Groote Schuur Hospital’s first male nursing manager, Aghmat Mohamed, has an abiding passion for his profession and cares deeply about the state of nursing in South Africa, writes Spotlight’s Biénne Huisman, who chatted to him about his decades on the front lines of healthcare.
Nurses cradle new life with tender hands and soothe those at the end of it. Yet through tireless grace, they’re underpaid, and risk getting stabbed and robbed on their way to work, he says.
After three decades in nursing, including nine years supervising 1 600 nurses as Director of Nursing Services at Groote Schuur Hospital, he considers himself an ambassador for the profession – but while expressing deep passion for his work, Mohamed does not mince his words when outlining challenges in the field.
This includes a 26 000 nursing shortfall across the public and private sectors, an ageing work force, training system bottlenecks, uneven distribution of nurses, particularly in rural areas, and simply not enough investment from government.
He says that while nursing shortages in South Africa are nothing new, this pressure is exacerbated by annual budget cuts at public hospitals.
“Currently, we are 26 000 nurses short in the country,” he tells Spotlight. “That’s a lot of nurses. And yet, it is expected that the show must go on. Posts are being cut, the money’s getting less, and there is this expectation of nurses to continue delivering quality care.”
Groote Schuur, Cape Town’s tertiary public hospital giant with just under 1 000 beds, lost 70 professional nurse posts due to budget cuts just last year, he says.
“Money is the problem. Most of any organisation’s budget is staffing, between 60% and 70%. So the easiest way to decrease costs is by cutting staff. We’ve had budget cuts every single year. Last year I lost 70 posts – professional nurses, just like that. So how do you continue to deliver quality patient care?”
Plugging holes
Groote Schuur is 532 nurses short across units that provide a 24/7 nursing service. “And it’s battles that leadership like myself face every single day, trying to plug the holes. Every day we need to compensate for those missing 532 nurses, for example, by using agency nurses, and overtime for our already exhausted and burnt-out nurses.”
He explains how nursing agencies work: “Out of that 532, for argument’s sake let’s say 15 are Intensive Care Unit (ICU) specialist nurses so every day we must get 15 nurses for ICU from agencies.… It will be different nurses from different agencies each day and it’s not ideal because you don’t know who you are getting, you don’t know how experienced they are. So these are additional stresses.”
The concept of “patient acuity” is used to allocate nursing resources, he says. This refers to the severity of a patient’s condition, determining their priority and level of care.
A calling but also a profession
On the professionalisation of nursing, Mohamed says the scope of nursing as a profession is ever-expanding, without adjusted remuneration. In a primary healthcare system, nurses are responsible for more patient care than ever, he adds
“Clinics are run by nurses,” he says.
“We bring children into the world, we hold the hands of dying people. When there isn’t a doctor, the next best thing is to give the task to a nurse. And that’s fine, because we love what we do. And we try to make sure we’re upskilled to be able to do these tasks. But the thing is, for decades, we’ve allowed this to happen: the scope of nursing is expanding and expanding, but the money’s not getting more. So you have more responsibility, are more accountable, but nobody’s talking more money.”
Mohamed adds that nursing is a profession governed by a nursing council and tertiary qualifications, and ought to be respected and paid accordingly. “You would be surprised how many nurses with PhDs are at the bedside because they want to be. They just love being with patients. So nursing is a calling, certainly, but it can’t be mahala (without payment). We need to be properly remunerated.”
State of the world’s nursing
Earlier this month (12 May, International Nurses Day), the World Health Organisation (WHO) and the International Council of Nurses (ICN) released the State of the World’s Nursing 2025 report. Much in the report echoes Mohamed’s arguments, placing South Africa’s nursing challenges in a global context.
The report notes: “While professionalisation can improve care quality, it should be accompanied by differentiated roles, scopes of practice, and corresponding compensation in work settings, to not fuel nurse migration to countries that offer better professional opportunities.”
Greener pastures
Figures quoted in the report suggest that one in seven nurses worldwide – and 23% in high-income countries – are foreign-born, highlighting the migration of nurses to wealthier countries. South Africa is considered an upper middle-income country, with an estimated 8% of nurses being foreign-born.
Mohamed can attest. After working as a nurse at the Red Cross War Memorial Children’s Hospital and some community health centres in Cape Town, in 2004 he accepted a job at St James’ Hospital in Dublin, Ireland.
To his surprise, the hospital paid for his studies at the Royal College of Surgeons in Ireland, where he obtained a Bachelor of Science degree in nursing and a Master of Science degree in leadership.
“I always knew I wanted to work abroad,” he says. “When I left, it was supposed to be for two years, but that became 10… Literally, doors just opened up for me like, wow! I was so fortunate; I didn’t spend a cent on these two degrees. So this is how first world countries retain staff; opportunities lead to job satisfaction.”
Mohamed says healthcare employers in wealthy countries snap up South African nursing graduates. Particularly, graduates who specialise in ICU, the operating theatre, trauma and emergency, psychiatry and oncology are in high demand worldwide.
He argues the only remedy to retain graduates is for the government to create better working conditions for nurses and job incentives.
The WHO report echoes this. “Low- and middle-income countries are facing challenges in graduating, employing, and retaining nurses in the health system and will need to raise domestic investments to create and sustain jobs,” it reads.
Dwindling workforce
To start with, South Africa’s nursing graduation rate is low. The report notes 70 552 students enrolled in nursing education in South Africa, with only 3 154 graduating annually.
This very low number might, among others, be attributed to recent regulatory and accreditation bottlenecks in the tertiary system. (According to our back-of-the-envelope calculation, there should be around 17 500 graduations per year, given that training typically lasts four years. This calculation excludes people who drop out of training.)
The report also notes South Africa’s ageing workforce, with only 4% of nursing staff aged under 35, and 33% aged over 55. This raises critical red flags for future staffing.
Safety concerns
Furthermore, the report states that of the global nursing workforce, 85% are female. In South Africa, this is slightly higher at 90%.
Mohamed outlines urgent safety concerns for his staff, whose shifts are from 7am to 7pm, and 7pm to 7am.
“It is expensive to live near the hospital, and I can’t expect a staff nurse or an assistant nurse to be able to afford even a room close by. So these women travel far to get to work, getting into a taxi at 4am, or walking to get a bus with two or three changes. They get robbed, they get stabbed, they get assaulted. So safety is another big issue. I mean, nursing is a calling and that’s fine, but in a country like ours, your safety should come first.”
Manenberg inspiration
As a child growing up in Manenberg, Mohamed says in the mornings he would stand on a kist (chest) at their front window watching the neighbours – two nurses in crisp uniform – leave for work. “They were two sisters,” he recalls.
“I used to be very curious about them; the way they dressed, the way the community admired them. I was fascinated. I used to stand up on the kist watching them walk up the road to catch the bus.”
Back then, it was safe for them to walk in the dark, he says.
In a poetic twist of fate, one of the neighbours who inspired Mohamed as a child, Sister Shahieda Kader, is now among his staff at Groote Schuur.
Additional inspiration in his formative years was a district nurse who cared for his grandmother, who had a foot wound from diabetes.
“The district nurse would interact with my grandmother and bring a smile to her face. The wound wouldn’t heal, but when the nurse came to our house, we saw how she made that wound better. And eventually my gran was able to walk again. She brought hope into our family.”
Mohamed started his diploma in general nursing at the former Nico Malan Nursing College in 1995, followed by more qualifications.
Today, with five bars on his nursing epaulettes, he remains involved in Manenberg. Along with friends, he organises a year-end party for up to 350 elderly people each year.
“It’s because of these older people that we are who we are today,” he says. “They were our role models, so I always feel as if I owe them something.”
See more from MedicalBrief archives:
SA nursing changes not enough to address shortage crisis
What’s behind SA’s nursing crisis?
Private sector frustration as nursing staff flock to greener pastures
Urgent call for state to invest in more nurses to avoid catastrophe