In a “blink and you’ll miss it” flash in the pan late in September, it was reported by News24 that the health department had spent some R182 million on health “communications” and events, before the news cycle rotated onwards.*
The bulk went to two companies: KMTV Media, appointed for strategic communication at R1,620 “per transaction” plus a 10% management fee. KMTV had already been paid R146.4 million by September 2026. The other is Dots Design Agency, handling events management at R540 “per transaction” plus a 9.5% fee. It had received more than R35 million.
Combined, the payments reached roughly R182 million, with a year still left on the contracts. The arrangements carried no overall ceiling. “Transaction” was never clearly defined, and the original tender language seeking hourly rates was quickly set aside in favour of open-ended quotes under a service-level agreement.
Documents showed the money was drawn from at least eight departmental programmes, including HIV/AIDS, tuberculosis, child nutrition, health promotion, and a National Health Insurance (NHI)-linked primary healthcare grant intended to place doctors in under-served clinics. One R52 million commitment was placed under the NHI indirect grant.
Minister Aaron Motsoaledi and Deputy Minister Joe Phaahla described the escalation from a R1,620 rate to R146 million as “ridiculous in the extreme”. Both confirmed they had known Khathu Mamaila, head of KMTV, for more than 30 years.
The department referred the matter to the Special Investigating Unit, Auditor-General, and Public Protector, while maintaining that the contracts covered legitimate prevention work against HIV, TB, malaria, cancer, alcohol abuse, diabetes, and smoking.
Department spokesperson Foster Mohale went further. He defended the expenditure by pointing out that “companies spend billions advertising harmful products” and that the state “cannot fold our arms while diseases are being sold to the public”. Health communication, he insisted, is “not a luxury, it is a necessity”.
“Public health” work
That is revealing.
Private firms spending their own money to promote legal products is treated as an emergency requiring a public countercampaign funded, in large part, by diverting resources from the treatment of ill people, particularly the needy.
The department is not merely informing the public of health risks, but using (ever scarcer) taxpayer funds extracted from clinical programmes to amplify one side of a contested debate over adult lifestyle choices.
Smoking and, increasingly, vaping – where consumer choice attention is presently focussed on in South Africa – are framed not as matters of personal risk and responsibility, but as a moral and policy emergency that justifies further statutory restriction.
This is what passes for “public health” work: the state financing an ideological campaign.
Anti-tobacco messaging does not sit in a dedicated, transparent communications budget. It is folded into the same multi-pronged “health and wellness” contracts that fund NHI promotion, billboards, television commercials, social media content, and events. The department has no central marketing allocation – each programme is expected to fund its own awareness activities.
In practice, this means resources earmarked for treating existing patients can be reallocated to messaging campaigns whose primary measurable output is visibility rather than clinical capacity.
The same appears in the department’s relationship with the National Council Against Smoking (NCAS).
A 2025 Free Market Foundation report by Nicholas Woode-Smith on the Tobacco Products and Electronic Delivery Systems Control Bill recorded that, at least since 2018, NCAS has received over R1.1 million annually from the department to operate a tobacco-cessation call centre. The same organisation has received departmental grants to assist in drafting regulations.
During public hearings and at NEDLAC, NCAS and allied groups – including the Cancer Association of South Africa and the Africa Centre for Tobacco Industry Monitoring and Policy Research – were given preferential platforms. The South African government delegation at NEDLAC even included representatives from the US-based Campaign for Tobacco-Free Kids.
Harm-reduction and pro-consumer voices, on the other hand, were more readily marginalised.
All constituencies
The state is meant to represent all its constituents.
The Constitution does not privilege non-smokers, like me, over smokers. It emphasises public health just as much as it emphasises individual choice. How is it, then, that the health department could fund anti-tobacco activism, but no other arm of state funds the work of a pro-consumer rights organisation?
None of this is about defending smoking or ill-health, but observing the strictures of constitutional democracy even (and especially) when we believe a cause might be righteous.
What “communications contracts” actually purchase in this setting is not treatment slots, medicines, or additional clinical staff, but media planning, creative production, influencer arrangements, event logistics, and content that frames lifestyle choices as a crisis requiring a dose of paternalist regulation.
The output is pamphlets, television spots, billboards, and “stakeholder sessions” timed to World No-Tobacco Day and the legislative calendar of the Tobacco Bill.
These can never be legitimate substitutes for the services taxpayers are paying the government’s collapsed public health system to provide to the ill. The system does not lack for messaging, but for beds, specialists, reliable medicine supply, and functioning primary care.
When uncapped contracts for strategic communication and events management can absorb tens of millions from HIV, TB, and child-nutrition lines, and when an NGO already receiving departmental transfers is simultaneously elevated as a preferred drafter of regulations, it is not about whether anti-tobacco work is a legitimate area in public health anymore. The question then becomes whether the department’s spending priorities track the actual clinical needs of the patients it is morally obliged to serve.
Parliament has not yet closed the door on correction, however.
The Portfolio Committee on Health adopted a motion of desirability on the Tobacco Bill and has moved into clause-by-clause consideration. That process, conducted under public scrutiny, remains capable of removing the most indefensible overreaches that years of preferential access for anti-consumer advocacy have helped to produce.
*This line has been amended to reflect the fact that News24 is the source of the reporting on the multi-million rand spending on health “communications” and events.
[Image: https://commons.wikimedia.org/wiki/File:World_No_Tobacco_Day,_31_May_P061243-966003.jpg]
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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