Are there recent updates on Groote Schuur Hospital’s request to reclassify SRS/bottom surgery as a quaternary service?

The long answer

A quaternary level service is a “fourth level medical service” that does highly specialised or experimental surgical procedures, and if SRS/bottom surgeries were to be so reclassified, it would mean that the national government would fund the surgeries, rather than the Western Cape provincial government. 

When this request was made by the Transgender Clinic in 2019, Dr Kevin Adams, a surgeon at the clinic, said that the clinic could then employ nurses who just did gender reassignment, and the surgeons could open more theatres and work till midnight. In that way, the waiting list could be dramatically shortened.

In December 2019, the National Essential Medicines List Committee (NEMLC) approved the use of gender-affirming hormones at tertiary and quaternary levels of care. Thus, the Transgender Clinic’s request was approved by the NEMLC, but the clinic is still operating at a tertiary rather than quaternary level, and the national government is not yet supporting it financially.

There were already extremely long waiting lists for SRS/bottom surgery in 2019 – people were waiting for over twenty years – but then there was the Covid pandemic, which put an end to surgeries for some 18 months, said Dr Kevin Adams in 2021. 

Currently there are hundreds of patients waiting for various gender-affirming surgeries. 

There is also currently the USAID freeze which has meant that the Wits Reproductive Health and HIV Institute (Wits RHI) which previously received USAID funding for transgender health programmes, has been forced to stop some services due to a "stop order communication" according to Wits University's Prof Shabir Madhi. The Wits RHI said on Facebook that “we are unable to provide services until further notice".

Trans activist Aurora Krotoa Moses of the Aurora Kaleidoscope Movement, wrote to the Western Cape Department of Health and Wellness (WCDHW) in February 2025 about the sudden lack of access to medication following the USAID freeze, and the Director of Emergency and Clinical Services Support, Juanita Arendse, replied, saying that “the WCDHW is unable to commit funds to a dedicated service based on pre-existing budgetary constraints.” The WCDHW did say that a guiding document was being drawn up and that a meeting was scheduled for May, but there has not been any public comment or document since. 

So unfortunately, we have no further information on developments. 

Wishing you the best,
Athalie