As countries across Africa count the cost of an exodus of talent from its fragile healthcare sectors to richer countries, the situation in South Africa is exacerbated by an ageing nursing population and a seeming reluctance by government to accept private sector help for training, writes MedicalBrief.
The situation has become increasingly frustrating for Netcare, with CEO Richard Friedland issuing yet another warning about the nursing shortage and government’s refusal to increase the number of nurses trained in the private sector.
He said the crisis was not only throttling the company’s growth prospects but also threatening the provision of healthcare in both the public and private sectors, reports Business Day.
The private hospital sector has been vocal, for years, about SA’s nursing shortage, and the the state’s squeeze on training in the private sector. Netcare, for example, had been accredited to train more than 3 000 a year; it now trains barely a tenth of that.
“We have an ageing population of nurses, just as (Eskom) has an ageing fleet (of power stations). The government was warned of this well in advance and chose to ignore it. We have a crisis at hand and it needs to be addressed,” Friedland said shortly after Netcare released its interim results for the six months to 31 March.
He expressed frustration that Netcare’s proposal to the government to create 50 000 jobs by training more nurses had failed to find traction, saying the plan could have eliminated the shortage within eight years. The plan was tabled at the presidential jobs summit in 2018 by the Hospital Association of SA (Hasa).
Hasa spokesperson Mark Peach said almost half the current contingent of nurses is due to retire in the next decade, and the public sector cannot keep pace with the required number of new nurses.
Life Healthcare CEO Peter Wharton-Hood said the nursing shortage was a bigger threat than the Eskom’s blackouts. Hospitals could buffer themselves against electricity outages with investment in generators, diesel and solar panels, but could do little to mitigate the risks of staff shortages, he said.
The national Department of Health’s human resources strategy for 2030 estimates that by 2025 there will be a shortage of 34 000 registered nurses in primary healthcare alone, while Hasa estimates the nursing gap at between 21 000 and 61 000.
In Nigeria, which is also taking straing from richer countries wooing underpaid but skilled professionals, the government hopes to remedy the situation with new legislation.
Michael Nnachi, president of Nigeria’s nursing union, said more than 11 000 of 150 000 members had left the workforce since the Covid-19 pandemic to seek better pay and conditions abroad.
MoneyWeb reports that the economic downturn in Nigeria has boosted the trend, according to the nursing union’s chairman, Olurotimi Awojide.
“Food, transport and rent are high, and money they pay now can’t meet our needs. Nurses feel they need to go out of the country to live a better life,” he said.
Shortage of staff
Nigeria has been on the WHO list of countries with a shortage of healthcare workers since 2020. Foreign employers are discouraged from recruiting nurses from the list, two-thirds of which this year are African states.
But the list has proven ineffective in stemming the flow and Nigerian hospital managers say patient care is suffering as there are not enough new nurses to replace those moving abroad.
Wasiu Adeyemo has managed Lagos University Teaching Hospital for more than a decade, but said he has never seen staff shortages as bad as now.
Four wards with more than 90 beds remain shut at the facility, one of Nigeria’s biggest specialist hospitals, with no nurses to operate them.
“Everyone talks about doctors leaving when the real problem we’re facing is nurses going daily,” Adeyemo said.
“Few nurses apply for jobs, and when we employ them … about 50% resign after three months to go to the UK.”
Heading to the UK
Britain is the favoured destination, and last year, 7 200 Nigerian nurses were registered with the Nursing and Midwifery Council, Britain’s professional body. Only the Philippines and India had more nurses in Britain.
The British Government says employers should not actively recruit from places like Nigeria on what it calls the “red list” of countries where the WHO says there is a shortage of healthcare workers. But candidates from those countries can still apply for jobs advertised in Britain.
Nigerians received 12% of the skilled health and care worker visas issued last year, Britain’s Home Office said.
The Telegraph yesterday reported that record numbers of overseas nurses were going to the UK, making up almost half of new recruits, official figures show.
The statistics from the nursing register show Britain has become increasingly reliant on India, Philippines and Nigeria, with a seven-fold increase in overseas joiners in the past five years.
Health leaders warned that the NHS must not keep relying on international recruitment to plug chronic staff shortages, raising concerns that countries who needed to keep their nurses were being drained.
The figures show 25 006 nurses, midwives and nursing associates who were trained abroad registered to work in the UK in the last year. The record figure, which compares against 27 142 new joiners who were trained in the UK, is the highest since records began two decades ago.
It is also a seven-fold rise since 2018, when there were fewer than 3 000 overseas joiners.
Health charities raised concerns that one in 10 of the new entrants came from countries such as Nigeria, which are on the “red list” drawn up by the World Health Organisation which should not be targeted.
Skilled health worker visas
Although Zimbabwe is much smaller than Nigeria, it was the number one African country receiving skilled health workers’ visas from the UK – accounting for 16% last year.
More than 4 000 doctors and nurses have left Zimbabwe since 2021, according to its Health Services Board, and in March, it was added to the WHO list of countries from where health workers should not be recruited.
Zimbabwean Health Minister Constantino Chiwenga said plans were under way to criminalise the foreign recruitment of health professionals and retain the workforce.
Back in Nigeria, lawmakers have passed a Bill to withhold licences from doctors and dentists until they have practised in the country for five years. The president has yet to sign this into law, but one parliamentarian already wants to put the same restrictions on nurses and pharmacists.
In response, doctors have threatened to down their stethoscopes and strike.
“It is a lazy approach,” said Jesse Otegbayo, professor of medicine at the University College Hospital in Ibadan. Instead, the government should address health workers’ concerns, he said. Hospitals were struggling, he added, with many nurses complaining of burnout.
“This is a serious situation … any health administrator and the public should be worried. The few nurses left are overworked, and this will affect the patients.”
For MedicalBrief, Chris Bateman writes that this was echoed by Kenyan Professor Khama Rogo, chair of the Lake Basin Economics Bloc’s Eminent Persons Advisory Committee, at the the Board of Healthcare Funders conference in Cape Town last week.
Beset by civil unrest, weak economies and dysfunctional healthcare systems, the health workforces of the four main African economic blocks were either on strike, had just completed a strike, planned to go on strike or “don’t know whether they’re on strike or working,” Rogo quipped.
“Right now, about a week ago and very quietly, several European countries, Australia, New Zealand, and Canada signed an agreement with Africa to send our workforces to them. They did so, knowing we can’t employ our own people, us having trained and upskilled them. It’s happening all the way from Sudan to South Africa. While nurse-training is ongoing, local recruitment is declining. Any Africa-trained nurse is more likely to get a job in the UK than locally,” he added.
Rogo said that for patients, this translated into mothers waking up a 6am to take a sick child to a clinic and returning at 6pm.
“Healthcare workers are too busy to care, yet we’re exporting labour to the developed world. There was a time when South Africa was the favorite place to work for the rest of Africa. No more – because of the perception of cost. It’s as expensive as Europe, so India and the Middle East are taking them,” Rogo said.
However, instead of proper dialogue between the public and private sectors in Africa, he encountered conflict, although at least in Southern Africa, “they’re talking, even though the private sector has performed poorly”.
If ever there was a sector where democracy failed it was the health sector, with dismal governance, regulation and management of African healthcare systems, and decisions "always made by somebody else who’s superior”, he said.
“We continue to adopt the colonial inheritance. Why is South Africa not leading the way? What I see is an attempt to implement a French or British medical style which is just not working in our public healthcare delivery. The only way to achieve NHI is to strengthen nurse-centred primary healthcare,” Rogo averred.
He said Africa’s poor were paying the highest prices for medicines, citing paracetamol in the Democratic Republic of Congo costing “20 times” what it does in developed world.
“You get fifteen middlemen between the manufacturer and the consumer. We want to manufacture here, but why are meds cheaper in India than here?” he asked.
Professor Alex van den Heever, Chair of Social Security Systems Administration and Management at the University of the Witwatersrand, said finding a starting point for solutions was difficult when “paper policies” failed to address systemic capacity weaknesses.
“Nothing has happened to the (SA) human resources framework developed in 2014 , or the recalibration of the financing system. It remains chaotic. More and more nurses cannot be absorbed by the system. Nobody seems to have checked out where scopes of practice fit into the financing discussion, or to strategically plan for human resources. We lack capable task teams and structures in government that can prioritise problem solving going forward. What’s happening is just nothing,” he claimed.
Dr Nomzamu Tutu, an occupational health physician and trustee of the Government Employee Medical Schemes (GEMS), said the BHF conference had not ‘changed the end point” so far.
“There are no doctor organisations here. We’re ignoring the pharmacies, the representatives of consumer organisations. Yet we’re trying to replot and replan the delivery of healthcare. We exclude the very people who will do all of that. We can’t talk about patient-centricity unless we talk about the consumer and suppliers. At present the NHI is just a huge plan, difficult to get to the bottom of,” she added.
“We’re perpetuating a myth that 80% of SA citizens have no access to health. The system is fully developed but poorly run and overseen. If the emperor has no clothes, we have to say that and not sing his praises all the time. It’s time for a Health CODESA. Put the best of all sectors together under a CEO focused on delivery and not politics,” she proposed.
MoneyWeb article – African hospitals suffer as nurses leave for more pay in UK (Open access)
The Telegraph – Record number of new NHS nurses come from overseas
See more from MedicalBrief archives:
Nursing Council resists training of new nurses, despite dire shortage, HASA conference told
Nursing shortage could spike to 300 000, new report finds
Urgent call for state to invest in more nurses to avoid catastrophe
Netcare again warns of SA’s critical nursing shortage
See more from MedicalBrief archives:
Nigerian doctors reduced to surgery by candlelight
Desperate Zimbabweans go to Zambia for medical care
Africa faces 5m shortage of healthcare workers