Nursing a crisis: SA’s potential health-care exodus in the wake of NHI

The signing of the NHI Bill may have marked a watershed moment for South Africa’s health-care system, moving the country towards universal health coverage. Picture: Oupa Mokoena/Independent Newspapers

The signing of the NHI Bill may have marked a watershed moment for South Africa’s health-care system, moving the country towards universal health coverage. Picture: Oupa Mokoena/Independent Newspapers

Published May 26, 2024


By Julia Penn

“Nurses dispense comfort, compassion and caring without even a prescription.” – Val Saintsbury. Despite, their unwavering dedication, endless hours of toil and true grit, South Africa's nurses are facing an even more uncertain future as the National Health Insurance (NHI) Bill starts its process of coming into effect.

The signing of the NHI Bill may have marked a watershed moment for South Africa’s health-care system, moving the country towards universal health coverage.

But, while the NHI aims to establish a unified health system that offers free care at the point of delivery, it also introduces significant risks, particularly concerning the exodus of health-care workers.

The impact of the legislation on South Africa’s strained health-care workforce, especially nurses, could herald a crisis of unprecedented proportions.

An exodus in the making

Since the NHI Bill’s introduction, the health-care sector has been rife with concern. One of the most pressing issues is the emigration of skilled health-care professionals. Canadian immigration consultants have reported a dramatic 50% increase in interest from South African doctors and nurses wishing to immigrate to Canada. The newly signed NHI Bill is a key driver of the trend, perceived by many health-care workers as a threat to their livelihoods and professional autonomy.

Alarmingly, since July 2023, nearly 10 000 health-care workers, including a significant number of nurses, have sought permanent residency in Canada. The migration is not limited to doctors but extends deeply into the nursing profession, a cornerstone of any health-care system.

Nurses cite inadequate pay, limited career growth and deteriorating workplace safety as primary motivators for seeking opportunities abroad. The number of nurses also lost to the UAE and other higher paying pastures, is keenly felt in my practice and I can, therefore, only assume it is even more tangible in the public sector.

The NHI Bill introduces a government-controlled NHI Fund, the sole purchaser of health-care services under the scheme. While this is designed to streamline health-care delivery and ensure universal access, it simultaneously restricts medical schemes from covering any benefits provided by the NHI. The limitation could undermine the financial viability of medical schemes, leading to a potential reduction in the quality and availability of health-care services.

For nurses, the new reality presents significant professional and personal challenges. The NHI’s implementation could mean fewer job opportunities in the private sector and more pressure on public health-care facilities, which are overburdened. The environment fosters a sense of instability and insecurity, prompting many nurses to consider emigration as a viable alternative.

Global demand and local supply

The global demand for health-care professionals, including nurses, is intense. Countries in the Global North, such as Canada, the UK and Australia, actively recruit South African health-care workers, capitalising on their high-quality education and training. The Royal College of Physicians and Surgeons of Canada’s recognition of South African health-care qualifications facilitates a seamless transition, making the prospect of relocation even more attractive.

Immigration consultants highlighted to BusinessTech that that the global shortage of health-care professionals has led to aggressive recruitment strategies. This is particularly true for nurses, who are seen as essential to the delivery of comprehensive health-care services. As the NHI becomes a reality, the outflow of the critical workers is expected to accelerate, exacerbating the critical shortage of health-care professionals in South Africa.

Nursing an impending crisis

The departure of skilled nurses poses a dire threat to South Africa’s health-care system. Nurses are the backbone of health-care delivery, providing essential services across primary and specialised care. Their exodus will not only strain the remaining workforce but also compromise the quality of care available to patients.

Furthermore, South African nurses are extremely well trained, dedicated and hard-working individuals. Their skillset, experience and ability to shoulder difficult situations in limited resources and under pressure, sets out nurses above and beyond many others.

As South Africa embraces the NHI, our government must urgently address the factors driving health-care professionals away. Without immediate and effective interventions, the country risks facing a health-care crisis characterised by severe staffing shortages and diminished patient care standards.

Certainly, the NHI Bill may set a visionary path towards universal health coverage, but its implementation presents formidable challenges. The loss of health-care workers, particularly nurses, threatens to undermine the goals the NHI aims to achieve. It is imperative for policymakers to engage with health-care professionals, address their concerns and create an environment that retains and supports the essential workers. Only through such efforts can South Africa hope to navigate the complexities of the NHI and secure a stable and effective health-care system for all its citizens.

Julia Penn is a director at Fairbridges Wertheim Becker.