Talk to any outpatient and the ruinous state of South Africa’s public health system requires no debate. However, a new AGSA report was recently presented to the Parliamentary Committee on Social Services. And it’s not good news …
Drawing empirical data from a 2024/25 audit of the Department of Health, the report paints the picture of a public health system in freefall, reports IOL. Worse still, the AGSA is adamant that the systemic dysfunction is costing patients their lives. Here’s how bad South Africa’s public health system has become …
SOUTH AFRICA’S PUBLIC HEALTH SYSTEM LAID BARE
R24 billion in unpaid accruals nationwide is rolling over into the next financial year, explained the AGSA report. And only one out of 10 departments have assets exceeding liabilities, which means they’re not in the red. Gauteng is the worst offender with R8 billion in accruals carrying forward next year.
Moreover, the AGSA identified chronic under-budgeting for legal cases filed against the public healthcare system due to negligence, medical malpractice and poor service. All on its own, this illustrates South Africa’s public health system is fundamentally broken. Foster Mohale from the National Department of Health, says the public health sector has suffered consistent underfunding across all provinces for many years.
INEFFECTIVE NATIONAL HEALTH COUNCIL
So, who is to blame for South Africa’s public health system flatlining? Mohale says the onus is on the National Health Council (NHC) to plan where funds go. However, the AGSA told parliament that one hospital in the Free State hasn’t had an operating theatre for 28 years. “Health institutions are meant to be places of healing, hygiene and safety. Yet, there is an absence of adequate maintenance schedules and hospitals are generally in deplorable condition,” outlined the report.
In fact, six out of 21 hospitals in the Eastern Cape, KZN, Mpumalanga and Northern Cape had no maintenance plans at all. Mohale stressed that healthcare continue 24 hours a day, 365 days a year and the demands are always rising. Therefore, South Africa’s public health system desperately needs relief. “We have lobbied the Minister of Finance for additional funding in 2025/26 financial year and the medium-term expenditure period,” said Mohale.
DIGITISE SOUTH AFRICA’S PUBLIC HEALTH SYSTEM
Furthermore, while the world digitises healthcare, South Africa clings to paper. The AGSA found that the department largely still relies on hard-copy record books – referred to as ‘flash books’ – for invoicing and debt collection. These are highly prone to error, inefficiencies and can be easily manipulated for fraud.
Finally, amongst the doom and gloom, one province has bucked the trend. The Western Cape’s public health system is the only one to maintain a clean audit. As such, the AGSA’s Nelisiwe Mhlongo explains: “Provinces achieving clean audits typically have strong, institutionalised internal controls. These include consistent reviews, active leadership involvement and timely corrective actions,” concluded Mhlongo.
What do you think? Is South Africa’s public health system in disarray? Have you visited a public hospital recently, and how what level of service did you receive? Let us know in the comments below …
