Medico-legal claims continue to place severe pressure on provincial health budgets, with the Eastern Cape and Gauteng reporting thousands of active cases and escalating financial liabilities.
The Gauteng health department had 707 active medical negligence cases and the Eastern Cape 2,332 up to June. Since 2019, the cumulative cost of such claims across provinces has exceeded R6.1bn, with R1.1bn paid out in 2024 alone.
Medico-legal claims against the state stood at R77bn in March 2024.
Health minister Aaron Motsoaledi provided some of these figures in a written reply to a parliamentary question submitted by EFF MP Mbali Dlamini.
Motsoaledi referred to two key engagements where the issue was addressed in detail: a joint press conference hosted by the national department of health and the Special Investigating Unit (SIU) in August 2024; and a follow-up briefing to a joint meeting of the committees of health, the standing committee on public accounts (Scopa) and the standing committee on appropriations in September 2024.
During these sessions, the department outlined a co-ordinated strategy to address the surge in medico-legal claims, many of which were found to be inflated or fraudulent. The SIU cited a R70m claim in Limpopo, where a patient alleged a botched circumcision — only for investigators to find that no procedure had taken place.
To deal with the crisis, the department has implemented a multipronged response. This includes strengthening patient safety protocols to reduce adverse events in public health facilities; improving medical record-keeping and communication between healthcare providers and patients; and introducing legal reforms such as mediation, a review of contingency fees and staggered payments to claimants.
These measures are aimed at curbing the financial effects of litigation, which has diverted billions of rand away from essential health services. Between April 2024 and early 2025, Gauteng spent R421m and the Eastern Cape R306m on medico-legal payouts. Since 2019, the cumulative cost of claims across provinces has exceeded R6.1bn, with R1.1bn paid out in 2024 alone.
While national payouts declined 8% from R1.2bn in 2022/23 to R1.1bn in 2023/24, Gauteng’s payouts rose 19% from R354m in 2022/23 to R421m between April 2024 and early 2025, and the Eastern Cape’s payouts rose 14% from R269m by January 2024 to R306m by January this year.
The auditor-general reported that the government failed to meet its target of reducing contingent liabilities to under R18bn by 2024. Instead, claims stood at R77bn in March 2024, with most cases involving birth injuries such as cerebral palsy and brain damage.
The department has acknowledged the continued use of manual record-keeping systems has hindered its ability to effectively defend claims. The transition to electronic health records remains a priority in reducing litigation risk.
The SIU’s investigations have already saved the state more than R3.1bn by identifying and preventing fraudulent claims. In the Western Cape, the unit uncovered 33 fraudulent birth injury claims worth R409m. The National Treasury has also reported a decline in contingent liabilities in some provinces, with Gauteng’s liabilities dropping from R18.4bn in 2022/23 to R12.3bn in 2023/24.
Despite these efforts, the volume and cost of medico-legal claims remain a significant threat to the sustainability of public healthcare.
The department has committed to continued collaboration with law enforcement, provincial treasuries and oversight bodies to mitigate these risks and ensure healthcare budgets are used for their intended purpose of delivering quality care to South Africans.
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