by Dr Bulela Vava, President of the Public Oral Health Forum

The ongoing Human Resources for Health policy review, led by a Ministerial Advisory Committee appointed by Health Minister Dr Aaron Motsoaledi, offers a crucial opportunity to disrupt and redesign the future of leadership in South Africa’s healthcare system. 

Yet, with disappointing predictability, the same outdated patterns continue to play out.

For instance, the Office of Health Standards Compliance (OHSC) is looking to fill the position of Executive Manager: Health Standards Development, Analysis and Support; a strategic, high-level leadership role tasked with shaping the metrics by which quality and safety in our healthcare facilities will be measured. Strangely, the advertisement stipulates that only medical doctors and nurses may apply.

But this is not an oversight. It is a wilful narrowing of the talent pool.

It dangerously assumes that only two professions in a sea of diverse, highly trained healthcare professionals are capable of strategic leadership and governance. It is a policy design that reeks of arrogance, lazy HR design, and a system terrified of change. 

It also illustrates why our public healthcare sector continues to fold under the pressure of poor leadership – chosen not for proven competency, vision, or innovation, but for credentials that do not correlate with executive capacity.

Leadership crisis

The South African public health system is in crisis. And it has not been led, for the last few decades, by social workers, oral hygienists, psychologists, dietitians, radiographers, environmental health practitioners, occupational therapists, or pharmacists. It has been led, almost exclusively, by medical doctors and nurses elevated into administrative positions by virtue of their clinical qualifications, not because they are natural leaders or competent managers. 

Nevertheless, the structure of South Africa’s healthcare system relegates other health professions to supporting roles, keeping them in the shadows while the spotlight remains fixed on our medical and nursing colleagues. 

This framing – whether by design or the result of the long-standing dominance of these professions – shapes public perception of what and who defines healthcare. 

This is not an indictment of medical or nursing professionals. Many of them are exceptional at what they do. But leadership and governance capacity are not crowns passed down from generation to generation by virtue of being born – or, in this case, graduating – as a member of a particular profession. Leadership is developed, tested, and earned. It requires a completely different skillset from clinical expertise: systems thinking, stakeholder engagement, policy design, budgeting, accountability mechanisms, and most importantly, the humility to lead diverse teams.

What message does it send to a highly capable and passionate pharmacist who has spent years in public health, holds a postgraduate qualification in health policy and management, and has a proven record in service delivery improvement? That their contribution is capped. That their ideas and experience are inferior. That their professional lineage disqualifies them from holding leadership posts. It is irrational, discriminatory, and costs us dearly.

New approach to healthcare leadership 

South Africa is blessed with a wide array of professionals whose expertise extends far beyond the clinical landscape. Yet, government entities and state bodies continue to reproduce the myth that healthcare leadership must remain the exclusive domain of nursing and clinical medicine. These assumptions have undermined accountability, created leadership vacuums, and bred toxic cultures fuelled by the destructive focus on hierarchies.

We need to rethink how we frame leadership and governance capacity in the healthcare sector. The Department of Health, along with all its associated bodies – including the OHSC – must take bold, honest steps to redefine what leadership means in the 21st century. They must move from a rigid, profession-bound hierarchy to a competency-based, inclusive model of leadership development. We need to move beyond the question of what you studied to what you can do, how you lead, and what vision you bring to the table.

South Africa’s healthcare crisis will not be solved by repeating the very mistakes that led us here. It will be solved by opening the doors of leadership to those who have the skills, courage, and commitment to reimagine public health, not just those who tick a conventional box.

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Dr Bulela Vava is an Atlantic Fellow for Health Equity in South Africa and President of the Public Oral Health Forum, a network of oral health professionals committed to improving oral health outcomes in South Africa through strategic advocacy, education, research, and collaboration. 

The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.