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·      Provincial Treasury strangled the Health department to channel funds to legal matters against the Department of Infrastructure Development (DID) ·      Each of the health facilities only have R2 million for maintenance ·      The Portfolio Committee on Health has recommended that the department should take charge of its infrastructure budget from DID

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Sizwe sama Yende

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Gauteng’s health infrastructure budget for maintenance has been described as a joke after it was slashed by R217.5 million in the current financial year.

Insiders within the Department of Health (DOH) said that this amount was certainly not enough to maintain just over 500 health facilities that include 37 hospitals (four academic and three tertiary), clinics, 15 mortuaries, emergency medical services and others.

The cut was precipitated by litigations and accruals at the Department of Infrastructure Development (DID), which have continued to put a strain on the budget and affected service delivery.

DID, as an implementing agent, controls the department’s entire infrastructure budget. DOH has begun taking it over and decided to rope in the Development Bank of Southern Africa to provide expertise to implement its own infrastructure projects.

The maintenance budget was R1.9 billion in the previous financial year and this year it was cut to about R1.7 billion. This happens despite the overall budget of the Health department having been increased from the previous financial year.

“We were like a purse for the DID, which was allowed to spend as it wished, resulting in accruals. So, about 40% of the R1.7 billion reduced budget we complain about is servicing debt incurred by DID,” a source said.    

According to the 2025 Medium Term Expenditure Framework budget allocation letter from provincial Treasury that City Press has seen, “R217 535 000” was cut for “reimbursement of funds from DOH to DID: court orders.”

The challenge that the province’s health facilities face is summed up in a November 5 Portfolio Committee on Health report.

Following an oversight visit in April, the committee recommended that the national and provincial departments of health should engage in discussions with National Treasury to explore the feasibility of assuming direct responsibility for its infrastructure projects. 

“The hospital’s infrastructure development and maintenance are entirely reliant on the Department of Infrastructure Development (DID), limiting its ability to respond promptly to urgent facility needs. This will assist to mitigate delays often associated with reliance on [DID] and enable more efficient project delivery aligned with the health sector priorities,” reads the report.

The committee visited Tembisa Hospital where it found non-functioning security cameras and general dilapidation as it was built in 1972. 

“Surveillance is inadequate – there are no security cameras installed in critical areas, and the existing cameras are non-functional, posing a significant safety and security risk.”

The tertiary hospital is not coping as it serves about 2.3 million people and does not have a district or regional hospital nearby where patients could first be admitted.

Thirty-eight clinics from Ekurhuleni, City of Johannesburg and Tshwane districts and three three Community Health Centres refer patients directly to Tembisa Hospital.

Gauteng Treasury referred questions about the maintenance budget cut to DID. DID’s spokesperson, Theo Nkonki, did not respond despite acknowledging receipt of questions.

The Gauteng Department of Health’s 2025/2026 is still the second biggest allocation after education at R66 billion. Over three years it will accumulate to R209.1 billion.

At most, the department has less than R2 million budget for maintenance to each facility in the current financial year.

“This is a joke,” an insider said. “Many of the buildings are 50 years old and above. Chris Hani Baragwanath Hospital has about 400 buildings alone and R2.2 million for maintenance of these buildings is a joke and a drop in the ocean.”

The source said the department had to prioritise the most vulnerable patients such new-born babies, mental patients, recapitalisation and purchasing of new equipment and, occupational health and safety (purchase of fire sprinklers).

He also said that purchase of X-ray and sonar machines in clinics and facelifting of emergency services were also among those prioritised.

“For us, this is a matter of life or death. For example, if a room temperature control system is not working, a surgery must be postponed. We’ve prioritised but we are caught between a rock and a hard place.”