The Committee was briefed by the National Department of Health (NDoH) on its state of readiness to implement the new nursing curriculum and training programmes in 2020. Pertinent issues raised included the progress made by the Department in rolling out the new curriculum, and how it intended to address the challenges of inadequate infrastructure at health institutions to accommodate clinical training programmes.
Responding to assertions that currently employed nurses were underpaid and exposed to abuse from the public at hospitals, the Department said it was collaborating with the Department of Labour and the bargaining chamber to improve conditions and services for nurses. The new curriculum offered better qualifications and training to address specific needs. Efforts were being made to end the fragmentation and inequality of services at nursing colleges, which dated back to the apartheid era.
The colleges which had been closed down in the Eastern Cape to undergo rationalisation and re-organisation, had since been reopened. The nursing colleges would be required to comply with the Council for Higher Education (CHE) for accreditation before they could start offering programmes for nursing qualifications registered on the National Qualifications Framework. Those nursing schools which were located within hospitals would be converted into clinical training units or sub-campuses.
The Portfolio Committee made several recommendations to the Department, including that the nursing profession should be prioritised, and attention should be directed to the well-being of nurses. The new curriculum would offer a three-year diploma in general nursing which would equip them with a wider scope of practice than was the case with the nurses currently enrolled. The Committee said it was important for the Department to meet with the heads of provincial and district health facilities to establish the needs of each province. The Committee was assured that the deployment of nurses was taking place successfully, especially in areas affected by shortages of health professionals.
Ms Nonhlanhla Makhanya, Government Chief Nursing Officer for South Africa: National Department of Health (NdoH), briefed the Committee on progress made in relation to the re-opening of nursing colleges and new nursing programmes.
She raised three areas of concern on the closure of nursing colleges, and progress made this far. She elaborated on the key recommendations made at the Nursing Summit in 2011, which had focused on:
- The re-opening of nursing colleges. She said that before 1994, nursing colleges were established along racial lines throughout the country, including in the former homelands. After the first democratic elections in 1994, the conditions at nursing colleges were exposed, such as the unequal distribution of resources, and the duplication and fragmentation which had been inherited from the apartheid system. The nursing college sector had historically produced 80% of nursing health professionals in the country, who continued to provide health at public and private entities.
- An update on the new nursing programmes and curriculum. There had been a need to produce a National Nursing Policy on nursing education, which should be unified on the basis of management, governance and the provisioning of nursing education.
- Collaboration with the Department on Higher Education and Training (DHET) in order to assist colleges, and to determine whether they were located in the higher education framework which had been developing since 2010.
During the early 2000s, all nine provinces had created a directorate for nursing with a mandate to reorganise the nursing profession by addressing racial discrimination and the allocation of resources, to alleviate of the duplication and fragmentation, and to improve conditions at nursing colleges. All provinces had reorganised their nursing colleges into a single unified provincial nursing college with campuses located at health institutions which offered various levels of health care. The nursing schools located within hospitals would be converted into clinical training units or sub-campuses. The nursing colleges would start with a new curriculum and new nursing programmes as from 2020. The new curriculum would include a three-year Diploma in General Nursing, to produce a Generalist Nurse with a wider training and scope of practice than the current enrolled nurses. There would also be an Advanced Diploma in Midwifery, and the third programme included a Postgraduate Diploma to produce nurses to offer services as needed.
Ms Makhanya said there were only two reported closures of nursing colleges. These were in the Eastern Cape, and had subsequently been re-opened after rationalisation. Of the colleges closed in the Northern Cape, none had been reopened due to a lack of funding. Other nursing colleges which were closed for the purpose of rationalisation and re-organisation were two in Gauteng and four in the North-West Province.
She gave an update on the current status and number of number of nursing colleges, satellite campuses and nursing schools in the nine provinces. The overall total of 138 facilities was made up of 16 nursing colleges, 32 satellite campuses and 90 nursing schools.
The Chairperson said the presentation appeared not to be complete, as there were issues not mentioned which would allow for the incoming Portfolio Committee (in the next Parliament) to be better informed and empowered.
Members agreed that the presentation lacked depth and important issues as to how the Department would roll-out its initiative to transform education and training in the nursing field.
The Chairperson asked about the progress made by the NDoH on hospitals’ compliance, and the investigation into colleges and the closure of bogus colleges. She also asked for clarity on the monitoring of private hospitals. Members queried the level of engagement with provincial health departments and districts to prepare for the new system. They asked about progress made on discussions with provincial health departments and districts to prepare for the new system.
Ms C Ndaba (ANC) asked about the level of salaries for nurses, as currently nurses were underpaid. She said nurses must be paid a proper salary, which would lead to a happy nursing environment.
Dr S Thembekwayo (EFF) asked about the salaries for nurses still to be trained and those in training. She asked how it was possible to implement clinical training platforms at hospitals where in fact there was no infrastructure. There were many nurses who had qualified over a long period of time and yet the SA Nursing Council failed to register them, and the Department should intervene. Nurses on training should receive renumeration, and suitable and decent accommodation. More detailed information was needed on the type of curriculum the Department would implement as from 2019. She asked as where students who had studied and been trained abroad in nursing were deployed to.
Dr P Maesela (ANC) said all colleges offered the same courses, and questioned why they still needed to be accredited for the courses they offered. He said that training for nurses should be uniform. Why had the presentation mentioned nothing about the closure of private colleges, and how the Department was monitoring them? The Department should restrict the number of nurses to train in specific fields, to avoid having too many qualified nurses in psychiatry, for instance, and not enough in the midwifery field. Hospitals should be made compliant, and nurses trained in colleges should specialise in primary care. The current training was too general, and the Department should consider more specialised training with the emphasis on primary health care.
Ms E Wilson (DA) asked how many nurses had qualified during 2018, and where they were, or would be, placed. She said the accommodation for nurses in Limpopo and the conditions at hospitals were very bad. Nurses were treated very badly too, and spent time cleaning up instead of seeing to patients.
Dr Gail Andrews, Chief Operating Officer: NDoH, responding to the Chairperson’s concern as to whether the Department was ready to roll out the 2019 curiculum, said it was ready as it was a process that had been planned over several years. The Department had done the assessment of training facilities in the country, but it was legally required to implement it only in 2020. The Department was therefore not rushing the process, as more time was needed to phase-out the old system.
Dr Andrews said the Department was focussed on new programme development, the conditions of service and salaries that needed to be finalised. It was still in the process of planning and costing. Clinical training would be done in hospitals, with students practicing on mannequins. The Department had undertaken to ensure the strengthening of clinical platforms. This would ensure that hospitals were functioning institutions, as stated in the norms and standards.
On the issue of registration, she said the Department had developed a handbook to assist councils in respect of registration of nurses into the profession. The Department was engaged in the constant monitoring and oversight of all health profession councils, and was moving rapidly towards automated registration.
The Department developed and coordinated a national programme of policy development, and the provinces were required to meet the minimum requirements. The Department had to recognise the needs of the country for health workers, and how they were placed in the provinces.
Ms Makhanya referred to the closure of private colleges, and said the Department had developed a national policy to define a framework for offering new qualifications. Private colleges had been informed that they no-longer could register old qualifications/programmes. A circular had been issued to all provinces regarding private providers using their own facilities.
She said that the current training programme of nurses would end only in 2019. The Department worked closely with the national norms and standards required for the placement of candidates. Accommodation was provided, depending on the available infrastructure. The Department was also in the process of developing a more detailed report on the training of nurses throughout the country.
Since nurses were now at a higher level of education, the Department was looking into issues of employment conditions, which included salaries and services, in collaboration with the Department of Labour and the bargaining chamber. This also included the conditions and salaries of current nursing staff. The Department had also developed a national core curriculum, but provinces were still allowed to adapt to this according to the needs of the province.
She said the Department was busy with a report on the state of readiness of nursing colleges, which included the accommodation, human resources and infrastructure.
On the question of how many nurses were qualified and how they were placed, she said 3 535 had qualified in 2018, 3 417 had been placed, and 118 student nurses had studied abroad.
Responding to Ms Wilson on statistics of nurses deployed in Limpopo, she said 334 nurses were placed in 2018, 248 bursary holders were placed, and 96 non-bursary holders were placed.
The Portfolio Committee recommended that:
- The Department of Health must prioritise the nursing profession.
- The Portfolio Committee should meet with the provincial Heads of Department on the training needs for the provinces.
- The Department should look at standardisation of nursing uniforms, as nurses’ uniforms should be the same, irrespective where they were placed.
- The Department should provide a detailed report on:
- State-of-readiness with regard to infrastructure;
- A national policy on private colleges;
- How the recruitment for nursing takes place;
- The proposed satellite colleges throughout the nine provinces, and how they are linked to the main colleges.
Draft Portfolio Committee Legacy Report
The Committee discussed its draft Legacy Report, and several amendments were suggested.
The Chairperson said that the draft report needed to be corrected and amended with the suggestions made at the meeting. It would be adopted near to the end of the financial year and the closure of the Fifth Parliament.
The meeting was adjourned.
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