Experts warn that urgent intervention is needed to deal with the staffing crisis in the healthcare sector, which has seen almost 6 000 doctors and nurses resigning every year from government facilities – nearly 125 000 altogether since 2013.
Recommendations include improving working conditions, upgrading infrastructure and developing incentive programmes for rural service – these, plus below-market salaries, all helping to drive professionals toward private practice or overseas opportunities, they observed.
The National Department of Health has previously attributed part of the problem to a reluctance to work in rural areas during the compulsory community service, but recent parliamentary data reveal the actual scale of the problem crippling the sector, reports The Citizen.
Official figures from the Persal system show that between 2013 and 2025, South Africa lost 12 745 doctors and 58 897 nurses from public healthcare facilities – an average of 5 900 doctor and nurse resignations per year over the 12-year period from 2013 to 2024.
When including pharmacists, other healthcare practitioners, and administrative personnel, the total number of staff who have resigned since 2013 reaches a staggering 124 123.
The crisis peaked in 2021 and 2022, when the country lost 1 340 and 1 350 doctors respectively, alongside 6 171 and 5 592 nurses.
The data, provided by Health Minister Dr Aaron Motsoaledi in response to a parliamentary question from DA MP Michéle Clarke, paints a picture of a system under severe strain.
Gauteng has been hit hardest, losing 3 351 doctors since 2013, followed by KwaZulu-Natal with 2 609 resignations.
Provincial breakdowns reveal the widespread nature of the crisis. Since the 2021-2022 peak, Gauteng has lost 1 206 doctors, while KwaZulu-Natal shed 599 medical professionals. The Western Cape recorded 433 doctor resignations, Eastern Cape 356, and Limpopo 322.
For nursing staff, Gauteng led with 4 697 resignations since the peak years, followed by KwaZulu-Natal’s 4 353 and Eastern Cape’s 2 631.
The Persal data has not been updated since January 2025, meaning current losses may be even higher.
However, in January this year, 53 doctors resigned across the country, while a total of 113 nurses resigned.
International brain drain crisis
Lured by greener pastures – good salaries combined with functioning systems – thousands of doctors and healthcare experts are flocking to other parts of the world, contributing to the staffing haemorrhage.
The South African Family Practice (SAFP) has said the brain drain extends beyond just the national borders, with skilled professionals migrating to developed countries.
According to research by Indiran Govender from the SAFP, in 2024 there were more than 23 400 health professionals from South Africa living and working in the United Kingdom, New Zealand, the United States and Australia.
Govender also noted that about 11.13% of South Africans with higher education indicate they are seriously considering emigrating.
The Fellowship of the College of Family Physicians of South Africa degree is widely recognised internationally, making it easier for specialists to emigrate.
“South Africa is argued to play a central role of ‘victim’ as well as ‘executer’ in this process,” Govender wrote.
The country exports doctors to richer nations while importing healthcare workers from poorer African countries.
Push and pull factors
Multiple factors that contribute to exodus from South Africa’s public system.
“Health facilities in South Africa are characterised by poor working conditions, and the salaries are sub-par,” according to Govender. Political instability, crime and economic uncertainty add to the exodus.
Rural placement blamed for staff shortages
Previously, the Health Department said young nurses and doctors did not want to work in rural areas for their community service, leaving underserved communities without critical services.
“We have openings in deep rural areas for community service, where there’s not even a cellphone network, but they tell us they can’t work far from home,” said department spokesperson Foster Mohale.
“They have all sorts of excuses – a sick mother or other reasons. So, it’s a very complicated process.”
This reluctance has left a number of qualified doctors unemployed rather than accepting rural postings. He said that some, after living in the rural areas, opt to resign rather than continue to live in the poverty-stricken regions.
The staffing crisis has been further exacerbated by widespread unemployment among junior doctors.
In January, the South African Medical Association wrote an urgent letter to President Cyril Ramaphosa highlighting that “more than 1 800 junior doctors, having completed their mandatory community service, remain unemployed despite severe shortages in public hospitals”.
The association warned that with only 0.3 doctors per 1 000 people in the public sector, well below the WHO’s recommendation of 1 per 1 000, the healthcare system was critically understaffed.
SAMA estimated that R2bn annually would be needed to create posts for medical officers and registrars, warning that “many are forced to volunteer, work without pay in the public sector, just to maintain their skills and hope for eventual employment”.
It said this fuels emigration, exacerbating the brain drain and further weakening the system.
Remunerative work adds to pressure
The crisis has been compounded by debates over remunerative work outside the public service, allowing employees to take on private practice during off-duty hours.
Motsoaledi blamed the misuse of remunerative work outside the public service for doctor absenteeism and lateness in public facilities.
Former SAMA board chair Dr Angelique Coetzee warned that restricting remunerative work outside the public service could backfire, that while stricter policies could improve public healthcare by ensuring “fewer doctors spending time in private practice, more focus on public healthcare”, overly restrictive measures could worsen the exodus.
“If it’s removed or heavily restricted, some doctors might resign, worsening your shortage of medical professionals in your state hospitals, leading to an increased patient load per doctor, again, negatively affecting patient care,” she cautioned.
Reforms necessary
Govender said South Africa requires comprehensive reforms to stem the exodus from the sector.
“The government should increase accountability in public health institutions, which are characterised by mismanagement and corruption, undermining the efficient functioning of the sector,” he suggested, while increased training capacity and better retention strategies were also critical.
He said without decisive action, universal health coverage plans and broader development goals remain at risk.
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