Overcrowded neonatal wards, shortages of skilled healthcare workers and inadequate intensive care facilities are among the challenges affecting newborn survival in several provinces, the National Department of Health has told Parliament.
The Eastern Cape, Free State, Mpumalanga and North West were identified as facing problems affecting neonatal care during the department’s presentation of its 2025/26 annual report to Parliament’s National Council of Provinces on Wednesday, 28 October 2026.
Director-General Dr Thembisile Xulu said that the Eastern Cape was struggling with neonatal sepsis, overcrowding in neonatal intensive care units and shortages of skilled staff.
In the Free State, prematurity had emerged as a leading contributor to neonatal deaths, alongside resource constraints and shortages of intensive care and hospital beds at Universitas Hospital.
Mpumalanga was experiencing overcrowding in neonatal wards and a lack of high-care and intensive care facilities.
The department also reported that intermediate- and low-risk patients were occupying space at tertiary and central hospitals in the province, despite being suitable for care at lower-level facilities.
In North West, increasing neonatal sepsis, overcrowded wards, inadequate intensive care facilities and a limited number of hospitals providing neonatal services were identified as challenges.
The department said it was proposing the use of district hospitals and maternal, neonatal and paediatric wards to expand neonatal care in the Eastern Cape.
In Mpumalanga, procurement of equipment had been completed, with delivery and distribution under way. District clinical specialist teams were also being appointed and trained to manage small and sick newborns.
The Free State was holding provincial perinatal morbidity and mortality committee meetings with districts to review severe cases and ensure that corrective measures were implemented.
The department reported an institutional maternal mortality ratio of 89.9 deaths per 100,000 live births, against a target of fewer than 100.
However, the national figures concealed provincial challenges. In the Eastern Cape, maternal deaths were associated with cardiac conditions that were not recognised early enough and poorly managed hypertensive disorders of pregnancy.
In Gauteng, poor antenatal care and patients being lost to follow-up were among the reported challenges.
Mpumalanga recorded an increase in maternal deaths linked to haemorrhage.
Xulu said that the proposed interventions included improving healthcare workers’ training in managing obstetric emergencies, encouraging pregnant women to book for antenatal care early and strengthening referral systems for high-risk pregnancies.
The department also planned to strengthen its safe caesarean section programme. The department reported a neonatal mortality rate of 12.5 deaths per 1,000 live births, compared with its target of 12.7.
She said the result indicated some improvement in interventions aimed at reducing newborn deaths, although several provinces continued to face challenges.
The department’s findings point to the need for improved staffing, infrastructure and referral systems to ensure that newborns receive appropriate care at the right level of the health system.