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The national department of health must be congratulated for receiving its first unqualified auditor-general's report in seven years. This is an indication that the health minister, Aaron Motsoaledi, is starting to turn round the administration that was so badly weakened by Manto Tshabalala-Msimang.

However, given that provinces rolled over a total of R3.3bn last year, that they have accumulated bank overdrafts totaling R8bn (the Western Cape was the only province not to incur significant budget overruns), and that the auditor-general pointed out that the department was still unable to get adequate performance information from many provinces, it is clear that the NHI cannot be implemented until the problem of provincial incapacity is addressed.

In these terms, the Western Cape is the only province that is delivering health services within budget and to capacity.

It is therefore time that health minister Aaron Motsoaledi stated exactly what he is going to do to solve these ongoing problems with provincial performance, because if he does not resolve them before the NHI steam train sets off, the NHI will quickly be derailed.

For many years in a row the auditor general has complained that the national health department cannot get some provinces to send the quarterly reports, which they are legally obliged to submit. These reports contain basic indicators on provincial departments' performance, such as the number of HIV tests conducted and the number of ARV treatments initiated.

If this basic information cannot be obtained, then it is difficult to see how the NHI, which will require enormously complicated reporting and accountability mechanisms on the part of provincial administrations, could work effectively.

Most provinces' failure to produce quarterly reports is a manifestation of poor financial and operational management, which allowed the Free State, for example, to run out of ARV drugs two years ago and also resulted in the under-expenditure of R402 million on the Hospital Revitalisation Grant - intended to rebuild and re-equip dilapidated state hospitals.

A minimum of R8 billion will be needed just to bail out the provinces that overspent their budgets, before additional funds for the NHI can be found.

The direct result of the poor performance of most provinces is that many people have suffered, and even died, unnecessarily. Politicians must not put their grand plans before the requirement to get the basics right.