How we finance this category of rights needs closer scrutiny

Share current article via Email Share current article via Facebook Share current article via Twitter Share current article via LinkedIn South Africa carries one of the world's largest HIV burdens, with the impact disproportionately affecting adolescent girls and young women, says the writer. Stock photo: Story audio is generated using AI South Africa needs to move beyond celebrating women's resilience and achievements only and confront the conditions that continue to undermine their health, dignity and full participation in society. Sexual and reproductive health and rights (SRHR) speak directly to this challenge. The ability to access quality health care, make informed decisions about one's body, and live free from violence and discrimination is fundamental to equality and human dignity. For this reason, SRHR must be placed at the centre of policy, planning and budget decisions. Doing so is not only a matter of advancing women's rights; it is an investment in South Africa's health, productivity and future. South Africa does not have a shortage of laws, policies or commitments in this area. What remains unresolved is whether we are financing these commitments sufficiently, equitably and effectively. Recent discussions in parliament on public finance and SRHR were timely because in a constrained fiscal environment — with low growth, rising debt-service costs and growing pressure on provincial health systems — difficult choices are being made about what the government can afford. The real question is whether public resources are reaching the people and services that need them, whether they are producing measurable outcomes, and whether our financing model is sustainable. South Africa carries one of the world's largest HIV burdens, with the impact disproportionately affecting adolescent girls and young women. The withdrawal of international funding has further exposed the vulnerability of HIV programmes to changes in the global financing environment. The budget should not merely count spending; it should show whether public money is shifting inequalities and improving lives Gender-based violence and femicide remain equally urgent. More than one in three women have reported experiencing violence during their lifetimes, while the country continues to face exceptionally high levels of femicide. Adolescent pregnancy is another major concern, with more than 117,000 adolescent girls giving birth in public facilities in financial 2025 alone. These are not simply statistics. They represent: lost educational opportunities; reduced economic participation; increased pressure on social services; and long-term consequences for families and communities. The recent discussions in parliament underscored an uncomfortable truth: rights that are not financed remain promises on paper. At present, SRHR expenditure is not always easily identifiable across national and provincial budgets. This makes it difficult to establish how much is actually being spent, where it is being spent and whether allocations correspond to identified needs. South Africa has traditionally relied heavily on incremental budgeting — last year's allocation becomes the starting point for this year's allocation, subject to adjustments for fiscal conditions. Financing SRHR demands a different approach, as incremental budgeting cannot deliver transformational outcomes. This brings to the fore the urgent need to pivot towards gender-responsive budgeting, which should not be reduced to a 'women's budget'. It is fundamentally about better budgeting — understanding how public expenditure affects different groups and whether it advances equality and reduces inequality. Gender-responsive budgeting offers a better logic: begin with the problem; identify who is excluded; cost the intervention; allocate resources; track implementation; and measure impact. The budget should not merely count spending; it should show whether public money is shifting inequalities and improving lives. South Africa is operating under significant pressure, with competing demands for limited public resources. Every rand must be disciplined, transparent and directed toward rights, dignity and measurable outcomes At the same time, external financing for health programmes is becoming less predictable. Experience elsewhere in the continent demonstrates how heavily donor-dependent health systems can be destabilised when external funding changes. South Africa is comparatively better positioned because of its more stable domestic budget framework, but it is not immune to these pressures. This requires that we consider innovative financing, including: blended finance; carefully structured public-private partnerships (PPPs); concessional finance; and results-based financing. These innovations must however not become a euphemism for the government withdrawing from its constitutional obligations. Any private or development financing must: mobilise additional resources; protect equity; deliver value for money; and remain aligned with the public interest. The debate about SRHR financing is ultimately a debate about what kind of society we want to build. Parliament must strengthen the visibility of SRHR in the budget process, insist on clear line items and expenditure tagging, interrogate provincial variations, demand outcome-based oversight, and scrutinise innovative financing so that PPPs, blended finance or donor support remain aligned with equity and the public interest. The government must not be absolved of its constitutional responsibility; rather, every rand must be disciplined, transparent and directed toward rights, dignity and measurable outcomes. South Africa has enough policy commitments. What it needs now is financing that follows those commitments, data that reveals who is being reached, and oversight that refuses to accept underfunded rights as inevitable. SRHR is not a marginal cost. It is a public good, a foundation for equality, and an investment in the country's social and economic future.