The government has failed to guarantee citizens’ right to health care, with deep-rooted structural, governance and capacity weaknesses continuing to undermine service delivery across public health facilities, an Ombudsman report has found.
The report found that the failure is “multi-layered,” spanning infrastructure, medical equipment, human resources and policy oversight. According to the investigation, district and primary hospitals remain unequipped to perform basic specialist procedures, forcing patients to be referred to tertiary hospitals and placing severe strain on already overburdened emergency units.
At the equipment level, the Ombudsman found that the absence of essential items—ranging from basic consumables such as sutures to high-cost diagnostic tools like MRI scanners—has resulted in unnecessary outsourcing of services to private facilities. This, the report states, has “burned through public funds without strengthening long-term public sector capacity.”
“These are textbook indicators of systemic failure,” the Ombudsman noted, adding that the shortcomings reflect failures of design rather than execution. The persistent gaps, the report argues, amount to a failure by the state to allocate sufficient human and material resources to guarantee the right to health, as required under national and international human rights obligations.
In an attempt to manage escalating debt and control referrals, the Ministry took a decision in September 2025 to suspend referrals to private facilities. Under the directive, specialists are now required to seek prior authorisation from the Secretary or Director of Specialised Health Care before referring patients.
The Ministry of Health (MoH), however, acknowledged challenges related to competency, capacity and governance that have contributed to the breakdown in health service delivery. In its submissions to the investigation, the Ministry said that during an internal probe into high medical fees paid to private facilities in early 2025, it uncovered allegations that medical equipment had been intentionally tampered with to force patient referrals to private hospitals.
The Ombudsman noted that these claims could not be verified due to a lack of direct evidence. “If substantiated, such actions would represent serious misconduct and misuse of public resources,” the report stated. While unproven, the allegations were said to provide important context for the persistently high levels of outstanding debt owed to private hospitals and the apparent lack of sustained investment in strengthening government health facilities.
In an attempt to manage escalating debt and control referrals, the Ministry took a decision in September 2025 to suspend referrals to private facilities. Under the directive, specialists are now required to seek prior authorisation from the Secretary or Director of Specialised Health Care before referring patients.
According to the Director of Specialised Health Care, urgent cases are processed immediately and the new system does not impede access to essential diagnostic, surgical or therapeutic interventions. However, the Ministry conceded that delayed decision-making could contribute to the progression of medical conditions, increased morbidity and, in some cases, more complex and costly treatment later.
The Ombudsman further highlighted chronic staff shortages as a central driver of the crisis. The report states that understaffing is the cumulative result of years of poor resource allocation, fragmented planning, underinvestment in infrastructure and equipment, demotivated personnel, and weak governance and leadership.
This has created a vicious cycle in which staff shortages lead to service delays, delays result in overcrowding and outsourcing, and outsourcing places further strain on public finances without improving systemic capacity.
Facilities such as Princess Marina Hospital, Sekgoma Memorial Hospital and Letsholathebe II Memorial Hospital were cited as clear examples, with specialist backlogs stretching from months to years, inadequate theatre capacity, poorly equipped wards and administrative delays that directly undermine access to timely and quality health care.
