Oct 23, 2021

Mawazo Writing Africa

Writing about the main

Ageing nurses: A crisis on the near horizon for SA

Nurses make up a large proportion of the health care workforce in South Africa, but nearly half of them will retire in the next 15 years, so the current shortage is just the beginning of a likely growing problem.

National spokesman for the Democratic Nursing Organization of SA (Denosa), Sibongiseni Delihlazo, says: “This is a ticking time bomb just waiting to explode in front of the eyes of South Africans.”

Loud According to the South African Nursing Council (SANC) statistics for 2020, the current age demographics of registered nurses and midwives is heavily geared towards older doctors, with less than a third being under 40 years of age. The statistics show that 27% of registered nurses are in with 50, 26% with 40 and only 21% with 30 (see table for more information).

The demographics of registered nurses and nursing assistants are spread only slightly more evenly.

The fixed retirement age for public nurses is 65 years old, with some extensions allowed. In short, that means that in 15 years, 47% of registered nurses will be retired. The same applies to around 26 to 30% of registered nurses and nursing assistants.

‘We have a crisis’

“We have a crisis in an aging workforce,” says Prof. Laetitia Rispel, the South African Research Chair for Health Workers at Wits University. She explains that while this is an international problem, the relatively young population of South Africa makes it worrying.

“Not only is it the replacement of actual individuals, but one also needs the cumulative experience and wisdom in the Health system and that won’t be replaced if we don’t take action now, “she says.

The Rural Health Advocacy Project (RHAP) has had a variety of consultations with care stakeholders in the past months. Lungile Gamede, project leader in their Human Resources for Health program, explains that while accurate data is not available on the nationwide comparison, “We have no doubt that rural communities will bear the brunt of the severe scarcity themselves deteriorate if almost half of the registered nurses and midwives retire at about the same time. ”

According to the Strategy of Human Resources for Health 2030 by SA 2030, this is the Fall, if nothing substantial is done, forecasts that by 2025, just four years from now, a shortage of registered nurses in primary health care of about 34,000 will likely be required.

Historical causes

The current and expected future bottlenecks seem to be due to general systemic problems as well as particular shifts in care to be. “It is an underinvestment in human resources for health care in general and a historical neglect by nurses and nurses,” says Rispel.

Prof Helen Schneider of the School of Public Health at the University of the Western Cape explains, that it is an “increasing professionalization of care with longer, more expensive training, with increasing expectations of status and remuneration”. She says this has led to problems with supply and affordability, as well as increasing division of labor at the base of the system.

Funding for staff is a major contributor, according to Delihlazo.

” First, poor workforce planning and continued government budget cuts to finance nursing education are at the heart of the problem, “he says.

Lerato Mthunzi, President of Young Nurses Indaba (YNITU), is working conditions to make matters worse address the problem and make the nursing profession less attractive. She says that because of burnout and brain drain, many have left their jobs or the country to get better working conditions, which puts pressure on those who remain. She says general wards now have a ratio of around 20 to 30 patients to a nurse and assistant, as opposed to the norm of around five to one, which shifts the focus from quality care to pure administration. p>

Gamede explains that, given the important role nurses play in this regard, this crisis will adversely affect primary care capacity and undermine the health system’s ability to focus on treating tuberculosis and HIV. Important health indicators, especially of children, and the general ability to achieve the health-related sustainable development goals (SDGs) are affected.

Problems with training

According to statistics published on the SANC website, the total number of nurses on their register has increased from around 238,000 in 2011 to around 280,000 in 2020. This is an increase of 18%, roughly proportional to population growth over the same period.

These figures seem to indicate that SA has made little or no progress in addressing the lack of care over the past decade. Additionally, recent setbacks in nursing education may cause the shortage to get worse before it gets better.

In 2020 legislation will be changed to require all Nursing Education Institutions (NEIs) to qualify as higher education institutions ( HEI). which was previously only connected by university nursing departments. The managing director of the Association for Nursing Education, Dr. Nelouise Geyer explains that this “should improve graduates’ critical analytical skills,” but that the transition has created a significant gap in the number of graduates.

She explains that many smaller private schools have closed because they couldn’t afford to enroll as a college. Public nursing schools did not meet the requirements, although the Minister of Higher Education created a transitional regime so that they can qualify temporarily.

Geyer says: “The The hardest change is that only universities are accredited to offer the professional nurse program – this will result in a nearly 80% decrease in professional nurse output in three years. ”

Geyer is particularly concerned on the shortage of specialist nurses – she says none were trained in 2020 and 2021 as none of the specialist programs were newly accredited. She does not hope that many will be readmitted again next year.

The National Health Department confirms that there are now 17 accredited universities, 10 public and 10 private nursing schools. The total number of students that can be admitted to the training per year per program is approximately 5,900.

Mthunzi says she heard that those attending the new accredited courses have many problems with it. She says lecturers also feel unsupported, frustrated, and often lacking the right qualifications, “which really leaves them behind when it comes to being more effective or delivering content as needed”.

Change of course

Change of course


A response from the National Health Department on these issues indicated that their focus in these matters was on “developing nursing education and practice is at the national level to meet the requirements and ensure an adaptation to the planning of the nursing staff ”.

In order to curb the growing shortage of nurses, one would clearly have to face the challenges in the training sector so quickly ask as possible. Schneider says that the new curriculum must urgently be implemented correctly, while Delihlazo says we should “reopen the previously closed nursing schools since yesterday” and increase the training infrastructure.

Gamede explains that the accreditation is urgent More could change training institutions in the form of a strengthening of the community service program, improvement of poor working and living conditions and adjustment of wages. Gamede says that to better equip nurses, training should be more accessible and less centralized, with nursing training institutions being more accountable. Strategy central. On paper, it looks strong and includes an emphasis on digital health technology, “harmonizing the accreditation, registration and regulation of NEIs” and “institutionalizing functional governance structures with empowered, competent, accountable and capable executives and nurse / midwife managers at national, provincial and district level. ”

Rispel, who was involved in the development of the strategy, says that unfortunately little has been implemented, but the starting point would be to understand what resources are and must be available, and on that work towards it.

“One of the main recommendations was that a highly specialized human resource information and information system is needed, which should be established in the National Ministry of Health, and that we could develop credible planning models that collect information, that we can forecast, and au ch show which political levers should be used, ”she says.

Although there are different models that are already outlined in the strategy, it is clear that change would begin with implementation. Rispel says: “In our strategy we have certainly emphasized that, regardless of the modeling used, we need an additional number of health workers.”

Although SANC responded to media inquiries from Spotlight, they largely shared statistics and did not provide any significant statistics Comments on other topics.

This article was originally published by Spotlight.