Gauteng’s health system is on life support; workers can no longer carry it alone

For years, the people who keep Gauteng’s hospitals running—nurses, cleaners, doctors, porters, and administrative staff—have been warning that the health system is collapsing.

Their warnings were often dismissed as “labour noise” or misread as resistance to accountability. Today, those warnings stand confirmed. Gauteng’s public health system is not experiencing isolated problems; it is in structural failure. Years of underinvestment, poor planning, and administrative paralysis have converged into a full-scale crisis that has left workers and patients at breaking point.

Every day, workers report for duty in unsafe, understaffed, and overstretched facilities, driven not by comfort but by duty to the people of Gauteng.

At Chris Hani Baragwanath Academic Hospital, the largest in Africa, staff contend with broken lifts, failing sanitation, and overcrowded wards. Charlotte Maxeke Johannesburg Academic Hospital, still scarred from the 2021 fire, operates under unsafe conditions.

Across the province, at Steve Biko, Dr George Mukhari, Tembisa, Edenvale, Sebokeng, and Kopanong hospitals, workers endure power cuts, leaking roofs, water shortages, and chronic staff shortages. Behind every malfunctioning system stands a worker doing their best with too little.

These workers have become the human infrastructure of Gauteng’s health system, holding it together where governance and planning have failed. But their resilience is finite. Many are burnt out, demoralised, and exposed to unsafe conditions that compromise both their health and their dignity. The collapse did not happen overnight.

For years, unions, health professionals, and community organisations have warned about maintenance budgets being diverted, essential posts being frozen in the name of “cost containment,” and procurement systems being eroded by corruption. The result is predictable: crumbling infrastructure, collapsing morale, and deteriorating patient care.

A system built to heal has become one that frustrates and exhausts those who serve within it.The recent Special Investigating Unit (SIU) interim report titled How Two Billion Meant for Healthcare

Was Stolen exposes the depth of this crisis. It reveals how three criminal syndicates, operating inside Tembisa Hospital and the Gauteng Department of Health, manipulated over 2 200 procurement bundles and 4 500 purchase orders to divert more than R2 billion into private pockets.

The SIU found falsified documents, fronting, and payments for goods never delivered. That money, enough to rebuild several hospitals, was instead spent on luxury lifestyles and private estates while health workers went without gloves, disinfectant, or functioning equipment.

This is not just theft from the fiscus; it is theft from the sick, the vulnerable, and those whose calling it is to heal. For nurses forced to reuse gloves, cleaners working without disinfectant, and patients waiting hours in overcrowded casualty wards, the SIU’s findings were no surprise, only confirmation of what they have endured for years.

The difference is that the evidence is now public, and accountability must follow. On 3 October 2025, NEHAWU Gauteng led thousands of health workers in a peaceful march culminating in the submission of a detailed memorandum to the Gauteng Department of Health. This was not a protest for protest’s sake; it was a plan for recovery, a call for the state to act with urgency and integrity.

The memorandum sets out six immediate interventions to stabilise and rebuild the provincial health system. First, the urgent repair of infrastructure, utilities, and staffing levels, as many hospitals have become unsafe. Second, guaranteed and timely payment of service providers and professionals to end the demoralising cycle of unpaid contracts.

Third, a credible turnaround strategy with clear timeframes for compliance with fire, safety, and hygiene standards to prevent another Charlotte Maxeke-type disaster. Fourth, increased staffing in specialised care units to alleviate intolerable workloads and improve patient outcomes. Fifth, structured and continuous engagement with unions to ensure workers are treated as partners in reform rather than scapegoats.

Finally, full compliance with the Occupational Health and Safety Act (Act 85 of 1993) across all health facilities to guarantee safe, hygienic, and compliant environments for workers and patients alike. These are not radical demands; they are the bare minimum requirements for a functioning, humane, and accountable public health system.

But no infrastructure plan or turnaround strategy can succeed without first repairing the broken relationship between the Gauteng Department of Health and its workforce. Health workers have lost faith in promises that never materialise and in leaders who too often shift blame instead of taking responsibility.

Rebuilding that trust is not an act of goodwill; it is a precondition for recovery. Workers must again feel like partners in delivering public service, not burdens on the budget. They must know that when they raise safety concerns, they will be heard, not victimised. Patients must once again experience hospitals as places of dignity, not despair. The state of Gauteng’s hospitals reflects the moral choices of governance.

Budgets reveal priorities. When executives receive bonuses while cleaners go unpaid, when maintenance funds are cut while consultants multiply, the message is unmistakable: workers are expendable, and patients are collateral damage. Public healthcare is not a financial burden; it is an investment in Gauteng’s human capital and economic future.

Neglecting it is not merely administrative failure; it is a betrayal of the constitutional promise of healthcare for all. Gauteng’s health workers are not resisting reform; they are demanding it. Their call is grounded in duty and conscience. They know that when hospitals fail, it is the poor who suffer first and most.

Their struggle is not against the government but against the conditions that make quality care impossible. When NEHAWU demands accountability and reform, it speaks for both worker and patient.

Defending the health worker is defending the citizen’s right to healthcare. Protecting the hospital cleaner is protecting the ward’s safety. Paying the nurse fairly is affirming the sanctity of life itself. Gauteng’s health system stands at a crossroads. It can continue down the path of neglect and crisis management, or it can embrace a new model of partnership, integrity, and accountability.

The choice will define not only the future of the province’s hospitals but the moral standing of the state itself. When the lights go out in Gauteng’s hospitals, it is not only machines that stop working, it is the faith of workers and the hope of patients that flickers.

Health workers have kept that light burning through dedication and sacrifice. It is now up to the government to ensure it does not go out.

Tshontshi is Provincial Secretary of NEHAWU Gauteng