This paper provides an analysis of the health HIV and TB budget and spending in South Africa over an eight-year period (2013/14 – 2020/21), with a special focus on the 2015/16 and 2016/17 provincial programme spending and the 2018/19 to 2020/21 budget. The analysis indicates government’s increasing financial commitment to HIV and TB against the backdrop of declining economic conditions. The problem of over- or under-spending by provinces has been partially attributed to poor estimation of costs, resulting in under- or over-budgeting. Improvements in this regard were made in 2016/17 after the provincial health HIV and TB finance and programme managers were provided with training and technical support by the FINCAP Project of CEGAA/ HE2RO1 to improve their costing of their Conditional Grant (CG) business plans and management of their finances. More accurate costing was promoted to ensure reasonable targets in line with available resources and real expenditure. Provinces were encouraged to accelerate their recruitment process of key personnel required for the expansion of the treatment programme, and to ensure that procurement and payment for services were done in line with the business plan timeframes. The FINCAP Project, in partnership with the National Department of Health, has contributed vastly to these improvements.