If the Botswana public health sector was a patient, the prognosis would be grim: Critically ill with a degenerative disease.
To take the pulse, you only have to walk into any government hospital. It wouldn’t be the whole story, but you would catch the drift. You would pass hordes of patients and their relatives surging in and out of the imposing entrance.
It’s busy outside and inside. Patients, mostly women, sit in long rows on wooden benches waiting for their turn to see a nurse or doctor. Many more are forced to wait on the floor.
An unattended cry for help or an angry remark from the queue would be some of the examples of the growing gulf between public expectations and the reality of what government clinics and hospitals can deliver on skeletal staff. Government clinics and hospital are forced to do more with less. Most do not have enough nurses to cover for time off, sickness and maternity leave.
The Assistant Minister of Health, Gaotlhaetse Matlhabaphiri, told parliament last week that the continued migration of nurses from the public service is a national problem that gives them sleepless nights.
Faced with the double whammy of increased workload and low wages, public sector nurses are deserting in droves to look for greener pastures, patients are having the worst of it. The minister said, “while migration of nurses to other countries is presently minimal, nurses continue to migrate from the public service to other local organizations for various reasons. Several studies carried out cited factors influencing nurses’ migration as among others, low salaries and benefits in the public sector as compared to where they are migrating to.”
Money, status and working conditions compare badly in the public health sector. Matlhabaphiri told parliament that,“Other push factors relate to lack of recognition, slow professional development and current workload in public health facilities caused by HIV/AIDS and related opportunistic diseases.”
He was answering a question from Palapye Member of Parliament, Moiseraele Goya, who had asked why nurses and other health workers continue to leave the public service in droves. The MP also inquired about strategies that government has put in place to curb the exodus. The nursing shortage has been a running problem for some time and it is nowhere near sorted. Pressure groups and members of parliament have to keep blowing the whistle about the risk to patient care.
Matlhabaphiri said the Ministry of Health continues to militate against nurses’ migration by introducing incentives meant to retain them. For example, he said, in 2002 nurses allowance was raised from 15 per cent to 30 per cent. Furthermore, discussions with relevant authorities on how to address issues of conditions of service such as increasing the current staff complement and upgrading skills are ongoing.
The nursing shortage has been a running problem for some time and it is nowhere near sorted. It is understood that most government health institutions do not have the right mix of nursing skills to meet patients’ needs. Indications are that the problem may get worse before it gets better. Late last year, it emerged that Botswana, which had for a long time depended on expatriate health professionals from Zimbabwe, would face crippling manpower shortages after a British funded campaign by the International Organization on Migration (IOM) introduced mouthwatering incentives meant to lure Zimbabwean health professionals back home and resuscitate the country’s health sector.
An earlier study by Gloria Thupayagae-Tshweneagae of the Department of Nursing Education at the University of Botswana revealed that Botswana got a major boost from the economic meltdown in Zimbabwe. The study found that migration of nurses is not only limited to nurses in service but also includes nurses in education. According to the study, between 1999 and 2005 about 232 nurses resigned from the public service, and about 18 deserted.
In 2006 about 146 nurses resigned and 24 nurses retired.
The recently opened Bokamoso private hospital has also dealt the public health service a crippling blow. Nurses deserted the public service in droves, attracted by better wages at the new private hospital.
Nurses were also irked by government’s refusal to grant them scarce skills’ allowance. In an earlier interview, Ministry of Health Public Relations Officer Themba Sibanda confirmed the loss of nurses.
“Issues concerning accommodation and long working hours with insufficient remuneration have soured relations between government and health personnel,” he said.
Botswana Nurses Association Executive Secretary Geetha Feringa concurred. To date, government continues to depend on the goodwill of expatriate medical staff from among others Cuba and China. Government has also expedited training of medical students at the University of Botswana and abroad, and the University of Science and Technology is also expected to provide relief.
But as things stand, the situation is slowly becoming drastic, with reports from around the country indicating that a number of clinics and hospital wards have been left unmanned due to the mass resignations.