South Africa’s National Health Laboratory Service (NHLS) spent approximately R116 million between June and November 2025 to outsource cancer pathology tests to private providers. The emergency measure came in response to a national outcry over dangerous delays in public diagnostic services.
NHLS Cancer Test Outsourcing Clears Critical Backlog
The crisis intensified at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), where a backlog of 14,300 cancer tests had accumulated by September. Patients were waiting up to three months for life-saving diagnoses. The Democratic Alliance (DA) raised the alarm, calling the delay a "human rights violation" and reporting it to the South African Human Rights Commission.
To address the emergency, the NHLS contracted private pathology firms - Lancet Laboratories, Ampath, and Pathcare - to clear the backlog quickly.
Public Pressure Forces Emergency Spending
Health Minister Aaron Motsoaledi confirmed in a parliamentary reply that the NHLS fully cleared the backlog by 19 December. However, the rapid turnaround came at a high price. The NHLS has been paying roughly R19.4 million per month to maintain a 48-hour processing standard via its private partners.
At CMJAH alone, reliance on private labs cost the government over R555,000 monthly.
R116 Million Spent On Private Pathology Labs
Lancet Laboratories handled the bulk of the outsourced testing, receiving R82 million. Ampath earned R18 million, while Pathcare - which operates primarily outside Johannesburg - collected R15.8 million.
These short-term arrangements averted further harm to patients but highlighted major weaknesses in the public sector’s diagnostic capacity.
Fiscal Constraints Block Long-Term Insourcing
Minister Motsoaledi acknowledged that while outsourcing helped in the short term, it is not sustainable. Internal assessments show that building NHLS capacity would be significantly cheaper. However, ongoing budget cuts from the National Treasury have left the department unable to expand services or raise fees.
Provincial health departments are also under severe financial stress, limiting their ability to support infrastructure or staffing upgrades.
New Tender Process Underway For Sustainable Solutions
The private-sector contracts expired at the end of December 2025. The NHLS is now working on a new competitive tender process for longer-term diagnostic support. The long-term goal remains to incrementally insource pathology services.
To support this shift, the department will prioritise upgrading diagnostic equipment and increasing staff salaries to attract and retain skilled pathologists. After achieving full staffing levels, the health system will reserve private labs for "exceptional surge scenarios" only.
The NHLS cancer test outsourcing initiative has bought the public health system valuable time. The Department of Health must now prioritise resolving the underlying funding and infrastructure challenges.
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