How Gauteng left millions unspent while hospitals fell apart

How Gauteng left millions unspent while hospitals fell apart

At a time when Gauteng’s hospitals are buckling under pressure, the province’s health department is preparing to hand back hundreds of millions of rands it failed to spend. The figure is staggering: R725 million unspent in the 2025/26 financial year, despite broken infrastructure, chronic staff shortages and desperate pleas from patients and healthcare workers alike.

According to a reply in the Gauteng Provincial Legislature, the underspending means only R261 million will be carried over with Treasury approval. The remaining R463.5 million will flow back to the national fiscus, money that will not fix leaking hospital roofs, fill vacant posts or clear unpaid supplier accounts.

A system starved, not of money, but of management

The Democratic Alliance’s Jack Bloom has described the situation as indefensible. He points to hospitals that are visibly crumbling, essential equipment that never arrives, and suppliers waiting months to be paid, all while money sits unused.

Officials have blamed delays in construction projects, late invoices from contractors and slow delivery of equipment. But critics argue these explanations wear thin in a province where health facilities have been deteriorating for years.

Treasury’s concern has gone beyond spreadsheets. Gauteng Health was reportedly warned it could be placed under administration, alongside other struggling provinces, due to risks including medication stock-outs, unpaid service providers, ballooning salary costs and persistently high vacancy rates for doctors and nurses.

Governance failures run deep

The budget failure does not exist in isolation. The Auditor-General has previously found Gauteng Health to be the only provincial department to fail all nine key governance areas assessed from procurement and financial controls to strategic planning and consequence management.

Leadership instability has only worsened matters. The department operated for more than three years without a permanent chief financial officer, a gap Bloom has labelled a “recipe for financial chaos”. Further turmoil followed the suspension of head of department Lesiba Malotana after a Special Investigating Unit lifestyle audit flagged him as high risk, amid widening corruption allegations linked to Tembisa Hospital, where more than R2 billion is reportedly implicated.

A familiar pattern of waste

For many Gauteng residents, the story feels depressingly familiar. Last year alone, the province returned over R1 billion to National Treasury after health and education failed to spend their budgets. Irregular expenditure climbed to R4.2 billion, while headline projects such as the Johannesburg Forensic Laboratory remain incomplete despite massive spending.

Community health centres tell the same tale. In Emfuleni, the Boitumelo Community Health Centre still exists largely as a hole in the ground after a decade and R20 million.

What’s at stake for patients

With a R67 billion health budget, Gauteng should be leading the country in care. Instead, patients queue in overcrowded corridors while funds go unused. On social media, frustration has been mounting, with residents asking how a department can claim lack of resources while returning money meant to save lives.

As pressure mounts on Premier Panyaza Lesufi and Health MEC Nomantu Nkomo-Ralehoko, one thing is clear: Gauteng’s health crisis is no longer just about funding. It is about whether the province can finally turn budgets into beds, plans into functioning hospitals, and accountability into action.