DA calls for a Parliamentary Enquiry into nursing shortages in SA

29 June 201

Today’s oversight visit by the DA to the Joubert Park Clinic in Hillbrow, serves to confirm that nurses are at the frontline of health care and yet the nation gives them little resources to carry out their duties or even extend congratulations for tirelessly serving the South African people despite the many challenges they face every day.

We have a nurse-based healthcare system and it is no surprise that our clinics are run by them. Today we thank the nurses for the extraordinary care they give to the nation’s ill and infirm.

Much like the Philippines, South Africa has an excellent and deserved global reputation for the quality of nursing (and physician) education and training. But we face a crisis in nurse education and training today. Unless reversed, it will result in the further decline of our reputation and in how we serve our people. Economists call it a supply side problem.

Let me explain, we have four categories of nurses:

(1) nursing auxiliaries who take 1 year to train; 

(2) enrolled nurses - 2 years; 

(3) registered nurses and midwives – 4 years; and 

(4) specialist registered nurses and midwives – 4 years plus 1-2 years specialist training.

We have a total of 270,437 nurses registered in South Africa today, not a bad figure comparatively at all. But we are short of 44,780 professional nurses and only 3,595 have enrolled according to the South African Nursing Council (SANC), for the nursing degree course. At this rate, the shortage will worsen.

The only remedy is to rapidly expand the training platform, which is not possible for reasons I will explain, or to bring in highly trained nurses from foreign countries, which would be politically problematic for a country with an unemployment rate as high as ours. A shortage of professional nurses will compromise care.

Research shows that having a critical mass of professional nurses in hospitals reduces the risks of patients dying by eight percent and significantly cuts the incidence of urinary tract infections, gastro-intestinal bleeding, hospital acquired pneumonia, shock, cardiac arrests and brings about a 3-12 per cent reduction in adverse outcomes. 

In Intensive Care Units (ICUs), one additional professional nurse reduces the incidence of falls. (South African Medical Journal 109 nos. 5&6 May-June 2013).

For individuals using the public sector, the problems are worse. Half of our 270,437 nurses are in the public sector caring for 84 percent of the population while the other half are in the private sector providing for the remaining 16 per cent.

This is because the work environment, conditions of service and morale are simply much better in the professionally run private sector. But it does mean that public sector nurses have work obligations that are beyond the pale: poor wages for hard thankless efforts to save lives, treat pain and alleviate suffering.

It is also true that 62 per cent of nurses work in the urban environments of Gauteng, Kwazulu-Natal and the Western Cape, while 38 percent are distributed among the remaining six largely rural provinces.

Nurses and doctors do not like working in rural areas. Incentive payment does not make much of a difference. Other countries struggle with the same thing. It compromises access to health care and we have to do something bold to remedy the problem.

But then a further calamity of blockages to accelerated training of auxiliary nurses and enrolled nurses. Professional nurses are the cavalry of health care and auxiliary and enrolled nurses the foot soldiers. Not only is there a shortage of personnel that take 1-2 years to train in the sea of female unemployment, we have stopped the education and training itself because the state bodies responsible are dysfunctional and cannot get their act together.

Laetitia Rispel, Professor and Head of the Wits School of Public Health, describes nursing as a ‘profession in peril’. She is, in a nutshell, referring to the fact that private colleges, who receive no state subsidy, train auxiliary and enrolled nurses in the old so-called legacy curriculum, but they may no longer do so because better courses on paper have been introduced. But the problem is that the new courses have not been certified and registered because of bungling by the SANC and the Department of Higher Education & Training.

It is, as they say, a monumental cock-up.

The transition from the old to the new – the so-called migration process - has simply not happened. New recruits to staff up clinics and community health have not been found, trained and employed on a vast scale. The Council of Higher Education takes 18 months to accredit courses.

Thus far only four private colleges appear on the SA Qualification Authority (SAQA) website.

We cannot staff up the existing system, never mind staff up against emerging demographic and health burden trends. Human resources are at the heart of any health system and what is the point of having grand plans without the trained people to run things.

Finally, the importance of community health workers has increased as health-care delivery is increasingly home based. The answer to a DA parliamentary question revealed that 24,634 workers out of a projected need of 29,747 have been employed, and this by non-governmental organisations (NGOs), leaving a shortfall of 5,112 in the provinces of Kwazulu-Natal, Limpopo, Mpumalanga and the Free State, places that can least afford to have shortages. (Question 1181).

What is to be done?

The DA calls for a Parliamentary Enquiry into the state of nursing in SA with a view to receiving practical recommendations on how:

- The SANC can be set right, protected from political interference, with its board appointed independently and made accountable to Parliament;

- New nursing qualifications can be expeditiously introduced;

- Private sector training can be incentivized through subsidies to train more auxiliary and enrolled nurses, which has been its forte;Bursaries can be expanded for the training of degreed and specialised nurses, written off by smart placements in demanding, especially rural, areas; and

- Supported by the National Planning Commission (NPC), superior health workforce planning can be done for a sustainable pipeline of nurses for a South Africa devoted to universal access to healthcare.

Issued by Wilmot James, DA Shadow Minister of Health, 29 June 2016