In the lead-up to the African Union’s (AU) 39th Ordinary Session of the Assembly of Heads of State and Government, South African health advocates are warning that the country’s health budget may be in jeopardy amid rising debt repayments.
According to the 2025 Budget Review estimates, South Africa is projected to spend R426.3bn on debt servicing this year, compared to just R296.1bn on public health.
Shocking disparity
Data presented during the "CSO Webinar on Africa Leadership for Health Sovereignty" — organised by AIDS Healthcare Foundation (AHF) Africa, Africa Reach, WACI Health, and RANA — reveals a shocking disparity.
The Africa Centres for Disease Control and Prevention (CDC) reports a $66bn annual health financing gap for the continent, a figure that is worsened by unfair global financial structures.
United Nations Economic Commission for Africa (UNECA) data highlights that Africa loses $89bn annually to illicit financial flows, money that could more than cover the health financing gap if retained.
South Africa was urged to lead the fight against these leaks during its G20 tenure.
With 34 African countries spending more on debt than health, the "fiscal trilemma" is a shared continental crisis that requires a unified political response.
This "fiscal trilemma" is crowding out critical social spending, exacerbating inequalities where the public sector is overwhelmed despite high per capita spending relative to the region.
Spiralling cost
The webinar’s call to action urges South Africa to use its G20 leadership to push for "Fairer Interest Rates."
African nations often pay 10% interest on loans, while high-income countries pay just 2–3%, a disparity described as "financial apartheid."
While South Africa’s spending is high for the region at $1,341 per capita, it masks the deep divide between the private sector, which serves 16% of the population, and the underfunded public sector.
"The spiralling cost of debt repayments must be framed as a moral issue," said Dr Penninah Iutung, AHF executive vice president, in her address to the webinar.
"Why is Africa held in a stranglehold of unpredictable and high interest rates?
“Our leaders must come together to negotiate better rates collectively. There is strength in numbers."
"South Africa has the regulatory maturity (level three) and the industrial base to lead Africa’s health sovereignty agenda," said Martin Matabishi, AHF Africa Bureau chief.
"But this potential is handcuffed by debt."
