The provincial health department’s failure to spend its budget has once again placed Gauteng’s health system under the spotlight. This comes even as hospitals deteriorate and frontline gaps widen. The Gauteng health department projects an underspend of R725 million for the 2025–26 financial year ending 31 March. This is according to an official reply from the finance and economic development department to the provincial legislature.
The Democratic Alliance’s health spokesperson, Jack Bloom, said the National Treasury has approved only a conditional rollover of R261 million of the unspent amount. That leaves the department returning R463.5 million to the national fiscus. In practice, the department will fail to use allocated healthcare funds to address urgent needs this year. This is despite ongoing pressure on facilities and staff.
Bloom described the underspending as indefensible, given reports of crumbling hospitals, critical vacancies, late payment to suppliers, and shortages of essential equipment. He said these conditions should make accelerated, well-managed spending a priority. He added that this should not be an ongoing failure.
Why the Gauteng Health Budget was not Spent
Bloom blamed the under-expenditure on delayed projects and contractors' late invoice submissions. He also cited delays in the delivery of machinery and equipment. These explanations are familiar across the public sector. But critics argue they are especially damaging in healthcare. For example, delayed procurement can translate into delayed diagnostics. It can also lead to longer waiting times and deferred maintenance that becomes more expensive over time.
They also criticised the department’s financial controls. Bloom said Gauteng health has been without a permanent chief financial officer for more than three years, calling it “a recipe for financial chaos”. Weak financial leadership can slow decision-making, limit accountability, and create risk around contract management and payment cycles.
Gauteng Health Budget Underspending Adds to Treasury and Governance Warnings
The budget concerns land amid broader scrutiny. In December, reports indicated that the National Treasury would write to Gauteng health MEC Nomantu Nkomo-Ralehoko, demanding she provide reasons against placing the department under administration. Bloom expected the Treasury to send similar correspondence to three other provincial health MECs.
According to Bloom, the issues flagged include a high risk of medication stock-outs driven by chronic late payment of service providers, salary overspending, persistently high doctor and nurse vacancy rates, and budget overruns linked to neglected infrastructure maintenance. Treasury reportedly sounded the alarm regarding medicine stock-outs, warning that the risk spikes when the department fails to pay service providers within 30 days.
Governance findings have also been severe. Bloom said the auditor-general previously found Gauteng to be the only provincial health department to fail all nine assessed governance areas. These include procurement, revenue and expenditure management, strategic planning, consequence management, and the use of conditional grants.
Leadership instability has added to the strain. The Special Investigating Unit (SIU) suspended the department’s head, Lesiba Malotana, following a lifestyle audit. The SIU reportedly flagged him as “high risk”. Corruption allegations have also intensified, with more than R2 billion allegedly looted from Tembisa Hospital.
Bloom stated that the DA will continue to press Premier Panyaza Lesufi to remove Nkomo-Ralehoko, as the province urgently needs competent and ethical leadership. He said proper spending of the department’s R67 billion budget could materially improve healthcare services for Gauteng residents.
A Pattern of Returned Funds and Irregular Spending
The latest underspending is not isolated. In May last year, provincial treasury head Ncumisa Mnyani said Gauteng returned just over R1 billion to National Treasury after health and education failed to spend allocated funds in 2024–25. The province reportedly was unable to spend the full R1.8 billion. The government allocated R1.041 billion of this total to health and education.
In September, finance MEC Lebogang Maile stated that Gauteng departments incurred R4.2 billion in new irregular expenditure during 2024–25. He also cited high-profile infrastructure failures. For example, the department has yet to complete the new Johannesburg Forensic Laboratory or the long-delayed Boitumelo Community Health Centre project in Emfuleni
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