Maverick Citizen

SPOTLIGHT IN-DEPTH

What is behind the Eastern Cape’s nurse training crisis?

What is behind the Eastern Cape’s nurse training crisis?
Lilitha Nursing College's campus in Gqeberha. (Photo: Luvuyo Mehlwana / Spotlight)

Lecturers doing administrative work, nursing student accommodation found to be uninhabitable, frequent break-ins at some campuses, an exodus of staff since 2017, and some campuses with no students. These are among the challenges at the Lilitha Nursing College in the Eastern Cape that the provincial legislature’s health committee flagged 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 subcampuses 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 affect the quality of care, 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 from the department on its progress in addressing the committee’s concerns, but they have not yet received one.

It has been more than 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 2022, members of the committee visited the Lilitha college campuses in Gqeberha, East London, Komani, Mthatha and Lusikisiki, where they met administrators, campus heads, lecturer forums and labour union representatives.

A report with numerous red flags followed.

The report noted that 22 staff members have left the college campuses since 2017 and none has been replaced. There are not enough finance personnel, so the 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 holidays.

A report by the Eastern Cape legislature’s health committee raised various concerns about Lilitha Nursing College after oversight visits. (Photo: Luvuyo Mehlwana / Spotlight)

The report also noted that exam papers are sometimes set in handwriting, while at the Komani campus, for example, the infrastructural challenges include dilapidated structures and terrible ablution facilities. Also, due to poor management of students’ results, their exam statuses are conflicting. Lecturers are currently managing the student management system on the Mthatha campus, which leaves it in a serious state of compromise, the report notes. On the same campus, a staff member defrauded the institution and paid herself enormous sums of money, read the report.

When the committee visited the East London campus there was no acting principal to receive its members. They found that this campus had spent R118,000 on a workshop held in Gqeberha – about 290km away. There is a strained relationship between staff when it comes to finance and procurement, the report notes. This poor working relationship resulted in the campus receiving incorrect stationery in 2021, resulting in a waste of resources and delays in its operations.

The report also flagged that there were no students on the St Patrick and Butterworth subcampuses because there have been no student intakes since April 2021. Several positions on the Madzikane kaZulu subcampus in Lusikisiki are vacant, 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.

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The health committee states frankly that problems, including with accreditation which hamstrung the production of nurse graduates at the 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 subcampuses 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,” it says.

About 22 staff members have left the college’s campuses since 2017 and none has been replaced. (Photo: Luvuyo Mehlwana / Spotlight)

“To restore human dignity and uphold institutional policies at Lilitha Nursing College, the department must intervene and resolve the current pandemonium.”

A staff member on the Gqeberha 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 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 that since the Department of Higher Education and Training is involved in this accreditation process, it could, “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.”

‘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 province’s 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 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 the Eastern Cape the quality nursing care that is already under severe strain.

Read in Daily Maverick: “SA has a critical shortage of qualified nurses, the backbone of healthcare

“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.

Call for independent probe

Member of the provincial legislature for the EFF, 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 be, so that we can be able to discover who is responsible for the collapse of that institution,” said Tetyana.

The EFF in the Eastern Cape has called for a probe into operations at Lilitha Nursing College. (Photo: GCIS)

“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 nursing council’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 must first submit their curricula to SANC and if accredited, then they submit to CHE. The [nursing education institutions] cannot offer the programmes if not accredited by both institutions,” said Mchunu.

“Lilitha Nursing College was fully accredited by the SANC to offer the Diploma in Nursing at all five campuses. Full accreditation was subject to the submission of proof of accreditation by the CHE. So far, there is no proof that the campuses are accredited by the CHE. The campuses cannot, therefore, offer the programme until accredited by the CHE and the qualification has been registered with the South African Qualifications Authority (SAQA).”

According to Mchunu, the subcampuses of each main campus were conditionally accredited by the SANC to offer the Higher Certificate in Nursing programme. The subcampuses have not yet fulfilled the conditions and therefore cannot offer the programme.


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“The SANC has jurisdiction over [nursing education institutions] that have been duly accredited to offer nursing programmes and to ensure that they meet SANC standards, criteria and requirements. The individual [institutions] must ensure that they maintain the accreditation standards, criteria and requirements all the time and not rely only on the SANC for its monitoring and evaluation function.”

Mchunu declined to say outright that Lilitha is operating illegally – just that it is not accredited. “Whenever an institution operates illegally, a criminal investigation can be initiated,” she said.

Read in Daily Maverick: “Nelson Mandela Bay state hospitals face collapse – doctors resign on ‘unprecedented’ scale

Despite the SANC not recognising the college’s programmes, the college had a graduation ceremony on 4 August 2022 and 370 students graduated after completing the four-year diploma programme, while 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 2021, 725 students graduated despite the conflicting accreditation statuses of these programmes.

Health department responds

Eastern Cape health department 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, as well as 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,” she said.

“Subcampuses 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 the SAQA has given the green light for training to resume. The college still has students on the platform who are working towards completing their studies and graduations are taking place every year since 2020, despite it not having commenced with new qualifications.”

Dekeda said the department is aware of the situation on the Komani campus and a new building project was prioritised but budget constraints caused it to be shelved for now. In the meantime, the department’s 2022/23 infrastructure plans included this campus (for repairs, upgrades and maintenance). If all planned activities went well, the contractor could be on-site during November or early December 2022, she added.

“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. Lilitha is part of the health department’s 2022 annual recruitment plan to fill some of its key posts, such as campus management.”

The department and Lilitha College management understood the “anxieties about the college commencing with the training activities”. Notwithstanding, the college was “optimistically gearing itself up to commence training in 2023”. DM/MC

This article was published by Spotlight – health journalism in the public interest.

 

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Comments - Please in order to comment.

  • Michael Forsyth says:

    It’s funny how spokespeople for Government Departments always INSIST that the enquiry is somehow wrong and that all is still fine. Vide Chris Hani Baragwanath, Charlotte Maxeke and so on. No grasping the nettle to make it better. All because of factionalism and rampant criminality.

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