1.2 Background
1.2.7 Nursing education programmes and the need for university education 12
Nursing education in universities is not the preferred system in South Africa, with just under 25% of professional nurses being educated in these programmes, the majority preferring Colleges of Nursing, which fall under the auspices of the Department of Health rather than the Department of Higher Education and Training. While this cadre of nurse is important, nurses trained at universities contribute to the continued professionalization of nursing, improved patient outcomes and the sustained growth of the nursing body of knowledge. In addition, the changing health care milieu requires an increase in graduate professional nurses (Raholm, Hedegaard, Lofmark & Slettebo, 2010; Kapborg, 1998).
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Patient outcomes are improved when hospitals have greater numbers of university educated nurses. Aiken, Clarke, Cheung, Sloane and Silber (2003) reported a 5%
decrease in surgical patient’s mortality and failure to rescue for every 10% increase in baccalaureate educated nurses. Nurses have to make complex decisions about
individualised patient care in a great variety of settings, and university education prepares them for problem solving, reflection, decision making and the ability to use deductive and inductive learning strategies that are all required for clinical decision making (Raholm, Hedegaard, Lofmark & Slettebo, 2010; Brodie, Andrews, Andrews, Thomas, Wong &
Rixon, 2004). Nurses are increasingly practising as independent practitioners and involved in developing individualized care for patients, requiring increased knowledge and skills and therefore a higher level of education (Idvall et al., 2012; Kubsch, Hansen & Huyser- Eatwell, 2008; Waters & Easton, 1999; Redfern, 1996). With South Africa’s very high HIV prevalence, estimated to be 12.3% in 2012 (Van der Linde, 2013), it has become necessary to engage nurses in task shifting to cope with the enormous treatment burden this has presented, requiring nurses to have higher levels of education (Fairall et al. 2012;
Zachariah et al. 2009). Recruitment and retention of new nurses with university education is therefore crucial to the sustainability of a competent, skilled and knowledgeable nursing workforce.
To summarize, in South Africa, there is a tension between transformation policy
expectations, student success, and funding of higher education in a context of university discretionary authority and institutional autonomy. Despite robust transformation policies, the lack of implementation guidelines has meant its universities invoke issues of autonomy when implementing selection criteria, and in so doing, may create barriers to access for disadvantaged students.
14 1.3 Statement of the problem
Despite a number of policies that address the transformation of higher education in South Africa, access to higher education by specific groups of students, Black African, female and disabled people, ages 18 – 24 remains a challenge (DoHET, 2013). The reasons for this slow pace of transformation could be due to differences in policy implementation, definition and execution thereby highlighting the tension between the policy developers, who are often politicians, and the administrators who implement them (deLeon & deLeon, 2001).
Many countries are addressing similar problems of inequality of access to higher
education, but often with access for minority populations (Chowdry, Crawford, Dearden, Goodman & Vignoles, 2013; Altbach et al., 2009; CHSE, 2008; Guri-Rosenbilt et al., 2007). South Africa`s dilemma is enabling transformation in access for the majority Black African population who had limited access due to previous political policies (CHE, 2010;
Bunting, 2008).
In 2006, the WHO suggested that the main objective of health workforce development should be to produce sufficient numbers of skilled workers with the requisite competencies whose background, language and social attributes make them accessible and able to extend their work to populations who are diverse in respect of their socio-cultural and
demographic features. There is a critical shortage of health care professionals, not just in South Africa but worldwide (Deloitte, 2013; WHO, 2013), with the WHO estimating a deficit of 12.9 million skilled nurses, midwives and physicians by 2035. A report
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published in 2013 entitled the universal truth: no health without a workforce indicated that there can be no health without a competent, skilled accessible, quality health care
workforce (Global Health Workforce Alliance & World Health Organization, 2013). Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation, said at the Third Global Forum on Human Resources for Health in November 2013:
“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations,” (WHO, 2013).
The education of an appropriate and sustainable health care workforce is necessary in order to provide healthcare to the nation, and is a goal of the Department of Health in South Africa (Department of Health, 2011). Dr Carissa Etienne, WHO Regional Director for the Americas, highlighted the need for everyone, but especially people in vulnerable communities and remote areas, to have access to a well-trained, culturally sensitive and competent health workforce (WHO, 2013). South Africa has many vulnerable
communities and a large rural population, all of whom require health care, but who did not receive adequate services under the country’s apartheid system and this need has been exacerbated by the HIV/AIDS epidemic. In order for health care professionals to be representative of the populations that they will serve, transformation of the health science student body needs to occur. Health sciences education in universities in South Africa is caught between transformation of higher education, providing skilled human resources for health, limited student places and a funding formula that rewards success and graduation all in the context of poorly prepared students from the secondary education milieu some of whom also come from low socio-economic backgrounds.
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