The Democratic Nursing Organisation of South Africa (DENOSA) held its last National Executive Committee (NEC) meeting for the year at its Head Offices in Pretoria between 10 and 12 December where it discussed and reflected on issues in the health sector in general and nursing in particular.
On gender-based violence:
The NEC noted the increasing incidents of gender-based violence that have tarnished the country and men, which underlined the urgent need for state’s intervention. The brutal attacks on women at the hands of ruthless men, which take place even during the time the country has set as a campaign on 16 Days of No Violence Against Women and Children, are highlighting the country’s weakness in sending a strong messages against perpetrators of this crime.
The nursing profession has also been affected greatly by this scourge and has lost many nurses through violent crimes. In many cases, the attacks on women and children have been as a result of domestic violence. The NEC resolved to establish and strengthen the work of its gender structures nationally so that they could play a bigger role in setting the agenda against gender-based violence.
On continuing health and safety risks to health workers in the workplace:
The NEC noted that Safety of health workers in the workplace is a serious issue that has reared its ugly head again across all provinces and the lack of commitment by the employers to strengthen safety and security in the workplace. Patients and health workers have been injured, and some have died from violence that erupted inside health facilities.
While health workers are designated as gun-free zones, there is poor plan to ensure compliance with this designation by the employer, and nurses and patients have been killed with no defense of ability to do so from security services. At the core of poor safety in health facilities is the outsourcing of security services by the provincial departments of health where service providers prioritize profit-making at the expense of safety of patients and workers. It has been proven many times that security personnel are under-resourced and criminals have come to realise this and are now capitalizing on it for their benefit.
The NEC resolved to begin the nationwide campaign on safety of patients and health workers inside premises of all health institutions, particularly calling for the insourcing of this critical service. This is the last resort as many federal calls for strengthening of security have only been responded to not holistically and after patients or workers had lost their lives or got injured.
The attacks of patients and health workers inside facilities have increased substantially and very little improvements have been made in securing facilities.
Four years ago, DENOSA ended the three-year lifespan of its national campaign on Positive Practice Environments (PPE), which began in 2013, where we were calling for, among others, safety in the workplace and adequate tools of trade.
DENOSA feels that the OHSA is being undermined by the employer on numerous occasions, and the events of attacks of patients and health workers have laid bare the poor state of affairs in security services in most government institutions. DENOSA is concerned that patients or health workers have to first get injured or killed before adequate improvements are made in health institutions.
What is most disturbing about poor safety at health institutions is that evidence from the International Committee of the Redcross (ICRC) indicates that, worldwide, health workers in countries that are not at war are far more at danger of being attacked than health workers who are working in countries that are at war!
If it will a national shut down of facilities for government to prioritize the issue of safety and security of patients and workers in health facilities, this is the area that DENOSA is considering because all other avenues of raising it with the employer have not yielded positive results.
On increase in professional disciplinary cases against nurses due to low staffing levels:
The NEC noted with great concern the cases where nurses have been brought before the South African Nursing Council (SANC), mainly as a result of shortage of staff facilities. It has become a norm that many wards in health facilities carry double the number of patients that they should be admitting due to overcrowding. What worsens the situation is the long-standing shortage of nurses that government does not see the need to resolve as speedily as it should.
As a result, the many cases that are brought to the regulatory body against nurses are to do with negligence where there was poor monitoring and evaluating patients, which is impossible with the current overcrowding in facilities. The NEC calls on provincial departments to realise that this shortage is hampering on its mandate of delivering excellent health services to communities.
On the threats to cut remuneration for public servants:
The NEC has noted the unending and disturbing threats by Treasury to always threaten to cut incentives of the public servants whenever the country's economy get unstable. Once again, DENOSA reiterates that government continues to make the same mistakes that it has been making over the years by making reckless pronouncements outside of the set bargaining structures just to look good and get public sympathy from those outside of the public service.
This also makes public servants to look inconsiderate in the eyes of the public, and urges the Minister of Public Service and Administration to stop this tendency and get respect the collective bargaining chambers, as their reckless utterances do nothing but harden the attitude of workers and trade unions. Government workers like nurses are not done any favours by being paid for their work and they continue to work under extremely difficult conditions where each does the work of three or more other nurses due to continuing shortage.
On National Health Insurance (NHI) Bill:
The NEC noted the deadline of 29 November 2019 for the submission of comments for the National Health Insurance (NHI) Bill and the ongoing Parliamentary consultations in provinces.
DENOSA reiterates its full support for the implementation of NHI in South Africa as means to provide Universal Health Coverage (UHC) to all South Africans regardless of their socio-economic standing.
DENOSA submitted its comments to the NHI Bill and continues to participate in the provincial consultations that the Portfolio Committee on Health is holding.
In our submitted comments to the Bill and inputs during the consultative processes in provinces, we have been consistent in calling for three areas of amendments so that the NHI is truly a single system that will cater for all the health needs of the patients. These areas talk to NHI coverage and inclusivity of the NHI Fund’s governing structures to ensure that all interests of the community are represented.
The three areas that DENOSA feels need to be amended are:
- Remove Section 8(2) altogether;
- Include a person with expertise on labour matters in the composition of the board on Section 13(5); and
- Include labour as the technical expertise required for membership in the Benefits Advisory Committee on Section 25(2).
We are extremely worried about Section 8(2) of the Bill, which we feel it is likely to open a can of worms and provide a window of opportunity for voluntary medical schemes to pay for services that will be offered by the NHI service. This is likely to disintegrate further the ideal of having a single purchaser model of healthcare service which the country has been longing for, for years.
According to Section 8(2), a healthcare user will not get NHI services, and must pay through a voluntary medical insurance scheme or other private insurance scheme, if a user:
a) is not entitled to health care services purchased by the Fund in terms of provisions of the Act;
b) fails to comply with referral pathways prescribed by a health care service provider of health establishment;
c) seeks services that are not deemed medically necessary by the Benefits Advisory Committee; or
d) seeks treatment that is not included in the Formulary.
This section contradicts what is on Section 33 of the Bill, which DENOSA fully supports (Section 33). This section reads thus:
“Once National Health Insurance has been fully implemented as determined by the Minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the (NHI) Fund.”
DENOSA has devised its own monitoring and evaluation mechanism as a key stakeholder where we will, for our own satisfaction and for sharing with our key stakeholders, observe the effectiveness of the NHI to all South Africans because its implementation is in line with fulfilling the Section 27 of the country's Constitution.
On festive season safety
As the festive season is upon us, the NEC wishes to remind people who will be on the road to their homes and holiday destinations alike to drive safely and ensure the rules of the road are adhered to at all times.
Nurses have first-hand experience of the consequences of road fatalities and injuries as casualties of these end up in health facilities. DENOSA pleads with holidaymakers to ascertain that their vehicles are roadworthy and are in good condition to travel long distances. DENOSA reminds South Africans that many deaths are due to injuries, and these emanate from road carnages.
The NEC notes that a further contributory factor to road fatalities is the shortage of resources in facilities where many accidents occur during this time of the year, i.e. in rural areas where there are severe shortages of staff. Many of these facilities get overwhelmed as majority people move from urban cities to their homes in December.
DENOSA calls on all South Africans to always obey the rules of the road at all times and get enough rest while on the road to their destinations.
DENOSA wishes all people a Healthy and Merry Christmas and a Happy New Year!
We wish all nurses, most of whom will be hard at work during this busy period, all the strength in caring for the vulnerable.
Issued by the Democratic Nursing Organisation of South Africa (DENOSA)
For more information, contact:
Cassim Lekhoathi, DENOSA Acting General Secretary
Mobile: 082 328 9671
Simon Hlungwani, DENOSA President
Mobile: 082 328 9635
Facebook: DENOSA National Page