Blood labs service faces scramble to keep critical blood tests running

The backbone of South Africa’s public health laboratory system, the National Health Laboratory Service (NHLS), is scrambling to secure new blood-testing providers after running out of funds for pathology services, seeming to have shifted scarce resources from one priority to another.

Business Times can today report that the current contract for small and medium haematology labs at the country’s largest hospitals — including Chris Hani Baragwanath, Charlotte Maxeke, Dr George Mukhari, Tshwane District, Groote Schuur, Red Cross Children’s, Nelson Mandela and Inkosi Albert Luthuli — has lapsed as funds in the blanket purchase agreement (BPA) had run dry.

The services were procured by the government under the BPA, an arrangement used by the NHLS to streamline the continued purchase of high-volume or frequently needed medical equipment, laboratory reagents, diagnostic media products and consumable supplies.

The laboratories, mostly situated in the country’s biggest hospitals, serve a broader network of the country’s more than 400 public hospitals. For example, the histology laboratory at Charlotte Maxeke serves a network of 15 hospitals across Johannesburg.

Small and medium labs process tests locally, drastically cutting down sample transport times. Doctors can get critical data — such as a complete blood count — in minutes rather than days.

Haematological tests can help diagnose anaemia, infection, haemophilia, blood-clotting disorders and leukaemia.

The key laboratories process about 300,000 cases (the entire patient file) and 1.7-million slides a year. Examining a drop of blood on a glass slide can reveal what is actually happening with the patient and so they are important.

Unnerving (Nolo Moima) The NHLS said there is currently no backlog in haematology testing attributable to the lapse of the contract for small and medium laboratories, insisting it has funds available to deliver services to laboratories.

“While the organisation operates in a financially constrained environment and must continually align available resources with growing demand for laboratory services, it has the budget to continue discharging its mandate,” a spokesperson for the entity told Business Times.

“The NHLS faces financial and operational pressures from rising testing demand; laboratory material and consumable costs; exchange-rate movements; logistics; fuel; utilities; information technology and cybersecurity expenses; ageing infrastructure and equipment; and the recruitment and retention of scarce scientific, medical and technical skills.”

These are being actively managed to prioritise essential testing and continuity of patient care.

“Procurement of the required haematology services is under way in line with applicable supply chain management requirements, although a confirmed appointment date for the new service provider is not yet available.”

The procurement documents paint a starker picture than the NHLS’s responses on the lapse of the contract.

According to the tender document: “The current contract for haematology small and medium labs has lapsed due to the depletion of funds on the BPA. The expiration of the contract leaves the laboratories with no services provider to supply the analyser and reagents.”

To enable the laboratories to continue providing haematology testing, a service provider needs to be appointed on a five-year contract, it says.

“This will ensure sustainability to services and allow adequate time for future transactions. Haematology testing forms part of the urgent tests that are critical for patient management at all levels of care.”

The NHLS is an important part of the public healthcare system. It is the only pathology provider for the many South Africans who depend on public health services — handling blood tests, virus tracking and cancer screening for public clinics and hospitals.

An efficient and well-funded pathology service is considered essential for National Health Insurance (NHI) to succeed, as many health-care decisions require a laboratory test.

The NHLS is facing a ballooning debt pile from the provinces it provides services to. Parliament heard in May 2026 that outstanding debt to the NHLS had climbed to R11.3bn, with a large chunk of this coming from South Africa’s two most populous provinces, Gauteng and KwaZulu-Natal.

KwaZulu-Natal owed the NHLS nearly R4bn at the end of March, while Gauteng’s debt came in at R3.3bn.

Health portfolio committee chair Faith Muthambi wrote in the Business Day in June that the huge debts owed by provinces were endangering patients and threatening the very existence of the NHLS.