Community service for nurses ‘ easier said than done
January 2005 will be a nerve-wracking month for hundreds of newly-qualified professional nurses who will be waiting to be told where they will serve a year’s community service.
But it will be an even bigger logistical nightmare for the Department of Health with just five months to ensure the latest programme of compulsory community service kicks off smoothly at the beginning of next year.
In July, Minister of Health Manto Tshabalala-Msimang announced ahead of her budget speech in Parliament the introduction of community service for nurses.
Community service has been an inevitable part of most health professionals’ lives in this country since it began in 1998. Last year, physiotherapists, occupational and speech therapists, clinical psychologists and dieticians were among the professional groups added to the list.
Deputy Director of academic health services Phumelele Zulu admits that despite some concerns about the feasibility of starting community service as early as January 2005, the department will be working towards that target.
While there is general agreement that there is a need for community service, there is also skepticism over the health department’s timing and the way this has been handled.
‘Our position is that [community service] is not a bad thing per se. But we differ in the manner in which they are doing it,’ said Thembeka Gwagwa, director of the Democratic Nursing Organisation of SA (Denosa).
Firstly, there is currently no legal provision to implement community service for nurses: ‘The Nursing Act does not make provision for nurses to be in limbo before they are registered. You can either be a student or a nurse,’ Nelouise Geyer, deputy-director at DENOSA, said.
The proposed legislation that makes provision for community service ‘ the Nursing Bill ‘ has yet to be passed by Parliament.
But in a briefing before her budget speech earlier this year, Health Minister Manto Tshabalala-Msimang pointed out that ‘there is an alternative, interim route if the Nursing Bill is not passed in time. And that would be to pass a small amendment to the existing law.’
Once this has been done, the real work will begin. According to Zulu, provinces will then be required to submit a list of posts as well as the facilities where they want these nurses to be placed. These institutions will then be gazetted.
According to Zulu, this process is usually done as early as February or March the previous year so that application forms would be sent out to community service health-care professionals in March or April.
Applicants can then make five choices from the list of gazetted facilities.
But this has not happened yet with nurses about to embark on community service. Whether this would all happen before 2005, is what Denosa wants to find out, Geyer said.
When announcing the move, Tshabalala-Msimang acknowledged the difficulty in introducing community service in a profession as complex as nursing.
There are different types of training: some nurses complete the four-year training in one go, while others train initially as enrolled nurses for two years and then later undertake a bridging course before becoming a professional nurse.
Only students from the four-year programme will be doing community service. Some nurses are trained by public sector nursing colleges and universities, while others receive training from private hospital groups.
Privately-trained nurses would also be required to do community service, Zulu said.
But this could be a deterrent for private sector training, argued a recent article in DENOSA’s monthly publication, Nursing Update.
‘It is not fair to expect private sector to invest thousands of rand to train nurses and then have to send them to community service for one year. An ‘artificial’ shortage of nurses will be created,’ Geyer warned.
Geyer also raised concerns about the ‘rush and lack of consultation’ in the Health Department’s preparations, especially in view of the numbers involved. According to the department, about 1 500 student nurses completed the four-year course in 2003.
The Health Department has been grappling with the efficiency of its community service programme since 1998. Despite this experience, it seems as if the Health Department ‘hasn’t learned any lessons,’ said Steve Reid, a researcher at the Centre for Rural Health at the University of KwaZulu-Natal.
Reid has conducted research into community service for health professionals and found that the experience of community service was not as negative as it had initially been made out to be.
But the implementation of the programme, which had been imposed without adequate consultation, had led to ‘an unnecessary amount of negativity,’ he added.
An example was the case of junior doctors taking the government to court, prior to the implementation of community service for doctors in 1998.
‘Although they agreed with the principle of it, they didn’t feel adequately consulted as to how it should be done,’ Reid said. He suggested that community service would not be an effective retention strategy in the long-term, as nurses would continue to leave the country in search of lucrative work overseas.
In 2003, the SANC estimated that there were 2 300 registered nurses working overseas. In an article published in the South African Medical Journal last year, Nicki Fouché of the Division of Nursing and Midwifery at the Faculty of Health Sciences at the University of Cape Town warned, ‘the numbers of nurses leaving the country are in excess of numbers of potential graduating students.’
According to Reid, community service could not be the only strategy in place to attract professionals to rural areas and areas in need. It had to be complemented with better working conditions, competent management, and rural allowances.
‘With the larger numbers involved this time around, it could be disastrous if it doesn’t happen properly,’ he warned.
‘I can accept that there is confusion. But the Minister did point out that we were working with the [South African] Nursing Council on this. We do have a plan,’ Zulu said.
The Department of Health and the SANC will establish a forum to look at barriers to meeting the target date. The forum will shortly be handing over an action plan to Tshabalala-Msimang.
The department will also be setting up a call centre within three months to deal with any queries on community service.
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