Health workforce distribution and determinants in South Africa – Insights from the WiSDOM Cohort Study
1
Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Equitable, inclusive, and sustainable health systems depend on a well distributed health workforce, but South Africa continues to grapple with the persistent maldistribution of health professionals between the public and private sectors. The WiSDOM (Wits longitudinal study to determine the operation of the labour market among its health professional graduates) cohort study offers important insights into health professionals’ choice of employment sector.
METHODS:
WiSDOM, a 2017 prospective longitudinal cohort study, consists of eight health professions: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. Every year we collect information on sector of employment, and the reasons for working in the private-for-profit health sector. We used Stata®19 for analysis, and panel logistic regression to investigate factors associated with working in the private sector across the eight professions between 2018 and 2025.
RESULTS:
In 2025, the mean age of the cohort was 31.9 (± 2.1), and the majority were female (74.3%). Overall, 49.2% of the cohort were employed in the public sector, with marked variations. Public sector employment ranged from 0% among oral hygienists and dentists to 76.2% among medical doctors, with other professional groups concentrated mostly in the private-for-profit sector. The top reasons for private sector employment were opportunities for professional advancement (23.0%), lack of public sector posts (23.0%), and better working conditions (16.8%). The predictors of private sector employment were health professional category, increased age, urban location, and higher socio-economic background and financial motivation at baseline.
CONCLUSIONS:
The WiSDOM study highlights significant inequities in sectoral employment across health professions, shaped by public sector absorptive capacity, professional aspirations, and working conditions. Expanding public sector career opportunities and improving working conditions are essential to promote more equitable health workforce distribution and ensure an inclusive health system in South Africa.
Equitable, inclusive, and sustainable health systems depend on a well distributed health workforce, but South Africa continues to grapple with the persistent maldistribution of health professionals between the public and private sectors. The WiSDOM (Wits longitudinal study to determine the operation of the labour market among its health professional graduates) cohort study offers important insights into health professionals’ choice of employment sector.
METHODS:
WiSDOM, a 2017 prospective longitudinal cohort study, consists of eight health professions: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. Every year we collect information on sector of employment, and the reasons for working in the private-for-profit health sector. We used Stata®19 for analysis, and panel logistic regression to investigate factors associated with working in the private sector across the eight professions between 2018 and 2025.
RESULTS:
In 2025, the mean age of the cohort was 31.9 (± 2.1), and the majority were female (74.3%). Overall, 49.2% of the cohort were employed in the public sector, with marked variations. Public sector employment ranged from 0% among oral hygienists and dentists to 76.2% among medical doctors, with other professional groups concentrated mostly in the private-for-profit sector. The top reasons for private sector employment were opportunities for professional advancement (23.0%), lack of public sector posts (23.0%), and better working conditions (16.8%). The predictors of private sector employment were health professional category, increased age, urban location, and higher socio-economic background and financial motivation at baseline.
CONCLUSIONS:
The WiSDOM study highlights significant inequities in sectoral employment across health professions, shaped by public sector absorptive capacity, professional aspirations, and working conditions. Expanding public sector career opportunities and improving working conditions are essential to promote more equitable health workforce distribution and ensure an inclusive health system in South Africa.
| eISSN: | 2654-1459 |
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