SA’s provincial health departments face significant financial pressures due to weak financial controls, unpaid obligations and medico-legal claims, according to National Treasury’s medium-term budget policy statement, reported Business Day (21 October 2026).
Five of the nine provincial health departments received qualified audits for 2025/2026; three received unqualified audits with findings; and only the Western Cape achieved a clean audit. Provincial health accruals, representing unpaid obligations, fell from almost R25bn in 2024/2025 to R20.5bn in 2025/2026 following additional government allocations. Provinces also owe the National Health Laboratory Service (NHLS) R10.7bn.
Contingent liabilities from medico-legal claims declined from approximately R110bn in 2019/2020 to R50.6bn in 2025/2026. However, Treasury warned that these claims continue diverting funds from healthcare delivery. Proposed reforms include replacing lump-sum settlements with structured payments and introducing alternative mechanisms for patients seeking redress.
Treasury also identified potential savings through better management of commuted overtime, rural allowances, medical intern remuneration and remunerative work outside the public service (RWOPS).
A ministerial advisory committee reviewing RWOPS is expected to report by April 2027. These measures could release funding for additional doctors, although tighter controls may affect doctors’ private practice activities and the wider healthcare sector.