ABSTRACT:
Health professions regulatory bodies are central to functional health systems, mandated to protect the public by setting and enforcing educational, licensing, ethical, and professional standards, and by investigating complaints of misconduct. Their role in safeguarding patient safety and public trust is critical, yet they are often criticised for prioritising practitioner interests over those of patients. In South Africa, these concerns gained national attention when a gender-based violence (GBV)–focused civil society organisation exposed a regulator for issuing lenient sanctions to repeat sexual offenders, allowing them to retain licences. Such failures occur within broader societal contexts of gendered power imbalances and structural violence. In response, the Health Worker Regulatory Accountability Group (HWRAG) was formed as a voluntary partnership of academics, civil society, survivors, and government officials to advocate for accountability and reform. HWRAG aims to address failures in handling sexual misconduct complaints, identifying systemic weaknesses, and developing evidence-informed reforms grounded in good regulatory practice and survivors’ lived experiences. The inquiry evolved from a volunteer-led investigation into a multi-stakeholder collaboration and included: (a) review of publicly available disciplinary judgements; (b) engagement with survivors to document reporting experiences; (c) review of international literature on regulating sexual misconduct; and (d) engagement with civil society and state accountability institutions, including the South African Human Rights Commission. The inquiry identified four interrelated systemic failures: weak and inconsistent sanctions for serious and repeat sexual misconduct; inadequate enforcement allowing deregistered practitioners to continue practising; limited transparency, including inconsistent publication of disciplinary outcomes; and prolonged administrative delays. Survivors described complaints processes as hostile and re-traumatising. HWRAG recommends reforms that implement trauma-informed complaints processes, ensure consistent and proportionate sanctions, strengthen transparency through routine publication of disciplinary outcomes, and improve enforcement and monitoring to prevent offending practitioners from continuing to treat patients.