Can SA’s new Director-General for health turn around a struggling department?

Dr Thembisile Xulu is the newly-appointed Director General of the National Department of Health. (Photo: Denvor de Wee/Spotlight)

Dr Thembisile Xulu is South Africa’s sixth permanent Director-General of health since the dawn of democracy. How will she measure up against her predecessors?

In recent months, we’ve been keeping an especially close eye on the media statements following the twice-monthly meetings of South Africa’s cabinet. Then last week, we finally spotted the line we had been waiting for – the announcement of South Africa’s new Director-General (DG) for Health. 

The name of the country’s sixth permanent DG since 1994 was a familiar one. Back in 2020, Spotlight interviewed Dr Thembisile Xulu when she was appointed CEO of the South African National AIDS Council (SANAC) – the national body established by Cabinet to coordinate South Africa’s response to HIV, Tuberculosis, and Sexually Transmitted Infections. 

In moving from the job of SANAC CEO to health DG, Xulu follows in the footsteps of Dr Sandile Buthelezi, who was CEO of SANAC from 2017 to 2020 and DG for Health from 2020 to early 2026, when he was suspended along with two other senior officials in the department. 

Prior to her time at SANAC, Xulu worked at the non-profit Right to Care for around a decade and a half. She is a medical doctor and has a master’s degree in public health. As far as we can tell, she is well liked in healthcare circles.

A huge task

The job facing Xulu is a daunting one. 

First, she will have to sort out problems within the department itself. As we pointed out in an editorial published in April, the department hasn’t gotten a clean audit in any of the last five years. The Digital Vibes scandal and the suspension of several senior officials earlier this year relating to another matter paints a bleak picture. While we know there are several committed and capable people working in the department, organisationally it seems to be exhibiting all the classic signs of chronic dysfunction and a lack of effective leadership. 

Maybe the most urgent task facing Xulu then is simply to turn the health department into a more professional organisation. This will require strong leadership and management skills, but it will also require her to more effectively protect the department from whatever the political whims of the day may be. Ultimately, a DG that always says, “yes Minister”, isn’t actually doing the Minister, or the public, any favours. 

But it won’t be easy. When the DG job was advertised back in March, the advert did not open by referencing the Constitution or the National Health Act, as one might expect, but by stating that the DG will be responsible for implementing the Presidential Social Compact for transformation of the health sector. The last health compact, signed in 2024, was a controversial document that did not get buy-in from several key business and healthcare worker organisations. That the job advert starts by referencing the compact rather than the relevant laws, seems an ominous sign for the DG’s chances of building a more capable, less politicised, department. 

Second, getting the department’s house in better order will help with what is of course Xulu’s main job – helping to address the country’s many health challenges. Top of the list is the chronic shortages of healthcare workers in the public sector. We have seen an important policy document and some extra funds for healthcare workers, but the incisive leadership and sustained commitment and planning needed to really get on top of the problem has been absent. 

There is a worrying pattern whereby government looks into a problem, maybe a committee of some sort is set up, the intentions are all good, but then everything stalls once some implementation challenge or political complication arises. We need a DG who does not allow important health issues to drift in this way, but who has the focus and determination to find workable solutions and to see them through. 

And then there is NHI

The NHI Act might currently be tangled up in a thicket of litigation, but whatever happens in the courts, NHI will be a big part of the DG’s work in the coming years (DGs are appointed for five years at a time). This may take the form of implementing some elements of the current NHI Act, or working with a revised Act, we just don’t know at this stage. 

But there will be many other bread and butter issues besides NHI demanding Xulu’s attention. In our analysis, the department has badly dropped the ball on urgent issues such as healthcare worker shortages, the regulation of private healthcare, and improving the quality of public healthcare services in areas such as mental health, diabetes, and hypertension. Hopefully under the new DG, the department will find ways of better addressing these issues in parallel with its work on NHI. 

A chance at renewal

There is some reason for optimism. With the appointment of Xulu as DG, and that of Dr Nonhlanhla Ndlovu before that as the department’s HIV czar, new people are now in two of the most important positions in the department. Such leadership changes offer a unique opportunity for organisational renewal. 

Spotlight has requested an interview with Xulu and we hope to get some time with her once she’s been in the job for a few weeks. We will ask her the tough questions, but we will also be fair and give her time. After all, we all want to see a health department and a health system that works. 

Republish