Report shines spotlight on 'extreme violations' of nurses rights
This was among the findings of an Oxfam South Africa report entitled: The Right to Dignified Healthcare Work, a Right to Dignified Health Care for All, which was developed in collaboration with the Young Nurses Indaba Trade Union (YNITU).
The report, which was released yesterday, highlights unfair labour practices and the poor treatment of health-care workers, which it claims has compromised the quality of health care in the country.
In reaction to the research findings, trade unions and activists together with Oxfam yesterday announced the launch of a national campaign #Care4Carers which will include mass demonstrations to highlight the plight of nurses and health-care workers.
According to the report, 84.6% of the population relies on public health-care facilities which spend R2500 per capita on medical care compared to the private health-care sector’s R25500 per capita spend on care.
“South African total expenditure on health is about 8.8% of the GDP (gross domestic product), but about 50% of this comes from private money spent on private health services which only caters for 16% of the population with medical aid,” the report said.
The report noted that it would take a nurse 65 years to earn the annual salary of the chief executive of a health-care facility and that three major private health-care firms made R11billion in profit and paid R19bn to shareholders in dividends and share buybacks between 2016 and 2019.
“The private-public mix cannot be sustainable owing to the increasing burden of financial returns to private shareholders which eventually translate into labour-costs saving measures which will impact on the quality of service. This is shown by comparative studies of health provision in the US, Cuba, Canada, Sweden and South Africa,” the report said.
“Poor labour conditions for nurses and community health-care workers are worsened by labour regulations that are not sensitive to the gendered nature of healthcare work. Employers have used these policy gaps to further exploit the workforce.
“The policy gaps include working hours regulation, wage setting and social protection, gender-based violence and safety, labour broking, and National Health Insurance.”
In a joint statement, Oxfam South Africa, the YNITU, the National Union of Public Service & Allied Workers, the National Union of Care Workers of South Africa, Treatment Action Campaign and the South African Federation of Trade Unions said that in the public sector, one nurse serves 200 patients, one community health worker serves 101 households, while 70% of doctors work in the private sector.
Nurses represent 77% of the public sector’s health-care human resources, making them the backbone of the system, the group said.
“Chronic under-staffing in our health-care sector and the reduction in admin staff has left them overworked, overstretched and unable to fully carry out care duties because of increasing administrative duties. Frozen salaries and ever-increasing labour brokering have left them for broke without labour protections,” the group said.
“They have been forced into debt to subsidise low pay, and they take up piece jobs or moonlighting to make ends meet.
“The private health-care sector, on the other side, has exploited loopholes in labour law, such as using labour brokers to avoid filling vacancies and paying competitive salaries,” the group said.
According to the report, the exploitation of nurses and community health-care workers was having a negative impact on the quality of patient care. Additional nurses were not hired despite staff shortages and labour brokers accounted for the supply of around 24% to 29% of nursing staff in private facilities.
Oxfam private sector policy adviser Ruth Mhlanga said compressed working hours of 12-hour shifts led to stress, exhaustion and other ailments.
“They work more than they humanly possibly should. The exhaustion also leads to lower levels of patient care, therefore compromising the health care system. The Department of Health has medical claims because of this type of system. The addition of the second job or moonlighting means we have overworked and tired community healthcare workers which comprises care,” she said.
Mhlanga said the report’s recommendations included a transparent healthcare system, increased government investment, living wages, decent working conditions and an end to gender-based violence.
Timothy Hodgson, legal adviser on economic, social rights with the International Commission of Jurists, said the campaign could result in improved working conditions.
He said the report had highlighted “extreme violations” of nurses constitutional rights to health and work.
“In terms of South African and international law, the state has a duty to protect the right to health of everyone and to regulate the private health sector to ensure it is affordable, accessible, available and of sufficient quality,” he said.
“We would like to see government take broader regulatory measures to get the private sector to serve our population. Private health-care companies cannot be allowed to trade in South Africa and then focus exclusively on their profits.”