrades at Dihlabeng Regional Hospital, and an electronic data system at Phekolong District Hospital. The Health Patient Registration System (HPRS), integrated with hospital and lab systems, ensures seamless care with unique patient identifiers. This progress supports the goal of Universal Health Coverage, preventing poverty due to medical costs.
Addressing Financial and Legal Challenges
Financial management is a key focus, with efforts to resolve Auditor General concerns, including the immovable asset register and Section 42 transfers to Public Works. Medico-legal claims, totaling R6.1 billion by May 2025, pose a significant threat, driven by cerebral palsy cases linked to maternal and neonatal care gaps. A six-point plan—employing more professionals, procuring equipment, upgrading infrastructure, and advocating for legal reforms—aims to prevent harm and reduce payouts by up to 80% through future care provisions.
Community Engagement and Emergency Services
Community involvement is vital. Hospital Boards and organised labour have held constructive engagements to address staff shortages, maintenance issues, and security concerns. The department plans to increase 24-hour clinics and appoint 280 Emergency Medical Services (EMS) officers, including coverage for 15 towns without ambulances, supported by R1 million for household emergency equipment. The Uniform Patient Fee Schedule will enhance EMS financial sustainability.
Pharmaceutical services have achieved 90% medicine availability, with multi-month dispensing and household delivery benefiting 20,000 elderly patients. Security improvements, including a three-year plan for 263 facilities, address break-ins and equipment shortages, with Masilonyana Municipality’s support proving effective.
Quality Assurance and Patient Care
Quality assurance is central to NHI readiness, with 24 of 29 hospitals (83%) certified by the Office of Health Standards Compliance (OHSC) since 2019. The Ideal Clinic Programme has 92% of 218 clinics compliant, though only 48% are OHSC-certified, prompting targeted support. Patient meal and laundry issues are being tackled with audits, new equipment, and R11.5 million for linen procurement.
Inspiring Stories of Resilience
MEC Mahlatsi shared uplifting stories, like Mr Khahliso Pitso, who survived a subdural haemorrhage thanks to Universitas staff, and Mr Mochato David Mokoena, who walked again after nuclear medicine treatment. These testimonies highlight the human impact behind the budget.
Conclusion: A Promise to the People
“This budget is not merely a financial document. It is an instrument of social justice, a plan to heal, protect, and restore dignity,” MEC Mahlatsi concluded.
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