Will the universities ever cope with
the mass production of nurses in
South Africa? We have so much, and
yet……
Prof Nokuthula Sibiya, R/N
Department of Nursing
7 March 2014
The Forum of Professional Nurse Leaders
We need to ask difficult questions and
have open discussion about these
issues!
Nursing is the…
Introduction
Background
Nursing is the heart beat of any health care
system.
Millennium development goals are linked to
nursing and midwifery.
Socio economic development of each country is
linked to health status of the population.
Leadership is key in ensuring nursing practice,
education and practice development.
Introduction
Background
•Gross shortage of nurses in South Africa.
•Need to increase the production of nurses in the
country.
•Currently mass production of nurses is in
colleges.
•Nursing education is now located in the Higher
Education band.
Outline of the
presentation
• Higher education institutions (HEIs) in South
Africa.
• Nursing in HEIs.
• Funding of HEIs in South Africa.
• Challenges of access and success in HEIs.
• Challenges faced by Nursing in HEIs.
Introduction
Status of HEIs
in South Africa
•23 public universities in SA.
•+ 2 new universities (Kimberly & Mbombela).
•11 traditional universities.
•6 comprehensive universities: combine functions of
traditional and Universities of Technology (UoTs).
•6 UoTs (previously known as technikons).
Status of
Nursing in HEIs
How many
universities
offer nursing
programmes?
• Out of 23 universities in SA, 22 offer nursing (two new
universities have nursing in their PQM).
• Only Central University of Technology (CUT) does not
offer nursing programmes.
• In KZN, there are four (4) universities.
• Out of the four universities, only three offer nursing
programmes.
• MUT does not offer nursing programmes (present in
their PQM).
Status of Nurse
How many
training in KZN colleges train
colleges
nurses in KZN?
Private Nursing Schools
• A number of private nursing schools in KZN.
Public Nursing College
• KZNCN: 25 campuses-10 campuses and 15 subcampuses.
Headcount enrolment : health science professions (2000 to 2011)
Average
Growth
ENROLMENT
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Nursing
MBCHB
Dentistry
Pharmacy
Physiotherapy
Optometry
Radiography
Emergency
Medical Care
5287
8212
1284
1281
1125
732
872
6260
8555
1264
1320
1155
694
958
5398
8476
1280
2089
1253
751
943
5794
8536
1317
2148
1207
795
969
5451
8499
1095
2271
1246
849
986
5354
8483
1314
2127
1287
882
1008
5084
8268
1263
2230
1488
831
1170
4966
8251
1172
2191
1468
775
1249
4979
8295
1165
2147
1437
719
1336
5810
8298
1126
2298
1438
644
1464
5873
8708
1182
2503
1514
606
1523
6529
8771
1114
2642
1567
571
1595
2%
1%
-1%
7%
3%
-2%
6%
196
174
174
217
323
367
417
434
468
504
546
543
10%
Data represents undergraduate enrolment. Occasional and Postgraduate excluded
- Should there be a concern regarding the decrease in certain professions.
- High growth within other professions - do we steer the system towards unemployment or oversupply?
Average annual growth in enrolment from 2000 to 2011
12.0%
9.7%
10.0%
8.0%
6.8%
5.6%
6.0%
4.0%
3.1%
1.9%
2.0%
0.0%
-2.2%
-1.3%
Average
Growth
0.6%
-2.0%
-4.0%
Actual average annual growth. What does SA need? EMC the fastest growing profession. Are our Universities coping and did they
prepare for such a high growth?
Graduates : health science professions (2000 to 2011)
SUPPLY
GRADUATES
Nursing
MBCHB
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Average
Growth
895 1023 1259
2%
1131 1229 1214 1296 1394 1511 1366 1297 1309 1255 1329 1300
1%
986 1307
847
933
881
808
873
920
867
Dentistry
220
239
175
244
168
239
268
206
214
193
271
201
-1%
Pharmacy
261
204
370
369
460
425
515
513
435
396
389
445
5%
Physiotherapy
246
222
251
265
246
262
351
326
335
329
310
303
2%
Optometry
151
131
144
145
123
157
190
123
177
156
142
131
-1%
Radiography
279
300
276
303
298
320
363
385
387
470
431
519
6%
Emergency
Medical Care
16
22
25
22
27
53
77
65
76
120
137
146
22%
Data represents undergraduate enrolment. Occasional and postgraduate excluded
Average annual growth in graduates : 2000 to 2011
25.0%
22.3%
20.0%
15.0%
10.0%
5.0%
5.0%
0.0% -1.3%
-0.8%
1.3%
1.9%
5.8%
2.2%
-5.0%
Graduate growth should be higher than enrolment growth.
Average
Growth
Capacity, Intake and Eligible Applicants Nursing
1200
18963000 by 2011
1000
800
Capacity
Intake
600
2010 Eligible Applicants
2009 Eligible Applicants
400
2008 Eligible Applicants
200
0
UKZN
CPUT
NMMU
UFS
UJ
UWC
WITS
Intake lower than capacity – NMMU, UFS, UJ, UWC
Noticeable the increase in the number of eligible applicants
Challenges
Health Science Deans - 17 Nov 2011
As presented by Prof S Essack on the 17 November 2011
• Inadequate infrastructure – teaching and learning spaces, skills laboratories,
residences
• Inadequate clinical teaching and training platform both in available student
placement sites as well as the facilities at these sites for non-clinical teaching and
learning
• Shortage of clinical supervisors within the clinical teaching and training platform as a
result of high vacancy rates and high workloads within public sector student placement
sites.
• Staff:student ratios mandated by the professional councils are increasingly difficult to
effect
• Increased operational costs, particularly transport costs linked to expanded clinical
teaching and training platform
• Limited and dwindling pool of credentialed healthcare professionals pursuing
careers in the academic health sciences
Unleashing academic talent
Pillar 1
Pillar 2
Pillar 3
• Teaching & learning-40%
• Research-40%
• Community engagement-20%
Career pathing
Promotion
Informal
Formal
Noninformal
Funding of
HEIs
Block grant-input subsidy
Number of students enrolled at the institution. Subsidy higher
for PG students.
Block grant-output subsidy
Number of students who complete their qualifications.
Block grant-research output subsidy
Research products of academics and students-publications in
accredited journals.
Earmarked grants
Specific projects such as infrastructure and students loan-CTG
for the clinical training for the UG students.
Other sources
of funding
• Two other major sources of funding:
1. Student fees often supported by National
Student Financial Aid System (NSFAS).
2. Donations and grants (often through funding for
research, for example Atlantic Philanthropies,
NRF, MRC, STTI etc.).
Funding for
provincial
Nursing
Colleges
Sources
•Most nursing colleges function according to
provincial legislation.
•Funded from the provincial health budgets.
•Funding based on a budget submitted by the
college principal.
•Funding not based on any norms or standards.
•Budgets do not automatically increase with
increased activity, e.g. more publications, more
funding.
Access and
success in
higher
education
Challenges
•Access and success are primary concerns of
university system throughout the world.
•Admitting and graduating students is the core
business of universities.
•Access and success are profoundly linked to the
social and political context within which universities
operate.
•These must be understood in historical terms.
Factors affecting student access and success
Access
Social context
Admission/ Application/ Testing
Academic staff
•
•
•
•
•
•
•
•
Curriculum
Pedagogy
Teaching
Technology
Language
Theories of
knowledge,
teaching and
learning
Academic
Development
Tracking –
early warning
systems
-
Institutions
Enrolment/Placement
Transition
Students
Leadership
Systems
Data
•
•
•
Finance
Housing
Student
support
services
Non - Academic
E
Academic
• Race
• Gender
• Socio–economic
status
• Schooling
• Choice
• Career guidance
• Preparedness
• Literacy
• Post-school
opportunities
• Disadvantage
• Equity
• Family support
Political and
economic context
Individual agency
•
•
•
•
Student engagement
Campus culture
Peer support
First year experience
Retention
Attrition
Success
Postgraduate
Pathways
Graduation
Throughput
Achievement
Employment
Graduate Attributes
Capabilities
• Partnerships
• Higher education
system
• Policy
• Funding
• Quality
assurance
• Data
• Expectations
of higher
education (HE)
• Political and
economic
forces
impacting on HE
• Post-school
pathways
• Youth
unemployment
& NEETS
• Articulation gap
Stopout,
Or Dropout
Access and
success in
higher
education
Challenges
• In the early 1990s, a massive expansion of black
student enrolment in HE occurred.
• Numbers increased from 495 356 in 1994 to 938 201
in 2011.
• Black student numbers increased from 55% in 1994 to
81% in 2011.
Graduation
rates in higher
education
Challenges
•15% of students at SA universities graduate
(Mtshali, 2013).
•The target set in the National Plan for HE (NPHE)
is 22.5% on an average three-year contact UG
programmes and 13.5% for UG distance
programmes.
•The bar has been raised to 25% for 2030.
Success rates
in higher
education
Challenges
•79% for contact students and 69% for distant
UG students.
•Success rates of African students are 10%
below those of White students (DHET, 2012).
•University success rates in SA are relatively
low compared to similarly developed
countries (National Planning Committee
2011).
Drop-out rates
in higher
education
Challenges
•SA has high attrition (low retention) rates.
•Of the year 2000 cohort of students, only 30% had
graduated after 5 years of study, while 50% had left
the institutions without graduating and 14% of
students were still registered after 5 years (Scott et
al., 2007).
•Black completion rate is less than half the white
completion rate (Scott et al., 2007; CHE 2013).
Implications for
nursing
•Nursing is not the first choice of career for the
high school learners (Mbangi & Sibiya, 2013).
•Nursing still attracts more African than White
students (Manson & Sibiya).
•The three universities are graduating far less than
the number of students that are graduated by
nursing colleges in KZN.
Implications for
nursing
•Enrolment plan submitted to DHET for 20142019.
•Where is the subsidy going to come from for
Nursing Colleges if they move to HE?
•Research culture still at its infancy stage-subsidy
for block grant-research?
•Entry qualifications is Masters.
•Pressure for staff to obtain doctoral qualifications.
Collaboration
with practice
Together we
can do more
• Advisory board meetings
• SANEN
• Partnership in organising conferences-2014
ANEC in collaboration with FPNL on 25-27
June 2014
Conclusion