We Asked the Question: How Can NHI Work When… the Health System is Buckling Under Pressure?

"Under pressure. Under‑resourced. We ask the question: How can NHI work when this is the reality?"

News trigger: MEC under fire as health facilities buckle under pressure — Gauteng’s public health system is facing severe staff shortages, mounting debt, and service delivery strain, with governance failures compounding the crisis.

The Story in Brief

• 25,000+ critical vacancies nationally, with Gauteng unable to fill posts due to budget freezes.

• R8 billion in unpaid accruals — 12% of the provincial health budget gone before the year even starts.

• 19.6 million patient visits in one year — exceeding the province’s population.

• Overcrowded wards, broken equipment, and medicine stock-outs reported across facilities.

• Non-compliance across all audit areas — the only provincial department flagged in every category.

• Court rulings against the department for failing to address cancer treatment backlogs.

Why This Matters for NHI

1. Staffing Crisis  NHI will require a larger, more diverse healthcare workforce to meet increased demand. With thousands of posts frozen and no budget to fill them, the system risks collapsing under the weight of new patient volumes. Understaffing also drives burnout, absenteeism, and attrition — all of which undermine service delivery.

2. Financial Instability  Debt repayments consuming a significant portion of the budget leave little room for infrastructure upgrades, training, or service expansion. If provincial health departments can’t manage existing budgets, NHI funding will be diverted to plugging old holes instead of building new capacity.

3. Infrastructure Deficits  Overcrowded wards, broken diagnostic equipment, and medicine shortages mean that even with NHI coverage, patients could face long waits and compromised care. Without urgent investment in facilities and supply chains, NHI risks replicating — not resolving — current bottlenecks.

4. Governance and Compliance Gaps  NHI will require strict procurement, payroll, and audit controls to prevent waste and corruption. Current non-compliance across all audit areas signals a readiness gap that could derail the scheme’s credibility and efficiency.

5. Public Trust Erosion  NHI’s success depends on public confidence in the system’s ability to deliver. Stories of treatment delays, stock-outs, and court-ordered interventions erode that trust, making it harder to secure buy-in from both the public and healthcare professionals.

The Takeaway

If the NHI is to succeed, these systemic weaknesses must be addressed before rollout — not after. That means:

• Stabilising provincial health budgets and clearing legacy debt.

• Filling critical vacancies and retaining skilled staff.

• Upgrading infrastructure to meet projected demand.

• Embedding governance reforms to ensure transparency and accountability.

Until then, the question remains: How can NHI work when the system it depends on is already buckling?

Source: MedicalBrief, “MEC under fire as health facilities buckle under pressure”, published 17 September 2025. Available at: https://www.medicalbrief.co.za/mec-under-fire-as-health-facilities-buckle-under-pressure/