The District Clinical Specialist Team (DCST) is a strategy implemented by the South African National Department of Health to strengthen district health systems. An amount of R396 million per annum will be required to fund posts in all 52 districts. During implementation, numerous risks were identified, the major one being the most expensive category of DCST personnel, i.e. Head of Clinical Unit. Similar risks will probably apply to other categories of personnel within the DCST. To achieve the objectives of the DCST strategy, risk reduction strategies need to be promptly applied.