National Health Council funding of 1,650 health worker posts welcomed

The National Health Council’s (NHC’s) announcement that it had approved R1.78-billion in spending to hire 1,650 public health workers has been deemed a positive, necessary step by professionals in the health sector, especially in light of the budget constraints and frozen health posts that have plagued state facilities in recent years.

However, the non-profit Rural Health Advocacy Project (RHAP) stressed the need to ensure that the new staff are distributed evenly between urban and rural areas to ensure that the healthcare needs of underserved populations are met.

Russell Rensburg, the director of RHAP, said: “We welcome these appointments. The human resources will be critical in aiding the National Department of Health to achieve its targets in its ambitious campaign to bring 1.1 million people living with HIV into treatment as part of its Close the Gap campaign, along with its End TB campaign, which aims to test five million people for TB.

“It’s unclear how the posts will be distributed. Each province comes up with a list [of posts to be filled] — is there any kind of process to determine where additional human resources will have the biggest impact?”

Read more:

• Godongwana’s Budget promises improved funding for the health sector — but is it enough?


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

Boost to public health workforce

The NHC is made up of Minister of Health Dr Aaron Motsoaledi, Deputy Minister of Health Dr Joe Phaahla, provincial health MECs and representatives of the South African Local Government Association and the military.

Motsoaledi announced the NHC’s decision to approve advertising of the posts on Thursday, 10 April, stating the NHC was greenlighting jobs for 1,200 doctors, 200 nurses and 250 other healthcare professionals.

Dr Percy Mahlathi, the deputy director-general in the National Department of Health, told Daily Maverick that the distribution of posts among provinces would be determined once the provincial departments of health confirmed how many qualified applicants they had received for the number of posts they advertised.

“You might find that, for instance, the Northern Cape wants to employ 80, but only 40 people apply — then the excess that is there would be distributed to other provinces, [such as] a province that advertised 115 [posts] but got 150 applications,” he said.

The provinces were prioritising applicants who had just completed their community service, said Mahlathi, to address the pool of about 1,500 newly qualified doctors who were unemployed.

“Employing even one [additional] health professional in public service is appreciated, because if you have two hands less, one brain less in the public health service, it’s a problem,” he said.

“If you actually look at a public health service that about 84% of the population depends on, we would never be able to get to a stage where we say, ‘Oh, we’ve got enough now.’ If there was a way, and we had adequate resources, we would actually be wanting to employ every health professional in the public service. But we know that’s not possible.”



The NHC’s announcement comes at a time of much uncertainty around the 2025 Budget. While the fiscal framework was passed by a narrow margin in the National Assembly on 2 April, the ANC is facing pushback from a number of parties about a planned VAT hike of 0.5 percentage points.

It is unclear at this stage whether the ANC will abandon the increase and how this might affect the budget for the health sector.

Read more: Next steps: ANC’s plan to navigate budget impasse and restore coalition trust

Rensburg questioned whether the decisions of the NHC would be sustainable if the current version of the Budget fell through.

“There’s also the question, obviously: Is this funded? What happens when, for instance, they agree that there’s no VAT increase and then there’s no money? I think that’s kind of the elephant in the room,” he said.

Committee for policy review

The NHC announced that it was launching a review of certain human resource policies in the health sector through the appointment of a “review committee”.

“There are a lot of health policies adopted at the dawn of democracy which we believe are now obsolete or no longer serve the purpose they were intended for. Some of them have created unnecessary costs without any tangible benefits. We can even say some have actually contributed to the undermining of the public sector’s ability to deliver quality services,” stated the NHC.

The committee was made up of people with experience in the public service, academia and clinical services, said Mahlathi.

Among the experts who make up the group are Dr Cassius Lubisi, former director-general of the Presidency; Laetitia Rispel, professor of public health at the University of Pretoria; Professor Eric Buch, former dean of the Faculty of Health Sciences at the University of Pretoria; and Professor Somadoda Fikeni, chair of the Public Service Commission.

“It’s an array of individuals that would be able to understand policy and practice ... and of course, that team will be interviewing quite a number of people. It will take submissions from across the board, so that when it comes to its recommendations, they are relevant and appropriate,” said Mahlathi.

Both Rensburg and Dr Shuaib Manjra, a human rights activist and board member of the Health Justice Initiative, said the committee was made up of well-qualified individuals.

However, Rensburg was concerned about the lack of patient or rural health sector representation within the group. He stressed that decisions about policy changes should be driven by data, rather than ideology or a drive to cut costs.

Mahlathi said the policies under review included:

• The one-year community service requirement for newly qualified doctors;


• The provision of a “rural allowance” to health professionals working in rural areas, designed to attract more workers in under-resourced areas;


• The management of commuted overtime for health workers; and


• The Remunerative Work Outside the Public Service (RWOPS) policy, which allows public sector health professionals to take on additional, private sector work.

“The question that has arisen is, if you spend about R7-billion on commuted overtime, because you are paying a few who are in the system, but you’ve got people outside the system who are unemployed, why not bring them in? And you use part of that commuted overtime budget to be able to employ those who are unemployed,” said Mahlathi.

Referring to the RWOPS policy, he said that it had become “unmanageable”, as a failure of oversight had allowed some professionals to take advantage of the system, shirking their public sector duties in favour of private-practice work.

Manjra said that the policy for RWOPS needed to be clearer and better regulated. He also highlighted concerns around discontinuing the mandatory community service requirement for young doctors.

“It’s a huge cost to the state, paying community service doctors. On the other hand, it’s a benefit to doctors because it guarantees you employment for another year in the public sector. And of course, it improves training in the sense that it gives doctors another year in the system,” said Manjra.

“To me, it’s important to doctors, but it’s a drain on the state... Whether they keep it or do away with it, somebody’s going to pay a price for that.”

Matters of procurement

The NHC said R1.3-billion had been allocated to procure 1.4 million items, including beds, mattresses, bassinets and linen, for public hospitals.

“One of the biggest differences between the public and private sectors is the hotelling services,” said the NHC.

It referenced the recently released Health Ombud report on the investigation into allegations against Helen Joseph Hospital in Gauteng, which followed a 2024 incident when radio personality Thomas Holmes — also known as Tom London — shared a video claiming he had experienced substandard care at the facility.

“[Of] seven complaints reported to the Health Ombud, five of them were dismissed as unfounded, and they have got to do with clinical care. The other two have to do with the issues of hotelling services,” said the NHC.

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

After “persistent media reports” about possible corruption and irregularities in the process that saw the Independent Development Trust tasked with overseeing the installation of self-generating oxygen plants in 55 hospitals across SA, the National Department of Health has elected to move the project to the Development Bank of Southern Africa (DBSA), according to the NHC.

“We wish to inform the public that the project had not yet started, so it was easier to move it to DBSA. We are also looking into the possibility of giving some of the hospital infrastructure maintenance to the DBSA,” said the NHC. DM