Gauteng Health has introduced a 'first' in South Africa system to reduce hospital waiting times and unblock surgical access, a situation which has reached crisis levels in some parts of the province and elsewhere in the country as state hospitals grapple with the lack of surgical experts, writes MedicalBrief.
In the Northern Cape, for example, close to 8 000 patients are on the surgical waiting list, and in Pietermaritzburg in KwaZulu-Natal, a chronic shortage of specialists has led to the Grey's Hospital recruiting private cardiologists to reduce long waiting times.
Gauteng health experts say early experience of the Treatment Time Guarantee (TTG) programme, introduced last year, suggests that the value of the programme lies not only in reducing waiting times, but in revealing where surgical access is blocked and where health-system capacity is being lost (see full details in New Gauteng system tackles waiting lists, surgical access in sidebar).
The system is billed as the first initiative of its kind in South Africa, and one of the first attempts in a low- and middle-income public health system to apply waiting-time guarantees across a whole provincial surgical service.
Health experts say rather than leaving patients on opaque lists held separately by individual hospitals, the TTG approach defines when a patient formally enters a treatment pathway, sets a clinically meaningful time expectation, and makes delay visible to clinicians, managers and provincial administrators.
TTGs are designed not simply to shorten waits, but to ensure that patients with similar clinical urgency are treated, regardless of where they enter the provincial health system.
Meanwhile, a chronic shortage of specialists in state facilities – and the mounting difficulties of matching private sector salaries – has led to Pietermaritzburg’s Grey’s Hospital battling to recruit permanent cardiologists and limiting the number of procedures done each week, reports The Witness.
It has also led to a reliance on private cardiologists as global competition for these specialists increases. The shortage is particularly difficult for inland hospitals, where they are often harder to attract.
The KwaZulu-Natal Department of Health said it had tried unsuccessfully to recruit specialists locally and internationally to fill the permanent posts at Grey’s.
“We have undertaken extensive recruitment efforts both nationally and internationally, but been unable to attract full-time cardiologists… these specialists are highly sought after by the private sector,” the department said.
Hospital staff told The Witness only about three patients were seen and treated during weekly sessions by a private cardiologist.
Grey’s has been without permanent cardiologists for several years, confirmed the department, adding that the number of procedures being performed was “currently limited” but that a private cardiologist had been contracted on a part-time basis to perform weekly procedures.
Patients needing urgent or life-saving treatment are referred to Inkosi Albert Luthuli Central Hospital in Durban.
The department was “working to finalise arrangements with a new supplier to ensure the hospital continued to have the equipment needed for procedures”.
Hospital employees said the shortage had been “a real crisis in the cardiology unit for some time”, and that staff morale had suffered they watched patients wait for treatment.
A source claimed that more than 900 patients were waiting for heart bypass surgery at Inkosi Albert Luthuli Central Hospital.
Health Portfolio Committee chairperson Dr Imran Keeka said the limited number of procedures once a week was “far” from adequate. He was not aware of any shortage of coronary stents, he added, but any confirmed shortage would require urgent investigation.
Any investigation should also establish whether similar shortages existed at Inkosi Albert Luthuli Central Hospital, he told The Witness. He suggested public-private partnerships, fixed-term contracts for foreign cardiologists, and dedicated programmes using private specialists to help reduce waiting lists.
Playing catch-up
In Gauteng, the Health Department has launched its fourth Mandela Month Surgical Marathon – from last Saturday until the end of this month – with 19 hospitals having pledged to perform a total of 1 078 surgeries and clinical procedures, surpassing last year’s 806, reports the SABC.
Health spokesperson Steve Mabona said the marathon honours Mandela’s legacy by restoring hope, dignity and timely healthcare to patients across the province.
“The procedures planned will range from hip and knee replacements to specialised interventions, paediatric reconstructive surgery and cardiac procedures. The initiative is further strengthened through partnerships with different organisations.”
Northern Cape backlog
The Northern Cape is also experiencing a massive surgical backlog, with the province’s only tertiary facility, Robert Mangaliso Sobukwe Hospital in Kimberley, struggling to keep up with demand.
According to the National Council of Provinces’ 2025 Oversight Visit report in the Northern Cape, an estimated 7 906 patients are on the surgical waiting list.
One patient, Alfred Montshe (65) told the SABC he had been waiting more than four years for a prostate operation after being referred from Gariep Hospital. He injured himself while working, which had led to further complications. When his condition worsened, he sought treatment and was then told he needed a prostate operation.
He said he has consistently been told to return at a later date, whenever he sees a doctor.
“They have now given me a check-up date for next January. Every time I go to the hospital, my next dates are always after a year or six months,” he said.
The Northern Cape Department of Health said its clinical review team had reviewed Montshe’s file but disputed aspects of his account.
Department spokesperson Lebogang Majaha said records show Montshe’s last visit to the facility was in 2022, which differs from the timeline presented.
“We can also ascertain that from the time he was assessed, there was nothing about him being scheduled on a waiting list for surgery,” she said, adding that Montshe had not kept a follow-up appointment.iting times, but in revealing where surgical access is blocked and where health-system capacity is being lost.
SABC article – Mandela Month surgical marathon to benefit over 1k Gauteng patients (Open access)
The Witness – Shortage of specialists forces Grey’s to use private cardiologists (Open access)
SABC article – N Cape patients face years-long waits as surgical backlog grows (Open access)
See more from MedicalBrief archives:
Free State team performs robotic surgery marathon
Marathon surgery collaboration cuts Kimberley hospital backlog
Surgery marathons to tackle Gauteng backlogs