Auditor-general flags weak accountability as health sector audit outcomes slip
· Citizen
The Auditor-General of South Africa said health audit outcomes regressed in 2025-26, with repeat findings and billions in medico-legal claims straining budgets and patient care.
The auditor-general told parliament’s portfolio committee on health on Thursday that the provincial health sector regressed.
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Gauteng received a qualified opinion after an unqualified result the year before, leaving five of 10 departments with qualifications.
According to the auditor-general, “The prevailing culture across these provinces appears to be one of weak accountability, inadequate ownership of controls, limited consequence for non-performance, and a reactive approach to governance, resulting in recurring audit findings, repeat qualifications and an inability to achieve sustainable improvements in audit outcomes.”
The report said no other department improved, although the Northern Cape reduced its qualification paragraphs.
Fiscal pressure from medico-legal claims
Medico-legal claims stood at R50.2 billion in 2025-26, while settlements totalled R1.57 billion.
The auditor-general found that only the Western Cape, Limpopo and KwaZulu-Natal made specific budget provisions for these claims.
The report said funds meant for goods, services and medical supplies were often diverted to settle litigation.
“This has a direct and adverse effect on the ability of departments to deliver quality healthcare services, as resources intended to support patient care are used to meet legal obligations,” it added.
The Eastern Cape also incurred R361 million in unauthorised expenditure for this reason.
The auditor-general recommended that departments “implement robust processes to independently assess and regularly review the valuation of medico-legal claims”.
Hospitals struggle with basic services
Auditors found that stock control, hand hygiene and staffing problems persisted at regional, tertiary and central hospitals.
Governance structures were absent or not functioning in eight provinces.
At 40 district hospitals, the audit found that up to 97% of referred cases could have been treated locally with a functioning theatre.
“Patients travel farther and at greater cost to access basic surgical and maternity services,” the auditor-general warned.
National department stays stagnant
At national level, four of seven entities achieved clean audits, with the Council for Medical Schemes joining the group.
The National Department of Health and the Mines and Works Compensation Fund again received unqualified opinions with findings.
The report said the department had not implemented consequence management and still had R187 million in irregular expenditure that remained unresolved.
The National Health Laboratory Service audit remained outstanding.
Call for sustained corrective action
The auditor-general said the problem was not identifying faults.
According to the report, “The sector’s challenge is not knowing what needs to be fixed, but consistently implementing and sustaining corrective action.”
It recommended that executives own every repeat finding and that quarterly accountability reviews be introduced.
“Until accountability, control discipline and proactive oversight improve, repeat findings and qualifications will persist.”