Gauteng health workers, experts raise alarm as hiring freezes pose risk to patient care

Health workers and policy experts in Gauteng have raised the alarm about a growing crisis in the province’s public health system, as the freezing of posts and financial constraints threaten the quality of care available at facilities.

*Lucy, a health worker at a public health facility in Gauteng who was assigned a pseudonym due to her concerns about professional backlash, told Daily Maverick that 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 in Gauteng health for so long because I’ve really believed that we could make a difference, that maybe next year will be better… but this is the first year… I’m seeking opportunities in private,” said Lucy.

“By next year, I definitely don’t want to work for Gauteng health. I’m trying to make an exit now, because I just feel like this is a point of no return.”

Prolonged post freezes

A key problem at state health facilities is the freeze on the hiring of new staff, in place since October 2024, said Lucy. This reportedly coincided with a freeze on the equipment budget, halting the ordering of new equipment across Gauteng 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 that 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 that 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… and it has never been this long. I really think this is an indicator that the country is probably in massive trouble,” she said.

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‘Out of money’

Jack Bloom, DA shadow MEC for health in Gauteng, confirmed that he had heard reports of frozen posts and equipment budgets from doctors in the Gauteng public health system.

“It is a freeze, whatever they try and tell you otherwise. 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,” said Bloom.

“It’s basically a crisis. At the end of the second quarter [of 2024/25], [the Gauteng Department of Health] was talking about a deficit of R4.8-billion; at the end of the third quarter, which was the end of December, it was R7.3-billion. Maybe freezing things slowed down the deficit, but it’s heading towards R9-billion or R10-billion 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 R291-million to fill 1,180 critical vacancies, due to the department’s projected over-expenditure on cost of employment.

Some vacancies referenced in Bloom’s release were:

• The head of department for surgery at Chris Hani Baragwanath Hospital;


• The head of department for orthopaedics at Kalafong Hospital;


• The head of department 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 that they’re using, not a scalpel,” he said.

In an investigative report on allegations of poor management at Helen Joseph Hospital, released by the Office of the Health Ombud on Monday, 10 March, it was noted that about a third (30.2%) of the funded nursing posts at the hospital were vacant. Health Ombud Prof Taole Mokoena urged the Gauteng Department of Health to review the staff establishment at Helen Joseph and fill vacant posts.

Read more: Tom London Video: Helen Joseph Hospital ombud report reveals substandard care, staff shortages, leadership ‘breakdown’

Both Bloom and Lucy said that the non-payment of suppliers at health facilities was a problem, including service providers such as Egoli Gas and Buhle Waste. Bloom noted that some accruals dated back to before the Covid-19 era.

“What will happen is they’re going to try and 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,” Bloom said.

Russell Rensburg, director of the Rural Health Advocacy Project, pointed out that on top of the financial constraints within the Gauteng Department of Health, the province was also one of the largest recipients of funding from the US President’s Emergency Plan for AIDS Relief (Pepfar), which was paused by an executive order from US President Donald Trump in January this year.

At the end of February, the United States Agency for International Development (USAid) axed its Pepfar funding for HIV/Aids organisations across South Africa and around the world.

Read more: ‘The axe has fallen’ — Trump’s USAID issues notices to terminate funding for key health programmes across SA

“I think there’s a need, especially in Gauteng, to really try and get all the stakeholders in the room and get a better sense of what is urgent,” said Rensburg.

“I think in Gauteng, because of the way 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 what is the best transition plan for the province. One of my recommendations would be that we place Gauteng [health] under national administration, so that we can unlock some new ideas around how we can improve Gauteng health.”

Bloom echoed the call for the Gauteng Department of Health to be placed under administration.

Funding queries

Daily Maverick contacted the Gauteng Department of Health about the alleged funding crisis in the province. Among  the questions was whether Gauteng health DDG Baloyi met hospital leadership about the cancelling of sessional worker contracts in the upcoming financial year.

While the department 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 the National Treasury”.

Gauteng Department of Health spokesperson Motalatale Modiba said that 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 Gauteng Department of Health maintains that posts at state health facilities are not frozen. However, “the department has prioritised the filling of critical, clinical and strategic posts to ensure the continuity of services”, said Modiba.

Modiba said the department 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,” he said.

“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 continue to prioritise the filling of other clinical and support posts.”

According to Modiba, 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 department 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 the department had incurred overspending on its 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 amidst growing needs and a growing Gauteng population,” he said. DM