Clinical leadership development: Current practices and future directions for Southern African primary healthcare

Family physicians are uniquely positioned to lead efforts to tackle Southern Africa's persistent primary healthcare challenges, yet such leadership is often perceived as a top-down process rather than a tangible presence. Drawing on insights from the 2025 South African Academy of Family Physicians (SAAFP) conference workshop, we synthesised leadership behaviours, innovative curricula, and workplace learning approaches, aligning with Entrustable Professional Activities and national unit standards. We outline a 5-year roadmap for clinical trainers, programme leaders, and the SAAFP, including: creating psychologically safe learning environments; embedding 360° feedback; normalising mindfulness and reflective practice; and leveraging mentorship for early-career family physicians.Contribution: This Open Forum contributes to the South African Family Practice journal's 45-year special collection by reflecting on significant milestones and proposing future directions for clinical leadership and governance. Practical strategies are offered to embed leadership presence, mentorship, and a culture of feedback into training programmes and health system strengthening activities.