(Note to Editors: The following debate was delivered during a Sitting of the KZN Legislature held today)
During the 2025/2026 year under review KwaZulu-Natal’s (KZN) Health portfolio committee, under the Government of Provincial Unity (GPU) operated within a constrained oversight environment, characterised by limited institutional time, competing provincial priorities and uneven levels of departmental accountability.
Despite these challenges, the committee adopted a deliberate interventionist and evidence-driven oversight approach. The focus shifted beyond procedural compliance towards outcome-based oversight prioritising service delivery impact, system efficiency and accountability.
The committee’s engagement with the Draft 2026/27 Annual Performance Plan (APP) and budget provided an important opportunity to assess whether KZN’s Department of Health (DoH) planning is responsive, realistic and implementable. While the department complied with procedural requirements, the committee identified several structural weaknesses. These included:
• A misalignment between budget allocations and service delivery pressures, particularly within Emergency Medical Services (EMS);
• Continued under-prioritisation of infrastructure maintenance despite deteriorating facilities; and
• Inadequate integration between human resource planning and actual service delivery demand.
The committee therefore emphasised that compliance with deadlines cannot replace credible and integrated planning linked to measurable outcomes.
The committee also tabled its Budget Report for Vote 7 and identified serious fiscal pressures facing the department. These include unfunded mandates, nationally determined wage agreements and the continued absorption of COVID-19 contract personnel without sufficient budgetary provision.
Particular concern was raised regarding the strain these pressures place on frontline health services. As a result, the committee prioritised EMS through a Focused Intervention Study aimed at strengthening oversight, accountability and sustained monitoring in this critical area.
Throughout the year, the committee considered DoH quarterly and annual performance reports. However, this process was significantly undermined by recurring administrative challenges such as late submission of reports, revised reports differing from analysed versions and limited time for meaningful engagement.
The postponement of the 2024/25 Third Quarter Report due to competing departmental priorities raised concerns about the DoH’s commitment to legislative accountability. Despite these limitations, the committee ensured that all engagements were supported by technical evidence and independent analysis to strengthen the quality of oversight.
The committee further strengthened accountability through monthly tracking of resolutions. Unfortunately, this process consistently exposed delayed implementation, repetitive reporting without measurable progress, and a lack of consequence management for non-compliance.
One of the most significant interventions undertaken during the year was the Focused Intervention Study on KZN EMS. The study, conducted across six districts, exposed deep systemic inefficiencies affecting emergency response capabilities across the province. Key findings included:
• Insufficient and poorly maintained EMS fleets;
• Prolonged response times particularly in rural communities; and
• Serious human resource constraints.
These findings point to a system under severe strain with direct implications for patient outcomes and public confidence. The committee has therefore resolved to continue this intervention into the next financial year to ensure sustained oversight and corrective action.
The committee also conducted several oversight inspections – both scheduled and unannounced – to provincial health facilities. These visits revealed recurring challenges such as:
• Ageing infrastructure;
• Equipment shortages; and
• Inconsistent management effectiveness across facilities.
The committee reiterated that oversight must translate into measurable improvements and that resolutions arising from these visits will continue to be closely monitored.
In addition, the committee undertook proactive Festive Season Readiness Oversight Visits, despite these not forming part of the original annual programme. These inspections assessed the readiness of hospitals during periods of increased road accidents and trauma cases. They also highlighted the growing pressure on emergency and trauma services and reinforced the importance of interdepartmental coordination in improving emergency response capacity during high-demand periods.
The committee also facilitated the 2025 Health Functionality Monitoring Programme across all 11 districts of the province which provided Members with direct insight into public health and EMS facility conditions.
The committee further participated in SCOPA hearings on the Auditor-General’s findings and Finance Portfolio Committee hearings relating to Vote 7, thereby strengthening financial oversight and accountability within the department.
Public participation and stakeholder engagement remained central to the committee’s work. Engagements were held with traditional health practitioners, community structures and affected communities across KZN. Importantly, the committee noted with concern the absence of senior departmental management during some key stakeholder engagements, particularly where community concerns required direct departmental accountability.
Despite numerous constraints, the committee achieved several notable successes during the year under review. These included;
• Improving the identification and claiming of unclaimed bodies through public awareness initiatives
• Strengthening collaboration with the private sector on infrastructure improvements and;
• Enhancing intergovernmental coordination during peak service delivery periods.
The committee also strengthened relationships with Chapter 9 institutions and institutionalised the festive season oversight programme as a standing feature of the Legislature’s annual oversight programme.
However, serious challenges remain. The committee experienced persistent difficulties in obtaining requested reports from the department, with compliance rates estimated at only 50 percent. This undermines effective oversight and constitutes a prima facie breach of the Legislature’s oversight authority as provided for in the Standing Rules. Additional challenges included inadequate meeting time, difficulty securing additional oversight slots and postponements caused by clashes with Cabinet programmes.
In response, the committee has made several key recommendations to the DoH. These include:
• Improving the quality and consistency of reporting;
• Strengthening financial management systems;
• Prioritising EMS fleet renewal and staffing, accelerating infrastructure maintenance institutionalising consequence management; and
• Improving alignment between planning, budgeting and service delivery outcomes.
In conclusion, while the committee substantially met its targets for the 2025/26 financial year, it remains clear that oversight must move beyond procedural compliance towards enforceable accountability.
The committee reaffirms its constitutional mandate in terms of Section 114(2) of the Constitution and will not hesitate to invoke the powers available to it under the Standing Rules where non-compliance persists. Accountability to the Legislature is not optional. It is real, enforceable and necessary to ensure improved health outcomes for the people of KZN. The GPU remains committed to a capable, ethical and very importantly a caring state.