Nurses: the essential foot soldiers for national health

This item was first published in the City Press, 25.02.2018

One of the policies listed for almost immediate implementation by South Africa’s newly installed President Cyril Ramaphosa in his recent State of the Nation address (Sona), concerned health. “The time has now arrived to finally implement universal health coverage through the National Health Insurance (NHI),” he announced.

To which the Congress of SA Trade Unions responded, demanding “clear commitments and timeframes to fast track the roll out of both the NHI and Comprehensive Social Security”.

The SA Federation of Trade Unions took a rather more jaundiced view, pointing out that in the three years since the NHI scheme was announced, only pilot projects had been implemented And these, the federation said, are now “threatened by budget cuts”.

Missing from this debate was one crucial factor: nurses. They are the foot soldiers, the core of the medical services army without which no health service — especially one focussed on primary health care — can successfully function.

Yet today, the largest nursing union in South Africa, the Democratic Organisation of Nurses (Denosa) estimates that there is a shortage of “at least 80,000 nurses” and that this is growing. The reason is that more nurses are retiring or leaving the profession than are being trained, a result of years of official neglect in the provision and funding of training facilities for nurses.

According to Denosa communications manager Sibongiseni Delihlazo, the latest statistics the union has available reveal that, in round figures, 11 000 nurses leave the profession annually while only 4 000 qualify to enter it. A number of those who have left have moved to other local jobs, but others took up offers for higher pay and better working conditions in countries such as those in the Gulf states or in Britain.

It is difficult to quantify how many South African nurses now work abroad, but most estimates put the figure at anything up to 30,000. And this “poaching” of medical staff — especially nurses — has long been a bone of contention between the wealthy countries and the developing world, including South Africa.

So much so that, in 2001, the British government agreed to limit the intake of nurses from numerous developing countries. But this was largely ignored in practice and official figures from the United States reveal that 15% of nurses in that country are foreign born and, probably, foreign trained.

The demand, and “poaching”, of nurses is also likely to increase. According to the American Nurses’ Association, US vacancies in nursing could be up to 1.2 million by 2024. Local training could lessen this considerably, but the shortfall will be made up by immigrant nurses who are often seen as a cheaper option.

The same may apply in Britain where, this year, there has been a dramatic decline in the number of student nurses. This because the British government has extended its high priced tuition fee regime to trainees in the medical field.

Previously, nurses and other health services students paid no tuition fees. From this academic year, fees were introduced at the standard £9 250 (R152 000) a year. After three years of work and study, this means that a qualified nurse entering (by British standards) a relatively low paid job, will have a debt of nearly R500 000.

But working conditions — and pay — in Britain, the US and other wealthy regions is usually much better than what is available on home fronts. So, in this global village, nurses will continue to be “poached” until and unless the countries in which they train, recognise their importance in terms, especially, of wages and conditions.

Time perhaps to realise that the nation’s health should be a high priority and that nurses are a crucial factor.