NHLS: A Pillar of Progress in South African Healthcare

In the world of public healthcare, few institutions carry the national significance of the National Health Laboratory Service (NHLS). Since its formation in 2001 through an Act of Parliament, NHLS has served as the backbone of South Africa’s disease monitoring, diagnosis, and health surveillance infrastructure. At its core, this government-owned entity ensures that vital pathology services reach all corners of the country, supporting patient care, informing public health policy, and reacting to national health threats with agility and scientific precision.

From the depths of the HIV/AIDS crisis to the ongoing fight against TB and the recent COVID-19 pandemic, NHLS has stood as a consistent and critical player. Today, even amidst operational and reputational challenges that have drawn media attention, the NHLS remains a powerhouse of expertise, infrastructure, and innovation – a national asset that continues to evolve and strengthen under new leadership.

“We aim to provide high-quality laboratory services with continuously improving turnaround times for test results to clinicians to enhance patient management,” says CEO Professor Koleka Mlisana, who took over the reins of the NHLS with a clear vision to modernise and optimise operations across its vast footprint.

STRENGTH IN NUMBERS

With over 260 laboratories across South Africa, the NHLS is a truly national operation, employing thousands of skilled professionals, including pathologists, technologists, scientists, and administrative teams. This immense network enables the NHLS to process more than 114 million diagnostic tests annually – a staggering volume that highlights the scale and relevance of the organisation in everyday healthcare.

“The total number of diagnostic tests performed across all pathology disciplines increased from 110,583,512 in 2022-2023 to 114,495,122 during the reporting period,” confirms Mlisana. “Our revenue increased from R12.2 billion in 2022-2023 to R12.4 billion in 2023-2024, reflecting steady growth and resilience. Revenue from laboratory testing accounted for 93% (R11.5 billion) of total income, underscoring the organisation’s robust operational performance.”

NHLS laboratories play a vital role in national disease surveillance and reporting, feeding real-time data into the decision-making processes of government and healthcare leaders. Its partnership with the National Institute for Communicable Diseases (NICD) is pivotal in identifying and responding to outbreaks – a strength that positions South Africa well in the face of emerging health threats.

STRATEGIC RENEWAL

Upon her appointment, Mlisana inherited a complex organisation facing a shifting healthcare landscape and rising demands on public resources. Rather than shy away, she initiated a far-reaching strategic refresh that positions the NHLS as a digitally enabled, patient-focused, and employee-driven organisation with a renewed sense of purpose.

“Looking ahead, the NHLS is committed to redefining its operations to ensure excellence in pathology services, focusing on patient-centred care and employee engagement. This transformation is anchored in several strategic initiatives,” she explains.

At the heart of this transformation is a hybrid model of service delivery that balances centralised efficiencies with decentralised responsiveness. Advanced specimen tracking systems, investments in automated logistics, and the deployment of next-generation technologies such as AI and digital pathology are reshaping the way diagnostics are delivered.

“The NHLS is enhancing service delivery through a hybrid model that balances centralisation and decentralisation where appropriate,” Mlisana continues. “This is supported by integrating and automating cutting-edge technologies across disciplines alongside improved logistics and specimen tracking systems. These efforts aim to streamline processes, improve accuracy, and reduce turnaround times, delivering better patient outcomes.”

EMPOWERING PEOPLE

Innovation in pathology is not just about machines and data – it’s about the people who make the science work. The NHLS is doubling down on its people strategy, recognising that the expertise and passion of its workforce is what truly sets it apart from commercial laboratories.

“Recognising the importance of its workforce, the NHLS is building a fit-for-purpose, future-focused organisation to secure a competitive edge over private-sector pathology laboratories,” says Mlisana. “This involves increasing the training of pathologists through multidisciplinary collaboration and partnerships with the private sector.”

With clear career development pathways, improved staff retention strategies, and flexible work options, the NHLS is investing in its people like never before. Its commitment to building a future-proof organisation is already visible in its partnerships with universities, professional societies, and training institutions, where the next generation of medical scientists and lab technicians are being groomed.

“The NHLS is also committed to fostering a positive workplace culture by addressing staff retention through flexible working policies, clear career progression pathways, and comprehensive capacity-building programmes for all staff categories.”

DIGITAL TRANSFORMATION

In a healthcare environment that increasingly relies on data, speed, and connectivity, the NHLS is moving boldly toward full digitisation of its corporate functions. Administrative systems that were once paper-based are being automated and optimised, and dashboards powered by business intelligence are enabling faster and smarter decisions.

“The NHLS is digitising its key corporate functions to enhance efficiency and enable data-driven decision-making. This includes automating forms and processes, leveraging business intelligence, and adopting innovative tools to optimise administrative and operational workflows.”

This internal overhaul complements the wider industry drive towards data-driven healthcare, where better outcomes are achieved through analytics, predictive modelling, and real-time monitoring. As South Africa’s leading public pathology network, NHLS is setting the standard for how digital transformation can strengthen patient outcomes and system resilience.

In terms of pure technology, the NHLS is not standing still. Significant investments are being made in digital pathology, rapid diagnostic tests, point-of-care testing, and flexible diagnostic platforms. These innovations are crucial in meeting the growing and diversifying needs of South Africa’s patient population.

“The introduction of cutting-edge technologies is at the forefront of NHLS strategy. Investments in digital pathology, artificial intelligence, next-generation sequencing, rapid diagnostic tests, and point-of-care testing are transforming laboratory operations,” says Mlisana.

By minimising outsourced tests and reducing sample rejection rates, the NHLS is also improving its financial sustainability – a necessary move as South Africa prepares for the implementation of the National Health Insurance (NHI).

“To ensure long-term sustainability, the NHLS is increasing test volumes by addressing logistical challenges and reducing blood sample rejections. Plans to minimise outsourced tests and develop alternative revenue streams are in progress,” Mlisana explains.

“Additionally, the NHLS is preparing for the rollout of the National Health Insurance, positioning itself as a cornerstone of South Africa’s healthcare infrastructure.”

FACING THE FUTURE

The South African healthcare system is undergoing significant change, influenced by policy shifts, technological disruption, and new models of care. The rise of corporate pharmacies, digitised health platforms, and mobile testing solutions are reshaping how diagnostics and treatments are delivered to patients.

A report from BCX outlines how healthcare providers must adapt, stating: “New models are emerging that prioritise accessibility, affordability, and customer experience – demanding that traditional institutions embrace digital transformation or risk falling behind.”

For NHLS, this evolving context represents both a challenge and an opportunity. With its public mandate, national scale, and technical expertise, the organisation is ideally positioned to bridge the gap between old and new. The success of South Africa’s broader healthcare reforms – including NHI – will depend heavily on strong, reliable, and forward-looking institutions like NHLS.

Despite recent scrutiny around issues such as the temporary cessation of antivenom production, the NHLS remains focused on its long-term role in supporting national healthcare outcomes. Facility upgrades, regulatory compliance, and operational enhancements are all underway to ensure this historic institution continues to serve future generations.

With a clear vision, solid leadership, and a commitment to innovation, the NHLS is showing what excellence in public healthcare can look like. Under Professor Mlisana’s guidance, it is transforming into a leaner, smarter, and more responsive organisation – one that not only supports clinical decision-making but also drives policy, research, and national wellbeing.

In a rapidly changing landscape, South Africa needs institutions that can evolve. NHLS is proving that, even with the weight of history and complexity on its shoulders, transformation is not only possible – it is happening.