The failure of five provinces - KwaZulu-Natal, Eastern Cape, Free State, Limpopo and Northern Cape - to spend on vital infrastructure and equipment not only disastrously affects basic healthcare but could hamper the introduction of a national heath insurance scheme.

Some of the funds were budgeted for a trauma unit, hospital improvements and preventing the spread of HIV/Aids.

Responding to a parliamentary question, Health Minister Aaron Motsoaledi yesterday revealed that the five provinces had underspent their allocations for the hospital revitalisation programme by a total of almost R2-billion.

Worst off was Eastern Cape, which was this year criticised for failing to care adequately for people living in rural areas, for whom the health department was allocated R361-million. It underspent by R191-million.

Just over two months ago, refurbishment at some hospitals in Eastern Cape came to a halt because of a funding crisis.

So dire was the situation that the department was struggling to fix broken air-conditioners in operating theatres, placing millions of lives at risk.

Eastern Cape health's acting head of infrastructure, Mlamli Tuswa said : "Revitalisation projects are at risk. There's just no money."

A recent visit by the parliamentary health oversight committee to Nessie Knight Hospital, in Eastern Cape, found that the hospital's infrastructure was dilapidated and it was recommended that the nurses' accommodation, the HIV/Aids and TB wards, and the generator room be condemned and demolished because they were a health and safety risk.

It found the TB wards were poorly ventilated, that the sanitation system needed upgrading and that the sewerage system was dysfunctional.

Motsoaledi - in his written response to DA MP Patricia Kopane - said the failure to spend was due to delays in the awarding of tenders, rolling-over of budgets from the previous financial year, poor performance by contractors and the consequent termination of contracts and court challenges.

KwaZulu-Natal underspent by R228-million, the Free State by R134-million from an infrastructure allocation of R378-million, Limpopo by R89-million from a R323-million budget, and Northern Cape failed to spend R158-million of its R420-million.

Kopane yesterday slammed the underspending.

"Behind the numbers lies a crumbling infrastructure with serious and, in some cases, life-threatening consequences for patients," said Kopane.

She said the Eastern Cape had a R22-billion infrastructure and maintenance backlog.

It is, however, not the first time that millions have been underspent on hospital revitalisation.

Last year, Eastern Cape underspent its HIV/Aids grant by R105-million in the first quarter of the financial year, and Limpopo underspent by R49.5-million.

Eastern Cape underspent its budget for forensic pathology by R14-million and Limpopo by R1.2-million.

"If funding is made available it must be utilised efficiently and effectively," said Kopane.

Karl le Roux , chairman of the Rural Doctors' Association of SA, said: "It is astonishing to hear that Eastern Cape had underspent given the state of many of its hospitals."

Le Roux said the Zithulele Mission Hospital, in Eastern Cape, "had been waiting for the past four years for the last phase of the revitalisation project and a much needed pharmacy".

The hospital needs a new TB ward and an ARV ward.

Two other hospitals, Canzibe and Madwaleni, were also in "desperate need of new facilities and new wards".

Eastern Cape health spokesman Sizwe Kupelo said infrastructure under-spending was due to delays on four major projects but by the end of the financial year the budget would have been met.

Kupelo said that though there were delays, they "did not directly affect the patients".

Some of the delays were due to labour disputes and contractors not meeting their obligations.

Kupelo said the health department was frustrated at the delays in refurbishing hospitals.

"We are not responsible for the appointment of contractors. Our core business is not infrastructure. If there are delays we are equally frustrated.

"Our core business is to render health services. The infrastructure is not our mandate, so we are now forced to get a third party, the Public Works Department and Coega, who are involved in these projects.

"We have money to pay them but they have to appoint contractors. They have to do monitoring."