This is why clinics are running out of medicine, Mr President

In his speech at the first national convention of the national dialogue, President Cyril Ramaphosa said that one of the pressing questions the country needs to address is why clinics run out of medicine.

However, those in the field have told Newsday that the answers do not need a talk shop, but better governance.

Medicine shortages in clinics are caused by poor management, lack of live budgeting, unqualified MECs, provincial distribution failures, budget constraints, external supply chain problems, brain drain, poor working conditions, mismanagement, and a lack of accountability and transparency in the health system.

“The chief executive appointed to health should be able to provide him with the answers,” ActionSA MP and Doctor Kgosi Letlape told Newsday. “And the answers are there for all of us to see.”

Before entering politics, Letlape was the president of the Health Professions Council of South Africa and the World Medical Association, the founder of the Africa Medical Association, and the chairman of the South African Medical Association.

From his experience, he said that poor management and a lack of live budgeting are behind the inefficiencies in the healthcare system. 

“The majority, if not all, of the MECs of health, are not healthcare professionals. We are outsourcing the management of our healthcare systems to people who don’t have sufficient knowledge,” he said. 

Letlape said these MECs are not fireable and don’t have to deliver to keep their positions. 

A lack of essential health resources is a problem that has plagued South Africa for several years and is the leading cause of medical negligence. 

The government disclosed that payouts for medical negligence claims increased by an average of 23% each year from 2014 to 2020. 

A report from Think Global Health found that clinical errors, mismanagement, lack of accountability, and inadequate facilities and equipment are the primary causes of medical negligence in South Africa.

Pressure on health-care professionals due to understaffing and insufficient resources can lead to mistakes.

“Let’s put the blame where it lies. Medicine is ordered by the national health department, but is distributed by the provincial government,” Gauteng Shadow Health MEC Jack Bloom told Newsday.

“For the President to have to ask the question, ‘why do clinics run out of medicine’ is an admission of failure in itself. It’s like asking why a fish can’t swim or why a swimming pool has no water. It shouldn’t be an achievement for a clinic to have enough medicine,” said Bloom.

He said that when it comes to essential medicines, the supply should be as close to 100% as possible, but the only province meeting this goal is the Western Cape, which points to a problem in distribution.

In Gauteng, Bloom said it is common for essential medicines, such as insulin, to be unavailable at some clinics because orders aren’t placed on time.

The National Health Department claims that occasional medicinal supply constraints are caused by external factors in the supply chain.

The Department has a dedicated unit, the Contract Management Unit (CMU), to intervene in cases of stockouts and publishes a monthly hot list of essential medicines with an availability of less than 90%. 

For July 2025, the list consists of 19 essential medicines. This includes Formoterol inhalers, used to treat Asthma, hydrocortisone, used to treat severe allergic reactions and other emergencies, as well as HIV treatment drug Ritonavir. 

The reasons for the shortages range from supplier issues and delays, manufacturer changes, expired stock, and global supply constraints. 

Poor management and a lack of expertise

Letlape said that a lack of live budgeting in the healthcare system has led to insufficiencies in medicine and equipment. 

National DA shadow minister of health, Michele Clarke, told Newsday that budget constraints are the cause of frequent medicine stockouts.

National Treasury has increased the budget for healthcare by R6,7 billion for the 2025/2026 financial year, bringing the total allocation to R64.8 billion.

However, Letlape is concerned that, without live budgeting, this amount is not being used effectively.

“We have spent billions on healthcare information systems across the provinces and even nationally, and to date, we have nothing to show for it,” he said. 

“We should be able to account for every single tablet, every single injectable, every single syrup,” he said. 

Letlape expressed concerns that the problem extends beyond medicinal shortages to equipment and staff. 

“Every hospital should be able to say: ‘I am a 200-bed hospital. Here is the expected staff complement that I need. Here is what I have, and here is my shortfall. Here is a plan to deal with the shortfall.’”

“There is none of that. No transparency. How do we expect the president to know these things when they are running an opaque system?”

Figures from the Department of Health show that the country lost 12,745 doctors and 58,897 nurses in public healthcare facilities between 2013 and 2025. This is equal to 5,900 doctor and nurse resignations per year. 

In January 2025, the Department admitted that it was experiencing a severe shortage of medical professionals.

“Clinics are severely understaffed, and huge pressure is placed on those who provide health care. This, in turn, affects the standard of health care provided to community members,” Clarke said.

Indiran Govender, a professor at the University of Pretoria in Family Medicine and Primary Health Care, blamed this shortage on “brain drain”. 

“South Africa’s health sector is being crippled because it is haemorrhaging medical professionals at an alarming rate, and this is affecting the quality of healthcare provided,” Govender said in a 2024 article. 

Aside from migrating to countries such as the UK, New Zealand, the USA, and Australia, the public healthcare sector continues to lose qualified staff to the private sector due to poor working conditions.

Govender warned that the government needs to increase accountability in public health institutions, which are characterised by mismanagement and corruption.

Of the increased budget, an additional R1.7 billion has been allocated to employ 1,650 healthcare professionals in public hospitals and clinics. 

The South African Medical and Dental Practitioners Association (SAMDP) said that, while the increase in funding is encouraging, “good intentions alone will not guarantee success.”

“The real question isn’t just about budget figures, it’s about how effectively these allocations will translate into a balanced and inclusive healthcare system.”

“The road ahead requires collaboration, transparency, and policies that support all healthcare providers, both public and private,” the Association said.