T Mbeki: Democratic Nursing Organisation of South Africa
anniversary

6 October 2006

Programme Director
President of DENOSA, Ephraim Mafalo
General Secretary of DENOSA, Thembeka Gwagwa
Members of the National Executive Committee
Chief Executive Officer of the International Council of Nurses (ICN), Judith
Oulton
Former President of ICN, Madame Stallknecht
Leaders of the nursing profession from the Southern African Development
Community (SADC) countries
Distinguished guests and delegates
Ladies and gentlemen

I apologise for the absence of the Minister of Health who has been
hospitalised.

It is with great pleasure that I join you today to celebrate 10 years of the
existence of the Democratic Nurses Organisation of South Africa (DENOSA). As we
know, the journey of organising nurses in this country is a long one, dating
back to 1914, when the first ever association of nurses was formed.

Like all else in our country, apartheid intervened and by 1993, on the eve
of our country's freedom, there were a total of 21 race-based nursing
associations representing over 150 000 nurses. The consequence of this was
acrimony and isolation within and between these associations to the detriment
of the profession.

It was therefore important that the concerned nurses of South Africa brought
together representatives of many of the different associations so as to forge
unity. This was indeed a significant step because for the first time in the
history of our country, the nursing profession was able to speak with one
voice.

This unification was part of the first steps of the broader transformation
processes that were taking place in our country and for the nurses this
represented a practical expression that their profession was also part of a
national movement towards the formation of a non-racial, non-sexist and
democratic South Africa.

From what I understand, it is clear that there is commitment to ensure that
DENOSA becomes a fully representative and leading organisation of all our
nurses, serving and empowering its members to continue to be the best in the
world. As we celebrate a decade of the existence of this non-racial, non-sexist
democratic body of the nursing profession, I would like to touch on two areas
of the mission of DENOSA. These are:

* to stabilise a harmonious and co-operative relationship between members
and their employers
* to promote and enhance the quality of patient care and health standards,
inspired by a caring ethos.

Indeed, it is critically important that we pay particular attention to the
achievement of these objectives.

We have to focus on this mission because the nursing profession as part of
the bigger family of health professions is driven by a set of values that are
regarded as sacrosanct and a critical feature of the medical profession.
Accordingly, it is not an accident that nursing is regarded as the foundation
of healthcare services in all countries.

Given its pre-eminence within the health care system, it is clear that this
profession should take up the mantle of leadership to promote good values,
determined to respect the dignity of all who need healthcare. For many years
the nursing profession has occupied the moral high ground among the majority of
our people because of the commitment, selflessness and the preparedness of most
nurses to go the extra mile to ensure the well-being of their patients. Many of
you would know how you become so attached to the patients that when some of
them pass on you have felt the same pain as those close to the departed.

Even when it became fashionable, among some of our people, to use the
legitimacy of our struggle to engage in acts that are inimical to the same
struggle, many of our nurses correctly took the position that their patients
were their first priority.

Indeed all of us felt very proud when nurses would never be seen near any
pubs or shebeens while in their nursing uniforms. It is because of this respect
for your profession that you also earned the respect of our people.

I must therefore take advantage of this historic moment in the life of
DENOSA to convey our special thanks to you and all the nurses in our country
for giving pride to our nation by your devotion to the service of the people,
even in circumstances in which your working conditions were not up to standard.
Many thanks. The nation is proud of you.

In recent times there have been reports that the standard of our nursing
profession is declining for a variety of reasons, including the significant
migration of some of our most experienced nurses to developed countries, as
well as the erosion of the ethos that has guided nurses for such a long period
of time.

As far as the migration of nurses is concerned, government is attending to
it, and is determined at least to reduce the number of nurses we lose to other
countries. It is also perfectly obvious that we must work even harder to train
and develop greater numbers of nurses.

It is on the issues of the decline of expertise and a caring ethos that
DENOSA, working with government and other stakeholders should make urgent
interventions so as to ensure that this profession continues to occupy its
rightful and respected place in our society.

Florence Nightingale, the pioneer of the nursing profession, showed through
her compassion, her integrity and her dedication that she too embraced the
universal values that we call ubuntu.

It is surely in the spirit of Florence Nightingale and our ancient wisdom
that we need to strengthen our people's contract, based on the moral tradition
of fairness, social justice, compassion and care. For it is only through human
solidarity and the restoration of human dignity and self-respect that we will
build a healthy, prosperous, and peaceful nation.

Necessarily and correctly, DENOSA fulfils a critical role as one of
government's important social partners to improve and expand access to good
health services. Without compromising your ability to represent your members,
it is very important that DENOSA helps our nursing profession to uphold its
high levels of commitment to professionalism and devotion to the welfare of the
sick.

Together, we need to engage in united action against anybody who might give
this noble profession a bad name through their unacceptable behaviour. As we
know, the history of nursing in this country has a rich heritage despite the
setbacks that were caused by apartheid. Stalwarts of the nursing profession
like Cecilia Makiwane laid a good foundation of providing selfless nursing care
to the poor. We must continue to respect this legacy.

Further, nursing is still a female-dominated profession and as a result, all
the challenges that women in the broader society are facing also apply to this
profession and to DENOSA. In addition, nursing continues to be a route of
access to the health sciences profession for all sections of our society.

Government fully understands that it has the responsibility to work with you
to ensure that such access is expanded even more. As the health demands of our
people increase, we must be able to respond immediately and effectively.

We need to make sure that our members have good conducts through which
services can be channelled to all communities, not only to save lives but also
to convey messages about the importance of maintaining healthy lifestyles. Ann
Bradshaw, writing in the British Medical Journal more than a decade ago,
asserted that nursing is not independent of the mores of society. She went on
to ask whether the change in the identity of nursing noticed in the United
Kingdom's National Health Service merely reflected the moral state of society
and healthcare within it?

Similar questions could be posed in our situation. Bradshaw talks of "a new
orthodoxy, which has brought fragmentation to the nursing profession as each
nurse is taught to become a wholly autonomous practitioner; hence, the ward
sister no longer inducts her charges into a [nursing] tradition but rather
takes on the role of a detached business manager."

(From website http://www.bmjournals.com taken from Bradshaw,
A., "Nursing and medicine: co-operation or conflict?", BMJ 1995; 331:304-305
(29 July))

We would need to look at some of these issues as we observe, during this
year, the international year of celebrating human resources for health. It is
therefore very significant that the Ministry of Health launched the National
Human Resources for Health Plan, which seeks to address major issues affecting
health workers. These range from planning and development to the area of
management. At the same time, the relevant government departments are attending
to the issue of remuneration of nurses and conditions under which they
work.

It is our expectation as government, that DENOSA will assist the Department
of Health in implementing the human resource plan and in re-positioning the
country's nursing services so that we are able to better manage our healthcare
system based on effective, compassionate and dedicated service delivery of
healthcare of the highest standards.

In this regard I believe that all of us should pay particular attention to
the 2006 World Health Report entitled, "Working together for health." Correctly
this report says:

"Developing capable, motivated and supported health workers is essential for
overcoming bottlenecks to achieve national and global health goals. Healthcare
is a labour-intensive service industry. Health service providers are the
personification of a system's core values; they heal and care for people, ease
pain and suffering, prevent disease and mitigate risk - the human link that
connects knowledge to health action.

"At the heart of each and every health system, the workforce is central to
advancing health. There is ample evidence that worker numbers and quality are
positively associated with immunisation coverage, outreach of primary care and
infant, child and maternal survival (see Figure 1). The quality of doctors and
the density of their distribution have been shown to correlate with positive
outcomes in cardiovascular diseases. Conversely, child malnutrition has
worsened with staff cutbacks during health sector reform. Cutting-edge quality
improvements of healthcare are best initiated by workers themselves because
they are in the unique position of identifying opportunities for innovation. In
health systems, workers function as gatekeepers and navigators for the
effective, or wasteful, application of all other resources such as drugs,
vaccines and supplies."

These comments of the World Health Organisation draw attention to the
critical importance for us to empower you to the fullest extent possible if we
are to achieve the goal of a better life for all, which includes health for
all. I would urge you constantly to engage government in this regard so that
together we respond adequately to your needs.

I am confident that consistently working together, listening to one another,
attending to the various problems that confront us, learning from the good
practices of those many experienced nurses and placing the patient first, we
will undoubtedly be able to retain the values and service that have made
nursing such a respected and valued profession.

Once again, I congratulate DENOSA and its members on your 10th anniversary
and wish you nothing but the best as you begin your second decade.

Thank you.

Issued by: The Presidency
6 October 2006