The National Health Laboratory Service is owed R8.9bn in unpaid accounts by various provinces – while also battling staff shortages and huge backlogs in toxicology reports, and as its failure to produce snake anti-venom makes national headlines.
Countywide, all provincial Departments of Health – except for the Western Cape – owe the NHLS money, the parliamentary Health Committee heard last week.
And with more budget cuts expected, there appears little chance of the non-payment issue improving, according to CEO Dr Koleka Mlisana, who described the debt as “unsustainable” when presenting the NHLS’ annual report to the committee.
State laboratories playing a vital role in the health system, the justice system and the manufacturing of snake, spider and scorpion anti-venom, desperately need a cash injection to upgrade laboratory equipment and hire more professionals, reports Daily Maverick.
The NHLS performs all medical testing, like HIV testing, TB testing and other medical tests for matters like 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 that the only province that does not owe money is the Western Cape.
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 concerning that the NHLS had received permission to increase its tariffs by only 1% in the current financial year, and that further budget cuts would also affect the service. She said there was no indication non-payment trends would improve.
The Eastern Cape Department of Health owes R941m, Gauteng R1.63bn and KwaZulu-Natal R3.1bn, but of this, R2.08bn is under dispute.
Mlisana said 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.
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.
But as things stood, they might not be able to take on the new 1.1m patients Minister of Health Dr Aaron Motsoaledi announced had to be tested for HIV and enrolled for treatment required by December 2025, she added.
Forensic labs
The biggest problems lie with the forensic labs, which are responsible for pre- and post-mortem 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 a need for a large capital injection as well as additional funding to improve operational performance.
“The capital injection is mainly required because the infrastructure has deteriorated, and the additional operational funding is required as these laboratories are currently underfunded,” the report continued.
On the plus side, the NHLS has reported that all forensic labs – except for Johannesburg – have 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. The laboratories managed to reduce only 40% of their forensic backlog.
“We have received approval from the Board to take steps to help us to clear the backlog, which 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 labs 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.
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.
Anti-venom failure
Oliphant acknowledged that they were not producing any anti-venom for snakes, scorpions or spiders. The service had previously produced 9 000 to 10 000 vials a year.
The NHLS claimed this was due to delays in construction and the commissioning of new equipment because the lab had to be updated to comply with international best manufacturing practices.
The DA’s Michéle Clarke, however, said the explanations 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 anti-venom 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 adequate answers.
“In light of the renovations, the DA specifically asked why no procedures were put in place to ensure the continued production of anti-venom. 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.”
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