Outsourced cancer tests cost NHLS R18 million monthly, says Minister Motsoaledi

Health Minister Aaron Motsoaledi said building the capacity of the National Health Laboratory Services (NHLS) in terms of staff and equipment was more cost-effective than outsourcing tests to private laboratories.

Motsoaledi said that while it was financially advantageous for the NHLS to in-source, such a move required sufficient budget and cash flow to compete with the higher salaries of private laboratories and high-cost equipment.

“This requires additional funding either through increased fees or an allocation from the National Treasury,” he said.

Motsoaledi was responding to parliamentary questions by DA MP Michele Clarke about NHLS partnering with private sector company, PathCare, to tackle the delays in cancer testing at its Johannesburg facility.

According to Motsoaledi, the provincial Health departments are under severe financial strain.

“So an additional increase in fees will not be accepted by provinces and is likely to result in accruals. The National Treasury has been reducing health budgets and has not been accepting bids for budget increases,” he said.

The minister also said the strategy was to incrementally direct surplus funds towards equipment and staff salaries.

“The use of private laboratories will then be scaled down and reserved only for exceptional surge scenarios once NHLS staffing levels are back to full strength,” said Motsoaledi.

Michele asked Motsoaledi about the vacancies at each NHLS facility and the specific equipment shortages, including but not limited to outdated and broken equipment, and the necessary materials needed to process samples.

The minister’s written replies showed that 46 vacancies have been vacant for periods ranging between three months and three years.

Pathologist posts have yet to be created at laboratories in some smaller provinces or secondary centres.

Motsoaledi’s response indicated that specific equipment shortages included ageing instruments and digital technology delays in all NHLS facilities.

There was a liquid nitrogen supply and occasional stockouts of certain special staining reagents at Charlotte Maxeke Johannesburg Academic Hospital.

The Universitas Hospital in Bloemfontein had a challenge with an automated special stainer, and it was resolved in August when it was installed after the equipment shortage had been experienced for years.

The Western Cape has challenges in digital pathology, but a contract has since been finalised, and it has been rolled out across 14 sites.

The Durban and Johannesburg facilities need new immunohistochemistry analysers, which have since been procured, and the delivery is expected by February.

Clarke asked about the NHLS partnering with Pathcare, which is contracted to perform histopathology tests on tissue biopsies related to cancer diagnostics and handles between 1,500 and 2,000 cases per month.

Motsoaledi said the NHLS was utilising a short-term agreement as an interim measure to tackle the delays in cancer testing at its Johannesburg facility.

“The current PathCare engagement spans approximately six months. It commenced in the second half of 2025 and is expected to run into early 2026.” 

He also said the temporary arrangement was approved as a stopgap measure while the NHLS finalises a longer-term solution through a competitive tender process.

Motsoaledi said the monthly cost fluctuates based on the number of cases referred each month.

“During this period, the NHLS is paying an estimated R15 million to R18 million per month, drawn from a board-approved budget allocation specifically intended for outsourcing to address backlogs.”

The projected total cost was about R90 million to R108 million over the six months.

“This estimate reflects the average monthly expenditure multiplied by the full term. The final amount will depend on actual monthly test volumes.”

Motsoaledi also said the NHLS has entered into short-term outsourcing arrangements with other private pathology laboratories - Lancet Laboratories, Ampath, and Vermaak Pathologists - to supplement the PathCare agreement.

Motsoaledi added that the Lancet, Ampath, and Vermaak process several thousand histopathology cases per month for the NHLS.

“All outsourced testing consists exclusively of histopathological examination of tissue specimens (biopsies and surgical pathology samples). Actual volumes vary month-to-month depending on NHLS internal capacity and operational needs.”

Their monthly costs vary according to the number of cases referred to each provider.

“Collectively, the NHLS spends approximately R15 million to R18 million per month on all outsourced anatomical pathology services, including PathCare, Lancet, Ampath, and Vermaak.”

mayibongwe.maqhina@inl.co.za