South Africa has a new health Director-General. Last week, a cabinet statement confirmed the appointment of Dr Thembisile Xulu, the outgoing chief executive of the South African National AIDS Council (SANAC). She becomes the country's sixth permanent health DG since 1994.
Her appointment moves her from coordinating the national response to HIV, tuberculosis and sexually transmitted infections into the top administrative post in the Health Department, widely seen as being in need of repair.
Who is Thembisile Xulu
As a medical doctor with a master's degree in public health, Xulu commands wide respect across healthcare circles. Before joining SANAC as CEO in 2020, she spent about 15 years at the non-profit Right to Care.
Her path echoes that of her predecessor. Dr Sandile Buthelezi was SANAC CEO from 2017 to 2020 before serving as health DG from 2020 until early 2026. At that point, he was suspended alongside two other senior officials.
The health Director-General's in-tray
Xulu inherits a department under strain. It has not achieved a clean audit in any of the past five years. The Digital Vibes scandal and this year's suspension of several senior officials over a separate matter have deepened a picture critics describe as chronic organisational dysfunction and weak leadership.
Her most urgent task, on that reading, may be to make the department more professional and to shield it from short-term political pressure. After all, a DG who defers to the Minister serves neither the Minister nor the public well.
One early signal has sparked concern. When the department advertised the post in March, the notice opened neither with the Constitution nor with the National Health Act. Instead, it prioritised the DG’s role in implementing the Presidential Social Compact for health-sector transformation. Several business and healthcare-worker bodies had contested that 2024 compact and refused to back it. Consequently, some observers saw leading with the compact rather than governing legislation as an ominous sign for efforts to build a more capable, less politicised department.
The bigger health challenges
Beyond internal repair lies the substantive work. Chronic shortages of healthcare workers in the public sector top the list. A policy document and additional funding exist. However, sustained leadership and planning to fix the problem have, by many accounts, been lacking.
National Health Insurance (NHI) will also loom large. Even as legal challenges tie up the NHI Act, the DG will spend much of their five-year term dealing with NHI, whatever the courts rule. This will happen either through implementing the current Act or a revised one. Alongside it sit long-standing "bread-and-butter" issues. These include regulating private healthcare and the quality of public services in areas such as mental health, diabetes and hypertension.
Analysis
Xulu's appointment is, in one framing, a test of the government's stated commitment to building a capable state. She takes over a department that many regard as capable in parts but dysfunctional as a whole. Her success will hinge on whether she can professionalise it while keeping political interference at bay. There is some cause for optimism: with Xulu as DG and Dr Nonhlanhla Ndlovu recently installed as the department's HIV lead, two of its most important posts now have fresh leadership. This is a rare opening for renewal. Whether that translates into steadier administration and real progress on healthcare-worker shortages, private-sector regulation and NHI will define her tenure.