The international trends indicate that there is a large public sector commitment to nursing education. In South Africa, about 96% of all nurses are employed in the public sector. It is important at this initial stage to present a brief historical perspective and the need for restructuring nursing education in South Africa in general, and in KwaZulu-Natal (KZN) in particular. Up to 1994 South African public policy was influenced by the apartheid policies of the previous government. The society was separated along racial and ethnic lines and all public services were provided within the constraints of this segregation policy.
As part of the new governments Reconstruction and Development Policy (RDP) the principles of democracy, non-racialism, equity and redress were stressed. The restructuring of provision and delivery of Health Services was one of the principal areas of focus in this process. The new system of delivery favoured the District Health System (DHS) with the main thrust being Primary Health Care Services. It is critical that nurse education, and the supply of nurses forms an integral part of this transformation process.
The current situation is a legacy from a fragmented history of providing separate nursing education colleges and schools. Aspects such as the sites of college campuses, student selection, and health care service delivery were based on racial grounds. This resulted in the concentration of educational resources in the metropolitan areas and in the duplication of nursing education programmes.
Rural areas were marginalised to the extent that nursing education in these areas had fewer resources. During this transition period, different health policies and health service delivery systems had to be reviewed. Core values such as accessibility, equity and availability needed to be considered. In addition, in order to streamline the health sector through the process of rationalisation, the provision of nursing education needs to be considered in light of future epidemiological and demographic needs and demands facing the health sector.
The cost of nursing education in KwaZulu-Natal, as in the rest of South Africa, is borne by the health sector, although there are indications that are moves to place it under the National Department of Education, like all other tertiary or higher education. With this background, the restructuring process was viewed in KwaZulu-Natal. It should not end with the identification of the most cost effective college structure but rather, the first step to analysing the total nursing future requirements of the province.
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