By Lungile Gamede – RHAP Graduate Intern
According to the World Health Organisation, a well-functioning healthcare system is defined as one that “responds in a balanced way to a population’s needs and expectations by; improving the health status of individuals, families, and communities; defending the population against what threatens its health; protecting people against the financial consequences of ill-health; and providing equitable access to people-centered care” (WHO,2010). Nurses in South Africa make up the majority of the health workforce (Rispel, 2015) and are also the first point of care for many rural communities in a primary healthcare setting. It is for this reason that nurses in South Africa are called the backbone of the healthcare system. Although this is the case, a well-functioning healthcare system in South Africa is being threatened by the challenges that exist within the nursing profession such as the inequitable distribution of nurses between rural and urban areas, staff shortages, the lack of caring ethos, the gap that exists between professional competencies and the health priorities of the population (Rispel, 2015) and nursing as an aging profession. These challenges seem to be exacerbated amidst the COVID-19 pandemic. In all of this, it is important to also note the burden and stigma that nurses have had to carry in healthcare settings and that even through that, there have been examples of exceptional practices of the art and science of nursing.
Of the nurses in South Africa, the age distribution data from the South African Nursing Council states that 29% of Registered Nurses/Midwives in South Africa are between the ages of 50-59 years. 29% of Enrolled Nurses/Midwives are also between the ages of 50-59 years and lastly, 34% of Enrolled Nursing Auxiliaries are between the ages of 40-49% (SANC, 2018). This shows that nursing is indeed an aging profession and that there is a need for better attraction and retention strategies to attract younger nurses into the profession. This, however, can only be effective if these attraction and retention strategies also consider equitable staffing of nurses at all levels for rural areas as well. Coupled with this, nursing education and curriculum need to be structured in such a way so as to align professional competencies and the priority health needs of the population. Failure to also absorb community service nurses also contributes to a weakened healthcare system. It adversely affects staffing norms in public facilities and thus can contribute to bad health outcomes for both the carer and the patient.
The World Health Assembly marked 2020 as the Year of the Nurse and Midwife in order to showcase and elevate the vital positions that nurses play in transforming healthcare globally. Nurses are often the first port of call into the health system for many communities – especially rural communities. As the policy landscape has shifted to focus on the development of a unified, primary healthcare catered health system under the NHI, RHAP has made the strategic decision to support more focused engagement with the nursing profession, with the firm belief that nurses are indeed the backbone of the health care system and have the potential to bridge the gap between communities and the healthcare system. Our first efforts towards that this year included organizing a nursing seminar focusing on The Future of Nursing in South Africa. The seminar aimed to explore opportunities for social responsiveness and accountability in current nursing education reform. This was scheduled to take place in March but had to be postponed due to the national measures that were put in place in order to curb the spread of COVID-19.
RHAP has also been in touch with a few healthcare workers in the OR Tambo District through surveys in order to understand the experiences of communities in rural areas and it was noted that the lack of formal COVID-19 training and PPE was a recurring issue amongst nurses and community healthcare workers spoken to. This together with the uncertainty that surrounds a pandemic caused by a novel virus cannot have a good impact on healthcare workers at all. It also points to a need for advocacy competencies among healthcare workers. Caring for the carers is extremely important together with creating an enabling environment for healthcare provision.
The COVID-19 pandemic has the potential to compromise an already fragile healthcare system. This realization, however, is an opportunity for us to gird up our loins as a nation particularly in relation to our health workforce. This calls for wisdom accompanied by multi-sectorial efforts and collaboration. Caring for the carers is caring for the nation!