World champs to ward champs: lessons from rugby

South Africans love to talk rugby. And right now, there’s a lot to talk about. Not only are the Springboks the reigning men’s Rugby World Cup champions but South Africa’s U20 side won the World Rugby U20 Championship in 2025, the Blitzboks finished top of the 2025/26 HSBC SVNS league table, and the U18 side is at the top of the international age-group game. 

Top 10 Men’s Rugby Rankings as of April 11, 2026. Source: sarugbyhub.com

What explains the success?

“Passion” and “gees” are important factors. So is Rassie. But there’s a lot more going on behind the scenes.

South African rugby is successful because it has built a high-performing development system.

Much of the explanation can be found in SA Rugby’s strategy documents, which describe development pathways, selection processes, coaching structures, talent scouting and performance science. The SA Rugby recipe for reliably producing great teams includes youth events (tools for talent identification), senior competitions (preparation for international rugby) and coaching development (a structured ladder).

Healthcare, unfortunately, works differently. Our method is more often about people making heroic efforts in weak systems.

South Africa’s 2030 Human Resources for Health (HRH) Strategy spells out problems in supervision, staff distribution, workplace conditions, human resource information and performance management. It talks about understaffed teams who are inadequately supported, poorly supervised and haphazardly developed.

Development pathways

SA Rugby doesn’t expect a Sasha Feinberg-Mngomezulu to emerge fully formed from a rural village, township or suburb. It has school and youth structures, provincial systems, academies, age-grade teams and tournaments with opportunities for talent to be found, tested and developed. When spotted, it has a path forward. 

Siya Kolisi was noticed at a youth tournament in Mossel Bay, received a scholarship to Grey Junior and then Grey High, played Grant Khomo Week and Craven Week, represented SA Schools, then the Junior Boks, and eventually captained the Springboks to two World Cup titles. This is a feel-good story. It is also an example of a system finding talent, giving it access to better coaching and opportunity, then carrying it forward. 

Kurt-Lee Arendse represented an under-18 sevens side, worked in a butchery after school, was spotted during SA Rugby youth-week structures by Chester Williams, found his way to stronger development opportunities, then played sevens as a route into elite fifteens before becoming a Springbok regular. 

Healthcare needs the same. The route from student to competent practitioner to confident team leader should be clearer. Each stage should come with expectations, support and next steps.

Meantime, many clinicians experience training as an endurance test, surviving one posting after another hoping somebody senior takes an interest. These are obstacle courses, not career pathways.

Coaching education

SA Rugby invests in coaches and not just at elite level. Structured coach education runs from Level 1 to Level 3, with emphasis on safe and enjoyable rugby at entry level and greater competence as players and coaches progress.

Healthcare has not taken this seriously. We tend to make people supervisors because they are senior, busy or available, not because they are good at teaching, feedback, assessment or team development. But those are the things that determine whether trainees grow, stall or burn out.

Again, the HRH Strategy points to inadequate supervision and poor practice environments as system weaknesses.

Rugby has coaching ladders; healthcare could benefit from supervisor ladders: preparation for mentoring juniors, feedback skills, workplace assessment, just culture and developing teams rather than just filling rosters and call schedules.

Look for talent widely

Rugby’s development system doesn’t depend on a single trial or a handful of traditional schools. Youth-week events create repeated selection opportunities.

SA Rugby’s transformation plan also acknowledges that development environments are unequal and that talent may need to move to stronger coaching and support environments to flourish.

The healthcare parallel is a system that keeps selecting mainly from those who had better schooling and more support which will probably keep producing service gaps in rural areas and underserved communities.

The HRH Strategy notes evidence that rural background and rural training are linked to retention in rural practice.

Performance science and safety

Modern rugby uses conditioning, analysis, medical support, recovery science and safety systems. BokSmart, launched in 2009,  is a national rugby safety programme designed to prevent injury and enhance performance.

In healthcare we like to talk about resilience. Often what this means is: please keep coping with this impossible situation for a bit longer. In rugby, fatigue, injury, psychological strain and unsafe conditions are not handled by encouraging personal resilience. They are considered as threats to team performance that require systemic solutions.

The healthcare equivalent of BokSmart would be attention to safe staffing, fatigue, supervision, workplace violence prevention, psychological support, incident reporting and learning. It would treat staff wellbeing and patient safety as connected priorities.

A broken pipeline

The analogy with rugby does have its limits. Rugby operates in one part of society while healthcare inherits the strengths and failures of the whole country. South Africa is deeply unequal. Basic education fails too many children, beginning in the early grades. The healthcare workforce pipeline can’t be better than the schooling pipeline that feeds it.

Healthcare also faces maldistribution on a bigger scale than rugby. The HRH Strategy cites major provincial disparities in specialist availability. Some environments are well supplied with supervision, infrastructure and professional opportunity, others are highly deficient.  Places most in need of good people are often the ones least able to support them. 

Another difficult reality is that South Africa trains most of its health professionals in the public sector, where the clinical exposure is intense and the service burden heavy, then almost immediately loses a substantial number to the private sector or to overseas. The pull of better working conditions and earnings outside the public service combines with the push of reduced numbers of funded positions. This creates even more adverse conditions for remaining staff. A pipeline leaking this badly will always struggle to produce strong public-sector teams, no matter how good the training is at the front end.

An example of an avoidable obstacle is the requirement that registrars complete an MMed research component before full specialist registration. The intention is laudable but evidence suggests it often delays completion and registration while competing with already onerous clinical learning responsibilities, service obligations and exam preparation.

South African rugby’s multi-year run of success. Image: OpenAI

Conclusions
It would be naïve to suggest that a better talent pipeline is the fix for South Africa’s healthcare system. The challenges are deeper. They include shrinking budgets, procurement processes vulnerable to corruption and facilities that are visibly deteriorating. In some areas, failures of basic services like water, sanitation and electricity undermine care at a basic level. These structural problems need political and managerial solutions. But because they’re so hard, it’s even more important to focus on what can be addressed: the way we identify, develop and support the people who keep the system going day to day.

Healthcare doesn’t need to be a version of rugby with victory songs after morbidity and mortality meetings. The lesson is that sustained excellence can be designed and built, in SA.

Finally, a word about Rassie. He is significant not only as a brilliant match day coach and innovator. His biography reveals him to be a systems thinker who has been instrumental in the success of the SA rugby programme, including its transformation to broad inclusivity without sacrificing performance. Healthcare needs more leaders like him who care about development pathways, data, talent identification, safety, coaching and overall system design.

References

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10. BokSmart. Springboks Rugby. Available at: springboks.rugby/pages/boksmart
11. Erasmus R. Rassie: Stories of Life and Rugby. Johannesburg: Pan Macmillan South Africa; 2025. Publisher page available at: panmacmillan.co.za/authors/rassie-erasmus/rassie/9781035029419
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