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The department of health attributed part of the problem to nurses and doctors' reluctance to work in rural areas where they are assigned for community service.
The brain drain is crippling the country’s health sector. Image: iStock
South Africa’s public healthcare system is hemorrhaging medical professionals at an alarming rate, with nearly 6 000 doctors and nurses resigning annually from state facilities.
Recent parliamentary data reveals the devastating scale of the brain drain crippling the country’s health sector.
Nurses and doctors resignations: provincial breakdown
Official figures from the Persal system show that between 2013 and 2025, South Africa lost 12 745 doctors and 58 897 nurses from public health care facilities.
Combined, this represents an average of approximately 5 900 doctor and nurse resignations per year over the 12-year period from 2013 to 2024.
When including pharmacists, other health care practitioners, and administrative personnel, the total number of health care workers who have resigned since 2013 reaches a staggering 124 123.
The crisis peaked in 2021 and 2022, when the country lost 1 340 and 1 350 doctors respectively, alongside 6 171 and 5 592 nurses.
The data, provided by Health Minister Dr Aaron Motsoaledi in response to a parliamentary question from DA MP Michéle Clarke, paints a grim picture of a health care system under severe strain.
Gauteng province has been hit hardest, losing 3 351 doctors since 2013, followed by KwaZulu-Natal with 2 609 resignations.
Provincial breakdowns reveal the widespread nature of the crisis.
Since the 2021-2022 peak, Gauteng has lost 1 206 doctors, while KwaZulu-Natal shed 599 medical professionals.
The Western Cape recorded 433 doctor resignations, Eastern Cape 356, and Limpopo 322.
For nursing staff, Gauteng led with 4 697 resignations since the peak years, followed by KwaZulu-Natal’s
4 353 and Eastern Cape’s 2 631.
The Persal data has not been updated since January 2025, meaning current losses may be even higher.
However, in January this year, 53 doctors resigned across the country, while a total of 113 nurses resigned.
Nurses and doctors rural placement complications
The department of health previously attributed part of the problem to young nurses and doctors’ reluctance to work in rural areas where they are assigned for community service.
Many prefer urban placements, leaving underserved communities without critical health care services.
“We find that we have openings in deep rural areas for community service, where there’s not even a cellphone network, but they tell us they can’t work far from home,” said department spokesperson Foster Mohale.
“They come with all sorts of excuses – mother is sick or other reasons. So, it’s a very complicated process.”
The department said this reluctance has left many qualified doctors unemployed rather than accepting rural postings.
Some, after living in the rural areas, opt to resign rather than continue to live in the poverty-stricken regions.
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Junior doctor unemployment compounds crisis
The health care staffing crisis has been further exacerbated by widespread unemployment among junior doctors.
In January 2025, the South African Medical Association wrote an urgent letter to President Cyril Ramaphosa highlighting that “over 1 800 junior doctors, having completed their mandatory community service” remain unemployed despite severe shortages in public hospitals.
The association warned that “with only 0.3 doctors per 1 000 people in the public sector, well below the World Health Organisation’s recommendation of 1 per 1 000,” South Africa’s health care system is critically understaffed.
The letter described a system where “many departments in public hospitals are dangerously understaffed, forcing existing health care workers to shoulder unsustainable workloads”.
Sama estimated that R2 billion annually would be needed to create posts for medical officers and registrars, warning that “many are forced to volunteer, work without pay in the public sector just to maintain their skills and hope for eventual employment. This fuels emigration, exacerbating the brain drain and further weakening our health care system.”
Remunerative work outside the public service controversy adds pressure
The crisis has been compounded by debates over remunerative work outside the public service, which allows health care workers to take on private practice during off-duty hours.
Motsoaledi blamed the misuse of remunerative work outside the public service for doctor absenteeism and lateness in public facilities.
Former South African Medical Association board chair Dr Angelique Coetzee warned that restricting remunerative work outside the public service could backfire.
She believes stricter policies could improve public health care by ensuring “fewer doctors spending time in private practice, more focus on public health care”.
However, she cautioned that overly restrictive measures could worsen the exodus.
“If it’s removed or heavily restricted, some doctors might resign, worsening your shortage of medical professionals in your state hospitals, leading to an increased patient load per doctor, again, negatively affecting patient care,” Coetzee said.
ALSO READ: Motsoaledi explains why state-employed doctors skip work or often arrive late
International brain drain crisis
The South African Family Practice (SAFP) in 2024 highlighted how brain drain extends beyond national borders, with skilled professionals migrating to developed countries.
According to research by Indiran Govender from the SAFP, in 2024 “there were more than 23 400 health professionals from South Africa residing and working in the United Kingdom, New Zealand, the United States and Australia”.
Govender noted that “about 11.13% of South Africans with higher education indicate that they are seriously considering emigrating to another country”.
The Fellowship of the College of Family Physicians of South Africa degree is widely recognised internationally, making it easier for specialists to emigrate.
“South Africa is argued to play a central role of ‘victim’ as well as ‘executer’ in this process,” Govender wrote.
The country exports doctors to richer nations while importing health care workers from poorer African countries.
Push and pull factors
Multiple factors drive health care workers away from South Africa’s public system.
Poor working conditions, inadequate infrastructure and below-market salaries push professionals toward private practice or overseas opportunities.
“Health facilities in South Africa are characterised by poor working conditions, and the salaries are sub-par,” according to Govender.
Urban areas continue to attract medical professionals away from rural communities, creating health care deserts in underserved regions.
Political instability, crime and economic uncertainty add to the exodus.
READ MORE: Public hospitals built but lack doctors to serve
Urgent interventions needed
Experts argue that South Africa requires comprehensive reforms to stem the health care brain drain.
Recommendations include improving working conditions, upgrading infrastructure and developing incentive programmes for rural service.
“The government should increase accountability in public health institutions, as facilities are characterised by mismanagement and corruption, which undermine the efficient functioning of the health sector,” Govender suggested.
Increased training capacity and better retention strategies are also critical.
Without decisive action, the country’s universal health coverage plans and broader development goals remain at risk.
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