SA’s public health system ‘on the verge of collapse’

AUDITOR - GENERAL'S REPORT

- SIZWE DLAMINI

SECTION 27 of the South African Constitution guarantees everyone the right to healthcare.

(Sourced/RHAP)

THE Auditor-General of South Africa (AGSA) has laid bare a public health system in freefall - plagued by financial ruin, institutional rot and a near-total absence of accountability.

The evidence, presented to Parliament's Select Committee on Social Services, was drawn from AGSA's 2024/25 audit of the Department of Health.

The report painted a picture of systemic betrayal and one that is costing patients their lives. Hospitals without operating theatres for 28 years, R24 billion in unpaid bills, vandalised TB facilities and provinces still using paper "flash books" to track invoices in 2025, were just some of AGSA's findings.

Foster Mohale, director of media relations at the Health Department, said the public health sector had faced long-term financial strain. "The public health sector has suffered consistent underfunding across all provinces for many years."

Mohale said a brief boost that was seen during the pandemic had faded. "There was a brief improvement in the response to Covid-19, but this has not been sustained."

He said that wage agreements had not been matched by budget increases. "Part of the problem has been the annual agreements on improvements to conditions of employment, which have not been supported by the additional funds required for salaries, benefits and overtime."

The AGSA told the committee: "Nine out of 10 departments have liabilities exceeding assets ... R24bn in unpaid accruals rolling over to the next year."

These are not abstract fiscal figures - they represent medicine not delivered, nurses not paid and surgeries cancelled. According to the AGSA, in Gauteng, R5bn to R8bn in accruals are carried forward annually, meaning the province begins each new financial year with a significant chunk of its budget already spent.