Governance, leadership and organisational capacity for decentralised medical training: insights from a South African medical school

Introduction Decentralised medical training has become a strategic approach for strengthening primary healthcare, expanding clinical training capacity and addressing health workforce shortages in South Africa. Despite its growing adoption, limited research has examined the governance, leadership and organisational conditions required for its successful implementation. Guided by Transformational Leadership Theory and Servant Leadership Theory, this study explores the governance structures, leadership practices and institutional readiness necessary to support sustainable decentralised medical training within a South African medical school. Methods An exploratory qualitative research design was adopted employing semi-structured interviews with 16 participants from a university and affiliated Department of Health clinical training sites in KwaZulu-Natal. Purposive and snowball sampling techniques were used to recruit participants and data were analysed thematically using NVivo 12. Results The findings demonstrate that effective implementation of decentralised medical training depends on collaborative governance, transparent communication, stakeholder engagement and distributed leadership. The results further highlighted the need for curriculum transformation, faculty development, adequate infrastructure, sustainable funding and strong partnerships between universities and the Department of Health. Organisational readiness was perceived as a multidimensional construct extending beyond the expansion of clinical placement sites. Discussion The findings demonstrate that decentralised medical training is a complex organisational transformation requiring the integration of effective governance, adaptive leadership and institutional capacity. The study extends existing scholarship by proposing an integrated governance and leadership framework that combines Transformational Leadership and Servant Leadership. The findings offer practical guidance for universities and policymakers seeking to strengthen decentralised medical training and improve the responsiveness and sustainability of health professions education in resource-constrained settings.