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Treasury warns weak health department controls risk public finances

Published

Five of the nine provincial health departments received qualified audits for 2025/2026, Treasury said in its medium-term budget policy statement. It says medico-legal contingent liabilities stand at R50.6bn and remain a significant risk to provincial health budgets.

Treasury tabled the statement in parliament on Wednesday. It said three other provincial health departments received unqualified audits with findings for 2025/2026. Accruals, which are unpaid obligations, fell from almost R25bn to R20.5bn. Provinces collectively owed the National Health Laboratory Service R10.7bn.

Contingent liabilities for medico-legal claims peaked at about R110bn in 2019/2020. Treasury said: "Medico-legal payments continue to absorb resources from health budgets that could have been used for the delivery of health services". The South African Law Reform Commission has recommended scrapping lump-sum payouts for victims of medical negligence.

Treasury said better management of commuted overtime would free money to employ more doctors. It said efficiencies must be found in rural allowances, medical intern pay and remunerative work outside the public service. A ministerial advisory committee expects to finish its review of that policy in April 2027.

Key facts

Who
Treasury (national department issuing the medium-term budget policy statement); Aaron Motsoaledi (health minister); South African Law Reform Commission (recommended scrapping lump-sum payouts for medical negligence victims); Office of the Auditor-General (told parliament about provincial health audit outcomes)
What
Treasury, in its medium-term budget policy statement tabled in parliament, flagged weak financial controls in provincial health departments as a significant fiscal risk. It reported that five of nine provincial health departments got qualified audits for 2025/2026, and that accruals fell from almost R25bn to R20.5bn while medico-legal contingent liabilities stand at R50.6bn.
When
21 October 2026
Where
South Africa, Western Cape
Status
Reported

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