The National Health Laboratory Service (NHLS), the largest diagnostic pathology service in South Africa providing laboratory and related public health services to over 80% of the population, is in a critical state due to a reported accumulated debt of R5 billion owed to them from various provincial health departments.

While some NHLS detractors are blaming financial mismanagement and a dysfunctional board, the crisis is largely attributed to KwaZulu-Natal and Gauteng not paying the NHLS for services rendered – owing R3 billion and R900 million respectively as of March 2014. Gauteng has made headlines in recent months regarding mismanaged finances, whereas rumours have indicated that KwaZulu-Natal wants to pull out of the NHLS and use private services.

According to the report, the lack of financial stability and frustration has resulted in the loss of skilled senior staff – including pathologists, technicians and technologists – to the private sector and overseas employment opportunities. The latest speculation indicates that CEO of the NHLS, Sagie Pillay, may be on his way out after his contract was not renewed when it expired in November 2014. This instability is reported to be severely affecting the NHLS’ capacity to deliver necessary services, such as TB and HIV testing.

Executive Director at the social justice organisation, Section27, Mark Heywood, said: “The NHLS is responsible for most HIV and TB tests in the public health system and plays a critical role in screening for cervical cancer. HIV and TB treatment depend on accurate and timely tests. Without the service, TB, HIV and cancer patients won’t have access to diagnostic testing, which means they won’t be properly treated. The implications are serious: without lab tests, there can be no other services.”

President of the Southern African HIV Clinicians Society, Dr Francesca Conradie, said it’s worrying that technicians and technologists are leaving. “Laboratory testing is a labour-intensive technical service – we train them; we want them to stay with us. If they don’t, we’ll see a decline in quality.”

Conradie added that the collapse of the service would have devastating implications for people who can’t afford private lab tests. “Without the NHLS, healthcare will grind to a halt. This service belongs to South Africa – it must be sorted out urgently,” said Conradie.

Health Minister Aaron Motsoaledi has blamed the situation on the billing system, and in September 2014 announced a process of reforms to save the NHLS. One reform aims to bypass the provinces and pay the NHLS a global lump sum directly from the treasury. Another is to create a national public health institute to monitor disease and respond to outbreaks, which would include the National Institute for Communicable Diseases, the National Institute for Occupational Health and the National Cancer Registry, which is currently run by the NHLS, as well as two new institutes – the National Institute for Non-Communicable Diseases and the National Institute for Injury and Violence Prevention.

Minister Motsoaledi also said the cost of training pathologists and technicians would become the education department’s responsibility instead of the NHLS.

Despite fears that the reforms are too little too late, the NHLS’s quality hasn’t been affected as of yet. However, an unnamed source has warned that this will happen when unpaid suppliers shut down their services. “We collect from every clinic at least once a day. We rely on private people to go to clinics in remote places and if they don’t get paid the logistics chain breaks – and the system collapses.”

Another insider said that because the service is state-owned it is the last to be paid. “We can’t stop services to the provinces because that would mean punishing patients.”

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