By Christina Pitt for Spotlight
The Western Cape health department is ramping up its workforce with 800 new frontline posts. After years of austerity and with long lists of vacancies, questions now turn to how soon the new posts will translate into staff on the ground.
The Western Cape health department is adding more than 800 staff to frontline and support services in a bid to strengthen a health system in which hiring has been stifled by years of austerity.
Health MEC Mireille Wenger announced a recruitment drive, which includes 316 nurses, 124 doctors and 80 emergency medical personnel. For medical workers to have more time at their patients’ bedsides, she said this plan also targets 38 allied health professionals, such as physiotherapists and dieticians, alongside 278 administrative and management staff.
As it stands, more than 33 000 staff in the province helped patients more than 20 million times in the last year, according to Wenger. For public hospitals and clinics, the news of the new jobs offers some hope that the constant pressure on staff capacity will be relieved.
One example of where the new jobs may make a difference is with surgical backlogs in the province. Of the nearly 100 000 people waiting for surgery in 2025, 87 975 have been waiting for more than a year, while 20 027 have been on the list for more than 60 months.
Some of these people entered the system during the height of the Covid-19 pandemic and have been left in limbo through years of budget cycles and hiring freezes.
The budget paradox
While governance has been poor in most of South Africa’s nine provincial health departments, with corruption and looting in Gauteng being a particular concern, the Western Cape health department has received seven consecutive clean audits, maintained stable leadership and largely avoided controversy.
As part of a total R106.8 billion package over three years, the Western Cape health department’s 2026/27 budget is R34.47 billion, which is a 6.25% increase from last year. When adjusted for inflation, provincial health budgets have been falling for most of the last decade.
This has contributed to constrained hiring budgets and exacerbated staff shortages. The tide finally turned with above-inflation increases in the 2025 and 2026 budgets – although belts remain very tight.
Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, said that the Western Cape’s health department is a relatively well-run machine yet is dogged by underfunding.
Understanding this requires a look at how provincial health departments are funded.
While provincial health departments get some funds via sources such as provincial revenue and conditional grants, most of their funding flows from the province’s slice of the national budget. For the 2026/27 financial year, the country’s nine provinces was allocated R810.5 billion.
How much each province gets is determined by the provincial equitable share formula, which has been under review since 2015. The provincial equitable share formula considers factors, such as the size of the school-aged population and the number of people living in poverty.
Its health component considers factors like the population without medical aid, adjusted for health risk, medical aid membership, and clinic and hospital visits.
Provinces decide how they divide their share of the budget between their provincial departments.
There are however some issues with the provincial equitable share formula.
Firstly, it makes use of certain data from the South African census, which means that the information does not reflect current demographic and service realities, said Van den Heever (the census is conducted only every 10 years).
Secondly, the usefulness of the results from the latest census of 2022 is in question because certain data sets, such as income, mortality, fertility, and employment figures, were missing.
As a result, National Treasury has been unable to fully update its calculations to factor in the census 2022 data, contributing to a lag in how population changes are reflected in budget formulas.
As far as we can tell, National Treasury has relied on datasets updated at different times in the year, such as Stats SA’s mid-year population estimates, allowing it to phase in changes gradually rather than introduce sudden adjustments.
Broadly, Van den Heever said the result is a system forced to pick up the tab for a population the national budget hasn’t yet acknowledged.
Citing an example linked to health, he says the formula ignores patients who travel from other provinces to access specialist care at tertiary hubs like Groote Schuur Hospital in Cape Town.
The claw-back
Some of the vacancies in the Western Cape health department reflect periods when the government cut funding due to broader economic challenges, Doctor Saadiq Kariem, the department’s Chief Operating Officer, told Spotlight.
Indeed, between 2021 and 2024, the province absorbed an R8.4 billion reduction in its budget allocation.
This has forced leadership to make some tough calls, including vacancies for frontline services like health.
Kariem explained: “It was a process of consciously delaying the filling of those posts so that we could make up for the loss in funding. Sometimes we, along with local managers, decided to shift posts from a vacancy to another part of the service platform based on service needs and pressures.”
He added:
“You know, these are heart-wrenching choices because all of those posts are absolutely essential and I know that not filling them will have an impact on the service provision and result in poorer health outcomes. So yes, the austerity measures had a significant impact on the post-filling rate.”
According to the health department’s annual report, 3 737 people left the department’s employment in the 2024/2025 financial year. By the end of March 2025, 2 772 funded posts remained vacant.
Nationally, vacancies among nursing staff are particularly acute. As of 2023, across enrolled, auxiliary, community service, professional, primary healthcare and specialist nurses, there were about 14 000 vacant posts across the country.
Sabelo Ntshanga, Western Cape provincial secretary of the Democratic Nursing Organisation of South Africa, said burnout caused by workload is the main driver of attrition.
“The reality is that it’s not being filled quickly. It takes up to a year sometimes while the demand in the communities remains high,” he said. “Burnout is underreported and when the nurses get sick from burnout, that’s another burden on top of the shortage of staff.”
Overall, while the 800 new posts represent a step in the right direction, it appears to be more about holding the line than an actual growth spurt. As Kariem says, it represents an effort to “claw back” towards a stable staffing baseline while attempting to invest in future service capacity.
The red tape
Things won’t change overnight, though. Wenger noted in her speech that “it will take time to fill these posts”.
Kariem explained that recruitment follows a multi-stage process as vacancies are advertised, followed by shortlisting and interviews. Final appointments then require approval at different levels of the system, depending on the seniority and specialty of the role. “We see delays throughout the process,” he said.
“Once there is the ability to advertise a post, we have to give sufficient time for an advert to run… then for interviews and for permissions to follow.”
This means that even funded posts can remain unfilled for extended periods as they move through administrative and approval processes.
Adding further delays to an already complex process, the National Treasury and the Department of Public Service and Administration (DPSA) advised cost-containment measures in October 2023, which was extended until March 2025. It required additional approvals before recruitment could proceed.
Wenger bemoaned these regulations when it was rolled out. “The DPSA’s recent regulations, intended to slow down recruitment, are doing real harm to large service delivery departments like Health. Staff retire or move on, and yet our system lacks the agility to replace them fast enough. This leaves remaining healthcare workers overburdened, and services strained,” she said.
At the same time, not all vacancies can be filled due to shortages of suitably qualified candidates, particularly specialist nurses. Kariem explained that this in part reflects longer-term gaps in investment in postgraduate training. He said the department is using recent budget increases to strengthen human resources information systems to better identify skills gaps and fill vacancies.
These staffing pressures also affect training and retention. Ntshanga said they limit the system’s ability to release nurses for professional development, constraining career progression and contributing to low morale.
At Groote Schuur Hospital, the department noted that nursing staff shortages have affected multiple units across the hospital in 2024/25, contributing to reduced service capacity.
For Ntshanga, the new posts are a small drop in a very large bucket. “As much as it is a good deed from the department, it doesn’t come close to what we need on the shop floor,” he said.
This article was first published by Spotlight – health journalism in the public interest. Sign up for the Spotlight newsletter.
