The Eastern Cape Department of Health is facing a critical shortage of medicines after racking up unpaid pharmaceutical bills of about R1bn, with 21 vital accounts having apparently been suspended for non-payment, reports Daily Maverick.
The department has conceded it will not be able to pay the outstanding amounts anytime soon, according to documents seen by Daily Maverick, with only R60m to R70m available for payments in March, and perhaps R500m at the start of the new financial year.
Health spokesperson Siyanda Manana said the department was experiencing “financial pressure”, but that this does not constitute a “widespread collapse” of its medicine provision.
While “isolated” shortages may occur, he said mitigation measures were actively being implemented, including alternative sourcing, redistribution between facilities and the prioritisation of lifesaving medicine.
The department is engaging with the national Department of Health to find a solution, he added.
Unpaid bills
Meanwhile, at least 21 accounts are being affected, including Aspen, AstraZeneca, Adcock Health, Sandoz, and Novartis.
Manana said these accounts were just “temporarily suspended” and that the department was engaging with suppliers, with some accounts already reactivated.
It is understood that, excluding the 21, nine additional accounts were reactivated after negotiations. Manana said payments for these accounts are being prioritised.
Even some of the cheapest drugs are currently out of stock, including medicine for scabies and beta blockers used by cardiologists.
Manana added that the situation was being compounded by rising medicine costs, increased patient loads and broader fiscal pressures.
Task team
In April last year, Eastern Cape Finance MEC Mlungisi Mvoko announced that a task team was to be appointed with a special focus on the financial instability in the provincial health department.
“…Its role is to monitor expenditure and efficiency. Provincial Treasury will continue to support the Department of Health (…) in streamlining their supply chain management processes to achieve value for money through the implementation of strategic sourcing techniques,” Mvoko said at the time.
Unanimous motion
By January, however, the situation had already become a crisis. The Eastern Cape legislature unanimously passed a motion, brought by the DA’s Jane Cowley, compelling the department and MEC Ntandokazi Capa to address the non-payment of suppliers.
Apart from having run up huge bills with pharmaceutical companies, the department also faces legal action from Afrox, a critical supplier of medical gases to public hospitals.
In her motion, Cowley asked that the provincial legislature note that these accruals “reflect systemic financial stress and directly undermine the department’s ability to comply with statutory payment timeframes, jeopardise service provider retention and expose the province to litigation and possible asset attachment”.
She also questioned why the current administration deliberately excluded the Department of Health from its publicly available “Have I Been Paid?” invoice tracking system, thereby limiting transparency and supplier recourse, and undermining the statutory objective of prompt payment within 30 days.
Among other actions, the motion ordered Capa to urgently convene a multi-disciplinary task team, comprising senior officials from Health, Treasury, Procurement and Clinical operations, to secure uninterrupted supplies of medical gases and essential consumables, and to report to the legislature on measures taken to protect patient safety.
The motion further stated that Capa must table a comprehensive, time-bound payment plan for all outstanding and compliant supplier invoices, clearly identifying funding sources, payment milestones and the implications for future procurement and service continuity.
The motion also ordered Premier Oscar Mabuyane to present a status report to the legislature on the “Have I Been Paid?” system, specifically including concrete steps to incorporate the Department of Health into the platform to restore transparency and accountability in supplier payments.
Auditor-General report
At the start of the current financial year, R514.2m was allocated specifically to cover unpaid bills. According to the Auditor-General report for the department, tabled in Parliament in November 2025, these unpaid bills have now run up to R7bn.
In this report, the Auditor-General highlighted that the department’s total liabilities exceeded its assets and it also had to commit 69% of its budget for 2025/2026 to cover accruals.
The Auditor-General also issued a dire warning: “Service delivery risk – high deficits and/or cash shortfalls result in delayed payments to suppliers and service providers, leading to disruption in healthcare delivery. Provinces are at risk of procurement delays for medicines, equipment and infrastructure maintenance.
“A lack of available medical support results in compromised health services, leading to negligence, risking citizens’ well-being.”
Repeating crisis
Last year, Eastern Cape hospitals were hit by chemotherapy outages, also because of the non-payment of accounts, while some hospitals battled with a needle shortage. The year before that, ambulance services were disconnected because of non-payment to Telkom. Dire cash flow problems also saw the department suspend overtime payments until the new financial year.
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