“SECTION27’s latest civil society report warns that South Africa’s 2026 Gender Budget Statement fails to include the health sector, undermining efforts to address gender inequality. The omission is particularly concerning as women disproportionately bear the burden of healthcare gaps during climate-related crises such as floods, droughts, and power cuts.”
South Africa’s healthcare system is once again under scrutiny following the release of SECTION27’s July 30, 2026 report on the Gender Budget Statement (GBS). While the GBS has expanded to cover twelve government departments, its exclusion of the health sector has sparked debate about whether fiscal policy is truly gender-responsive. This issue is particularly urgent as climate shocks intensify, placing additional strain on public health services and disproportionately affecting women.
Background: Gender Budgeting in South Africa
Gender-responsive budgeting (GRB) is designed to ensure that fiscal decisions reflect the different needs of men and women. South Africa’s GBS has grown from covering five departments to twelve, including education, energy, agriculture, and social development. This expansion signals progress, but critics argue that without health, the framework remains incomplete.
Why Health Matters in Gender Budgeting
Women interact with the healthcare system in multiple roles:
- As patients needing access to clinics and hospitals.
- As caregivers responsible for family health.
- As healthcare workers forming the backbone of service delivery.
- As unpaid laborers filling gaps when public services fail.
When clinics are understaffed or medicines unavailable, women absorb the burden, often without compensation. This unpaid care work perpetuates inequality and undermines socio-economic rights.
Climate Shocks and Health Vulnerability
South Africa faces increasing climate-related crises: floods, droughts, heatwaves, and power cuts. These shocks disrupt healthcare infrastructure, making clinics, hospitals, water systems, and ambulance services vulnerable. Women are expected to absorb the resulting care burden, intensifying gender inequality. The report emphasizes that health is where the consequences of budget decisions become most visible in everyday life.
Civil Society Engagement
SECTION27 conducted dialogues with women in the Eastern Cape, revealing how climate shocks exacerbate healthcare challenges. Women reported long waits at clinics, shortages of medicines, and unreliable ambulance services. These testimonies highlight the lived realities of budget decisions and the urgent need for health inclusion in the GBS.
Policy Implications
The exclusion of health from the GBS raises several policy concerns:
- Equity: Without health, the GBS cannot fully measure whether spending reduces gender inequality.
- Resilience: Climate shocks demand stronger investment in healthcare infrastructure.
- Accountability: Civil society argues that government must be held accountable for ensuring healthcare is gender-responsive.
Recommendations from SECTION27
The report calls for:
- Inclusion of health in future Gender Budget Statements.
- Investment in climate-resilient healthcare infrastructure.
- Recognition of unpaid care work in fiscal planning.
- Stronger collaboration between National Treasury, civil society, and health departments.
Conclusion
South Africa’s 2026 Gender Budget Statement represents progress in gender-responsive budgeting, but its exclusion of health undermines its effectiveness. As climate shocks intensify, the need for resilient, equitable healthcare becomes urgent. Civil society voices, particularly women, are demanding that health be placed at the center of fiscal policy. Without this, the burden of care will continue to fall disproportionately on women, perpetuating inequality and weakening the country’s healthcare system.
