The Gauteng Department of Health is facing a difficult decision between implementing cost-cutting measures and maintaining quality of care.
The department has recently enforced stringent cost-saving actions, such as reducing commuted overtime pay and terminating doctors’ short-term contracts (sessional doctors).
Several clinicians and leadership from medical schools and industry professional bodies released a statement rejecting the austerity measures, calling on the department to reverse its decision. The health professionals argue that the 20 hours of overtime doctors are currently putting in are vital in making sure that doctors are available beyond the standard 8-hour workday.
However, Gauteng health spokesperson Motalatale Modiba says the department is not cutting any commuted overtime nor changing the policy. Rather, it’s enforcing the current policy requirements.
He tells Health-e News that doctors have been unable to produce proof of evidence when it comes to commuted overtime.
“This is all about accountability. Doctors should now account for the commuted overtime. Due to the nature of the issue at hand, the department issued a circular on 4 April to clarify its position on the matter,” he says.
Modiba says the department wants to correct irregular, unjustified expenditure, indiscriminately reduce remuneration.
“Efficient use of resources enables better service delivery and fair workload distribution. Considering that the government spends billions of rands annually on commuted overtime, it surely should be something that is welcomed by all to see the department finally implementing the letter and spirit of the current policy,” he says.
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Wages account for a significant proportion of the health department’s budget. Dr Abieyuwa Ohonba, a health economist at the University of Johannesburg, says the health department is trying to reduce its wage bill by cutting commuted overtime payments and terminating sessional contracts.
“These payments are significant, and in a strained budget environment, reducing them may appear to be the responsible choice. On paper, it offers financial relief,” she explains.
But the long-term consequences could be severe.
“The harsh reality is that these cuts could cause much deeper and costlier damage, such as poor outcomes leading to re-admissions, delayed care resulting in preventable deaths, staff burnout prompting resignations and legal claims, and communities losing faith in the public health system.”
‘Reinstate sessional doctors’
Professor Priya Soma-Pillay, Chair of the School of Medicine at the University of Pretoria, says 11 sessional doctors were asked to vacate Kalafong Provincial Tertiary Hospital in Pretoria earlier this month, as their contracts could not be renewed.
“As a result, the hospital no longer has access to paediatric genetics services [providing support for children and adolescents with genetic conditions],” says Soma-Pillay.
Kalafong Hospital serves a population of about 800,000 people. In early April, the hospital leadership, including the acting CEO, clinical medical manager, and assistant director, submitted a letter to the provincial health department, urging the reinstatement of sessional doctors in the ultrasound and radiology units.
According to the letter seen by Health-e News the ultrasound department performs around 1,100 examinations per month.
“We provide services to in-patients, out-patients, paediatrics, emergencies from casualty, ophthalmology, and urology. There are only three doctors in the department responsible for all of these examinations,” the letter reads.
It continues: “Doctors are also required to attend to patients in the adult Intensive Care Unit (ICU), Paediatric ICU, and the labour ward — especially those who are intubated or too unstable to be brought to the ultrasound department.”
Hospital leadership warns that without the sessional doctors, it will be impossible to maintain current service levels. Waiting times for in-patients could increase from two days to between four and six days, while out-patient waiting times — already averaging four months — could stretch even further.
Doctors left unemployed
For the past three years, Florence* has worked as a sessional doctor in the emergency department at Helen Joseph Academic Hospital. Contracted by the health department, she found the role both fulfilling and essential. When her contract expired in December 2024, she was told it wouldn’t be renewed.
“As sessional doctors, we work 80 hours a month and are assigned to specific departments within the hospital. We also help cover overtime, including late-night and weekend shifts,” she explains.
Florence believes that terminating sessional contracts will place significant strain on already overburdened departments. She has been fortunate to have secured a job in the private sector in January. Her friend Dimakatso*, who recently gave birth, was not as lucky.
“I’ve completely lost my job, and it’s extremely stressful. I’ve worked as a sessional doctor for three years. I was shocked when they told me my contract wouldn’t be renewed,” Dimakatso says.
She notes that Helen Joseph Hospital has already lost five doctors from the emergency department alone because their contracts were not renewed in December.
Modiba denies reports that the department has terminated sessional doctors’ contracts, calling the reports “a deliberate attempt to mislead the public”.
“It is important to ensure that the correct procedure is followed when appointing sessional doctors. The majority of our facilities complied, and there were no issues. A number of factors contributed to the delays in approval of sessional doctors at a few facilities such as a late submission of requests,” he says.
Junior doctors to pick up the slack
A junior doctor at Helen Joseph Hospital tells Health-e News that junior doctors will have no one to call for advice.
“Most of the people affected by commuted overtime are senior doctors and specialists. We call them for advice, especially on night shifts. Sometimes, if you are in surgery, they come and operate with you. Without these specialists, there is no one to call at night for difficult cases. You will be left alone as a junior doctor; this will be extremely detrimental to patients,” he argues.
He believes that there will be nights when there’s no doctor in Helen Joseph’s emergency department.
“Now this is crazy because it’s an academic hospital, and as a junior doctor you are supposed to be there to learn. You have to be supervised by the specialists and this is happening across multiple disciplines,” he says.
Soma-Pillay adds that none of the austerity measures have been provided in a written document.
“The plans to downgrade the commuted overtime tiers for specialists have been postponed to June for implementation,” she says.
She says the plan to downgrade commuted overtime is causing anxiety among clinicians that their monthly salary will be reduced.
“We have already been informed about resignations by colleagues in the Wits circuit. These measures may result in the suspension of some clinical services and this will have an impact on research output,” Somapillay says.
Beyond economic implications
Ohonba stresses that reducing the availability of healthcare professionals in urgent, life-threatening situations is not merely a matter of statistics or balancing budgets.
“We are dealing with moments where seconds matter, where a delayed response can mean the difference between life and death. When there aren’t enough hands at the bedside, it’s no longer just a hospital issue – it becomes a societal crisis,” she says.
Ohonba argues that investing in frontline healthcare workers is not a luxury.
“As health economists, we advocate for allocative efficiency, directing resources to where they make the greatest impact,” she explains. “This could involve cutting non-essential administrative costs, streamlining procurement processes, or investing in community health initiatives that reduce pressure on hospitals. These are smart reforms — not desperate reductions.”
She warns that a resilient public health system cannot be built by weakening its foundations. – Health-e News
*Not their real names
