Hospitals ‘borrow’ medical equipment to impress inspectors, watchdog warns

The country’s health standards watchdog has raised alarm about health establishments “borrowing” medical equipment and documents from other facilities during inspections in a bid to appear compliant.

The Office of Health Standards Compliance (OHSC) told parliament on Tuesday that this deceptive practice, referred to as “window dressing”, is becoming increasingly common as healthcare establishments rush to obtain certificates of compliance before the rollout of the National Health Insurance (NHI).

“The OHSC has observed instances where some health establishments resort to window dressing by borrowing medical equipment or documents from other facilities during compliance inspections to portray an impression of readiness,” said OHSC CEO Dr Siphiwe Mndaweni.

“This practice is unethical, impermissible and contrary to norms and standards regulations,” she said.

Oversight under strain

The OHSC, which is mandated by the National Health Act to inspect and certify both public and private health establishments, told the parliamentary portfolio committee on health that it is buckling under severe staff shortages and limited funding, crippling its ability to execute its mandate.

During its briefing on the 2024/25 annual performance report, Mndaweni said the resource crisis has weakened inspection coverage, a critical concern given the OHSC’s pivotal role in certifying facilities before NHI accreditation.

“The shortage of human and financial resources compromises inspection coverage, especially in the NHI era, where the OHSC must inspect and certify facilities before accreditation,” Mndaweni said.

Partial inspections and missed targets

Parliament heard that the OHSC failed to inspect all health establishments as required by law, conducting checks on only a portion of public and private facilities. Despite spending 106% of its allocated budget, the OHSC still missed its target under Programme 2, the compliance inspectorate.

The annual target plan for inspection of health establishments was 3,741 and the OHSC managed 3,116

“This shortfall is mainly due to budget constraints, which directly impact service delivery,” the committee was told.

Mndaweni said some planned inspections could not be completed due to various challenges. Some private health facilities were found to be non-acute, no longer operational, or had changed names and registration details.

Inspection statistics

During the 2024/25 financial year, the OHSC conducted 715 routine inspections at public health establishments. The Eastern Cape recorded the highest number of inspections (170), while the Free State had the lowest (21).

Thirteen private health establishments were not inspected, two had shut down, one was not fully functional as an acute facility, one used multiple names, and nine were classified as non-acute establishments.

Achievements and governance

Despite these operational challenges, Mndaweni said the OHSC had achieved 308 re-inspections and conducted several risk-based inspections.

She added that the entity continues to demonstrate sound governance, having consistently received unqualified audit opinions from the auditor-general of South Africa.

“This is important for attaining high-quality Universal Health Coverage,” Mndaweni said, adding that the OHSC plans to review and update its norms and standards to include health outcomes and incorporate critical new elements.

“The self-assessment for private acute hospitals was launched, and 205 out of 215 hospitals completed their self-assessment during the financial year. The OHSC conducted guidance and support workshops, achieving 159% of its target,” she said.

Treatment Action Campaign Gauteng chairperson Monwabisi Mbasa said the borrowing of equipment and documents needs to be condemned.

“It gives a wrong impression. Actually it is fraud and taking away from patients. For instance hospitals have to refer patients to other hospitals because they don’t have equipment. It would be wrong for them to pretend they have all the equipment just to get a compliance certificate,” he said.