Comment on Medium Term Budget Policy by Metropolitan Health

• It is very concerning that the government salary bill remains the largest share of the spending. This obviously limits our ability to spend money on other pressing issues such as infrastructure and areas where we will benefit the economic development.

· Healthcare is budgeted at a R139 billion with continued focus on TB and HIV and the promise of NHI sometime in the distant future. As the economic pressures become more severe, I think we will start to see further delay in the implementation of the National Health Insurance plan. We need to get to grips quickly with the wastage in the healthcare system and wait for the arrival of the NHI.

· The continued growth in the numbers of South Africans to 17 million that now receive some form or other social grant is also of great concern.

· Overall a sober presentation of the challenges we face and with some comfort that we are still quite resilient in a very tough lower growth world.

· The consolidated government expenditure is projected to grow on average by 8.2% over the period 2012/13 to 2015/16 whilst real GDP remains between 2.5% and 4.1%. Given the state of the world economy it is more likely that we will see muted growth. This I think will need careful review of expenditure in the future unless we get the SA economy up and running quite strongly.

· It seems to me that we need to get on and start the bold process of the implementation of the New Development Plan as I think with each year forward things are going to become more difficult.

· The wildcard remains the impact of a future weak rand on inflation and the personal debt burden South Africans is carrying.