The absence of permanent CEOs at state hospitals across South Africa is alarming, with Gauteng alone having 13 out of 37 facilities headed by people in acting positions – one for more than five years, according to provincial Health MEC Faith Mazibuko.
TimesLIVE reports that countrywide, more than 50 public hospitals are operating without permanent CEOs, with provinces saying budget cuts and austerity measures are mainly to blame.
The information was revealed by Mazibuko in a written reply to a question from DA MPL Jack Bloom in the provincial legislature.
Gauteng Health spokesperson Steve Mabona cited fiscal restraints as a reason, in many cases, for the delays in filling the vacancies.
Bloom asked why the Pholosong Hospital CEO position in Ekurhuleni had remained vacant for five years, pointing out that the facility had been linked to the looting and corruption at Tembisa.
“The late Dr Ashley Mthunzi was CEO at Pholosong before he became CEO at Tembisa – when contracts with fake companies were rife – and trade unions have expressed huge concern about maladministration at Pholosong, which needs a decent permanent CEO as soon as possible,” he said.
However, the crisis is not just in Gauteng: KwaZulu-Natal Health spokesperson Ntokozo Maphisa said 15 of that province’s 67 hospitals had acting CEOs, “but the department categorically states that no facility is without leadership”.
North-West has four vacant CEO posts, and had apparently made “notable progress in reducing vacancies at senior management level during the 2025/26 financial year”, although four CEO positions “are currently occupied through acting appointments”.
Mpumalanga, which has 30 public hospitals, has only one CEO vacancy – at Rob Ferreira Hospital.
The Western Cape reported that CEO positions at all 50 hospitals were filled.
Health Department spokesperson Dwayne Evans said “no public hospitals in the Western Cape have a completely vacant CEO position, and there are no facilities where a permanent hospital CEO appointment has been outstanding for longer than 12 months”.
“Leadership stability is an important part of ensuring that public health facilities run well and are able to provide person-centred care, enabling residents to start well, live well and age well, supported by a health system that is run well.”
Limpopo reported three vacant CEO positions, the Northern Cape said it had 10, and the Eastern Cape reported 15. The Free State is still “consolidating its figures”.
National Health spokesperson Foster Mohale said the department was aware of the vacancies and was working with provincial departments to fill them.
The vacancies persist despite substantial public spending on healthcare. According to the Department’s 2024/25 annual report, it spent R61.882bn of its final allocated budget of R62.225bn, representing a 99.4% spending rate.
The largest allocations were directed towards communicable and non-communicable diseases (R25.4bn), hospital systems (R23.9bn) and health system governance and human resources (R7.5bn).
In addition, the National Treasury allocated more than R6.6bn through the health facility revitalisation grant during the 2024/25 financial year for the upgrading, construction and maintenance of infrastructure.
However, critics argue that infrastructure spending alone cannot address governance and management challenges if hospitals continue to operate without permanent leadership at the highest level.
TimesLIVE article – Scores of public hospitals are run without permanent CEOs (Restricted access)
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Call to resolve acting CEO crisis in KZN hospitals
Nursing unions: State hospitals like rudderless ships, with acting CEOS
Convicted fraudster gets CEO job at Free State hospital