26 March 2014
TAC and SECTION27 call on the Minister of Health to urgently bring an end to the financial woes facing the National Health Laboratory Service (NHLS). The continued year-on-year delayed and non-payment by Gauteng and Kwazulu-Natal speaks to a failure of governance and oversight on the part of the National Department of Health and National Parliament.
The NHLS is responsible for the vast majority of HIV and tuberculosis related tests conducted in the South African public health system. It also plays a critical role in screening for cervical cancer which, in the words of the National Minister of Health, is “one of the biggest killers of women” in South Africa. The NHLS has now stopped collecting test samples from certain primary healthcare clinics in Kwazulu-Natal due to the province owing the NHLS an estimated R3 billion. Gauteng, where testing has not yet been interrupted, owes the NHLS an estimated R900 million.
The suspension of NHLS services will severely reduce the quality of healthcare services provided. Optimal HIV and TB treatment is dependent on accurate and timely results from various kinds of blood and other tests. If laboratory services continue to be interrupted this will make a mockery of South Africa’s flagship HIV/AIDS and TB programmes. Ultimately it is patients who will suffer.
It appears that the problem of non or late payment goes back to at least 2010. Despite the numerous attempts on the part of the NHLS to address the issue for example at the end of the 2011/12 financial year Kwazulu-Natal and Gauteng owed the NHLS a combined debt of R1.7 billion. It was only due to an intervention by the Minister of Health who engaged in mediation with the two Provinces that laboratory services were not affected. A ministerial task team was then appointed in 2012 by the minister of health to look specifically into the dispute between the Kwazulu-Natal department of health and the NHLS given the amount the province owed. It appears that the Task Team was unable to resolve the dispute. We will seek clarity from the minister of health on the outcomes of this task team.
Again, at the end of 2012, the NHLS appealed again to Parliament, asking for assistance indicating that they continued to have cash flow problems because of delayed and non-payment by Provinces. And, that this would result in the NHLS being unable to their service providers for the goods and services they need for their day to day operations. The Chief Executive Officer of the NHLS told the National Parliament that to have to shut down services would “be unfair to the patients as their access to health services would be threatened.”
Despite the NHLS being open about the issue with the two provinces it appears the National Minister and National Parliament have not been able to avert a crisis. In October last year, the NHLS annual report of 2012/13 tabled in Parliament, clearly stated that the delayed payment, and non-payment from Gauteng and KZN was threatening their ability to operate, putting patients’ lives at risk and threatening the jobs of those employed by the NHLS. The Chief Executive Officer told Parliament that the “viability and sustainability was seriously threatened, for the second year, due to there still not being any resolution with the debt situation, as the KZN Provincial Health Department owed the NHLS R2 billion alone”.
We understand that part of the dispute involved the Kwazulu-Natal department of health questioning the NHLS’s billing system. The department claimed that the NHLS was not cheaper than private laboratory services and raised concerns about how the NHLS determines its tariffs. However, the NHLS reported to parliament last year that they were offering services at a cost of about 37% lower than the private sector.
It is a disgrace that the NHLS, the two Departments, the National Department of Health and Parliament knew more than three years ago about these problems and that we’re nevertheless now facing, yet again, a crisis. Their failure to have resolved this issue amounts to a serious failure of governance and accountability and oversight. TAC and SECTION27 are deeply concerned that it is patients who have to pay the price for this failure.
TAC and SECTION27 will be writing to the Kwazulu-Natal and Gauteng departments of health to seek clarity on what steps they will take to ensure laboratory services remain available in their public health systems. We will also seek clarity from these provinces as to how this crisis developed and what will be done to prevent such a crisis in future.
TAC and SECTION27 will also ask the Minister of Health to intervene urgently to ensure that there are no further disruptions to testing services in Kwazulu-Natal and Gauteng. We will also seek an explanation from the minister as to how this situation has developed and how it will be resolved.
For media comment please contact:
– Anele Yawa, TAC National Chairperson on 073 555 8849 or
– Thokozile Madonko, SECTION27, on 083 710 3440