A health worker has described a “point of no return” in Gauteng’s public health services as prolonged freezing of posts and the potential loss of sessional workers pose a risk to patient care – but the provincial Department of Health says “posts are not frozen”, that budget constraints have necessitated a “cautious approach” to cash flow management.
Staff, however, warn that the system is on the brink of collapse.
*Lucy, a health worker at a government facility, told Daily Maverick the public could face a “massive reduction” in essential medical services if posts continued to go unfilled.
“This is the first time I can honestly say I think Gauteng Health is going to collapse… I’ve stayed …for so long because I’ve really believed we could make a difference, that maybe next year will be better, but this is the first year I’m seeking opportunities in private,” she said.
“By next year, I definitely don’t want to work here. I’m trying to make an exit now…I feel this is a point of no return.”
Prolonged post freezes
A major problem is the freeze on employing new staff, in place since October 2024. This reportedly coincided with a freeze on the equipment budget, halting the ordering of new equipment across provincial hospitals.
In February 2025, Gauteng Department of Health Deputy Director-General (DDG) Basani Baloyi allegedly met hospital CEOs and human resource managers to tell them the post freeze would continue, and sessional worker contracts would not be renewed in the new financial year, according to Lucy.
These contracts, usually renewed at the end of March, are for employees who work for only a certain number of hours each month.
An internal memo, dated 3 March 2025, has since been circulated at the health facility where Lucy works, confirming that all sessional worker contracts would be terminated at the end of the month.
Lucy told Daily Maverick her department would lose 25% of its workers as a result. It had already lost 31% of its workforce since October 2024, due to post freezes, illness and redistribution.
“I’ve been through post freezes before. I’ve worked for Gauteng Health for about 15 years, and we went through it in 2018 and it was very unpleasant… but this is on another level. We’ve never had our sessional doctors cancelled… I really think this is an indicator the country is probably in massive trouble,” she said.
‘Out of money’
Jack Bloom, DA shadow MEC for health in Gauteng, confirmed he had heard reports of frozen posts and equipment budgets from doctors.
“It is a freeze, whatever they tell you. It’s hitting hospitals very severely. And the latest… is they’ll only be able to fill posts in July (2025). That will be the second quarter of the financial year,” he said.
“It’s basically a crisis. At the end of the second quarter (of 2024/25), (Gauteng Health) was talking about a deficit of R4.8bn; at the end of the third quarter, which was the end of December, it was R7.3bn. Maybe freezing things slowed down the deficit, but it’s heading towards R9bn or R10bn by the end of this month. So, basically, they’ve already run out of money.”
On 18 February, Bloom issued a press release stating that the National Treasury had refused the Gauteng Department of Health’s request for R291m to fill 1 180 critical vacancies, due to the department’s projected over-expenditure on cost of employment.
Some vacancies were:
• The HoD for surgery at Chris Hani Baragwanath Hospital;
• HoD for orthopaedics at Kalafong Hospital;
• HoD for internal medicine at Tembisa Hospital;
• The head of the unit for anaesthesia at Rahima Moosa Hospital;
• The head of the unit for psychiatry at Tshwane District Hospital; and
• The heads of units for radiology and anaesthesia at Helen Joseph Hospital.
Bloom told Daily Maverick he had heard that sessional worker contracts would be cut at Helen Joseph Hospital and elsewhere at the end of March.
“It’s just a brutal across the board (post) freeze… Effectively, it’s a butcher’s knife they’re using, not a scalpel,” he said.
Both Bloom and Lucy said the non-payment of suppliers at facilities was a problem, including service providers like Egoli Gas and Buhle Waste.
Bloom noted that some accruals dated back to before the Covid-19 era.
“What will happen is they will try to settle them in the first quarter (of 2025/26)… so they’re just going to rob the next financial year, and there’s no fat in the budget.”
Russell Rensburg, director of the Rural Health Advocacy Project, pointed out that on top of the financial constraints within Gauteng Health, the province was also one of the largest recipients of funding from Pepfar.
“I think there’s a need, especially in Gauteng, to really try to get all of the stakeholders in the room and get a better sense of what is urgent,” he said.
“In Gauteng, because of how the services are structured where there’s probably more funding for regional and tertiary type hospitals and less funding for district health services and clinics… we need to use this crisis as an opportunity to understand the best transition plan for the province. One of my recommendations would to place Gauteng (Health) under national administration, so we can unlock some new ideas around how we can improve things.”
Bloom echoed the call for Gauteng Health to be placed under administration.
Funding queries
Daily Maverick contacted the Gauteng Department of Health about the alleged funding crisis, and among the questions was whether Health DDG Baloyi had met hospital leadership about the cancelling of sessional worker contracts in the upcoming financial year.
While it didn’t respond to this question directly, it noted that “like all other government departments, the Gauteng Department of Health is affected by the cost containment measures implemented by National Treasury”.
Spokesperson Motalatale Modiba said the department had adopted a “cautious approach to cash flow management”, which included the prioritisation of critical services and projects while deferring non-urgent expenditure. He said these measures were temporary and subject to regular review as the financial year progressed.
The department maintains that posts are not frozen. However, it has “prioritised the filling of critical, clinical and strategic posts to ensure continuity of services”, said Modiba.
Gauteng Health, Modiba added, had employed 169 new medical officers, including bursary holders, and filled 350 posts for community service nurses, clinical psychologists, diagnostic radiographers and “other categories” of health workers.
“The other posts could not be filled due to the department projecting an over expenditure on compensation of employee budget.
“With the above appointments, we would like to assure the public that services will not collapse. We are working to ensure that in the new financial year, we will continue to prioritise the filling of other clinical and support posts.”
The delays in payments to suppliers were largely due to “cash flow pressures” arising from budget constraints and the need to prioritise essential health services.
“The Gauteng Department of Health remains committed to honouring its obligations and is engaging with both provincial treasury and affected suppliers to resolve outstanding matters promptly,” he said.
On the matter of the freezing of the equipment budget, Modiba said they had incurred overspending on machinery and equipment due to accrual payments.
“We are working on a strategy to minimise accruals as this has an impact on our current budget. It is important that we maintain fiscal balance amid growing needs and a growing population.”
See more from MedicalBrief archives:
Freeze on equipment outlays as Gauteng budget falters
Overtime cuts impact on hospital services
Gauteng Health owes millions in unpaid hospital electricity bills
Gauteng Health owes thousands of suppliers R4bn
Tembisa Hospital buckling under pressure of shortages
Gauteng Health in trouble for unpaid R1bn owed to suppliers
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