By Reon Janse van Rensburg
The provision of good healthcare services is largely dependent on the labour force in the health sector in terms of the numbers, quality of the skills the workers possess, how and where they work, as well as the management and deployment of the medical services, equipment and staff.
Students – the future
One of the biggest challenges in the nursing industry in South Africa is the shortage of nursing staff. According to the Health Department, a shortage of more than 44 700 nursing staff was already experienced as far back as in 2010, and in 2016 there was a shortage of 44 780 professional nurses while only 3 595 students enrolled for the degree course. The prediction is, therefore, that the shortages will escalate.
In addition, there are serious shortages of nursing lecturers, nursing researchers, management staff, clinical specialists, midwives, paediatric as well as primary and community health practitioners. Hospersa (Hospital Personnel Association of South Africa) voiced its concern about the nursing shortages to the Health Department on several occasions but received no feedback. Almost 41% of the public clinics in South Africa that had been assessed during the government’s Ideal Clinic Programme did not have sufficient and effective managers. These clinics are supposed to form the basis for the future focus on community health.
Extensive financial shortages as well as shortages in human resources, equipment and material resources exist within the nursing training environment. Accredited private nursing education institutions in South Africa are especially in trouble since many of the courses offered there had been suspended by the South African Nursing Council (SARV) in 2015. The SARV began with the development and accreditation of a new curriculum and two new qualifications in 2012.
Six years later, only a few training institutions have received accreditation. The key problem is that the SANC is delaying the approval of private nursing training institutions. The transition from the old to the new (the so-called migration process) simply has not taken place. New recruits for clinics and community health services have not been found, trained or employed. The SANC is currently experiencing crucial problems with regard to transformation of the nursing profession within South Africa. The implementation of new training and the accreditation of institutions take place very slowly. So far, only four private colleges appear on the SA Qualification Authority website.
Training is still provided by universities and colleges under the auspices of the Department of Health (DoH) and the Department of Higher Education and Training (DHET). However, the transfer of nursing training to only the DHET has not yet taken place and public colleges are still waiting for amendments to the Nursing Act.
Almost 60% of nursing training take place in private training institutions. If these institutions do not receive accreditation, it will lead to even more serious nursing shortages in future. The number of nurses to be trained as specialist nursing staff will be particularly affected. Private hospitals, including Mediclinic, Netcare and Life Healthcare, have undertaken to train 50 000 new nurses through the SA Hospital Association, but if private hospitals will only be able to start nursing training in 2022, the nursing shortages in South Africa will only begin to be addressed by 2059. Laetitia Rispel, professor and head of the Wits School of Public Health, described nursing as “a profession in peril”. The problem lies with the new courses that have not yet received accreditation due to the process being delayed at the SANC and the Department of Higher Education and Training.
How can young people take up nursing as a profession?
Prospective students can complete their nursing qualifications at a public tertiary institution or at a private nursing college. These private colleges, such as Mediclinic, Netcare Education or Life College, provide the same diploma or degree courses as universities or universities of technology.
Nursing training takes place in a complex institutional environment, including at 20 of the 23 public universities, at 12 public nursing colleges (with many satellite campuses) responsible for the nine provincial health departments, at a nursing college run by the defence force, at private nursing colleges run by the three large private hospital groups in South Africa, and at private nursing schools run for profit. These training institutions provide nursing staff and most of them work in public health facilities. Their employment is linked to a bursary agreement in terms of which nurses who received state bursaries are required to work in the public sector. They are therefore employed by provincial health departments.
According to SARV data, about 50% of all registered nurses are older than 50, and only 5% are younger than 30. Critical shortages will develop in the near future when highly skilled nursing staff, lecturers, nursing managers and clinical specialists retire.
According to the Democratic Nursing Organisation of South Africa (Denosa), more nursing staff currently resign or retire than can be trained and enter the workforce. According to Denosa, only 4 000 new nursing staff can be appointed for every 11 000 nurses leaving the profession.
The above figures indicate a decrease of 8 535 graduate students from 2016 to 2017. This indicates a decline of 39,5% since 2013!
According to Denosa, former President Jacob Zuma, in his 2011 State of the Nation Address, undertook to reopen 105 nursing colleges across South Africa and to get them functional again. However, nothing came of that.
The training of enrolled nurses and nursing assistants was also discontinued without the new qualifications making provision for the training of these nursing staff, which has led to the overall decrease in the numbers of these nurses. Health Minister Dr Aaron Motsoaledi said in 2018 that the changes to the nursing curriculum has been detrimental to the nursing profession.
According to the SANC records, a total of 21 286 nursing students were registered in 2017. However, when looking specifically at the number of students in each study programme (four-year programme, bridging programme, pupil nurses, assistant pupil nurses and psychiatric nursing programme) who completed their studies in 2017, the numbers are vastly different.