More than 50 public hospitals across South Africa are operating without permanent chief executives. The issue of hospital CEO vacancies is raising concerns about leadership, accountability, and patient services in an already-strained health system.
Provincial health departments have blamed budget pressures, austerity measures and controls on employee compensation. These constraints have delayed the appointment of permanent senior managers.
Acting executives have been appointed at affected facilities. However, critics argue that prolonged temporary leadership can weaken governance and make it harder to address operational failures.
Hospital CEO Vacancies Hit Gauteng
In Gauteng, 13 of the province’s 37 public hospitals are being managed by acting chief executives.
The figures were disclosed by Health MEC Faith Mazibuko in a written response to Democratic Alliance MPL Jack Bloom.
This means more than a third of Gauteng’s public hospitals lack permanent CEOs.
Gauteng Health spokesperson Steve Mabona said recruitment delays were linked to fiscal constraints. He also cited expenditure controls, including limits on employee compensation.
Bloom questioned why the chief executive position at Pholosong Hospital in Ekurhuleni had remained vacant for five years.
He said the appointment of permanent leadership was particularly important because of concerns about maladministration and alleged links to the Tembisa Hospital corruption scandal.
The late Dr Ashley Mthunzi served as chief executive of Pholosong Hospital before moving to Tembisa Hospital. Contracts involving companies accused of fraud later came under scrutiny.
Trade unions have also raised concerns about management at Pholosong Hospital.
Provincial Hospital Leadership Vacancies Remain Widespread
KwaZulu-Natal has 15 hospitals with acting CEOs among its 67 public facilities.
Provincial Health Department spokesperson Ntokozo Maphisa said no hospital was without leadership. Acting executives had been appointed to maintain administrative continuity and patient care.
The North West Health Department reported four vacant hospital CEO posts. It said progress had been made in reducing senior management vacancies during the 2025/26 financial year. However, budget limitations continued to affect recruitment.
Mpumalanga reported one vacancy among its 30 public hospitals. The vacant position is at Rob Ferreira Hospital.
Limpopo has three vacant CEO positions. The Northern Cape reported 10 vacancies, while the Eastern Cape recorded 15.
The Free State Health Department was still consolidating its figures.
Western Cape Reports No CEO Vacancies
The Western Cape was the only province cited as having filled every hospital chief executive position.
Health Department spokesperson Dwayne Evans said none of the province’s more than 50 public hospitals had a completely vacant CEO post.
He also said no permanent CEO appointment had been outstanding for longer than 12 months.
The figures highlight significant differences in public hospital leadership across provincial health systems.
Hospital CEO Vacancies Linked To Budget Cuts
National Health Department spokesperson Foster Mohale said the department was aware of the vacancies. It was working with provincial authorities to fill senior management posts.
Mohale said financial pressures and budget cuts were among the main reasons appointments had been delayed.
The National Department of Health spent R61.882 billion of its final allocation of R62.225 billion during the 2024/25 financial year. This represented 99.4% of its budget.
Major allocations included R25.4 billion for communicable and non-communicable diseases. A further R23.9 billion was directed to hospital systems, while R7.5 billion was allocated to governance and human resources.
National Treasury also allocated more than R6.6 billion through the health facility revitalisation grant. The funding supports infrastructure construction, upgrades and maintenance.
However, critics argue that infrastructure spending cannot solve leadership and governance failures. Hospitals may struggle to improve services when permanent executive appointments remain unfilled for years.
Resolving South Africa’s hospital CEO vacancies will require more than temporary appointments. Provinces will need stable funding, faster recruitment processes and stronger accountability to ensure hospitals have consistent and effective leadership.
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