Original Research

Appropriateness of laboratory expenditure for primary health care facilities across South Africa

Ozayr Mahomed, Naseem Cassim
African Journal of Primary Health Care & Family Medicine | Vol 15, No 1 | a3740 | DOI: https://doi.org/10.4102/phcfm.v15i1.3740 | © 2023 Ozayr Mahomed, Naseem Cassim | This work is licensed under CC Attribution 4.0
Submitted: 09 July 2022 | Published: 19 June 2023

About the author(s)

Ozayr Mahomed, Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
Naseem Cassim, Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; and National Health Laboratory Service, Johannesburg, South Africa


Background: Primary health care (PHC) services have been prioritised from a cost-containment perspective. To manage expenditure, facility managers use the Laboratory Handbook that indicates the Essential Laboratory List (ELL) tests.

Aim: The aim of this study was to analyse PHC laboratory expenditure to assess the impact of the ELL in South Africa.

Setting: We reported ELL compliance at the national, provincial and health district levels.

Methods: A retrospective cross-sectional study was used to analyse data for the 2019 calendar year. The unique tariff code descriptions were used to develop a lookup table to identify ELL compliant testing. Researchers analysed data for the human immunodeficiency virus (HIV) conditional grant tests and by facility for the bottom two districts.

Results: There were 356 497 tests (1.3%) that were not ELL compliant that equated to an expenditure of $2.4 million. Essential Laboratory List compliance ranged from 97.9% to 99.2% for clinics, community healthcare centres and community day centres. The provincial ELL compliance ranged from 97.6% for the Western Cape to 99.9% for the Mpumalanga province. The average cost per ELL test was $7.92. At the district level, ELL compliance ranged from 93.4% for Central Karoo to 100% for Ehlanzeni.

Conclusions: High levels of ELL compliance have been demonstrated from the national to the health district level, demonstrating the value of the ELL.

Contribution: This study provides data for quality improvement initiatives at primary care facilities.


ideal clinic; Essential Laboratory List test; primary health care; healthcare expenditure; South Africa; appropriateness; national health insurance.


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