South Africa: In-Depth - What Is Behind the Eastern Cape's Nurse Training Crisis?
By Luvuyo Mehlwana
Lecturers who are doing administrative work instead of teaching, some nursing student accommodation that was found uninhabitable, frequent break-ins at some campuses, an exodus of staff since 2017, and some campuses with no students - are among the challenges at Lilitha nursing college in the Eastern Cape that the provincial legislature's health committee flagged as highly concerning after an oversight visit.
Established in terms of the provisions of the Education and Training of Nurses and Midwives Act 4 of 2003, Lilitha nursing college comprises five campuses and 19 sub-campuses spread across the Eastern Cape.
The health committee tabled its report with findings and recommendations in June. The findings showed the situation is dire in a province where nurse shortages not only impact the quality of care people receive but also contribute to medico-legal claims against the provincial health department.
According to the chairperson of the Eastern Cape Legislature's health committee, Nozibele Nyalambisa, they expected a written response on its progress in addressing the concerns from the department, but they have not yet received one.
It has been over two months since the report was tabled.
"The department is arrogant since we consistently make these types of findings and they do not bother to respond. We have been struggling to get a response from the department since 2020. They keep saying they have noted our findings. The committee will make sure that the department responds to issues raised during the Lilitha Nursing College oversight," she told Spotlight.
"This is a very concerning issue," Nyalambisa said, "because we cannot have a nursing college that is questionable. Bringing Lilitha Nursing College back to its former glory is what we are looking for. It is unacceptable that an institution funded by the government cannot produce quality nurses and the same department that trained these individuals does not recommend them when vacancies arise."
What the health committee found
In March this year, members of the health committee visited the Lilitha college campuses in Gqeberha, East London, Komani, Mthatha, and Lusikisiki, where they met with college administrators, campus heads, lecturer forums, and labour union representatives.
A report with a litany of red flags followed.
The report noted that 22 staff members have left the college campuses since 2017 and none of them have been replaced. There are not enough finance personnel, so the college's Gqeberha campus struggles to manage its budget. Apart from excessive municipal service fees, the institution also has poor security plans resulting in break-ins, especially during the holiday season.
The report also noted that exam papers are sometimes set in handwriting and at the Komani campus, for example, the infrastructural challenges include dilapidated structures and terrible ablution facilities. Also, due to poor management of students' results, the students' exam statuses were conflicting. Lecturers are currently managing the student management system at the Mthatha campus, which leaves it in a serious state of compromise, the report notes. The same campus was the victim of a staff member who defrauded the institution and paid herself enormous sums of money, read the report.
During their visit to the East London campus, there was no acting principal to receive the committee members. They found that this campus had spent R118 000 on a workshop that they held in Gqeberha - about 290 kilometres away. There is a strained relationship between staff when it comes to finance and procurement, the report notes. This poor working relationship last year resulted in the campus receiving incorrect stationery, resulting in a waste of resources and delays in its operations.
The report also flagged that there were no students at the St Patrick sub-campus and Butterworth sub-campus as there have been no student intakes since April 2021. Several positions at Madzikane kaZulu sub-campus in Lusikisiki are vacant, including posts for a finance officer, an HR practitioner, an admin clerk, and a data capturer. Staff at Butterworth and St Patrick continue to be underutilised when there are no students and the head office is aware of this problem, the report notes.
The legislature's health committee is frank in stating that issues, including accreditation issues that hamstrung the production of nurse graduates at the Lillitha Nursing college, pose a threat to providing quality healthcare in the Eastern Cape.
Staff and accreditation issues
"South African Nursing Council (SANC) non-accreditation is another dark cloud hanging over the college. Almost all campuses are filled with acting senior management personnel. In the province, nursing education is in crisis and the grand plan to establish both main and sub-campuses has been derailed," read the report.
"The department must fill all vacant positions with qualified personnel as soon as possible. There is a need for the department to explore the best ways to address infrastructural challenges at the Queenstown campus. In order to ensure proper management of student affairs, the department must ensure that the respective personnel are employed. A progress report in this regard must be submitted to the Committee within 30 days after the adoption of this report by the House.
"To restore human dignity and uphold institutional policies at Lilitha Nursing College, the department must intervene and resolve the current pandemonium."
A staff member at the Gqerberha campus, who asked not to be named, told Spotlight, "Lilitha College played a crucial role in producing nurses who are badly needed, but poor management is putting an end to nursing careers in the province. This situation would lead to a future crisis if the department does not address the poor management and administration at Lilitha College."
"There are always break-ins on campus and nobody seems to care," the staff member said. "The books are arriving late and we are expected to produce quality nurses. When there is not enough equipment for teaching and learning, how do you produce a good product?"
"The problems started," she said, "when the nursing regulatory and accreditation bodies reported that our management was lacking in management qualifications. As a result, it was not possible for the college to be accredited under the new system."
The staff member said since the Department of High Education and Training is involved in this accreditation process, they can, "if they were keen, speed things up". "I don't understand why the accreditation issue took over two years to be resolved. The colleges in KwaZulu-Natal and elsewhere are accredited and they are preparing for their intake, but here at Lilitha we are stuck."
the Lilitha Nursing College situation is a clear indicator that the provincial health services are headed for disaster - Sivuyile Mange, DENOSA
'headed for disaster'
The chairperson of the Democratic Nursing Organisation of South Africa (DENOSA) in the province, Sivuyile Mange says the Lilitha Nursing College situation is a clear indicator that the provincial health services are headed for disaster.
"DENOSA is concerned about what is happening in Lilitha College because there are only final year students there. There are no first-year or second-year nursing students since the college stopped taking in nursing students two years ago. This means the healthcare system in the province is facing a bleak future, as we have a huge shortage of nurses. As a result of staff shortages and working equipment shortages, the department is overwhelmed with medico-legal claims, yet there is no annual intake of students to ensure a supply of nurses," he says.
"Every year, nurses are leaving the department through natural attrition and resignations for various reasons. When nurses leave the department, this leaves a big void. The annual intake ensures that these gaps will be closed. The stoppage of the annual intake is depriving the people of Eastern Cape the quality nursing care that is already under severe strain.
"This is not only affecting students, but it also affects lecturers as they are facing a bleak future because soon they will also be told that they are redundant due to the absence of students to train This, he says, is equal to fruitless expenditure to have people paid every month for doing nothing and yet the very same department is crying foul of being bankrupt," said Mange.
Lilitha College is badly run from the building (infrastructure) to curriculum and from administration to management and in the next two years it will be dead. - Yazini Tetyana, EFF MPL
Call for independent probe
Member of the provincial legislature for the Economic Freedom Fighters, Yazini Tetyana has called for an independent probe into the dysfunction at Lilitha College.
"Lilitha College is badly run from the building (infrastructure) to curriculum and from administration to management and in the next two years it will be dead. We believe that the college is collapsing because of political interference. We want the issue of Lilitha college to be investigated and create a commission if needs to be so that we can be able to discover who is responsible for the collapse of that institution," said Tetyana.
"The provincial health in the province is in a state of paralysis. For example, how do you run a health institution that is not accredited by the SA Nursing Council? The department has high medico-legal claims, but we still have people who are not accredited and registered with the body that regulates the nurses. When these lawyers want to litigate, they look at those things and say these nurses are coming from an institution that is not accredited."
No accreditation, no training
The SANC's Registrar and CEO, Sizo Mchunu, confirmed to Spotlight that Lilitha College will not be able to offer any new programmes until it receives accreditation from the Council on Higher Education. (Spotlight recently reported on the complexities of how nurse training is regulated in South Africa.)
"All nursing programmes must be accredited by the South African Nursing Council (SANC) and the Council on Higher Education (CHE) because all nursing qualifications are now under higher education. The Nursing Education Institutions (NEI) must first submit their curricula to SANC and if accredited, then they submit to CHE. The NEIs cannot offer the programmes if not accredited by both institutions," said Mchunu.
"Lilitha Nursing College was fully accredited by SANC to offer the Diploma in Nursing at all five campuses. Full accreditation was subject to the submission of proof of accreditation by CHE. So far, there is no proof that the campuses are accredited by CHE. The campuses cannot, therefore, offer the programme until accredited by CHE and the qualification has been registered with the South African Qualifications Authority (SAQA)," she said.
Whenever an institution operates illegally, a criminal investigation can be initiated - Sizo Mchunu, CEO SANC
According to Mchunu, the sub-campuses of each main campus were conditionally accredited by the SANC to offer the Higher Certificate in Nursing programme. The sub-campuses have not yet fulfilled the conditions and therefore cannot offer the programme.
"SANC has jurisdiction over NEIs that have been duly accredited to offer nursing programmes and to ensure that they meet SANC standards, criteria, and requirements. The individual NEIs must ensure that they maintain the accreditation standards, criteria, and requirements all the time and not rely only on SANC for its monitoring and evaluation function."
Mchunu declined to say outrightly that Lilitha is operating illegally - just that they are not accredited. "Whenever an institution operates illegally, a criminal investigation can be initiated," she said.
Despite SANC not recognising the college's programmes, the college had a graduation ceremony on 4 August 2022 and 370 students graduated who completed the four-year Diploma programme, 146 completed the Bridging Course, 14 completed the Post-Basic Programme, four completed the Enrolled Nursing Assistant Programme, and three completed one year of study in midwifery. In August last year, 725 nursing students graduated despite conflicting accreditation statuses of these programmes.
Health department responds
Eastern Cape Health spokesperson Yonela Dekeda insists that the college is accredited to offer at least some nursing qualifications.
She said Lilitha received full accreditation for the Nursing Diploma (R171) from the SANC and conditional accreditation for the Higher Certificate in Nursing (R169). In keeping with the new qualifications system, the colleges have applied for accreditation and we are waiting for the approval of SAQA. Training cannot commence and the college continues to make follow-ups with the said accreditation bodies for the finalisation of the process.
Sub-campuses of Lilitha saw reduced activity over a period of time in lieu of the process to phase-out legacy programmes in preparation for the new qualifications stream. The situation will soon change once SAQA has given the green light for training to resume, she says. The College still has students on the platform who are working towards completing their studies and graduation are taking place every year since 2020, despite it not having commenced with new qualifications.
Dekeda says the department is aware of the situation at the Komani campus and a new building project was previously prioritised, but budget constraints caused it to be shelved for now. In the meantime, the department's 2022/23 Infrastructure Plans have included the Komani campus (for repairs, upgrades, and maintenance). With all planned activities going well, the contractor can be on-site during November or early December 2022, said Dekeda.
"Lilitha, like all entities of the department, faces similar constraints with respect to staffing. This situation has been mitigated by bringing staff from satellite campuses, where work had either scaled down or no programmes are provided," she said. "Lilitha is part of the 2022 health department's annual recruitment plan to fill some of its key posts, such as campus management."
Dekeda said the department and management of Lilitha College understand the "anxieties about the college commencing with the training activities". Notwithstanding, the college is optimistically gearing itself up to commence training in 2023."
This article originally appeared on Spotlight
Photo: Spotlight