The South African public healthcare system is largely supported by private sector partners providing human resources, capacity building and other assistance. The rationale for this study stemmed from the need to understand how provincial health systems sustain critical human resources for health (HRH) functions in the face of donor funding transitions. It examined the impact of USAID/PEPFAR funding termination on HRH management (including planning, recruitment, deployment and sustainability) at the Limpopo Department of Health.

A qualitative case study design was employed, drawing on key informant interviews, semi-structured questionnaires (with HRH practitioners) and document review to triangulate perspectives. Data was analysed thematically, guided by the WHO’s health system building blocks (HSBB) and the social determinants of health (SDOH) frameworks.

The findings revealed that the withdrawal of donor-funded partners exposed weaknesses in governance, financial sustainability and workforce retention. The absence of structured absorption and transition mechanisms led to delays in recruitment, data fragmentation and reduced planning capacity. Despite this, there was evidence of adaptation, including the integration of donor-supported functions into provincial structures, the establishment of wellness units and renewed efforts towards digital recruitment and workforce monitoring. The study concluded that sustainable HRH planning requires institutionalised transition frameworks, routine policy evaluation and stable financing aligned with South Africa’s HRH Strategy 2030. The insights will contribute to ongoing efforts to strengthen provincial health systems and promote HRH resilience in post-donor contexts.

December 2025