CMSA statement on the impact of austerity measures undertaken by provincial departments of health on the specialist training platform in South Africa

The Colleges of Medicine of South Africa (CMSA) is the national examining body for medical and dental specialists in South Africa. It consists of 29 Colleges with more than 10 000 members. As a key role player in specialist training in South Africa, CMSA has noted troubling reports in the media and from its own members during the course of 2025 on the impact of austerity measures undertaken by some provincial departments of health on the medical specialist training platform. It is critical that the pipeline of medical specialists be maintained, and specialist posts be created and filled in the public sector to ensure access to specialist medicine for the vast majority of South Africa’s population. Failing to do so risks quality of care within the public sector and will likely exacerbate the inequitable distribution of specialists between private and public sectors, and between provinces.

The ‘freezing’ or reduction of funded specialist posts in the public sector in South Africa has serious implications. In addition to increasing inequities within the South African health system, the reduction of job opportunities for specialists within the public sector increases the risk of emigration. It has been reported that Canada alone issued 350 temporary work permits to South African medical specialists between January 2020 and July 20241 and diminishing opportunities in the public sector are likely to accelerate the loss of South African-trained specialists to countries such as Canada, Australia, and the United Kingdom. Of particular concern to CMSA is that training and supervision of registrars (specialist trainees) is likely to be affected by a reduction in funded specialist posts in the public sector with the remaining specialists having to balance the competing demands of increased teaching and service delivery responsibilities. A net reduction in medical specialists in the public sector results in an increase in service delivery

The Colleges of Medicine of South Africa (CMSA) is the national examining body for medical and dental specialists in South Africa. It consists of 29 Colleges with more than 10 000 members. As a key role player in specialist training in South Africa, CMSA has noted troubling reports in the media and from its own members during the course of 2025 on the impact of austerity measures undertaken by some provincial departments of health on the medical specialist training platform. It is critical that the pipeline of medical specialists be maintained, and specialist posts be created and filled in the public sector to ensure access to specialist medicine for the vast majority of South Africa’s population. Failing to do so risks quality of care within the public sector and will likely exacerbate the inequitable distribution of specialists between private and public sectors, and between provinces.

The ‘freezing’ or reduction of funded specialist posts in the public sector in South Africa has serious implications. In addition to increasing inequities within the South African health system, the reduction of job opportunities for specialists within the public sector increases the risk of emigration. It has been reported that Canada alone issued 350 temporary work permits to South African medical specialists between January 2020 and July 20241 and diminishing opportunities in the public sector are likely to accelerate the loss of South African-trained specialists to countries such as Canada, Australia, and the United Kingdom. Of particular concern to CMSA is that training and supervision of registrars (specialist trainees) is likely to be affected by a reduction in funded specialist posts in the public sector with the remaining specialists having to balance the competing demands of increased teaching and service delivery responsibilities. A net reduction in medical specialists in the public sector results in an increase in service delivery n several disciplines. Austerity measures have severely weakened medical, maternal, and paediatric services by reducing budgets, and undermining essential health programmes.

CMSA calls on provincial governments to reconsider and reverse decisions taken to reduce funded specialist and registrar posts as well as address any other austerity measures that affect the specialist training platform. While CMSA acknowledges the resource constraints under which many provincial governments operate, the short term ‘cost-saving’ of austerity measures directed at specialist medicine will detrimentally impact access, quality of care, and equity within South Africa’s health system. CMSA urges provincial governments to address the underlying reasons that necessitated the austerity measures including governance issues and the lack of accountability within some provincial departments of health that has seen billions of rands lost from South Africa’s health system due to corruption and wasteful expenditure. CMSA through its Health Policy Subcommittee will shortly undertake a survey of heads of academic departments and divisions responsible for specialist training to evaluate the extent and impact of systemic challenges affecting the specialist training platform. CMSA plans to use this data to engage constructively with provincial departments of health to strengthen the specialist training platform and improve access to specialist medicine in South Africa.