Absenteeism in Healthcare and Nursing in South Africa

This guide is for HR managers, nursing managers and hospital and clinic managers in the public and private sectors. It covers the South African data, what drives absence in healthcare, the leave rules for public and private employers, and how to measure absence by ward and occupation.

What is the absenteeism rate in South African healthcare?

There is no national rate for healthcare. These are the South African figures that can be traced to a source:

• 2.63% sickness absence rate among 3,543 full-time staff at a South African teaching hospital from January 2017 to December 2019. 78% of staff took at least one spell of sick leave. Staff averaged 2.65 spells a year, with each spell lasting 2.25 days on average. (Khan, UCT, 2022)
• 2.8% for hospitals in a 2010 CAM Solutions study of sick certificates for more than 180,000 employees, second only to mining. (Sunday Times, 2010)
• 7.3 sick leave days a year on average across the public service over 2020 to 2023, with sick leave costing R10,181,620,776 in 2023. The Public Service Commission's report does not give a separate sick leave figure for health departments, but health and education account for most employees with capped leave. (Public Service Commission, 2025)

The teaching hospital study breaks the rate down by group, and the differences are large:

Source: Khan (2022), Table 2. The thesis does not name the hospital.

The author links the higher rates among nurses, pharmacists and non-clinical staff (such as cleaners and security officers) to physically demanding work. He also notes that doctors may be working while sick, which is presenteeism rather than low illness. (Khan, 2022) For how these figures compare with other sectors, see our guide to South African absenteeism benchmarks.

What drives absence in healthcare

Physical strain and musculoskeletal injury

Conditions of the musculoskeletal system caused 40.1% of sick leave at the teaching hospital, followed by acute upper respiratory infections at 13.2%. (Khan, 2022) Lifting and moving patients, long periods on your feet and short staffing all contribute. This is the largest single cause, and it is one an employer can act on through manual handling equipment, training and staffing.

Infection exposure

Health workers are exposed to the infections their patients carry. A systematic review of TB among South African health workers reported a national survey of 133 primary health care facilities (2006 to 2008) that found TB incidence 2 to 3 times higher in health workers than in the general population. In eight eThekwini public hospitals, health worker TB incidence averaged 1,133 per 100,000 over 1999 to 2004, against 497 per 100,000 in the KwaZulu-Natal population. (Grobler et al., BMC Health Services Research, 2016) Staff with infections should stay home, so some of this absence is necessary and protects patients.

Burnout

A survey of 4,298 nurses in 143 public and private South African hospitals, conducted during the COVID-19 pandemic, found that 43.9% had high levels of burnout and a quarter intended to leave their jobs. (Coetzee et al., Journal of Nursing Management, 2026) Burnout shows up in absence data as rising short-term sick leave, and later as resignations.

24-hour rosters, fatigue and second jobs

Hospitals run around the clock, often on 12-hour shifts. A 2010 survey of nurses in 80 hospitals in four provinces found that 40.7% had moonlighted or worked for an agency in the preceding year, 51.5% had felt too tired to work, and 10.9% had taken sick leave when not actually sick. Moonlighters were more likely to report sick leave when not sick, but the difference was not statistically significant after adjusting for other factors. (Rispel and Blaauw, Global Health Action, 2015)

Shift patterns also change how sick leave is counted. BCEA section 22(2) gives paid sick leave equal to the number of days the employee would normally work in six weeks. (BCEA s22) A nurse on 12-hour shifts works fewer, longer shifts, so their entitlement is counted in shifts, and each absent shift leaves a 12-hour gap to fill.

What does absence cost in healthcare?

The direct cost of sickness absence at the teaching hospital was 2.93% of the total cost of employment, or US$618.14 per employee per year (the thesis reports costs in US dollars). That figure counts only the wages of absent staff. It leaves out overtime, agency cover and the cost of wards working short. (Khan, 2022)

Agency cover is a large cost in its own right. In 2009/10, the South African public health sector spent R1.49 billion on nursing agencies. (Rispel and Angelides, Global Health Action, 2014) A case study of two Gauteng public hospitals found further indirect costs, with managers reporting problems with agency nurses including a perceived lack of commitment, unreliability and sub-optimal quality of care. (Rispel and Moorman, Global Health Action, 2015)

To estimate your own cost, add the wages of absent staff, overtime premiums, agency invoices for shifts that covered absence (not vacancies), and the management time spent finding cover. Our cost of absenteeism calculator handles the direct part, and the cost of absenteeism guide covers the rest.

Sick leave rules: public and private healthcare

Private hospitals and clinics

• Sick leave is a 36-month cycle, with paid sick leave equal to the days normally worked in six weeks. In the first six months of employment, one day is earned for every 26 days worked. (BCEA s22)
• An employer does not have to pay for an absence of more than two consecutive days, or for absences on more than two occasions in eight weeks, if the employee does not produce a medical certificate when asked. (BCEA s23)
• Absence caused by an occupational injury or disease, including infection acquired at work, falls under COIDA rather than the sick leave rules, except for any period when no compensation is payable. (BCEA s24)

See our guides to sick leave in South Africa and medical certificate requirements.

Public sector health departments

Public servants get 36 working days of normal sick leave with full pay in a three-year cycle, and unused days do not carry over. A medical certificate is required when sick leave goes beyond two consecutive days, and an employee absent on more than two occasions in eight weeks must also submit one. When the 36 days are used up, the employer may grant incapacity leave under the Policy and Procedure on Incapacity Leave and Ill-Health Retirement (PILIR). (Public Service Commission, 2025) The PSC report notes that this open-ended management discretion is where poor management and misuse of sick leave occur, and it recommends that departments, including supervisors and HR units, audit sick leave records.

How to measure absenteeism in a hospital or clinic

1. Measure by ward or unit and by occupation. Nurses, doctors, allied health and support staff have very different rates, as the table above shows. A hospital average hides the ward that is always short.
2. Use scheduled shifts as the denominator. Absenteeism rate = unplanned absence days (or shifts) divided by scheduled working days (or shifts), multiplied by 100. The absenteeism rate calculator shows the formula.
3. Separate leave types. Keep sick leave, injury on duty and occupational infection, incapacity leave, family responsibility leave and unauthorised absence apart.
4. Count spells. Most healthcare absence is short. Frequent single-shift absences are the hardest to cover. The Bradford Factor calculator weights them.
5. Link absence to cover cost. Track how many agency and overtime shifts were booked to cover absence, not only vacancies.

What the evidence says works in healthcare

• Target the main causes. With musculoskeletal conditions the largest cause at the teaching hospital, safe patient handling and adequate staffing address absence directly. The study's author calls for targeted risk mitigation based on the causes found. (Khan, 2022)
• Strengthen infection control and staff TB screening. Higher TB incidence among health workers is documented. Occupational infection is also a COIDA matter, so record it as such.
• Manage fatigue and second jobs. Rispel and Blaauw recommend strong nursing leadership, effective management, and consultation with front-line nurses to deal with the effects of agency work and moonlighting. (Rispel and Blaauw, 2015)
• Talk to staff when they return. A short, consistent return-to-work interview picks up burnout, injury and personal problems early.
• Use incapacity processes for long-term illness. See incapacity versus misconduct.

For a general overview, see how to reduce absenteeism.

How Appsentia helps healthcare employers

Appsentia works from the leave records in your payroll system: an Excel or CSV export, or a nightly PaySpace sync. For a hospital or clinic group, it gives you:

• Absenteeism rates by department and sub-department, which you can map to facilities, wards or occupational groups.
• Nursing managers who see only the departments they are assigned.
• Flags for short sick spells on Mondays and Fridays, next to public holidays, on or after payday, and next to other leave.
• An attendance risk score from 0 to 100 for each employee, recalculated nightly from how often they are absent, how much of their sick leave falls on Mondays and Fridays, their recent trend and comparison with their department.
• Alerts when an employee's risk score moves into the high band or rises sharply.
• A Rand cost of sick leave, from sick days and the average daily salary you set, plus scheduled PDF and Excel reports.

What it does not do: Appsentia does not read duty rosters, so it cannot tell a missed day shift from a missed night shift, and its cost figure is direct wage cost only. Agency and overtime cost come on top. A pattern flag shows timing and frequency. It does not establish misconduct, and every individual report recommends a supportive check-in about health, workload and workplace factors as the first step. In healthcare, where burnout is common, that first conversation matters.

Frequently Asked Questions

Sources

1. Khan MA (2022). The burden and cost of sickness absenteeism amongst healthcare workers at a teaching hospital in South Africa. MPH dissertation, University of Cape Town.
2. Public Service Commission (February 2025). Report on the utilisation of categories of leave in the Public Service: facts, observations and recommendations. Tables 12 to 14 and section 4.5.
3. Sunday Times (18 October 2010). Mining records highest absenteeism rate.
4. Rispel LC, Blaauw D (2015). The health system consequences of agency nursing and moonlighting in South Africa. Global Health Action 8:26683.
5. Rispel LC, Angelides G (2014). Utilisation and costs of nursing agencies in the South African public health sector, 2005 to 2010. Global Health Action 7:25053.
6. Rispel LC, Moorman J (2015). The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals. Global Health Action 8:26494.
7. Coetzee SK et al. (2026). Nurse and patient outcomes in private and public hospitals in South Africa during the COVID-19 pandemic. Journal of Nursing Management.
8. Grobler L et al. (2016). The epidemiology of tuberculosis in health care workers in South Africa: a systematic review. BMC Health Services Research 16:416.
9. Basic Conditions of Employment Act 75 of 1997, sections 22 to 24.

This page is general information, not legal advice. Check the current Act, your sectoral determination or your bargaining council agreement before acting on a specific case.