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 January 2006, Vol. 12, No. 1Safe Motherhood The emigration of trained professionals poses an ongoing challenge in South Africa. Among nurses, this phenomenon—and the pressure it places on nurses who remain—may be contributing to a high rate of maternal mortality in that country. The Population Council’s Frontiers in Reproductive Health program, in collaboration with the University of Witwatersrand, conducted a study to learn more about the workloads, morale, and career plans of maternity nurses in South Africa. The study was carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa. All public sector hospitals providing maternity services in the three provinces were notified of the study and then faxed a questionnaire. Site visits were made to 15 hospitals and 27 clinics. Workload challenges and poor motivation The results suggest that although nursing staff turnover, shortages of staff, and workload are extremely problematic at some facilities, not all facilities are equally badly affected. In the sampled clinics, the mean workload was 770 clients per month per professional nurse. The mean number of deliveries performed per professional nurse per month in hospitals was 16.5. In terms of absenteeism, the study found that although a large number of days were taken off sick, these were often isolated days and not long periods of sick leave. The average length of service of sisters-in-charge (charge nurses) was more than five years. The mean number of years that professional nurses had worked at a facility was nine years in Mpumalanga and KwaZulu-Natal and nearly six years in Limpopo. A high percentage of nursing staff working in public facilities said they were discouraged, burnt out, and considering leaving the facility where they worked. Sixty percent of professional nurses agreed or strongly agreed with the statement, “These days I don’t feel motivated to work as hard as I could,” and 43 percent agreed with the statement, “When I get up in the morning, I dread having to face another day at work.” Reasons for leaving service It is not possible to discuss any issue related to health in South Africa without considering the impact of the HIV/AIDS epidemic. The epidemic was found to have a role, but not to be directly responsible for problems with nursing morale in maternity units. Only 15 percent of nurses said that the risk of catching HIV has made them think about leaving their jobs. Indeed, more nurses (37 percent) were worried about catching HIV outside of work. The study found that both financial and nonfinancial factors influenced nurses’ decisions on where to work. Good management and a well-equipped hospital were as influential in nurses’ choices as a 15 percent pay increase. The qualitative data showed that various policy initiatives instigated by government to retain staff, such as an additional allowance for nurses working in rural areas, have had mixed outcomes. In the case of the rural allowance, only professional nurses (and not nursing assistants) receive extra pay when they work in rural areas. This means that nurses who receive the allowance feel badly for their colleagues and in many cases are faced with colleagues being uncooperative and saying, “You get the rural allowance, you do the work.” The researchers note that interventions are badly needed to improve this situation, even though the low morale may be an obstacle to successfully implementing such efforts. Policymakers need to pay more attention to how policies are implemented and to the impact of policies on the relationships among nurses, and between nurses and managers in facilities. The researchers recommend that improving facility management should be a priority of South Africa’s National Department of Health. But they acknowledge that such a task may be challenging, since many facility managers themselves are demoralized. Source Outside funding See Also
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