Parliament has called provincial health departments to account for the R11bn they owed the state laboratory service at end-March, a debt that has hampered its operations.The debt to the National Health Laboratory Service (NHLS), which operates about 233 medical testing facilities countrywide, is current and historic, dating back many years. It cites the chronic nonpayment by provinces as a critical risk factor limiting its ability to invest in the new equipment needed for testing and to increase its personnel. NHLS CEO Koleka Mlisana told MPs in parliament’s health committee on Friday that the situation is unsustainable and poses a threat to the entity’s going concern status. Another problem is that approved tariffs have been below the NHLS’s requested level for several years. Koleka told the briefing, which was also attended by provincial MECs and heads of health departments, that the NHLS has held discussions with provinces for some time about the repayment of the debt, and seven have submitted repayment proposals. However, past commitments to pay have not been kept. One solution, Koleka said, is to ask the National Treasury to ringfence provincial laboratory funding as an essential service so that the funds could be transferred directly to the NHLS. If provinces commit to paying their current debt, it would make a big difference to the NHLS’ financial position, she added.NHLS CFO Pumeza Mayekiso estimated that based on current trends the entity is likely to recover only 40% of the outstanding debt. Meanwhile, eight provinces undertook to submit quarterly reports to the committee on the progress made in repaying their debts.The committee sent Eastern Cape health MEC Ntando Capa and her department of health officials packing for submitting their presentation after the meeting had already commenced, contrary to its rules. The provincial representatives said they have or are in the process of drawing up repayment agreements. Committee chair Faith Muthambi said it will talk to the National Treasury about the direct transfer of funds if there is no improvement. The worst offenders are KwaZulu-Natal, with a debt according to the NHLS of R4.8bn at end-March; Gauteng at R3.3bn; and the Eastern Cape at R1.2bn. The North West owed R660m, the Northern Cape R524m, the Free State R331m, Limpopo R81m, Mpumalanga R68m and the Western Cape R58m, the latter three being the best-performing provinces. Koleka Mlisana said the Free State is in a good recovery pattern and the Eastern Cape is moving in a positive direction. The debt of the three best provinces is mostly current, indicating the prompt settlement of invoices. Mlisana is particularly worried about the Gauteng debt, which has increased by 73% in the past year, from R1.9bn in March 2025 to R3.3bn in March this year. The acting head of the Gauteng health department, Darion Barclay, cited increasing migration into Gauteng as playing a role in the debt escalation. He also raised the problems of weak end-to-end verification, duplicate billing, missing requisition forms, rejected tests and limited transaction-level verification, while acknowledging that corruption is a problem. Barclay said Gauteng has submitted a formal payment plan to NHLS that involves paying the historic debt off over three years while simultaneously paying the current debt. The province has proposed that R694m of its debt arising from Covid-19 tests be written off, as no additional funding was received for this. KwaZulu-Natal health department head Penny Msimango said her department faces severe cash flow challenges, which makes payment to all suppliers and service providers difficult, not only the NHLS. There is also a dispute with NHLS over R2.1bn of historic debt. She noted that the NHLS agreed that it owed R803m for the rental of laboratory space since 2006. North West CFO Nancy Mmadire Rampedi said the department of health is underfunded and has suffered budget cuts that hit goods and services. Northern Cape acting health department head Kemothibile Phiri also cited serious funding challenges that mean the budget does not allow for it to service outstanding NHLS debt.