Nursing Education Conference, Gold Reef City
3 October 2006
The Director-General for the national Department of Education, Mr Duncan
Hindle,
Head of Department of the Gauteng Department of Health, Mrs Sybil Ngcobo,
Chief of Operations of the Gauteng Department of Health, Dr Abdul Rahman,
Representatives of the World Health Organisation,
Chief Directors,
Managers of Nursing Colleges, both public and private,
Representatives of universities,
Representatives of the South African Nursing Council,
Representatives of nursing labour unions:
Programme Director, the nursing crisis that is facing the world, our country
in general and Gauteng province in particular cannot be overemphasised. The
Department of Health's Human Resource Plan attempts to deal with this crisis at
national level and the Gauteng Provincial Government Human Resource Strategy
deals with challenges and opportunities that we face as a province broadly.
I believe this conference is being held in the context of responding to the
Department of Health's human resource plan. I appreciate the need to consult
broadly and extensively on matters that have a direct impact on quality of
healthcare and service delivery.
The Health Human Resource Plan identified the following areas that need
urgent attention regarding nurses:
* improved remuneration for nurses
* improved conditions of service for nurses
* review of nursing qualifications
* review of scopes for practice.
The shortage of nurses in our province prompted the Premier in his State of
the Province address in 2004 to commit the Gauteng Department of Health to
increase the intake production of nurses by 20 percent per annum as from the
2004/05 financial year.
Programme Director, according to the 1995 and the 1999 household surveys the
medically uninsured population of Gauteng increased from approximately 59.7
percent in 1995 to approximately 73.1 percent in 1999. This percentage increase
in the medically uninsured population has placed additional pressure on the
public health system in our province. The additional burden of HIV and AIDS has
already compounded the crisis that we are facing.
The number of people who can afford private healthcare is decreasing as they
resort to the public healthcare system which they expect to meet their health
needs. This in turn implies that the current nurses are faced with an
increasing patient load.
The current nurse patient ratio in our public health facilities is not
healthy. This is a real challenge for the South African health system.
I trust that this conference will deliberate on an appropriate analysis of
the current situation with a view to determine exactly what resources we
currently have, in which areas of healthcare are shortages acute and on also
how the available resources can be utilised.
Programme Director, nursing problems are complex indeed hence there is a
need for all stakeholders to be involved in trying to resolve them. I have
observed that while there is general agreement around the nature of the nursing
crisis there seems to be less agreement on how to resolve it.
I have read many reports out there in the market on what needs to be done to
resolve the crisis yet all these reports and action plans that have been
suggested are fragmented in their approach to finding a solution. Different
stakeholders are still working in silos in trying to address this
challenge.
As the largest employer of nurses in Gauteng, we as the Gauteng Department
of Health are a motive force and are well placed to drive a strategy that will
address this challenge.
In driving a strategy that seeks to address the challenge we are facing, we
need to acknowledge some factors that have brought us to where we are. Some of
these factors are the following:
* the inherited fragmented health system resulting from apartheid health
planning
* rising costs of healthcare
* the effect of HIV and AIDS and the burden resulting from associated
opportunistic infections
* matters pertaining to low salaries and failure to manage performance at the
point of entry and through out the career
* lack of status and career progression
* coaching by the private sector and the developed world
* a changing population with a totally different disease profile.
The problems that we face are not only limited to funding and hence nurses
conditions of service as some people tend to speculate. We acknowledge that at
some stage training of nurses was not prioritised due to the previous
government's skewed understanding of social services.
At the time social spending was not regarded as investment, hence the
resultant neglect of nurse training. This lack of prioritisation had long-term
effects in that nurse tutoring did not become an attractive career option and
we are suffering the consequences of shortsighted policy choices.
The increase in poverty-related illnesses in the under developed and
developing countries imply that that will always be an acute shortage of nurses
who are trained in rendering comprehensive primary healthcare services.
Continued poaching of our nurses by the developed world compounds the
problem. However, the problems that I have just listed are well known and they
are not insurmountable. It is our responsibility therefore to leave this
conference with a clear programme of action with clear targets and timelines
that will ensure that the while we increase nurse intake and production we also
reduce nurse attrition.
This conference must also address issues such as the quality of recruits in
order to ensure that the people who eventually qualify as nurses indeed deliver
quality healthcare.
Programme Director, a simplistic approach would be to increase the quantity
without inculcating the values that are a bedrock of nursing in the course of
training. The quality of the nurses we produce must also relate to the health
needs and the disease profile of our province.
The combined shortage of nurses and that of medical doctors compel us to
revisit our training priorities and strategies. We have to determine which
categories of nurses need to be prioritised in order to ensure that adequate
numbers of qualified auxiliary, enrolled, professional and specialist nurses
are available to meet the increased demand for quality patient care.
Following the Premier's commitment in 2004, we have increased the intake of
new nursing students that are enrolled in the four-year integrated diploma for
professional nurses in the Medium Term Expenditure Framework (MTEF). In 2004 we
enrolled 697 new students in 2005 we enrolled 689 new students and this year we
enrolled 862 new students.
As from 1 January 2006, 400 professional nurse graduates were placed at the
institutions in the province. However, we still need to ensure that placing of
these graduates indeed addresses our service delivery needs.
Since the launch of our internship programme for nurses in 2005 we have
employed 1 895 auxiliary nurses. Most of these auxiliary nurses still need to
be trained as enrolled nurses. It is therefore clear that the shortage of
professional nurses remains acute.
While this increase in recruitment of new students is remarkable there are
other factors that need urgent attention. The environment in which these
students are trained needs to encourage a desire to continue working in Gauteng
after they have qualified and fulfilled their terms of the contract they will
have signed with us.
Programme Director, we have committed ourselves to open more nursing
colleges in our province. In doing this we need to consider the geographical
location of these colleges and also the capacity of the infrastructure of the
existing colleges.
The continued increase in the population density in Ekurhuleni compels us to
consider utilising the clinical facilities in that region for the purposes of
training of nurses.
Programme Director, I will not over emphasise the need to guard against
compromising the quality of nursing education and training by the increased
quantity of student intake. We need to balance this with the need to deliver
quality healthcare and meeting our service delivery needs.
Programme Director, we have recently struggled to attract nurse tutors due
to a number of reasons, chief among which was the issue of conditions of
service. We also need to become innovative if we want to address this problem.
There are measures that can be undertaken to attract nurse tutors to the
province and retain them in our healthcare system.
Programme Director, I will not be prescriptive in terms of exactly what must
be done in order to prevent the attrition of nurse tutors in the province and
also to attract more to remain in the province. I urge you to consider what
other provinces have opted for in trying to address these problems.
With the current budget for nursing education standing at R300,000,000, I am
sure you are more that equipped to devise means of addressing the issue of
attraction and retention of nurse tutors.
Having outlined the challenges that we currently face as the public health
system it is imperative that we become imaginative and innovative in addressing
them. We have a number of private nursing colleges that are accredited to train
nurses. We must explore Public-Private Partnerships (PPP) in order to address
some of the problems I mentioned earlier.
Programme Director, the mandate that was given to us by the Premier was to
increase nurse production by 20 percent per annum. We in turn have set
ourselves a target of increasing the production of nurses by 100 percent by the
end of the MTEF in 2008. At the end of this conference we must therefore ensure
that strategies and concrete plans to realise the above are in place.
I hope this will not become a talk shop where we will moan about nursing
problems that we face as a province. Instead, I trust that you will be able to
identify the gaps between the supply of nurses and demand for quality
healthcare services.
Programme Director, it is important to remind ourselves that this is not the
first conference in the country to deal with the matters that I have raised
above. A national summit on nursing was held in 2001 and some of the issues
that I have highlighted were dealt with, however, the focus was not on Gauteng
as a province. Research papers on the nursing crisis have been written and
published yet the problems remain acute.
Programme Director, we need an aggressive nursing marketing strategy in
order to attract young people who will perceive nursing as comparing favourably
with other career options. We need to communicate success stories among those
that have opted for the nursing profession. We need to create an environment
that attracts young people to the nursing profession.
I therefore trust that in your deliberations you will be mindful of the fact
that we are all about quality of care. The patients must therefore be central
in whatever resolutions that are adopted and programmes of action must
ultimately improve quality of care.
I thank you
Issued by: Department of Health, Gauteng Provincial Government
3 October 2006
Source: SAPA
