Monday, 02 July 2018
The Democratic Nursing Organisation of South Africa (DENOSA) reconvened its National Executive Committee (NEC) meeting which sat from Thursday 28 June to 29 June at DENOSA Head Office in Pretoria where it deliberated on health matters in general, and nursing in particular.
On the release of NHI Bill and Medical Schemes Amendment Bill
The NEC notes the release of two critical bills that intend to shape the country’s healthcare system towards realization of universal access to health for all South Africans – Medical Schemes Amendment Bill and National Health Insurance (NHI) Bill – which are out for public comment.
DENOSA believes that the release of the bills takes the country a few steps towards this goal of achieving universal health coverage. The injustice in the creation of two health systems in the country – the private healthcare which is catering specifically for the 16% of South African income-earners who can afford to pay and the public healthcare for both medical scheme members and the 84% South Africans who are either unemployed or in informal employment.
Creating a single healthcare funding mechanism for ALL South Africans’ health needs was always the logical and non-discriminatory route the country needed to have taken a long time ago. May the processes of setting up structures of NHI as well as finalization of its financing model move faster.
In the Medical Schemes Amendment Bill, DENOSA is particularly happy with the proposals to do away with the co-payment provision, abolishing of brokers and the abolishing of Prescribed Minimum Benefits (PMBs). These will surely have positive effects on the lowering of costs for those belonging to medical schemes, and that the schemes will also be forced to include primary healthcare in their packages.
As an organisation for nurses who are majority health professionals, we understand that it is impossible to eradicate every deficiency in the country’s healthcare system before NHI is ushered in. However, we feel that there should be a clearly defined forward-looking way of dealing with the current backlog of problems, particularly the issue of the severe shortage of nurses and other health professionals who will be greatly needed if both quality and affordable healthcare is to be achieved. Currently, we do not see that forward-looking commitment and solutions-based plan, and already we are entering the second-phase of NHI.
One such solution, which DENOSA will include in its comments to the NHI Bill, is the essence of reopening the previously closed nursing colleges so that production levels of nursing professionals could satisfy the country’s dire need.
NHI gives great emphasis on primary healthcare, and primary healthcare is dominated by nursing cadres with Schools Health programme and the introduction of Community Health Workers at the apex of it, both of which are dominated by nursing cadres.
DENOSA really hopes that the minister finds it in his good heart to accept that there is a dire need to fulfil the promise made by government in 2011 to reopen and revitalize the previously closed nursing colleges, and that the Treasury and Presidency see the importance of this in line with the achievement of NHI.
DENOSA congratulates government for releasing these two ground-breaking bills as they stand to benefits patients and communities.
On the call for Health Minister to resign in light of crises that have besieged the country’s healthcare system
DENOSA has noted with great concern the fast pace at which the country’s healthcare system is going down, with very little intervention from the top despite glaring evidence of this down spiral. More disappointing to DENOSA has been the continuous absence of leadership from the national Department of Health, particularly from the Minister of Health.
DENOSA fully agree with Health Ombudsman’s version that the country’s healthcare is collapsing. In fact the World Health Organization share the similar view, when it recently revealed that the country’s health system is one of the worst in the world.
The NEC reiterates the call that the Minister of Health is overwhelmed by the magnitude of the multifaceted challenges in health and that the best possible solution is for President Cyril Ramaphosa to cut the loss and appoint a new minister with a clear vision and a turn-around strategy before the country regress on the successes that it has made on the health outcomes.
DENOSA believes the minister has had a good nine-year period where he could have brought solutions to many health challenges that the country faces, including the concurrency issue which he views as an impediment for him to intervene in problems that occur in provinces. We are now at the tail-end of his second term and no moves have been made towards resolving this issue.
The classical example of a more disaster that is coming under the leadership of the current minister is when he envisions a total of six million South Africans getting into the country’s Anti-retroviral Treatment programme in the next few months and yet he does not match that with the commitment to employ additional nurses as the programme is now fully run by nurses. The shortage of nurses, which the minister does not see at all, is threatening the health of South Africans because, due to long queues, many patients face the possibility of defaulting on treatment as they often have to turn back from facilities whose dispensaries close at 16h00. The Centralised Chronic Medicines Dispensing and Distribution (CCMDD) programme has not proven to be a solution so far as not many people pick up their chronic medications in convenient pick-up points nearer to their homes.
Furthermore, his lack of early planning for the crisis caused by a number of immigrants in the country into the healthcare service is what has led to this crisis. Immigrants too have a right to health and they must be cared for in the countries they are in, and the responsibility to plan lies with the Department of Health.
Therefore, it cannot be that all key stakeholders in health are of the same view that the health is on the verge of collapse and only one person, the minister, sees otherwise.
On the need to strengthen the Chief Nursing Officer position and establishment of provincial nursing directorates in South Africa
Following the World Health Assembly (WHA) meeting in Geneva in May where matters of health, including nursing, were discussed and the essence of the roles of Government Chief Nursing and Midwifery Officers (GCNMOs) were emphasized, DENOSA NEC calls on South African government to strengthen the work of its own Chief Nursing Officer in the country, following a number of crises in health that have come to affect many nurses negatively.
Establishing and strengthening these offices is critical for leadership, policy and management of nursing. Currently, there is no synergy into nursing management in the country from head office to provinces. In one province, nursing matters are under Human Resource Directorate (HRD), which is a support function within the department of health while nursing is a core function. In essence, core function is under the support function. This is part of the reason there is no solution to many nursing challenges.
South Africa was among the first countries in the African continent to establish the office in line with the call by World Health Organization (WHO) in the early 2000s for countries to establish Chief Nursing Officer positions which will look into affairs of nursing and midwifery, including personnel, resources and remuneration as means to achieve Universal Health Coverage (UHC).
However, DENOSA notes with some level of concern that the office has been underplayed for a number of reasons. While it was great that the Chief Nursing Officer was appointed in 2014, as a nursing association in South Africa, DENOSA feels that the office remains underutilized, much to the disservice of nurses in the country.
For starters, the office remains largely understaffed which makes the work of the person in that office ineffective. Secondly, there should have been Nursing Directorates and Chief Nursing Officers positions established in provinces to synergize the nursing function in the country, which will help improve better health outcomes for communities as nurses form the largest group of health professionals. Not more than three provinces have established both the nursing directorates and chief nursing officer position so far.
DENOSA particularly makes this call in the wake of recent spate of crises in many health departments in provinces, which have become a serious challenge to the achievement of quality healthcare service and gave rise to the need of that office. South African nursing cadres are finding the working environment in the country’s health facilities extremely challenging and impossible to cope under. As a result, DENOSA has noticed that some of the skilled nurses have started to leave the country for developed countries where opportunities and conditions of service are far better.
There is a glaring lack of staff retention strategy by the Department of Health currently, as the old strategy, in the form of Occupation-Specific Dispensation (OSD), has long passed its sell-by-date as it should have been reviewed in 2012. The absence of this incentive or retention strategy is largely owed to the fact the Chief Nursing Officer position has been pitched so low that it does not even report to the Director-General. Just as we have Police Commissioner or Major-General in the army, DENOSA is of the view that the Chief Nursing Officer for the country should be the person who is in a similar stature as the accounting officer on the country’s nursing function, because nursing is classified as an essential service.
Now that the World Health Organization (WHO) has also appointed the Chief Nursing Officer in January, Elizabeth Iro, which will assist with the coordination of nursing matters from the world body to the member countries, South Africa must move a gear up and ensure that the Chief Nursing Officer function is strengthened for the benefit of South African communities.
On performance of non-nursing duties by nurses
The NEC has noted with concern that nurses in health facilities are still subjected to performing non-nursing duties. Nurses still scrub floors due to non-hiring of cleaners; some are dispensing medication in the absence pharmacists, and, moreover, some assistant nurses are heading up clinics due to non-hiring of professional nurses.
Once again, DENOSA calls on nurses to stop and refuse to do work that is not under their scope of practice. DENOSA further urges nurse managers to desist from enforcing non-nursing duties onto nurses. Continuing with this practice will only prolong the existing lack of urgency on the employer to hire sufficient stuff.
DENOSA calls on affected nurses to inform DENOSA in their province of this abuse. DENOSA will be embarking on a nationwide campaign to stop nurses from performing non-nursing duties.
On the Ebola outbreak in the DRC and shortage of protective equipment for nurses
DENOSA has noted with grave concern the outbreak of Ebola virus in the Democratic Republic of Congo and the high risk in which nurses were exposed to infection due to shortage of equipment.
Nurses have had to care for Ebola-infected patients with their naked hands due to shortage of working gloves. What is even worse, which needs the urgent intervention of SADC leaders, is that those nurses whose fear for their life are fetched from their homes by security forces and forced to health facilities to care for patients without protective gear.
This is a serious violation of their right, as they have a right to work in an environment that is safe and not compromising their own right to health.
DENOSA calls on governments in the SADC region to assist the DRC because chances of the virus outbreak spreading throughout the region are quite high.
DENOSA is particularly concerned with the vulnerability of health workers in rural areas where the guard is low against outbreaks like the Ebola in terms of resources. Most concern is on the nurses working in health facilities closer to the borders where community members from different countries visit those facilities in large numbers, as nurses often have to work without protective gear.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information and comment, contact:
Cassim Lekhoathi, DENOSA Acting General Secretary
Mobile: 082 328 9671
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635
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