The Select Committee on Social Services has called for accountability and immediate interventions to address weaknesses in the public health system. The committee made these remarks during a briefing from the Department of Health on its annual report for the 2025/26 financial year.

In her presentation, the Department of Health Director-General, Dr Thembisile Xulu, said the department had maintained its unqualified audit opinion and achieved its target of paying 100% of valid invoices within 30 days. She also noted that the implementation of key elements of the National Health Insurance (NHI) continues, including the establishment of advisory structures, accreditation systems and electronic health records.

The department also reported that over 3.6 million patients are receiving medication through the Central Chronic Medicines Dispensing and Distribution programme, exceeding the target of 3.5 million patients.

Members of the committee acknowledged the progress made in some areas of the health sector. However, they expressed concern about the gap between budget expenditure and the lived reality of patients using public healthcare facilities, ongoing infrastructure challenges, maternal and neonatal deaths, the slow implementation of corrective actions in provinces, shortages of healthcare professionals and the continued underperformance in service delivery.

The committee questioned the impact of departmental programmes on patient outcomes. Members stressed that performance reporting must move beyond compliance. It must demonstrate the improvements made in the lives of South Africans who depend on the public healthcare system.

Committee Chairperson Ms Desery Fienies said committee members are concerned that many of the challenges identified during oversight visits and by constitutional oversight bodies remain unresolved, despite repeated interventions. “The committee is concerned about communities who continue to experience challenges in accessing quality healthcare services despite significant public investment in the health sector,” she said.

The committee also expressed concern about the infrastructure challenges at health facilities across South Africa. Committee members also questioned the department on the delays affecting projects funded through conditional grants. Of concern were stalled projects and the termination of contracts with implementing agents, which have contributed to underspending in infrastructure programmes.

Committee members questioned whether current reporting mechanisms adequately reflect the impact of government programmes and urged the department to provide clearer evidence linking expenditure and programme implementation to improved outcomes for communities.

The committee welcomed progress in expanding cervical cancer prevention services, youth-friendly healthcare services and chronic medicine dispensing programmes. However, committee members stressed that performance gains must be sustained and must translate into improved healthcare experiences for patients.

On NHI, members of the committee wanted clarity on progress with NHI implementation and why there appeared to be limited evidence of impact. The committee heard that they will not see implementation of NHI-specific interventions until the Constitutional Court has issued a judgment.

Regarding unemployed doctors, the committee questioned why qualified doctors remain unemployed while facilities face staff shortages and high numbers of patients requiring care, as the system continues to be overstretched. The department noted that healthcare professionals more generally are also required, not just doctors. However, doctors remain in the spotlight. The department said it hoped that one day it would have sufficient budgets to employ these doctors.

The committee voiced its concerns about the effectiveness of the government’s response to gender-based violence and femicide (GBVF), particularly the monitoring of cases after survivors have been referred for support services. Members questioned whether adequate systems are in place to track referrals and ensure that victims receive the assistance they require.

In response, the department acknowledged that referrals to social services were not tracked previously. However, systems are now being developed to strengthen monitoring, reporting and coordination across government departments.

The committee said the delays in the processing of forensic evidence in GBVF cases and the possible impact these could have on investigations and access to justice for victims are concerning. The department advised that while health facilities and Thuthuzela Care Centres continue to provide medical and psychosocial support to survivors, delays are often experienced in the processing of DNA and other forensic evidence.

Ms Fienies said the committee expects a coordinated and effective response to GBVF across all sectors of government. She added that weaknesses in referral systems and forensic processes must be addressed to ensure that survivors receive timely support and that perpetrators are held accountable.