Billions in irregular spending rock Mpumalanga health system

The Mpumalanga public health system is facing mounting scrutiny after billions of rands in irregular expenditure, chronic underspending, infrastructure failures and severe staffing shortages were revealed in recent legislative oversight reports.

According to Lowvelder, findings presented to the Portfolio Committee on Health in the Mpumalanga Legislature, and audited by the Auditor-General of South Africa, paint a troubling picture of a department struggling to translate its substantial budget into functioning hospitals, adequate staffing and improved patient care.

The findings raise serious concerns about the province’s readiness to implement the National Health Insurance Act 20 of 2023, which aims to deliver universal healthcare coverage.

Irregular and wasteful expenditure

In the 2024/25 financial year alone, the Department of Health recorded R3.2b in irregular expenditure, largely due to failures to comply with supply chain management regulations.

An additional R145m was classified as fruitless and wasteful expenditure, including payments linked to cancelled contracts and penalties for delayed infrastructure projects.

The pattern has continued into the current financial year.

By the end of the second quarter of 2025/26, irregular expenditure had already reached R1.2b, while a further R87m was lost to wasteful spending, including payments for unused medical equipment and contractor penalties.

Underspending and rising administrative costs

The department underspent R1.8b allocated for infrastructure in 2024/25, leaving hospital upgrades and clinic maintenance incomplete. By mid-year in 2025/26, underspending had reached R4.8b.

Administrative costs increased by 12% in 2024/25 and by a further 9% in the first half of the current financial year, while critical frontline services remained underfunded.

Staffing crisis and EMS delays

The reports highlight a severe staffing crisis affecting healthcare delivery across the province.

In 2024/25, the department aimed to recruit 5 000 nurses but appointed only 3 200, leaving a shortfall of nearly 40%. In the second quarter of 2025/26, only 1 400 healthcare professionals were appointed out of a target of 2 500.

These shortages have placed additional strain on existing staff and contributed to long waiting times, burnout and declining morale.

Mpumalanga Emergency Medical Services remain under pressure, with ambulance response times in rural areas averaging 65 minutes, far exceeding the 40-minute target.

Infrastructure failures

Infrastructure failures continue to undermine healthcare delivery.

Of 20 hospital revitalisation projects planned for 2024/25, only seven were completed.

Similarly, just five of 12 hospital and clinic projects scheduled for completion in the second quarter of 2025/26 were delivered.

Contractor disputes, procurement failures and budget rollovers have delayed critical upgrades.

In one case, a R45m contract for medical equipment was cancelled after late delivery, resulting in wasteful expenditure.

More than R300m allocated for rural clinic upgrades was rolled over instead of being spent, delaying improved healthcare access for vulnerable communities.

Mapulaneng Hospital in Bushbuckridge has been declared unsafe due to severe structural decay, water supply problems and deteriorating infrastructure. Oversight officials warned that parts of the hospital are at risk of collapse.

Despite long-standing plans to replace the hospital, the project remains stalled, leaving communities dependent on unsafe and deteriorating facilities.

Cuba programme and placement concerns

Medical equipment worth millions remains unused due to infrastructure shortcomings and poor planning.

The province has invested more than R150m in training 221 South African medical students in Cuba since 2012 as part of a bilateral co-operation programme.

By 2017, 33 of these students had returned as qualified doctors, but only 17 were placed within Mpumalanga’s healthcare system.

During the same time, Cuban doctors have been appointed while locally trained graduates reportedly remain unemployed. VF Plus MPL Werner Weber said the programme continues to raise serious concerns.

“This imbalance has not only cost millions, but has also further undermined community trust. Healthcare services that restore dignity, properly place doctors, and provide certainty to communities are urgently needed,” he explained.

“The latest findings also show that National Health Insurance (NHI) has little chance of success. If a province cannot manage its existing funds transparently and effectively, a national system requiring even greater responsibility simply cannot be sustainable.”

Calls to pause NHI roll-out

DA MPL Bosman Grobler highlighted both the systemic and political challenges facing Mpumalanga’s health system.

“The only way contractor disputes can be addressed is by involving an independent committee to mediate. The committee must have expertise on both the technical and financial aspects of the project to find a middle ground between the department and the contractor,” he said.

On pausing the NHI roll-out, Grobler emphasised that the roll-out of the NHI will completely deplete the department’s budget.

“With the current system already underperforming, implementation of the NHI would be catastrophic. Facilities are not ready, and staffing shortages are severe.”

On improving health infrastructure delivery, Grobler said: “Contractors should be appointed based on proven track records and sufficient financial reserves to complete projects on budget and on time. Health infrastructure is a major capital expenditure and requires reliable companies.”

He added that South African citizens should be prioritised for appointments.

“Foreign personnel should only be considered if there is a shortage of healthcare professionals or skills.”

Grobler concluded: “The department needs a change in political will, starting with work ethic, pride in your workplace and commitment to service. Facilities must be safe, equipped and comfortable, while systems must be upgraded to increase efficiency. All of this requires political will, which is currently lacking.”

The reports highlight ongoing co-ordination failures between national and provincial health departments, weak contractor management and poor financial oversight.

Questions on the above-mentioned issues have been sent to the Department of Health.

At the time of publishing, no reply had been received.

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