Provinces owe National Health Laboratory Service R8.9bn amid labs urgently needing upgrades and staff

11 Mar 2025

The provincial departments of health, except the Western Cape, owe the National Health Laboratory Service R8.9bn in unpaid accounts, the parliamentary health committee heard last week. With more budget cuts expected, the state laboratory management fears this may not soon improve.

Describing the provincial debt owed to the National Health Laboratory Service (NHLS) as “unsustainable”, CEO Dr Koleka Mlisana said that it has no hope that current non-payment trends will improve.

The payment crisis hits while state laboratories that play a vital role in the health system, the justice system and the manufacturing of snake, spider and scorpion antivenom are in dire need of a cash injection to upgrade laboratory equipment and hire more professionals.

Mlisana was presenting the NHLS’s annual report to the health committee in Parliament.

The NHLS performs all medical testing, like HIV testing, TB testing and other medical tests for matters such as kidney function, blood count testing and diagnostic testing relating to viruses and pathogens for state hospitals and clinics in South Africa.

NHLS Chief Financial Officer Pumeza Mayekiso said the debt owed by the provinces was steadily increasing and now stood at R8.9-billion. The only province that does not owe the NHLS money is the Western Cape.

“It is quite a big concern,” she said. KwaZulu-Natal was trying to eradicate its historic backlog, but the NHLS is still owed a substantial amount by mainly the Eastern Cape, Gauteng and the Northern Cape.

Tariffs blow, budget cuts expected

Mlisana said it was also of concern that the NHLS had received permission to increase its tariffs by only 1% in the current financial year.

“It is going to be very difficult for us to deliver a mandate with insufficient cash resources,” she said. The provincial debt to the NHLS had grown to unsustainable levels. She expected that further budget cuts would also affect the service.

“There is no indication that the current payment trends will improve,” she said. The service was hoping provinces would ringfence the money intended for laboratory services payment.

The Eastern Cape Department of Health owes R941-million, Gauteng R1.63-billion and KwaZulu-Natal R3.1-billion, but of this R2.08-billion is under dispute.

Mlisana said that despite the huge debt, the laboratory service had achieved 72% of its annual performance targets, but its forensic laboratories performed dismally when it came to toxicology analysis.

Mlisana said that for both health testing and forensic analysis, the service had identified that its procurement processes were too slow and had drawn up a new procurement plan to speed things up.

She said that, for instance, as things stood, they might not be able to take on the new 1.1 million patients that Minister of Health Dr Aaron Motsoaledi announced had to be tested for HIV and enrolled for treatment required by December 2025.

Forensic laboratories

But it was the forensic laboratories where the service had its biggest problem, said Mlisana.

The NHLS’s forensic laboratories are responsible for pre- and postmortem analyses of blood alcohol levels for drunken driving, as well as toxicology analyses of bodily fluids and human organs in cases of murder and suicide.

According to the annual NHLS report, an initial analysis of forensic chemical laboratories’ capabilities showed there would be a need for a large capital injection as well as additional funding to improve operational performance.

“The capital injection is mainly required as the infrastructure has deteriorated and the additional operational funding is required as these laboratories are currently underfunded,” the report continued.

In better news, the NHLS has reported that the forensic laboratories, except Johannesburg, have all managed to eradicate the backlog in blood alcohol level tests.

But for toxicology tests, the backlog was reduced only by a third.

“Blood alcohol level tests and toxicology tests still need quite a lot of work,” said Mlisana.

“This is where we have a big problem,” she said. The laboratories managed to reduce only 40% of their forensic backlog.

“We have received approval from the board to take steps that enable us to clear the backlog that we will implement in the 2025/26 financial year.”

Mlisana said they had received a 24-month goal to clear the toxicology backlog.

The NHLS has managed to eradicate the backlog in blood alcohol testing in all laboratories except in Johannesburg, said NHLS COO for Strategic Initiatives Clothilde Oliphant. In 2024, Motsoaledi said the Johannesburg backlog was at 35,176 cases.

To address this backlog, Oliphant said, the NHLS had added another laboratory in Pretoria, and would improve staffing and ensure they had functioning instruments.

The service is also in conversation with the KwaZulu-Natal Department of Health to open an additional toxicology laboratory for that province, and the Eastern Cape, she said.

Antivenom failure

Oliphant acknowledged that they were not producing any antivenom for snakes, scorpions or spiders. She said the service had previously produced 9,000 to 10,000 vials a year.

Read more: ‘Nightmare crisis’ — SA’s National Health Laboratories run out of snake, scorpion and spider antivenom

The NHLS has explained that this was due to delays in construction and the commissioning of new equipment because the laboratory had to be updated to comply with international best manufacturing practices.

The DA’s Michéle Clarke, however, said the service’s answers on antivenom production were vague.

“The DA has already submitted parliamentary questions to demand the answers the NHLS has failed to give and will be requesting that they return to the committee to provide clarity on the following issues: We asked the NHLS how many vials of antivenom they had produced since 2023, and where shortages are occurring. Despite the life-threatening nature of this crisis, the NHLS failed to provide clear information on these vital statistics. The DA also sought details on the cost and timeline of the renovations at the South African Vaccine Producers (SAVP) facility. The public deserves to know what is being done to resolve this situation and how long these renovations will take. Regrettably, we did not receive sufficient answers. In light of the renovations, the DA specifically asked why no procedures were put in place to ensure the continued production of antivenom. The failure to prepare for this eventuality is a glaring oversight that continues to cost lives, and the NHLS has failed to explain why this was allowed to happen.”

Clarke said she would ask that the NHLS and other relevant officials return to the committee to provide answers “as a matter of urgency”. DM

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Tariffs blow, budget cuts expected

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