“You can advertise for 5000 nurses and you won’t even get 1000,” says Denosa Provincial Secretary Khaya Sodidi. “Or if you do get 1000, that will just be leaving a gap of 1000 nurses somewhere else in the country.”
Sodidi was speaking to Grocott’s Mail after nurses, cleaners and porters at Settlers Hospital in Makhanda demonstrated in front of the hospital’s casualty section on Monday 20 July.
Last weekend, as the growing number of Covid-19 cases put additional pressure on the hospital, a section of the 32-bed former private Netcare ward was prepared and opened for patients.
But staff and management alike are concerned about who will work there.
The Department of Health has advertised for additional nursing staff, and the South African Nursing Council has offered temporary free renewal of registration for qualified nurses during the State of Disaster.
Some managers in the Department of Health blame private hospitals and nursing agencies for snapping up staff keen to work for better rates.
But that’s not the whole story, says Sodidi.
“There simply is no pool of nurses,” Sodidi said. “The provinces, the districts, are all fighting for the same nurses. It’s the very same nurses who are being recycled between public and private; from one province to another.
“There are no more nurses for the government to employ.”
It wasn’t true that agencies were to blame.
“Denosa deals a lot with private nursing agencies,” Sodidi said. “Their rates are not better than the government’s, plus they take commission.”
In addition, nurses were not held to a contract by these agencies.
“They have nurses on their books and they use them when needed. Most nurses prefer to work for the government because they pay better.”
Sodidi believes the biggest mistake the government made was [temporarily]closing government nursing colleges post-1994.
“For years there were no new nurses being trained in those colleges. That is why today we have a huge vacancy rate.”
Private organisations such as Netcare and Life Hospitals had stepped in to fill the training gap, and started their own training programmes. But nurses trained there went into private hospitals.
We didn’t know then about Covid-19, but that is what has happened
Every year, nurses retired or resigned, leaving the pool ever smaller.
Four years ago, in 2016, Denosa led a march to Bhisho by nurses in the Eastern Cape with demands to improve health services in the Province’s facilities and also object to plans to reduce the nurse complement.
At the time, the Department was overwhelmed with medico-legal claims. Sodidi, at the time acting provincial secretary, said the chronic shortage of staff and working equipment, as well as poor nursing education, compromised the quality of nursing care to patients.
“We warned the Department then that this situation would lead to a future crisis,” Sodidi said this week. “We didn’t know then about Covid-19, but that is what has happened.”
Of health facilities across the province, Sodidi said, “Back then there was a vacancy rate of 40%, doctors and nurses were resigning because of poor and dangerous working conditions, there were no ambulances, no proper working equipment and no support staff.
“That situation is still there,” he said, referring to Eastern Cape hospitals in general.
Four years ago, Denosa called for calling for the national Department of Health to intervene and put the province under administration, section 100. Earlier this month, these calls were widely renewed. However, Sodidi says this is not the right answer to the Department’s shortcomings now.
“This is not the time to put the province under administration,” Sodidi said. “Not when the national Department has its hands full dealing with the pandemic in every province.
“Rather, the Province should receive support until we have weathered the storm.”
- The Department of Health has responded in detail to questions about resources at Settlers Hospital in particular, including nursing staff. Please find it in full at the end of this article – ‘Frontline fears as Covid cases rise’.
Where will more nurses come from?
Before 1994, nursing colleges in South Africa produced 80% of nursing health professionals in the country, who continue to work at public and private entities. However, these colleges were racially segregated and unequally resourced. This excerpt from the minutes of the December 2018 Parliamentary Monitoring Group meeting sets out what a new nursing training system was intended to do:
During the early 2000s, all nine provinces had created a directorate for nursing with a mandate to reorganise the nursing profession by addressing racial discrimination and the allocation of resources, to alleviate of the duplication and fragmentation, and to improve conditions at nursing colleges.
All provinces had reorganised their nursing colleges into a single unified provincial nursing college with campuses located at health institutions which offered various levels of health care. The nursing schools located within hospitals would be converted into clinical training units or sub-campuses.
By December 2018, the colleges which had been closed down in the Eastern Cape to undergo rationalisation and re-organisation, had since been reopened.
At that time, according to Nonhlanhla Makhanya, Government Chief Nursing Officer for South Africa: National Department of Health (NdoH), two nursing colleges in the Eastern Cape had closed. Both had been re-opened after rationalisation.
Of the colleges closed in the Northern Cape, none had been reopened due to a lack of funding. Other nursing colleges closed for the purpose of rationalisation and re-organisation were two in Gauteng and four in the North-West Province.
As of December 2018, a total of 138 facilities was made up of 16 nursing colleges, 32 satellite campuses and 90 nursing schools.
The Department on Higher Education and Training (DHET) has since 2010 been developing a new framework and collaborated on creating a new nursing curriculum. Nursing colleges were required to comply with the Council for Higher Education (CHE) for accreditation before they could start offering programmes for nursing qualifications registered on the National Qualifications Framework.
A new curriculum with different nursing programmes was set to be introduced this year, 2020. It includes:
* A three-year Diploma in General Nursing;
* An advanced Diploma in Midwifery;
* A Postgraduate Diploma in other nursing specialisations.
In a post on its website earlier this year, the South African Nursing Council explained that the four-year Degree and Diploma programme. (R.425) was a legacy nursing qualification being phased out in line with the requirements of the Higher Education Qualifications Sub-Framework and gazetted in July 2016. The last intake for this programme was 2019; however, for students already enrolled it would continue to be offered for the next four to six academic years.
The new four-year (R.174) Bachelor qualification will be offered by several Council-accredited Universities and Public Nursing Colleges. They had opted to start offering this programme in 2021, the SANC said. The two programmes would for some years run concurrently.
The Eastern Cape Department of Health’s allocation for Nursing Training Colleges in the 2019/20 financial year was R344.8 million (adjusted appropriation). In the 2021/22 financial year, they are estimated to receive an allocation of R365.1m. (From Estimates of Provincial Revenue and Expenditure for the Eastern Cape).
According to Businesstech, salaries for nurses in South Africa range between R160 600 and R459 200 and average R302 000 annually.
- Health Researcher at the Public Service Accountability Monitor (PSAM) Tlamelo Mothudi provided support in accessing provincial budget information for this article. Other sources include: