Medical negligence costs billions, but SA still can’t measure patient harm

Health-e News Medical negligence costs billions, but SA still can’t measure patient harm South Africa’s medical-negligence crisis is exposing failures far beyond individual doctors and nurses, with experts warning that weak leadership, poor adherence to clinical guidelines, inadequate documentation, staff shortages, and a lack of reliable data are allowing preventable harm to remain invisible.

The warning comes as the Eastern Cape reports that its estimated medico-legal liability has almost halved, from R38 billion to just under R19 billion over five years.

But experts caution that a lower projected compensation bill does not necessarily mean fewer patients are being harmed.

Former Health Ombud Professor Malegapuru William Makgoba says South Africa still lacks a reliable national picture of how many patients die or suffer serious harm because of failures in healthcare.

“We still have no idea what the contribution of the medical profession is to mortality.” Professor Alex van den Heever, chair of Social Security Systems Administration and Management Studies and an adjunct professor at the Wits School of Governance, says the country’s estimated medical-negligence liability should be treated as a warning about healthcare delivery rather than simply a financial problem.

“The legal process is the consequence of the failure to prevent negligence,” he says.

The concerns come ahead of the South African Medical Legal Association’s (SAMLA) annual conference in Gauteng, where experts will discuss medico-legal risk, patient safety and accountability in healthcare.

Billions in potential liability National Treasury puts provincial medico-legal contingent liabilities at R57.6 billion for 2024/25, down from R62.5 billion the previous year.

The figures represent potential future obligations rather than money already paid.

Actual provincial settlements average about R1.5 billion annually.

The Eastern Cape has sought to reduce its exposure partly by providing some injured patients with future care in public facilities instead of paying large lump sums for anticipated medical and rehabilitation costs.

But that approach depends on the state’s ability to provide the promised care over the patient’s lifetime.

A Supreme Court of Appeal judgment on February 11, 2026, highlighted the risk.

The court overturned an Eastern Cape High Court order substituting public healthcare and undertakings to pay for lump-sum compensation for a child injured through negligence.