On average, there are 383 nurses per 100 000 people in South Africa. This is according to an Econex health note released in December last year, which was based on figures that there were 189 710 nurses registered with the SA Nursing Council (SANC) and actively working in the country last year.
Over a nine-year period between 2000 and 2009, South Africa averaged 410 nurses per 100 000 people and, on the surface, trumped countries such as Brazil (290), Mexico (400) and Greece (350).
However, the Econex figure for 2010 translates into a ratio of each nurse serving 261 people. This appears to indicate that professionals are overworked, which inevitably compromises the quality of health care. The 2011 figure from SANC is 231 086 registered nurses, but not all of them are practising as nurses.
Last month President Jacob Zuma announced that the government would revitalise 105 nursing colleges. The colleges were closed about a decade ago due to lack of funding. But is this really a solution?
Asanda Fongqo, the spokesman for the Democratic Nursing Organisation of SA, said the union was happy about the commitment to re-open the colleges because it meant more nurses would enter the profession. This was part of the answer, but more had to be done.
“We have been saying re-open the colleges but also resource them well. It is important to make sure that the environment is conducive (and) friendly for them to deliver quality health care. We are talking in terms of remuneration, equipment, humane workload and issues of safety and security,” Fongqo said.
The shortage of nurses is mainly attributed to poor working conditions, low remuneration levels, emigration, illnesses such as HIV/Aids, the burden of disease and increased demand. The closure of the colleges has also contributed as it meant fewer nurses were produced for the workforce.
It takes an average of four years to train a registered nurse (RN) and one year to produce an enrolled nursing auxiliary (ENA). Judging by this, it looks like Zuma’s pronouncement is more of a long-term solution.
The Hospital Association of SA (Hasa), which represents the majority of private hospital groups, said this was an excellent start to addressing the skills shortage.
“The training of a nurse starts benefiting patients from the very first time such a student is at the bedside, which has proven to (be) the best training possible globally. The students will relieve registered nurses by quickly taking over functions like feeding, dressing, cleaning and mobilising patients,” Hasa chairman Nkaki Matlala said.
“They will also be an extra eye for the already overwhelmed nurses. Over time, increased numbers will alleviate the skills shortage in South Africa. We should, however, not forget that equal attention should be given to improved output, better health-care delivery models and improving the patient’s own experiences within the health sector.”
Matlala said there was a need to improve science and maths teaching at school level so that there would be enough students in the pipeline.
Econex does not believe there is a shortage of nurses. It said if current market trends continued, there would be a steady increase in the supply of nurses by 2020 as it expected the number of nurses to rise to 291 942, implying a population ratio of 560 per 100 000. But, the consultancy said, what was of concern was the change in the type of nurses over time.
It said the percentage of RNs had decreased over time, while the percentage of Enrolled Nurses (ENs) and ENAs had increased.
“Further… it is clear that RNs in general are much older than ENs and ENAs with a much larger percentage (43.7 percent) of this group being older than 50. This exacerbates the problem… as almost half of the current stock of RNs will retire within the next 10 to 15 years (almost 3 000 per year)… while fewer will be added,” the consultancy said in its health note.
Econex said it was also mostly RNs who emigrated.
With the government colleges closed, there has been a mushrooming of private nursing colleges. The Private Health Providers of SA has more than 30 registered schools, with the highest concentration in Gauteng and KwaZulu-Natal.
The organisation had received a lot of support from the government, especially in relation to women empowerment as 99 percent of the colleges were owned and run by females, said Thulisile Shezi, who handles marketing for the institute. In 2009, she said, 68 percent of the nurses produced were from private colleges.
Shezi co-owns DT Nursing Institute with Dumile Mofokeng, a college that has been operating since 2003. It has to date produced more than 2 000 nurses who qualified as either ENAs or ENs.
The majority are employed by the public sector on graduation. How do they feel about the re-opening of the 105 colleges and will it threaten their business? Mofokeng is confident that the revival of these colleges will open more opportunities for them.
“It will allow us to grow and we will be able to train more nurses and those who will do higher levels and maybe it will assist us to get more buildings,” Mofokeng said.
The Department of Health did not respond to questions asking for details regarding this plan sent more than two weeks ago. - Slindile Khanyile