Scores of public hospitals are run without permanent CEOs

More than 50 public hospitals across South Africa are operating without permanent CEOs, with provinces citing budget cuts and austerity measures as key reasons for delays in filling the critical vacancies.

In Gauteng, more than a third of public hospitals do not have a permanent CEO, with one operating without a chief officer for five years.

This was revealed by Gauteng health MEC Faith Mazibuko in a written reply to a question from DA MPL Jack Bloom in the provincial legislature.

She said 13 of the province’s 37 public hospitals are currently led by acting CEOs.

Gauteng health spokesperson Steve Mabona said delays in filling the vacancies were due to fiscal constraints.

“The delays in filling certain senior management posts were largely influenced by broader fiscal constraints and expenditure management measures implemented across the public sector, including controls aimed at managing expenditure on the compensation of employees’ budget,” said Mabona.

Trade unions have expressed huge concern about maladministration at this hospital, which needs a decent permanent CEO as soon as possible

—  Jack Bloom, DA MPL

Bloom questioned why the Pholosong Hospital CEO position, in Ekurhuleni, had remained vacant for five years.

“It appears there may be a lot of corruption there that was linked to the looting at Thembisa Hospital,” he said. “The late Dr Ashley Mthunzi was the CEO at Pholosong before he became CEO at Thembisa at the time when contracts with fake companies were rife. Trade unions have expressed huge concern about maladministration at this hospital, which needs a decent permanent CEO as soon as possible.”

The issue extends beyond Gauteng, with several provinces reporting significant vacancies.

KwaZulu-Natal health department spokesperson Ntokozo Maphisa said 15 of the province’s 67 hospitals have acting CEOs.

“While we confirm that 15 out of our 67 hospitals currently have vacant CEO posts, the department categorically states that no facility is without leadership,” said Maphisa.

He said acting CEOs had been appointed at all affected hospitals to ensure continuity of administration and patient care.

North-West has four vacant CEO posts.

“The North West department of health has made notable progress in reducing vacancies at senior management level during the 2025/26 financial year,” the department said. “However, four CEO positions at hospitals remain vacant and are currently occupied through acting appointments.”

The department said budget limitations continued to affect recruitment efforts

Mpumalanga, which has 30 public hospitals, has only one CEO vacancy — at the Rob Ferreira Hospital.

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

—  Dwayne Evans, Western Cape health department spokesperson

The Western Cape reported that all hospital CEO positions were filled.

Health department spokesperson Dwayne Evans said there were no vacant CEO posts in its more than 50 public hospitals.

“There are no public hospitals in the Western Cape with a completely vacant CEO position, and no facilities where a permanent hospital CEO appointment has been outstanding for longer than 12 months,” said Evans.

“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 that it had three vacant CEO positions, the Northern Cape said it had 10 vacancies and the Eastern Cape reported 15. The Free State said it was still consolidating its figures.

National department of health spokesperson Foster Mohale said the department was aware of the vacancies across provinces and was working with provincial health departments to fill them.

Mohale said budget cuts and financial constraints were among the main reasons why many senior management positions had remained vacant for extended periods.

The vacancies persist despite substantial public spending on health care. According to the department of health’s 2024/25 annual report, the department 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 health care 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.