The Hospital Association of South Africa (HASA) has announced the appointment of a new Board of Directors following its Annual General Meeting held on Monday, 6 October 2025, in Sandton.
Gale Shabangu from Mediclinic Southern Africa has been elected Chairperson, succeeding Melanie Da Costa from Netcare. Mark Bishop from Lenmed will serve as Deputy Chairperson.
Shabangu is widely recognised for her leadership in advancing inclusive, values-driven corporate cultures across South Africa’s private sector.
The newly elected Board represents a broad cross-section of the private hospital industry, from day hospitals, large hospital groups and smaller hospital operators, bringing together strategic insight, operational experience to strengthen HASA’s role in advancing the country’s healthcare priorities.
HASA Chief Executive Officer, Dr Dumisani Bomela, welcomed the new Board and extended appreciation to the outgoing Chairperson and Board members, and said: “I am pleased to share that HASA has elected a new Board of Directors for 2025/2026 to help steer the Association through the next phase of its journey. We also wish to extend our sincere gratitude to Melanie Da Costa, our outgoing Chairperson, for her dedicated leadership over many years, and for her invaluable insights and contributions, in particular on health policy matters, during her tenure.”
This new Board marks a moment of renewal for HASA, with several young professionals taking their place at the Board table, ensuring the Association plays an even more constructive role in advancing South Africa’s healthcare reform agenda. The collective expertise and insight of our members will ensure that the private hospital sector continues to be a strong partner in building an inclusive, resilient and high-performing health system.”
Dr Deidre McPherson is one of ten women trauma surgeons in South Africa’s public healthcare sector. (Photo: Discovery Foundation)
By Biénne Huisman
Groote Schuur Hospital in Cape Town has one of the busiest emergency centres in the Western Cape. As it turns to the public to raise R20 million for the opening of a new emergency centre, Dr Deidre McPherson chats to Spotlight about the hospital’s trauma frontline.
Deep into the night while most of Cape Town is asleep, trauma surgeon Dr Deidre McPherson slips into work scrubs, hitting the highway to Groote Schuur Hospital to save the lives of critically injured patients.
In a boardroom next to the hospital’s Trauma Centre, McPherson details her solitary early-morning drives along the deserted N1 highway to perform life-saving surgery on people hurt in road accidents, gang violence, and other incidents.
She says she is called out from her home in Bellville past midnight at least once or twice a week. “It’s a surreal feeling,” she says. “I mean driving alone while the rest of the world is sleeping. By now, my husband is used to me leaving at weird times and coming back at like 03:00 or 05:00.”
In South Africa, trauma surgery only became a defined sub-speciality in 2008, meaning a formal training pathway for trauma surgery as its own discipline was created. Trauma surgeons are trained to manage multi-system injuries.
McPerson explains: “We are there at the most crucial moments, when life hangs in the balance. For me, there is nothing more rewarding than seeing a patient arrive critically injured, and walk out the hospital three weeks later, back to their lives.”
R20 million to equip new emergency centre
A new state-of-the-art emergency centre, which includes a new trauma centre, is being constructed at Groote Schuur, beside the existing facility. While it is set to open in 2026, hospital executives are turning to the public for R20 million in additional funding to fit the new premises with upgraded equipment.
As part of the fundraising drive, healthcare professionals recently took journalists on a candid tour of the existing facilities. Inside, corridors are clean but with linoleum floors peeling in places; some patients on trolley beds are stationed against walls, indicating wards filled to capacity.
Just beyond a sign that reads “C14 Welcome to Trauma Centre” – with translations in Afrikaans and isiXhosa – McPherson points out the trauma centre’s resuscitation ward, which can hold six intubated patients, she says. One recent admission can be seen on life support.
Increased capacity and privacy for critically injured patients
McPherson says the new facility will have a more spacious assessment or triage area, where staff decide which patients require immediate life-saving care and which can safely wait.
She says the new trauma centre will expand capacity across all three colour-coded wards. The resuscitation ward (red) will increase from six to ten beds. “This is severe trauma, for example [patients involved in] a motor vehicle accident, with head injury, chest injury and fractures needing life support”. The intermediate ward (yellow) will increase from 12 to 16 beds. “This is moderate trauma, for example, [patients with] multiple fractures, but stable”. The minor ward (green) will increase from 12 to 14 beds. “This is minor trauma for example, [patients with] cuts, bites and bruises – the walking wounded”.
Through the public funding drive, they hope to upgrade the computer system, buy more mobile ventilators for critically injured patients, and get a new full-body X-ray machine for rapid imaging in seconds, which McPherson says is “critical for assessing multiple gunshot or high-impact injuries”.
She says that the centre’s current computer has been in use for over 15 years and frequently stalls. “Sandy, our secretary, is on the phone to IT every second week,” McPherson says, adding that it isn’t necessarily dangerous but that it’s very frustrating. “Time matters so much in trauma,” she emphasises.
In addition, there are lighting issues in some of the examination rooms, with doctors occasionally having to do sutures by headlamp or the flashlight on their phone, McPherson says.
A woman in a male dominated field
During our follow-up interview in the boardroom, McPherson’s gestures are soft, framing her words. Her eyes are level, her cadence precise and unaffected. At present, she is one of ten women trauma surgeons in South Africa’s public sector, compared to 22 men. She is the only woman of four trauma surgeons at Groote Schuur’s trauma centre, which is led by Professor Andrew Nicol.
“Surgery has always been male-dominated and even more so sub-specialties like trauma,” says McPherson. “I was discouraged from following this path by colleagues and even family. This is not a career for women, they said. What if I have a family? The hours are so unpredictable. And there are the violent things we see each day…”
But she was determined. For McPherson, it was a calling, a job she loves. “it doesn’t feel like work,” she says.
Road accidents and gang violence
On average, 1000 patients are admitted to Groote Schuur’s trauma centre per month. Critical injuries, particularly road accidents, spike around Easter, on public holidays, on pay day, and in December, she says. She suggests semigration to Cape Town has seen an additional traffic burden and increased road accidents. Another major contributing factor is accidents involving delivery motorcycle drivers.
In addition, August and September this year have seen a marked month-on-month increase in gunshot wounds, McPherson says, with up to three patients with firearm injuries admitted each day.
“On particularly violent days, that number can rise to as many as 10 patients in 24 hours,” she says.
“What is particularly striking is not just the frequency, but the severity. These are not single gunshot wounds – we often see patients who have sustained multiple injuries, sometimes up to 20 bullet wounds at once.”
This echoes damning murder statistics recently quoted in The Guardian, which notes six people aged from 19 to 25 shot dead over two days in Wallacedene and Eikendal, on the Cape Flats.
Responding, McPherson says: “Sadly what is described in The Guardian is not an isolated incident – it is our daily reality. At Groote Schuur Hospital, we feel that burden first-hand. Every day we are treating teenagers and those in their twenties – who should be building their futures, not fighting for their lives – in our resuscitation bays.”
The latest crime statistics from the South African Police Service lists four precincts on the Cape Flats among the country’s five police stations with the highest murder rates. From January to March this year, Delft had 66 murders, Mfuleni had 65, Nyanga had 63, and Philippi East had 59. This is topped only by Inanda in KwaZulu-Natal which had 74 murders. In each of the last three years over 25 000 people were murdered in South Africa.
This constant cycle of violence is devastating and disheartening, she says, particularly “the high rate of recidivism – when patients return again and again with new injuries”.
For McPherson, cases linked to gender-based violence are especially disturbing. “And yet, as trauma surgeons, we try to focus on what we can do in those critical moments: stop the bleeding, repair the injuries, and give our patients a second chance at life.”
Are there any solutions?
Ultimately, McPherson says the real solution to trauma lies “upstream” in prevention.
“This means tackling the drivers of violence: unemployment, poor housing, failing schools, and the lack of opportunities that trap so many young people in cycles of crime and despair. It also means building safer communities through stronger policing, a justice system that works, and meaningful gun control laws to reduce the number of firearms circulating in our neighbourhoods,” she says.
Then there is preventable road accidents.
“Road traffic injuries remain one of the leading causes of admissions to our unit. As we move into the festive season, I want to urge the public to take responsibility for one another: do not drink and drive, wear seatbelts, and slow down on the roads. These are simple actions that can save lives,” she says.
To this end, she points out the importance of South Africa’s “Arrive Alive” campaign which aims to decrease the number of lives lost on the country’s roads through raising public awareness of road safety. Western Cape officials estimate that 139 people died in road accidents in the province between 1 December 2024 and 11 January 2025, with 627 arrests made for drunk driving.
Childhood inspiration
Born in Bellville to parents who worked in education, the eldest of three sisters, McPherson’s interest in medicine started early, fuelled by a weekly booklet series called How My Body Works. “It was out every Friday, I couldn’t wait for it to arrive. These booklets sparked my fascination with biology and science and it has stayed with me ever since. I still have them at home, packed away in a box,” she says.
McPherson matriculated at Settler’s High School in Parow and studied medicine at Stellenbosch University. She completed her internship at Tygerberg Hospital with a community service year in Atlantis, on the West Coast, where she first saw “how daily violence devastates young people”.
A mother to three-year-old twins, a boy and a girl, McPherson scrolls on her phone to her WhatsApp profile picture, which features her children dressed up in tiny doctor’s scrubs – pink and blue – each with a tiny stethoscope. “It was ‘career day’ so we chose outfits that was easy,” she says, smiling.
McPherson, who also counts a PhD on her resume, says she has processed pangs of “mum guilt” for her children. “My husband has been a constant pillar of support,” she says.
“Plus, I am happy and fulfilled, my children are growing up with a happy mother – but yes, it’s a juggling act, sometimes I have to decide which ball to drop. Is it a rubber ball, that will bounce back, or a glass ball that might shatter?”
To relax, she says she likes to read “sappy romantic fiction” like novels by Danielle Steele.
On her future radar? Becoming a full professor.
In the meantime, McPherson says she believes every encounter is an opportunity to make a difference. “We don’t just treat the injuries, we also try to offer support and counselling, hoping that this time might change the trajectory of a life,” she says.
As the complexities of global healthcare evolve, the need for collaborative, values-driven investment in health systems has never been more urgent. Rand Mutual Assurance’s (RMA) recent completion of the Welkom Sub-Acute Rehabilitation Hospital upgrade offers more than a modern facility; it stands as a bold statement of intent on how the private sector can participate responsibly as a vehicle of driving universal healthcare coverage that addresses the disparities in access to quality healthcare.
General health inequities in South Africa are well-documented and mirror the persistent income inequalities of an unequal society. Bridging these inequity gaps demands multilateral thinking that transcends siloed programme implementation and that sees rehabilitation as a core component of the healing journey. RMA’s approach exemplifies how a private occupational healthcare insurer can work hand-in-hand with regulators, multi-disciplinary clinical teams and local stakeholders, to construct a shared vision for rehabilitation and wellness.
Hospital upgrade
Established in 2016 to provide basic wound care for injured workers and assisted living for disabled ex-miners (RMA pensioners), the Welkom Sub-Acute Hospital has undergone a major upgrade. It now features:
• Specialist wound management and vocational rehabilitationunits
• Assisted living units for ex-workers injured and/or disabled in the line of duty
• A multidisciplinary clinical team of occupational therapists, physiotherapists, sessional medical officers and urologists• 24-hour nursing support and dedicated case management, and
• An in-house orthotics and prosthetics centre developed via a joint venture.
These enhancements speak to RMA’s core values of serving with care and compassion and its aspirations of being a pioneering social insurer. Patients benefit from seamless care journeys that prioritise functional recovery and long-term wellness. More broadly, the facility serves as a tangible blueprint for what future-focused healthcare investment can achieve in injury and disability management by integrating wound care, rehabilitation and custodial care with vocational reskilling infrastructure, all under one roof.
Inclusive innovation
Innovation, too, must be inclusive. RMA’s willingness to integrate independent joint-venture partners in key clinical areas, such as orthotics and prosthetics, demonstrates how ethical investment can fuel niche specialisations that were previously inaccessible in under-resourced regions. As private and public sectors increasingly intersect, providers who prioritise equitable collaboration will shape the standards for occupational health, post-acute care and sustainable rehabilitation pathways.
The Welkom upgrade also delivered tangible socioeconomic benefits. Construction created temporary jobs for local labourers, artisans and suppliers. As the hospital transitions to full operation, it will sustain roles in clinical services, administration, facilities management and auxiliary support – all drawing from the surrounding community.
Building equitable, resilient healthcare
Crucially, the project demonstrates that ethical healthcare investments need not be confined to metropolitan hubs. In a world where access to healthcare and especially rehabilitation services is driven primarily by affordability more than by need, RMA raises the banner of corporate citizenship by investing in the community where the health-insured population resides, and that mainstream healthcare providers might otherwise overlook, so as to promote health equity goals. By situating a cutting-edge sub-acute hospital in Welkom, Free State, RMA created a ripple effect, attracting specialised talent, strengthening referral networks and inspiring similar initiatives in other underserved areas. This industry influence signals a turning point where sub-acute care is no longer an afterthought but a strategic pillar of resilient health systems.
Looking ahead, RMA remains committed to scaling these principles, thus advocating for policy frameworks that foster public-private collaboration, driving research into cutting-edge rehabilitation modalities and championing community-centred care models. In doing so, it positions itself as a social insurer that is invested in shaping a more equitable, resilient future for South Africa and beyond.
Media enquiries: Gopolang Peme, Group Communications Manager, Rand Mutual Assurance
Author: Dr Tryphine Zulu, Head Healthcare, Rand Mutual Assurance
By Dr Dumisani Bomela, Chief Executive Officer of the Hospital Association of South Africa
There’s an old African idiom: “When elephants fight, the grass suffers.” The “elephants”, however, are two interdependent players in healthcare: the government, which is pushing for the National Health Insurance (NHI), and private healthcare providers and funders, who have long raised serious concerns about the initiative.
At the heart of the dispute is whether a single-fund NHI is constitutional, viable, and sustainable. The legal conflict is shaping up to be unlike anything we have seen in this country.
Dr Dumisani Bomela, CEO of HASA
Some legislators argue that the private healthcare sector opposes reform because it is driven by profit and harbours anti-poor sentiments. But no one in the private healthcare sector is opposed to the objectives of the National Health Insurance. We are in favour of healthcare reform that works. There is a crucial difference.
It is a difference dismissed by those determined that only their view matters. The result is that not only has the country spent nearly two decades in a fruitless debate about the NHI, but it appears that those in charge of the healthcare system have prioritised stagnation over progress. When alternatives could have been explored, expert advice considered, research examined, and insights heard, none were.
Instead, constructive dialogue leading to a positive compromise benefiting patients is perceived as a weakness to be denied and overcome. Perspectives have become so entrenched that mutual understanding seems out of reach. Consequently, energy, effort, and resources will be spent in courts rather than on designing solutions.
Meanwhile, the country’s healthcare users are not getting the attention they deserve. South Africans continue to suffer in under-resourced facilities or struggle to afford medical coverage.
Current legislation and regulation already allow for immediate reforms that could lower healthcare costs and ease pressure on the system and public hospitals. We could complete the reform pathway that would support the affordability of medical aid for millions more South Africans, a move that experts and the Health Market Inquiry have recommended.
Through public–private collaboration and innovation, we can upgrade healthcare infrastructure and develop a stronger base of critical healthcare skills, particularly in nursing, ultimately creating jobs and strengthening the national fiscus. These are realistic and achievable solutions that would deliver real progress in the short term and better position us to move more confidently towards universal healthcare coverage.
Our greatest achievement as a nation has been our ability to unite in times of crisis. We can do it again, but only if all role players are meaningfully involved in healthcare reform – including the private sector – and are willing to listen, consider, and compromise with each other to meet the needs of all healthcare users. To begin with, the government must view private healthcare as a strategic partner, a national asset that can offer significant ideas to resolve the national health delivery crisis. Private healthcare, on the other hand, faces challenges, some of which were identified in the Health Market Inquiry, and others that will undoubtedly be raised in the roundtable debates accompanying the collaborative initiatives crucial to strengthening the system.
If we don’t change course, patients waiting in overcrowded facilities will continue to suffer, and families will continue to struggle to afford care. Dedicated doctors and nurses already working under increasingly difficult conditions will face a darkening future, and the entire system will creak more ominously.
The path to reform does not have to be adversarial. We can redesign healthcare together, combining the strengths of both public and private sectors in the spirit of recognising our shared humanity and interdependence. We can still choose collaboration over confrontation, practical solutions over political battles, and progress over passivity.
But we must act now. Time is running out, and every day spent fighting in courtrooms rather than sitting eye to eye and exchanging ideas is another day that South Africans suffer without the healthcare they deserve. The choice is ours: Will we fight each other, or will we fight together for a healthcare system that serves everyone?
The latest survey from the European Centre for Disease Prevention and Control (ECDC), the fourth of its kind, confirms that Candidozyma auris (formerly Candida auris) continues to spread quickly across European hospitals, posing a serious threat to patients and healthcare systems. Case numbers are rising, outbreaks are growing in scale, and several countries report ongoing local transmission. The findings highlight the importance of early detection and control of transmission to avoid widespread rapid dissemination.
Candidozyma auris (C. auris) is a fungus that usually spreads within healthcare facilities, is often resistant to antifungal drugs, and can cause severe infections in seriously ill patients. Its ability to persist on different surfaces and medical equipment and to spread between patients makes it particularly challenging to control. Between 2013 and 2023, EU/EEA countries reported over 4 000 cases, with a significant jump to 1 346 cases reported by 18 countries in 2023 alone. Five countries – Spain, Greece, Italy, Romania, and Germany – have accounted for most of the cases over the decade.
“C. auris has spread within only a few years – from isolated cases to becoming widespread in some countries. This shows how rapidly it can establish itself in hospitals,” said Dr Diamantis Plachouras, Head of ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections Section. “But this is not inevitable,” he added. “Early detection and rapid, coordinated infection control can still prevent further transmission.”
Recent outbreaks have been reported in Cyprus, France and Germany, while Greece, Italy, Romania and Spain have indicated they can no longer distinguish specific outbreaks due to widespread regional or national dissemination. In several of these countries, sustained local transmission has occurred within only a few years after the first documented case, highlighting a critical window for early interventions to stop its spread.
While some countries have showed positive results in limiting C. auris outbreaks, many are facing key gaps. Despite rising case numbers, only 17 of 36 participating countries currently have a national surveillance system in place for C. auris. Only 15 countries have developed specific national infection prevention and control guidance. Laboratory capacity is comparatively stronger, with 29 countries reporting access to a mycology reference or expert laboratory and 23 offering reference testing for hospitals.
While the number of C. auris infections is clearly rising, without systematic surveillance and mandatory reporting, the true scale of the problem is likely under-reported.
ECDC has regularly assessed the epidemiological situation, laboratory capacity and preparedness for C. auris in four surveys since 2018 and published rapid risk assessments including options for infection prevention and control. This is to support Member States in improving their preparedness and early response capacities to prevent or contain C. auris outbreaks in a timely manner and prevent further transmission.
Inkosi Albert Luthuli Central Hospital is KwaZulu-Natal’s only public hospital with a functioning cardiac unit. Photo by Hush Naidoo Jade Photography on Unsplash
By Chris Bateman
Doctors have blown the whistle about a crisis at one of KwaZulu-Natal’s most important public hospitals, saying it is functioning far under capacity due to a series of crippling cuts.
The Inkosi Albert Luthuli Central Hospital in Durban’s Cato Manor is operating at around 40% below surgical capacity, according to senior doctors there. As one of a small number of central hospitals in South Africa, it provides specialist services unavailable elsewhere in KwaZulu-Natal and serves as a critical hub for training healthcare workers.
Several doctors who work at Albert Luthuli, who asked to remain anonymous for fear of reprisals, told Spotlight that frozen posts, severely understaffed ICUs, shortages of surgical consumables, and delays in diagnostic tests have combined to drive an austerity-fuelled collapse they say is costing lives.
One doctor said theatre slates – daily surgery schedules – have been cut by as much as 60% compared to pre-pandemic levels. Some described the situation as worse than during COVID-19, when all elective surgeries were cancelled.
“Patients have to wait or be sent home when they can’t get on a theatre list. Then they’re either lost to follow-up or they present ‘in extremis’ later,” said one senior doctor. “Paediatric cases are among the worst. They should be referred on day one, but because of ICU nursing shortages they only get admitted on day four or five – if at all. Often, they’re too ill for our care to be effective.”
Spotlight put these allegations to the KwaZulu-Natal Department of Health, but the department had not responded by deadline despite several follow-ups.
Collapsing specialist services
Albert Luthuli is KwaZulu-Natal’s only public hospital with a functioning cardiac unit, according to one of the doctors who spoke to Spotlight. The doctor said the province has just one adult cardiologist in the public sector who sees over 60 patients per day and that cardiac surgeries have dropped from 600 per year to under 300 projected for 2025. By contrast, there are over 30 adult cardiologists working in the private sector in the province.
Anaesthesiology is among the hardest hit areas. According to Spotlight’s sources, eight anaesthetic consultants resigned in the past year, citing burnout and workload. Where nine or ten theatre slates once ran daily, there are now only four or five. Eleven anaesthetists remain to cover 19 theatres.
“I never thought I’d see the day when I wouldn’t want to come in. We are four ICU consultants covering nine beds. ICU needs one nurse per bed, but we’re usually staffed with six or seven nurses in total. Across six ICUs, we’ve got 25 nurses. We pull in ward staff or rely on overtime. You can’t have one nurse running between beds – it spreads infection, mistakes happen. It’s impossible,” one ICU doctor told Spotlight.
Doctors estimate a 45% shortage of qualified ICU nurses. “It’s like airplanes circling, running out of fuel, and crashing before they can land,” one senior doctor said. “Patients deteriorate while waiting for beds or for a theatre list to open.”
Specialist theatre nursing posts have also been cut, compounding the strain.
Registrars squeezed, training undermined
The hospital is meant to offer advanced procedures, experimental treatments, innovative research, and specialist training. Instead, registrars – these are doctors in specialist training – say they are losing out on irreplaceable experience.
Junior registrars are allegedly blocked from logging procedures they need to qualify, because seniors are prioritised to assist with the shrinking pool of operations.
Spotlight has seen a grievance letter from the Anaesthetics Department’s Registrar Representative, addressed to the hospital CEO, medical manager, the SA Society of Anaesthesiologists, and training stakeholders. It warns that the consultant exodus has left registrars running high-risk cases with inadequate supervision, “directly compromising both patient safety and registrar training.”
One senior doctor said theatre usage had more than halved in recent months compared to historical averages. With no new registrar intake and no appointments of departed registrars to consultant posts, it is projected only 10 or 12 permanent consultants will remain for the hospital’s 846 beds – there should be at least 21 consultants. (A registrar becomes a consultant, or qualified specialist, once their training is complete.)
“This is no longer a looming concern, but an active crisis,” the letter warned, threatening patient safety, staff wellbeing, and the integrity of training in KwaZulu-Natal.
“What they broke in six months will take years to fix,” said one registrar.
But some are more positive. Professor Dean Gopalan, Head of Anaesthesiology, Pain Medicine & Critical Care at UKZN’s School of Medicine, said austerity cuts had dented efforts to achieve excellence, but “we remain above required training norms”. He said he was awaiting feedback from the Health Professions Council (HPCSA), which inspected the hospital in July and raised concerns about specialist and nurse shortages. Spotlight followed up with the HPCSA, but had not received a response by the time of publication.
Not all departments are as fortunate. One doctor said it would be “almost impossible” to meet training accreditation standards for cardiology given the patient workload.
Human cost
Doctors say the crisis is most visible in paediatric congenital heart disease cases.
“These children could live normal lives if operated on early. Instead, they wait until they are drastically sick before making the theatre slate – often six months later,” said one doctor. “People forget surgery is also a primary healthcare intervention. Breadwinners sit at home unable to work, while their families suffer.”
In orthopaedics, doctors say the waiting list exceeds 1 300 patients, with the first elective surgery dates only available in March 2028. Before COVID-19, they say the waiting period was seven months.
“Many patients are unable to work due to their conditions and would be able to get back to work if they had their operations,” said one source. “We try prioritising them, but then you put them ahead of others also in severe pain. Complications are already coming in from other hospitals due to unavailable implants and delayed treatments.”
Procurement freeze
Several doctors trace the crisis to a “G77 notice” issued by the KZN Department of Health on 14 November 2024, freezing new purchase orders until April 2025 to “manage accruals” and reduce overspending. Exceptions required approval from head office.
While a less prescriptive circular has since replaced it, procurement remains “extremely difficult”, sources said.
Doctors said the freeze caused months-long delays in acquiring consumables, drugs, and equipment. “We’re almost at the point where we’re only doing emergencies,” said one doctor. “We prioritise cancer patients for chemo or radiation instead of urgently needed surgery. But in cardiac surgery, there’s definite mortality. You can’t avoid it when you can’t do bypasses or valve replacements. Waiting lists are years long.”
One anaesthetist recalled a patient being “closed” mid-operation because a critical consumable was unavailable.
A national problem?
The situation at Albert Luthuli hospital partly reflects a wider national crisis in specialist care. A 2019 government strategy paper noted only 16.5 specialists per 100 000 people overall, with just seven per 100 000 in the public sector, compared to 69 per 100 000 in private.
Professor Eric Buch, CEO of the Colleges of Medicine of SA, said austerity has worsened matters by reducing registrar posts and constricting the pipeline. “Specialist posts are being frozen, impeding access to specialist care and reducing the number of specialists available to train registrars. Even before austerity we had far too few specialists. Some registrars waited up to two years for a post.”
The Albert Luthuli hospital crisis is “not unique”, said Dr Reno Morar, COO of Nelson Mandela University’s Faculty of Health Sciences.
“Equity of access to specialised services simply does not exist,” he said. “Despite the mess, there are pockets of excellence, but there’s no strategic national vision for highly specialised services.”
Health Ombud Professor Taole Mokoena told Spotlight his office had not specifically investigated Albert Luthuli, but said that, “sadly, there are reports not dissimilar from many hospitals in the country,” citing Helen Joseph Hospital in Johannesburg and Robert Mangaliso Sobukwe Hospital in Kimberley.
Doctors at Albert Luthuli hospital have indicated to Spotlight they will lodge a formal complaint with the health Ombud.
Posts advertised
While the KZN Department of Health did not respond to Spotlight’s questions, there are signs of movement. Two days after we requested comment, a circular went out advertising dozens of specialist posts across provincial referral hospitals, including 12 anaesthetics posts, five of them at Albert Luthuli, plus 100 staff nurse and 50 registered nurse posts.
We also understand that an internal briefing of department heads was called for 27 August, 36 hours after Spotlight’s first request for comment.
Doctors, however, remain sceptical.
“Nothing will change for six months as we go through the interview, verification, and induction processes. Why did they take so long to listen? The damage is done. Relief is 18 to 24 months too late,” said one doctor.
Another senior doctor said that with each resignation over the past year, he lined up replacements and pleaded in vain for permission to advertise. “Since posts reopened this week, I know of just one applicant. Do they expect specialists to suddenly appear out of the woodwork?”
The job advertisements are for “far less than what has been lost and needed. And it’s far more than just numbers – it’s skills and experience”, noted another doctor. “It will take years to get back to where we were.”
Despair among staff
Several doctors expressed despair at what they see as a lack of urgency from government.
“It makes me wonder how resources are managed. Local cuts feel disproportionate compared to national ones. It’s disheartening. Some of us are here to make a difference, but we’re starting to lose hope,” one said.
Another added: “If you know there’s light at the end of the tunnel, you can keep going. But when it feels endless, it’s damn hard. We try to hide our disenchantment, but it’s becoming impossible.”
He speaks in measured tones – calm, reflective, deliberate. But when Dr Dumisani Bomela describes the future he envisions, the words carry power. For the CEO of the Hospital Association of South Africa (HASA), healthcare is not just a profession. It is a promise rooted in dignity, equity and access to every South African.
Q: Dr Bomela, what drew you to medicine and what keeps you committed to healthcare in South Africa? A: I have always seen healthcare as an act of service. As a doctor, you learn to see beyond symptoms, to understand the person behind the diagnosis. As a leader at HASA, I take that same approach. Our work is about people. About making sure that every South African can get quality care when they need it.
Q: HASA represents South Africa’s private hospital sector. Why is this sector important to the country’s overall health system? A: Private hospitals are a cornerstone of healthcare in South Africa. We treat millions of patients each year. More than that, HASA members invest heavily in medical training, advanced technology and infrastructure. We are strategic partners in the national system, that makes our sector a vital national asset.
Q: How does HASA contribute to economic development beyond just healthcare? A: Healthcare is a growth engine. HASA members are major employers, from doctors and nurses to technicians and support staff. We support local communities and stimulate investment. When healthcare systems are strong, economies thrive – and so do people.
Q: What is HASA’s stance on universal health coverage? A: We believe every person has the right to choose their provider and to receive high-quality care. That is why we support reforms that strengthen the system and build equity. HASA members are ready to work side by side with the government to make that vision a reality. Our hospital groups bring deep experience, including in some cases from geographies where universal healthcare systems operate, and strong infrastructure to the table.
Q: What kind of leadership do you believe is needed in South African healthcare today? A: We need leaders who listen. Who understand not just policy, but people. Leadership in healthcare must be grounded in compassion and collaboration. At HASA, we strive to lead by example, building trust, fostering partnerships, and always remembering that every system ultimately affects human lives.
Q: How do HASA hospitals stay at the forefront of medical technology and innovation? A: By investing intentionally. Our members understand that modern medicine is not static, it is constantly evolving. We equip our hospitals with advanced diagnostic and treatment tools. But technology alone is not enough. We also invest in people – training nurses, specialists and support teams to lead with excellence.
Q: In a country facing complex health challenges, how do you stay hopeful? A: Hope grows where there is action. Across our hospitals, I see incredible work being done every day – surgeons saving lives, nurses comforting families, teams innovating to improve care. We are proving, together, that with collaboration and commitment, South Africa’s health system can be strong, inclusive and world-class.
Q: What gives you the greatest sense of pride in your work with HASA? A: Honestly, it is seeing the impact private hospitals have. When families walk out of our hospitals healed. When professionals grow into health leaders. When communities feel their well-being is supported. These outcomes remind us why the work matters. My pride does not come from titles; it comes from knowing we are making a real, human difference every single day.
But women doctors in this attire are often misidentified as nurses or medical assistants. And preferences for doctors’ dress strongly influenced by clinical context/medical specialty
Patients are still more likely to trust doctors and consider them more professional when they wear white coats, although women doctors in this attire are often misidentified as nurses or medical assistants, finds a review of the available research on the topic, published in the open-access journal BMJ Open.
But patient preferences for doctors’ attire seem to be strongly influenced by clinical context and medical specialty, with a growing acceptance of scrubs, especially in emergency or high-risk settings, the findings indicate.
In the 19th century, doctors primarily wore black, because medical encounters were viewed as serious and formal occasions. But with the growing emphasis on hygiene and scientific advancements in medicine, white coats represented cleanliness and professionalism and became standard attire for doctors worldwide in the 20th century, note the researchers.
Since the publication of a previous comprehensive review of published research on the impact of doctors’ attire at work, which highlighted the significant role this has in patient satisfaction, trust, and adherence to medical advice, health care practices and societal expectations have evolved, they explain.
The researchers therefore wanted to update those findings, broadening the scope to include diverse clinical contexts, in a bid to gain a deeper understanding of how doctors’ attire might influence interactions with patients and treatment outcomes.
They scoured research databases for relevant studies published between January 2015 and August 2024. From an initial haul of 724 studies, 32 were eligible for inclusion in the review.
Most of the studies were carried out in the U.S. (17); two each came from Japan, China, and Pakistan; and the rest were carried out in Indonesia, India, Ethiopia, Korea, Germany, Malaysia, Saudi Arabia, Singapore and Switzerland.
Clinical setting had some bearing on patient preferences. For example, palliative care doctors’ attire didn’t affect patients’ trust, or assessments of the practitioner’s capabilities, but patients preferred emergency care doctors to wear white coats or scrubs. And they were happy for primary care doctors to be dressed casually and to wear white coats.
Specialty also seemed to influence perceptions, with patient preferences for doctors to wear white coats observed in orthopedics, surgery, dermatology, ophthalmology, and obstetrics and gynecology, for example.
The included studies indicated a distinct preference among patients for male doctors to wear suits. One study indicated that accessories, such as watches and glasses worn by male doctors, significantly enhanced perceived professionalism and trustworthiness, which aligns with the findings of previously published studies, note the researchers.
The UK, however, has implemented a ‘bare below the elbows’ policy, which bans doctors from wearing white coats, watches, ties and long sleeves to minimize infection risks.
And even when male and female doctors wore identical attire, female doctors were still more likely to be misidentified as nurses or medical assistants—a misidentification that was consistently observed across different cultural settings.
But patients preferred white coats over business or casual attire for both male and female doctors, and irrespective of gender, they favored doctors wearing white coats, perceiving these practitioners to be trustworthy, respectful, skilled, communicative and empathetic.
Notably, male surgeons wearing a white coat over scrubs were looked on less favorably than those wearing a suit with a white coat, scrubs, or just a suit. On the other hand, female surgeons in white coats over scrubs were preferred over those in suits or casual attire.
“This preference aligns with recent evidence indicating that female physicians are often judged more on appearance than their male counterparts. The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold,” write the researchers.
“These gender-specific preferences for surgical attire were each supported by a single study and warrant further validation… Nonetheless, gender-related perceptions of physician attire were consistently reported across studies with a low risk of bias, supporting the robustness of this theme,” they add.
A few studies explored doctors’ attire during the COVID-19 pandemic, when numerous doctors reported a preference for wearing scrubs to prioritize hygiene and ease of movement.
These studies consistently reported a shift in patient preference towards practical and hygienic attire, such as scrubs and face masks, reflecting heightened sensitivity to infection control, say the researchers.
The researchers acknowledge various limitations to their findings, in particular the fact that most of the included studies were carried out in the U.S., there were none from South America, and only a few from European, Asian, and African countries. Many of the studies also relied on self-reported data, and none included children or patients with mental health issues.
“While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings,” they write.
“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians, which highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients,” they add.
Medical institutions should consider adopting flexible dress codes that align with patient preferences for different clinical environments and medical specialties, they suggest.
As healthcare reform gains momentum in South Africa, value-based care is becoming a hot topic – but meaningful progress has yet to take hold. The biggest hurdle? How care is purchased. Despite clear signs of stagnation, most funders remain committed to the same failed approach and have yet to drive the change that is needed.
“It’s encouraging to see a move away from fee-for-service thinking and a growing focus on value-based care. But to turn that interest into action will require real system reform – starting with strategic approaches to purchasing care that support system reengineering,” says Lungile Kasapato, CEO of PPO Serve, a healthcare management company that has been implementing value-based care in South Africa for more than a decade.
At its core, value-based care flips the script on how private healthcare is purchased in South Africa. Instead of rewarding volume, it prioritises prevention, puts patients at the centre, and ties payment to measurable outcomes. This stands in stark contrast to the dominant fee-for-service model, where doctors and hospitals are incentivised to provide more services rather than focus on delivering effective care.
A leading example of value-based care in practice is The Value Care Team, operationally supported by PPO Serve. This GP-led multidisciplinary programme broadens access while keeping costs in check. Teams are paid a risk-adjusted global fee to provide holistic patient care, along with substantial incentives tied to improved outcomes. The result is a model that aligns payment with patient outcomes – not the volume of services delivered.
To put it simply, Kasapato explains; “With value-based care, you don’t pay for every kilometre run, you pay to cross the finish line. And that finish line means improved health outcomes, prevention, and system efficiency.” For patients, primary healthcare under The Value Care Team looks and feels completely different. With no scheme benefit limits to navigate, patients are supported by a dedicated care coordinator who guides them through decisions made by their nominated GP and allied professionals. Each clinical team member has a complete picture of the patient’s health, working collaboratively rather than competitively to share accountability for delivering better outcomes.
This new approach to delivering primary care in the private sector isn’t just an isolated test run – it’s being developed and refined in real time. “We’re not just talking about value-based care, we’re implementing it,” says Kasapato. “At PPO Serve, we partner with practices to navigate day-to-day challenges, while working with medical schemes to design payment models that enable strategic purchasing. The Value Care Team is proof that value-based contracting isn’t just possible – it’s already happening in South Africa’s healthcare system.”
For this approach to take root and scale, medical schemes and state funders must take the lead by creating the market incentives that encourage providers and hospitals to adopt new ways of working. The Competition Commission’s 2019 Health Market Inquiry warned that without bold reform, South Africa’s private healthcare sector could face collapse – a warning that remains just as relevant today. But there is still an opportunity to change course. By embracing a strategic purchasing role, funders can help drive the system-wide transformation that’s urgently needed.
The Value Care Team is already leading by example, with a presence across Gauteng and KwaZulu-Natal, as well as in Bloemfontein and Gqeberha. Recognised by the World Health Organisation and featured in international peer-reviewed research as a breakthrough case study in emerging markets, the programme is actively driving real change – improving care coordination, cutting waste, and reducing unnecessary hospital admissions. Even so, Kasapato points out, the journey is far from over; “There is still a lot to learn from and with others as we move from talking about value to actually implementing it.”
Pretoria – The Health Ombud, Professor Taole Mokoena, has released the findings of an investigation into the treatment, complications, and deaths of psychiatric patients at the Northern Cape Mental Health Hospital (NCMHH) and the Robert Mangaliso Sobukwe Hospital (RMSH). The investigation revealed that two patients died, and another underwent craniectomy and remains bedridden.
The investigation was initiated following a complaint filed by the Honourable Minister of Health, Dr. Aaron Motsoaledi (MP), regarding the Northern Cape Mental Health Hospitals in October 2024. The reported incidents took place in July and August 2024, during which it was alleged that two patients died at NCMHH, and two others were admitted to RMSH in critical condition.
In response to the Minister’s request, the Health Ombud deployed a team of two investigators in accordance with Section 81(3)(c) of the National Health Amendment Act (NHAA). This investigation report is issued based on Section 81A (11) of the NHAA, 2013 (Act No. 12 of 2013), pertaining to the functions of the Office of Health Standards Compliance and the handling of complaints by the Health Ombud. The report is intended to inform both the complainant and the health establishments as well as the general public of the findings and recommendations derived from the investigation.
ISSUES INVESTIGATED
The investigation was carried out through a detailed analysis and triangulation of information and documentary evidence obtained from the NCMHH and RMSH, as well as through on-site visits. The following issues were identified for investigation based on the analysis of the complaints, allegations, and engagement with both health establishments:
The circumstances surrounding Mr. Cyprian Mohoto’s care at NCMHH and his subsequent death at RMSH;
The circumstances surrounding Mr. Petrus De Bruins’s care at NCMHH and his admission to RMSH;
The circumstances surrounding Mr. Tshepo Mndimbaza’s care and death at NCMHH; and
The circumstances surrounding Mr. John Louw’s care at NCMHH and his admission to RMSH.
The investigation revealed that, at the time of the incidents, NCMHH and several neighbouring health facilities were facing challenges with their electricity supply due to cable theft and vandalism at their power substation. This power loss impacted the communication infrastructure, leaving the hospital without telephone lines.
Electricity supply was restored within days at two of the neighbouring hospitals; however, it took an entire year for the electricity to be restored at NCMHH. The investigation found that the delay in repairing the electricity supply to NCMHH was due to dysfunctional Supply Chain Management processes within the Provincial Department of Health. This delay rendered the hospital’s Heating, Ventilation, and Air Conditioning (HVAC) system nonfunctional, exposing patients and staff to extreme weather conditions during the summer and winter. Additionally, because of the lack of electricity, the available resuscitation equipment was not operational, as it could not be charged, and other necessary equipment was unavailable for use. NCMHH procured poor quality pyjamas and blankets which were inadequate to provide warmth to patients during the severe winter’s cold, especially at night.
It was established that the Clinical Manager at NCMHH had written a complaint letter to the Acting Head of the Provincial Department of Health, detailing the adverse conditions which patients at NCMHH were being subjected to. These circumstances negatively impacted their health and violated their human rights.
FINDINGS
The investigation uncovered several findings regarding the medical care of four patients:
Circumstances surrounding Mr. Cyprian Mohoto’s care and admission to RMSH: The investigation revealed gross mismanagement surrounding Mr. Mohoto’s care, which ultimately led to his death. He was admitted to RMSH on 13 July 2024, with a suspected abdominal or bowel obstruction following complications at NCMHH on 12 July 2024. Admission abdominal X-rays ruled out bowel obstruction while the chest X-ray revealed multi-lobar pneumonia. The pneumonia was never treated during the 3 days that the patient stayed in the Surgical Recovery Unit until his death. His deteriorating clinical status was never attended to by either the nursing personnel nor the doctors. Mr. Mohoto died on 16 July 2024, in the Emergency Centre at the Surgical Recovery Unit at RMSH.
Mr. De Bruin was transferred from NCMHH to the Emergency Centre at RMSH on 30 July 2024, after collapsing and being unresponsive in Ward M2 at NCMHH. He was stabilised and later admitted to the RMSH Medical Recovery Unit for hypoglycaemia, the medical care and investigations conducted in the Emergency Centre were appropriate. However, the monitoring by nursing personnel was found to be inadequate.
The Circumstances Surrounding Mr. Tshepo Mdimbaza’s Death: Mr. Mdimbaza was discovered unresponsive in his bed on 3 August 2024, at NCMHH. The resuscitation process was delayed due to the unavailability, malfunction, or unpreparedness of resuscitation equipment. There was also a lack of monitoring of the patient’s vital signs before and during resuscitation by medical or nursing personnel. Mr. Mdimbaza did not survive the resuscitation attempt. The post-mortem report indicated that he died due to “exposure to the elements” at NCMHH.
The investigation into the circumstances surrounding the care and admission of Mr. John Louw to RMSH revealed that he had an acute subdural haemorrhage. An emergency craniotomy and craniectomy were successfully performed on 07 July 2024 and 23 July 2024, respectively, and he was discharged back to NCMHH on 28 October 2024. Mr. Louw remains bedridden.
The investigation also established additional findings, including leadership instability in the Northern Cape Provincial Department of Health, which negatively affected service delivery, safety, and the quality of patient care at NCMHH and RMSH.
Northern Cape Mental Health Hospital was found to have poor governance and systemic lack of leadership and poor management at all levels, unpreparedness for emergency cases, crumbling infrastructure, poor pharmacy and medicine control management, shortage of staff, poor quality assurance management, non-compliance with patient record keeping, and poor laundry services.
Robert Mangaliso Sobukwe Hospital was found to be experiencing critical staff shortage across the board; lack of oversight with nursing supervision; communication breakdown of reporting systems, non-compliance with guidelines on principles of good record keeping and overcrowding at the hospital emergency centre, aggravated by the absence of a district or regional hospital.
The investigation concluded that the general care provided at the Northern Cape Mental Health Hospital and the Robert Mangaliso Sobukwe Hospital to the patients was substandard, and patients were not attended to in a manner consistent with the nature and severity of their health condition, as required by Regulation 5 (1) of the Norms and Standards Regulations Applicable to Different Categories of Health Establishments, 2018 (Norms and Standards Regulations).
RECOMMENDATIONS
The Health Ombud made clear, actionable recommendations to address the systemic failures observed at both health establishments to improve the overall safety and quality of patient care. Key recommendations include; the Provincial Head of Department of Health must immediately appoint a Task Team to monitor the implementation of the recommendations as outlined in the report, hold accountable officials found to be in breach through formal disciplinary processes, the National Department of Health should initiate a forensic investigation into the procurement processes for the NCMHH, priority should be given to the development, reinstatement, and implementation of an effective and efficient reporting system for continuity of care and effective communication, and the development of comprehensive Standard Operating Procedures (SOPs)/Protocols/Guidelines to guide healthcare personnel in providing healthcare services. The complete set of recommendations is included in the report.
