Healthcare workforce recruitment and retention in the rural areas of the Limpopo Province, South Africa
Simon Matome Nkgapele & Xolani Thusi
Abstract
Previous studies examined the challenges of recruiting and retaining healthcare professionals across the health sector. However, they have not explicitly focused on the public health sector, particularly in the rural areas of Limpopo province. This paper explores challenges experienced in recruiting and retaining healthcare professionals in rural areas and suggests strategies for the Limpopo Department of Health (DoH) to attract and retain these professionals effectively. The paper employed a qualitative descriptive research design and gathered data through semi-structured interviews. The findings were analysed using thematic content analysis. The paper found that rural public hospitals under the Limpopo DoH struggle to recruit and retain healthcare professionals due to poor living conditions, centralised recruitment, limited career development, and the unattractive nature of rural areas. These challenges show weaknesses in public sector Human Resource Management (HRM) and policy implementation. They lead to staff shortages, burnout, reduced quality of care, and continuous loss of skills. These factors undermine effective healthcare service delivery and the constitutional right to healthcare under Section 27 of the Constitution of the Republic of South Africa, 1996. The paper therefore recommends improved administrative planning, decentralised recruitment, better working and living conditions, and stronger interdepartmental coordination to support sustainable healthcare delivery in rural areas. These recommendations align with national priorities and constitutional obligations to ensure every South African has access to equitable and quality health services. This paper contributes to public administration practices in public health and public sector HRM and provides a theoretical contribution to the HRM sub-field in public administration.
Keywords
healthcare professional, turnover, human resource management, healthcare service delivery
Author information & Contribution
Simon Matome Nkgapele. Corresponding author. Master of Public Administration and Management. Student, Department of Public Administration, University of Limpopo. Email: nkgapelesimon@gmail.com
Xolani Thusi. Doctor of Public Administration. Senior Lecturer, Department of Public Administration, University of Limpopo. Email: xolanithusi@yahoo.com
"All authors equally contributed to the conception, design, preparation, data gathering and analysis, and writing of the manuscript. All authors read and approved the final manuscript."
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This work was not supported by any funding.
Institutional Review Board Statement
This study was granted an ethical clearance certificate by the University of Limpopo Turfloop Research Ethics Committee (TREC) with project number TREC/34/2025. Permission was granted by the Limpopo DoH Research Committee and the Limpopo DoH District Office to conduct the study at the selected rural hospitals.
Data and Materials Availability
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
AI Declaration
The authors declare the use of Artificial Intelligence (AI) in writing this paper. In particular, the authors used Writefull in restating sentences to improve clarity and logical flow. The authors take full responsibility for ensuring proper review and editing of contents generated using AI.
Notes
Acknowledgement
References
Adebayo, A., & Akinyemi, O. O. (2022). “What are you really doing in this country?”: emigration intentions of Nigerian doctors and their policy implications for human resource for health management. Journal of International Migration and Integration, 23(3), 1377-1396. https://doi.org/10.1007/s12134-021-00898-y
Ahmed, M.A.A., Diakite, S.L., Sissoko, K., Gagnon, M.P. & Charron, S. (2020). Factors explaining the shortage and poor retention of qualified health workers in rural and remote areas of the Kayes, region of Mali: a qualitative study. Rural and Remote Health, 20(3), 1-9. https://search.informit.org/doi/abs/10.3316/INFORMIT.492916640290875
Andersen, L. B. (2009). What determines the behaviour and performance of health professionals? Public service motivation, professional norms and/or economic incentives. International review of administrative sciences, 75(1), 79-97. https://doi.org/10.1177/0020852308099507
Berndt, A.E. (2020). Sampling methods. Journal of Human Lactation, 36(2), pp.224-226. https://doi.org/10.1177/0890334420906850
Choi, S. (2020). Flexible work arrangements and employee retention: A longitudinal analysis of the federal workforces. Public Personnel Management, 49(3), 470-495. https://doi.org/10.1177/0091026019886340
De Beer, J.N., 2019. The recruitment and retention of medical practitioners and specialists in rural areas: the case of the North West Department of Health (Doctoral dissertation, North-West University (South Africa)). https://repository.nwu.ac.za/items/eba6b76f-9b76-4d76-9f93-9366efcbf86d/full
De Beer, M. (2022). Intermediate phase educators’ experiences of the use of online tools to enact formative assessment in Social Sciences Teaching and Learning (Doctoral dissertation, University of Johannesburg). https://www.proquest.com/openview/0acbcdcafddaa261779cbc7ff5c5fddd/1?pq-origsite=gscholar&cbl=2026366&diss=y
de Villiers, K. (2021). Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty, 10, 1-7. https://doi.org/10.1186/s40249-021-00804-9
Democratic Alliances. (2024). Limpopo Health Department forks out hundreds of millions in medical legal claims, DA Limpopo. Available at: https://limpopo.da.org.za/2024/03/limpopo-health-department-forks-out-hundreds-of-millions-in-medical-legal-claims (Accessed: 05 October 2025).
Deonarain, M. (2024). The quality of work life of frontline healthcare workers that affect service delivery at selected hospitals in South Africa (Doctoral dissertation, Cape Peninsula University of Technology).
Gathongo, J. K., & Ndimurwimo, L. A. (2020). Strikes in essential services in Kenya: the doctors, nurses and clinical officers’ strikes revisited and lessons from South Africa. Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad, 23(1). https://www.ajol.info/index.php/pelj/article/view/216587
George, A.S. (2023). Brain drain or brain gain: assessing the costs and benefits of India’s manpower exports. Partners Universal International Innovation Journal, 1(6), 19-37. https://doi.org/10.5281/zenodo.10257669
Gumede, D.M., Taylor, M. & Kvalsvig, J.D. (2021). Engaging future healthcare professionals for rural health services in South Africa: students, graduates and managers perceptions. BMC health services research, 21, 1-15. https://doi.org/10.1186/s12913-021-06178-w
Hadley, A. (2024). Migration and professional mobility: Rural attraction and retention of South African educated physicians. Social Science & Medicine, 350, 116884. https://doi.org/10.1016/j.socscimed.2024.116884
Health Professions Council of South Africa (HPCSA). (2024). Annual Report 2023/2024, Health Professions Council of South Africa. https://www.hpcsa.co.za/9c4858ec-e277-4b64-bed5-9ca892db2d69
Hlayisi, V.G. (2022). Increasing unemployment rate amongst health professionals: Will there be jobs for newly graduated South African audiologists post-COVID-19? South African Journal of Communication Disorders, 69(2), 909. https://journals.co.za/doi/full/10.4102/sajcd.v69i2.909
Holst, J. (2020). Increasing rural recruitment and retention through rural exposure during undergraduate training: an integrative review. International journal of environmental research and public health, 17(17), 6423. https://doi.org/10.3390/ijerph17176423
Jansen, D. (2023). What is research design? 8 types + examples, Grad Coach. https://gradcoach.com/research-design/
Kamkuemah, M. (2021). The epidemiology of Chronic Non-Communicable Diseases (NCDS) and NCD risk factors in adolescents & youth living with HIV in Cape Town, South Africa. http://hdl.handle.net/11427/35558
Kim, M.Y. & Torneo, A. (2021). The roles of strategic human resource management and person–environment fit on nonprofit public service motivation. Public Integrity, 23(1), 33-51. https://doi.org/10.1080/10999922.2020.1775059
Limpopo Department of Health (2024). Department of Health Limpopo Province Vote No. 07 Annual Report 2023/2024 Financial Year, Ldoh. Available at: https://www.ldoh.gov.za/ldoh-admin/documents/latestnews/documents/ANNUAL%20REPORT%2020232024.pdf
Mahapatro, M., Roy, S., Nayar, P., Panchkaran, S. & Jadhav, A. (2023). Adherence to behavioural intervention in RCT study by the women experiencing domestic violence and attending ANC in a public hospital in India-an analysis. Dialogues in Health, 2, 100126. https://doi.org/10.1016/j.dialog.2023.100126
Mamabolo, J. K., & Fombad, M. C. (2026). A knowledge retention strategy for professional nurses in South Africa. Information Development, 42(1), 239-250. https://doi.org/10.1177/02666669231209956
Marambire, E. T., Chingono, R. M., Calderwood, C. J., Larsson, L., Sibanda, S., Kavenga, F., … & Kranzer, K. (2024). Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe. PLOS global public health, 4(1), e0002328. https://doi.org/10.1371/journal.pgph.0002328
Matlala, N. T. (2019). Factors related to the provision of quality health care services at selected public clinics in the rural areas of the Capricorn District, Limpopo Province (Doctoral dissertation). http://ul.netd.ac.za/handle/10386/2932
Mpongoshe, M. (2022). The Effectiveness of Ideal Clinic System in Increasing Job Satisfaction in the Rural Areas: A Case in the Eastern Cape Province, South Africa. Journal of Human Resource and Sustainability Studies, 10, 557-578. https://doi.org/10.4236/jhrss.2022.103034
Mumbauer, A., Strauss, M., George, G., Ngwepe, P., Bezuidenhout, C., de Vos, L., & Medina-Marino, A. (2021). Employment preferences of healthcare workers in South Africa: Findings from a discrete choice experiment. https://doi.org/10.1371/journal.pone.0250652
Nchabeleng, M.T. (2022). Challenges experienced by healthcare workers when rendering services at a district hospital in the Limpopo Province, South Africa (Doctoral dissertation). http://ul.netd.ac.za/handle/10386/4634
Netshisaulu, K.G., Malelelo-Ndou, H. & Ramathuba, D.U. (2019). Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa. Curationis, 42(1), 1-8. https://journals.co.za/doi/abs/10.4102/curationis.v42i1.1921
Ngene, N.C., Khaliq, O.P. & Moodley, J. (2023). Inequality in health care services in urban and rural settings in South Africa. African Journal of Reproductive Health/La Revue Africaine de la Santé Reproductive, 27(5s), 87-95. https://www.ajol.info/index.php/ajrh/article/view/262974
Nkengasong, J.N., Raji, T., Ferguson, S.L., Pate, M.A. & Williams, M.A. (2021). Nursing leadership in Africa and health security. EClinicalMedicine, 36. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00210-8/fulltext
Nkgapele, S. M. (2025). Employee Motivation and Healthcare Quality in the Post-COVID-19 Pandemic: A South African Public Health Sector Perspective. Journal of Management & Business Studies, 7(1), 1-17. https://doi.org/10.32457/jmabs.v7i1.2637
Nkgapele, S. M. (2025). The recruitment and retention of medical professionals in rural areas at the Limpopo Department of Health, South Africa (Doctoral dissertation). http://hdl.handle.net/10386/5310
Nkgapele, S. M., & Mofokeng, S. (2024). Merit-based recruitment in the South African Public Service: Challenges and opportunities. International Review of Social Sciences Research, 4(4), 148-170. https://doi.org/10.53378/irssr.353136.
Nkgapele, S. M., & Thusi, X. (2025). The Recruitment and Retention of Critical Healthcare Professionals: Focus at Polokwane Provincial Hospital. Journal of Management & Business Studies, 7(1), 1. https://doi.org/10.32457/jmabs.v7i1.2486
Nkgapele, S. M., Dlamkile, P., & Mofokeng, S. (2025). Leveraging business principles to improve human resource management in the public sector in South Africa. International Journal of Management, Entrepreneurship, Social Science and Humanities, 9(1), 179–194. https://doi.org/10.31098/ijmesh.v9i1.2677
Nkobeni, M.L., Mukonza, R.M., Mokoena, O.P. & Ntuli, S.T. (2024). job satisfaction levels and contributing factors among health professionals in rural public healthcare facilities of Limpopo Province, South Africa. Al-Sihah: The Public Health Science Journal, 136-143. https://doi.org/10.24252/al-sihah.v16i2.50110
Ntuli, S.T. & Maboya, E. (2017). Geographical distribution and profile of medical doctors in public sector hospitals of the Limpopo Province, South Africa. African Journal of Primary Health Care and Family Medicine, 9(1), pp.1-5. https://journals.co.za/doi/abs/10.4102/phcfm.v9i1.1443
Payne, A., Koen, L., Niehaus, D.J. & Smit, I.M. (2020). Burnout and job satisfaction of nursing staff in a South African acute mental health setting. South African Journal of Psychiatry, 26, 1454. https://journals.co.za/doi/abs/10.4102/sajpsychiatry.v26i0.1454
Popescu, M., Popescu, C., Per, E., & Csosz, I. (2018). Rural area and rural development. Definition and features. https://www.cabidigitallibrary.org/doi/full/10.5555/20183195738
Republic of South Africa. (2006). Managing staff retention: An information guide for government departments. Department of Public Service and Administration (DPSA). http://www.dpsa.gov.za/documents.asp
Republic of South Africa (RSA). (2006). Managing Staff Retention: An Information Guide for Government Departments. Department of Public Service and Administration (DPSA). http://www.dpsa.gov.za/documents.asp
Republic of South Africa (RSA) (1996). The Constitution of the Republic of South Africa, 1996. http://www.gov.za/documents/constitution/constitution-republic-south-africa-1996-1%20 .
Republic of South Africa (RSA) (1997). White paper on human resource management in the public service. Department of Public Service and Administration (DPSA).
Rural Health Info. (2023). Healthcare access in rural communities Overview – Rural Health Information Hub, Overview – Rural Health Information Hub. https://www.ruralhealthinfo.org/topics/healthcare-access
Shipalana, M. L. (2019). Recruitment and retention of healthcare professionals in the public health sector: focus at the Limpopo Department of Health. http://hdl.handle.net/10386/2763
Thusi, X., & Nkgapele, S.M. (2024). Sustainable strategies for enhancing the recruitment and retention of health professionals in rural areas in the public health sector, South Africa. Asian Journal of Management, Entrepreneurship and Social Science, 4(04), 1751-1769. https://doi.org/10.63922/ajmesc.v4i04.1030
Van Schalkwyk, B. B. (2015). Challenges in realising sustainable community development in rural South Africa. Agriculture, forestry and fisheries, 4(4-1), 73-79.
Wleh, C.J. & Nkoane, N.L. (2025). Assessing the impact of human resource shortages on patient care: Perspectives of registered nurses in a Gauteng Public Hospital, South Africa. In Nursing Forum (Vol. 2025, No. 1, 9939848). Wiley. https://doi.org/10.1155/nuf/9939848
Workplace testing. (2021). What is a health professional? – definition from workplacetesting. WorkPlaceTesting.com. https://www.workplacetesting.com/definition/10/health-professional World Health Organization. (2022). Health systems resilience toolkit: A WHO global public health good to support building and strengthening of sustainable health systems resilience in countries with various contexts. https://iris.who.int/bitstream/handle/10665/354177/9789240048751-eng.pdf
Yoganathan, V. (2024). Medico-legal liabilities drop as provinces adopt new measures. Juta MedicalBrief. https://www.medicalbrief.co.za/medico-legal-liabilities-drop-as-provinces-adopt-new-measures/
Cite this article:
Nkgapele, S.M. & Thusi, X. (2026). Healthcare workforce recruitment and retention in the rural areas of the Limpopo Province, South Africa. International Review of Social Sciences Research, 6(2), 1-24. https://doi.org/10.53378/irssr.353341
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