Hundreds of newly qualified pharmacy graduates are facing an uncertain future after a sharp reduction in internship posts for 2026, triggering concern from professional bodies, student formations, and political organisations who warn that the crisis could deepen pressure on South Africa’s already strained healthcare system.

At the centre of the alarm is the Pharmaceutical Society of South Africa (PSSA), which says the shrinking number of internship placements threatens not only graduates but the stability of the country’s medicine supply and patient care systems.

South Africa already operates below international benchmarks for pharmacist-to-population ratios. Compared to similar middle-income countries, it has significantly fewer pharmacists per 100,000 people. In that context, the PSSA argues, every pharmacist in the system matters.

An internship is not optional. It is a mandatory, year-long requirement before a pharmacy graduate can register as a pharmacist with the South African Pharmacy Council (SAPC). Without it, graduates cannot practise, cannot enter community service, and cannot legally dispense or manage medicines.

“In pharmacy, the pathway from student to intern, from intern to community service pharmacist, and ultimately to independent practitioner, must function as an uninterrupted continuum,” the PSSA said. “When one segment fails, the entire system feels the impact.”

Yet that continuum is now under strain.

The shortfall has been particularly acute in KwaZulu-Natal and Mpumalanga. In Mpumalanga, only 17 pharmacy internship posts were released for 2026. In KwaZulu-Natal, the Provincial Health Department initially indicated there would be no pharmacist internship posts due to budget constraints. Following public pressure, around 70 posts were later made available, still leaving more than 100 graduates without confirmed placements.

Other provinces have also reported that expanding internship posts would require budget approvals beyond existing allocations, competing with other health priorities.

For affected students, the consequences are immediate. Many have accumulated significant debt, relocated for their studies, and structured their lives around a clear pathway into professional practice. Without an internship placement, their degrees effectively stall.

The Economic Freedom Fighters Youth Command (EFFYC) has accused the Department of Health of abandoning pharmacy students from the Class of 2025.

“In previous years, pharmacy graduates were previously guaranteed internship placements, as these are mandatory. They are a structural requirement to enter the profession,” the EFF Youth Command said. “That social contract has now been broken.”

“These are not statistics. These are young people whose lives are suspended, families plunged into uncertainty, and futures placed on hold.”

The crisis unfolds against a backdrop of persistently high youth unemployment, currently exceeding 45%, according to Statistics South Africa. Labour analysts have long pointed to a contradiction in the healthcare sector: skills shortages coexist with unemployed graduates, largely because of fiscal constraints rather than a lack of service need.

The National Department of Health (NDoH) has acknowledged the seriousness of the situation but says internship placements are not solely dependent on the public sector.

Department spokesperson Foster Mohale said the pharmacist internship programme is regulated by the SAPC and can be undertaken at accredited sites in either the public or private sector.

“It is, therefore, not solely dependent on placement within the public service,” Mohale said.

Within the public sector, he explained, internship posts are funded and managed at the provincial level and are subject to approved budgets and compensation ceilings.

“At present, fiscal constraints across provinces are affecting budgets for the cost of employment, which limits the number of funded internship posts that can be created and filled,” Mohale said.

Graduates have been encouraged to seek placements in accredited private institutions and other recognised training platforms.

However, the PSSA cautions that private-sector flexibility should not become a substitute for creating funded public-sector posts. Pharmacy has historically allowed internships and community service placements in private settings, including industry, which helped absorb pressure in previous years.

This year, private-sector opportunities appear more limited, shrinking what had served as a safety net. The PSSA warns that shifting responsibility away from the state undermines workforce planning and risks destabilising the pharmacist training pipeline.

The organisation links the internship crisis to broader systemic vulnerabilities. South Africa is grappling with periodic medicine shortages, rising antimicrobial resistance, and mounting service pressures in hospitals and clinics.

Pharmacists are central to rational medicine use, medication safety, antimicrobial stewardship, and pharmaceutical stock management. Interns support medicine dispensing, compliance monitoring, and patient counselling in facilities across the country.

Disruptions in training today, the PSSA warns, will translate into workforce gaps tomorrow.

Fewer pharmacists entering the system could weaken medicine supply oversight, increase the risk of dispensing errors, and further strain already stretched primary healthcare services.

Another issue raised by the PSSA is the absence of a standardised national system for allocating pharmacist internships. Processes differ by province, resulting in uneven outcomes and delayed communication.

The society has called on the National Department of Health to open the Intern and Community Service Placement (ICSP) system, currently used for medical graduates, to pharmacist interns. Extending the platform to pharmacy, it argues, would improve transparency and planning coherence.

Internship sites themselves are strictly regulated by the SAPC and must meet defined criteria, including adequate patient exposure and supervision by approved tutors. While these safeguards protect training standards and public safety, they also limit the ability to rapidly expand posts without proper planning and funding.

In response to the current crisis, the PSSA is advancing a Human Resources for Health initiative focused on pharmacy workforce modelling. The aim is to better align graduate output, funded posts, and service delivery needs to prevent recurring bottlenecks.

The internship crisis has now evolved into a broader debate about health system priorities.

“Public clinics are collapsing under pressure, yet trained professionals are being locked out of the system,” the EFF Youth Command said. “This is not a numbers problem. It is a priority problem.”

The Department of Health maintains that fiscal constraints are real and that provincial budgets ultimately determine the number of funded posts.

karabo.ngoepe@inl.co.za 

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