BackgroundPrimary 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.AimThe aim of this study was to analyse PHC laboratory expenditure to assess the impact of the ELL in South Africa.SettingWe reported ELL compliance at the national, provincial and health district levels.MethodsA 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.ResultsThere 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.ConclusionsHigh levels of ELL compliance have been demonstrated from the national to the health district level, demonstrating the value of the ELL.ContributionThis study provides data for quality improvement initiatives at primary care facilities.