I see a minimum of 60 patients a day, many days up to 100, says Sister
Jaconuum Cupido, who works in a primary health clinic in Springbok in the
Cupido cares for a wide range of needs from pregnant women to psychiatric
Work pressure has increased substantially on primary health care nurses like
Cupido since government moved from expensive hospital-based care to
clinic-based primary health care (PHC).
But it is at these clinics that staff shortages are often felt most acutely.
Given that there is a worldwide shortage of health professionals, nurses
with poor working conditions are vulnerable to overtures from wealthier
nations able to pay good salaries.
Countries such as the UK, Canada and the USA are facing a growing demand for
healthcare from their aging populations and have embarked on aggressive
recruitment policies, according to the SA Health Review.
An experienced theatre nurse, for example, can earn up to five times her
annual salary in the UK. In South Africa, she would earn around R90 000 a
year, but if she goes to Saudi Arabia she could earn up to R360 000 tax free
while in the UK, her salary could be as high as R448 000.
The World Trade Organisation's General Agreement on Trade in Services (GATS)
has also made it easier for health workers to move from poorer to richer
countries by reducing immigration, visa and work permit restrictions.
SADC health ministers have condemned this recruitment drive by wealthy
countries as looting similar to colonial times when mineral wealth was
looted to industrial countries.
But by last year, 12% of nurses in the UK were South African. In addition,
600 South African doctors are registered in New Zealand, an exodus which has
cost an estimated loss of R600-million in taxpayers' money.
Work overload, staff shortages and inadequate medicine supplies are
contributing to burnout, high absenteeism, stress, depression, low morale
and de-motivation and are responsible for driving health workers out of the
public sector, argue researchers David Sanders and Bridget Lloyd.
Nurses also cite the HIV/AIDS epidemic as a factor that has both strained
the health system and pushed some health workers to leave as they are afraid
that they might get infected with HIV at work.
While Cupido says she loves her job, she confesses that it sometimes gets
to me when I realise that the following day will simply be a repeat and the
next group of patients will be waiting for me.
Thus pay increases alone, while necessary, will not be enough to prevent
large numbers of nurses from leaving the profession.
But South Africa has not even trained enough new nurses to keep pace with
the population's growth, let alone compensate for those who go and work
Over the past eight years, population growth has outstripped the production
of nurses. While the population has grown by 14%, only 12% more
professional nurses and 6% more enrolled (staff) nurses have been trained.
This year there are 109 professional nurses per 100 000 people, whereas in
2000 there were 120 nurses per 100 000 people.
A large proportion of the newly trained professional nurses were already in
the health system, meaning that the profession is failing to attract and
train new people.
Of the 34 264 professional nurses who qualified in the past eight years,
over 40% were enrolled nurses who completed two-year bridging courses to
become qualified as professional nurses.
At the same time, many newly trained enrolled nurses were auxiliary or
assistant nurses who upgraded their skills. But not enough auxiliary nurses
have been recruited and there has been a disturbing 1.6% decline in these
Even more worrying is that, although 34 264 professional nurses were trained
over the past eight years, the SA Nurses Council only registered an increase
of 10 707 new nurses.
This is less than a third of those trained and reflects that a large number
of nurses - over 20 000 - have left the profession in the past eight years.
What has made matters worse, says researcher Hasina Subedar, is that during
the same period, the demands on nurses have increased considerably because
the country has moved to primary health care which is based on nurses being
the main service provider.