Nursing In Global Health Systems - South Africa - Research Paper Example

? Nursing In Global Health Systems (Country: South Africa) Valerie Blemur Florida International NUR 4667 – Nursing in Global Health SystemDecember 3, 2012 Introduction In the early 1990’s, South Africa as a nation had started aligning itself with the mission and vision of the World Health Organization (WHO) organization. It was during this period that the government enacted laws disseminating HIV services at the primary health care level, creating ways for greater integration to address women’s health and to reduce maternal mortality. South Africa has shown its efforts in addressing HIV-related goals by implementing comprehensive services for women and children especially with family planning (FP), as well as maternal child health (MCH). The country, according to the annual report released by the Department of Health, shows that while there is progress in fighting the HIV/AIDS epidemic, there is still a long way to go in terms of the overall improvement of health services. The country still faces serious challenges for pregnant women, maternal mortality, poverty-related diseases and gender-based violence (2006). South Africa attracts a lot of attention from medical researchers due to the unbalanced health care among its citizens. In addition, the issue of racial apartheid was a problem prior to 1994 and this had a profound impact on the dissemination of health services among its citizens. Therefore, South Africa’s history of apartheid, unbalanced health care/ HIV-AIDS epidemic makes it an ideal place to examine. Location Geographically, the country is located on the Southern tip of the African continent. The Atlantic Ocean borders it on the west while the Indian Ocean borders it on both the South and East. Namibia, Botswana, and Zimbabwe lie on its Northern border while Mozambique and Swaziland are located on its Northeast borders. South Africa uniquely encloses an independent kingdom called Lesotho (Inter Knowledge Corp, 2010). Population The country is about 472,000 square miles wide (equivalent to 1.2 million sq. km.) and lies beneath the Tropic of Capricorn. It is comprised of three geographical primary regions: an extensive central plateau – and a nearly unceasing cliff of mountain ranges that circle the plateau from the Western, Eastern and Southern side, with a strip of land along the coast (Inter Knowledge Corp, 2010). According to WHO statistics, South Africa has a population of approximately 50,133,000 with a gross national income per capita (PPP international $) of 10,360. In the year 2009, the life expectancy at birth m/f (years) was 54/55 but the probability of dying under five (per 1,000 live births) is currently unavailable. The total expenditure on health per capita is approximated at 935 with a total expenditure on health % of GDP (2010) estimated at 8.9 (WHO, 2012). Government In pre-apartheid times, the South African government had a highly bureaucratic health care system. The administration of health care was divided into 14 separate departments, which were responsible for looking after the health of the different racial groups, the homelands, and six self-governing territories. The health care services were divided into preventive and curative among government departments, the provinces and the local authorities. The expenditure on tertiary health services was prioritized above primary health care services. This led to the development of a private health sector that is unregulated by the government. In addition, a lack of commitment by the government in terms of training, staffing and ways to eradicate poverty have contributed to the country’s high infant mortality, maternal mortality, life expectancy at birth and incidences of infectious diseases (such as tuberculosis and measles) among many citizens, especially black people (Department of health, 2010). However, in 1994, South Africa was among the few African countries that had started transforming the health care system. Legislature passed bills that ensured equal distribution of resources, restructuring the health system according to the district health system and delivering health care according to the principles of the primary health care approach (Department of health, 2010). South Africa Economy South Africa falls under the category of a middle-income country. It has a gross domestic product (GDP) per capita of USD 3000 and a population of approximately 47.3 million (Pierre-Louis, Akala, & Karam, 2004). The research indicates that USD 16.7 billion is spent on health care, which amounts to 8.7% of GDP. It was also estimated that the private health care sector share is 5.2%, while that of the public sector is 3.5%. The country has a tax funded public health care system that covers 85% of the population and a well-entrenched private health system covering the rest (Pierre-Louis, Akala, & Karam, 2004). The private funding comes from medical aid contributions of about 66% and out-of-pocket payments totalling 23%. However, donor aid played a minor role in the health care sector (Pierre-Louis, Akala, & Karam, 2004). The National Department of Health leads the public health system and is entrusted with the responsibility of ensuring that health policies are implemented. Implementation and delivery of health services is through the 9 provinces (states) and 284 municipalities, where the provinces provide mainly curative hospital services (Heritage Publishers, 2010). Health Status Statistics shows that South Africa’s Infant Mortality Rate is 45/1000, and life expectancy averages at 50 years for males and 53 years for females. The Infant Mortality Rate is projected to increase due to effects from the HIV/AIDS epidemic. Statistics show that, approximately 60 children in 1000 succumb to death before their fifth birthday. In addition, the numbers of mothers who die delivering babies are estimated to be 83 per 100,000 women (Department of health, 2011). A related problem is the HIV/AIDS epidemic and Tuberculosis (TB). The TB rate is increasing at an alarming rate in the country; it is estimated that 50% of HIV-infected persons will contract TB, thus increasing the rate. With respect to chronic diseases, the annual Health Department report indicates that about 8% of adults had asthma, 12% suffer from hypertension and obesity at 9% for men and 29% for women (Department of health, 2010). Domestic violence against women is also a growing problem among most citizens. It has been reported that men who are less educated propagate the violence. The report also indicates that about 13% of women are physically abused and about 4% being raped(Department of health, 2011). Health care personnel in South Africa The health care sector was among the first to acknowledge the racial disparities amongst health professionals. For this reason, guidelines for equity distribution have been established for all health professional training institutions in the country, which has created tensions in some sections of public and private health care, with many prospective applicants for training and other few places. Another issue facing South Africa and other developing countries is the loss of health professionals to more developed countries (Zwegenthal, 2009). South Africa has voiced its sentiments in various international forums about the issue of losing its professionals. As a result, numerous factors have been investigated and analyzed, which resulted in additional strategies being put in place within the Human Resource Plan. The recommendations included improving the health facilities and working conditions, training adequate health professionals and developing health workers. The HIV/AIDS epidemic has also taken a toll on the health of doctors and nurses, as evidenced by an increased patient load, as well as infections among the health workers. The occupational health concerns of medical professionals is of increasing concern due to the biological hazards they are confronted with on a daily basis in both inpatient and outpatient settings. Tuberculosis in the health workforce is rising (Millar, 2007). South Africa is assisting with the education and training of medical practitioners and other health professionals in the region. Through its mode of learning, Universities in South Africa are supporting an extensive Public Health program within South Africa and across Africa. Private Health Sector The private health sector is well equipped with adequate doctors as well as established international acquisitions. The health plan industry has extensive investments and several activities in the region. Private hospitals play a critical role in the South African health system. The access to private hospital services is still very limited for many citizens, they cost significantly more than the public sector. The beneficiaries of medical schemes are main customers of the private health sector, although there is an increasing trend of self-funding patients over the years (Shigman, 2011). Medical Research Researchers from this country have contributed a lot in different health sectors such as the heart transplant program, and innovative public health delivery systems. This has been achieved due to the strong legal, ethical and good government framework that offers considerable financial support together with human investments from the international donor community (Merson & Black, 2011). Nursing Education Nursing students in South Africa undertake 2000 hours of clinical practice before completing an examination to become certified as nurses. Some of the courses they undertake are Nursing History, Standard Nursing Care, First Aid, Elementary Nutrition, Anatomy and Physiology, and Comprehensive Health Care. During the second year, the courses, General Nursing Care, Nursing Care for the aged, Community Nursing Care and Psychiatric Care Nursing are taken. Registered Nurses are certified and have qualifications in different areas. These areas are distinguished by different colors: yellow-community nurse, green-midwife, dark blue-psychiatric, white-nursing education, silver-nursing management (Merson & Black, 2011). One of the major challenges that nurse face include a constant backlog of patients, sometimes 500 per day, in understaffed hospitals. One single nurse is responsible for 32 patients, with some of them working in extreme conditions. When combined with an absence of inadequate amenities, nurses end up exhausted. The outcome is a mindset where nurses are required to “treat the numbers, not the patient” and eventually, there is a compromise in proper patient care (Shigman, 2011). Health Priorities Having a stable economy and peace is necessary to sustain the health system. The government should invest in broadening housing options and providing a cleaner environment with access to water, food, security and jobs (Merson & Black, 2011). There is an urgent need for an integrated system that will decrease the morbidity and mortality associated with chronic disease. Dealing with diseases of lifestyle is equally important, especially given the pace of the epidemiological transition in the country (Zwegenthal, 2009). Equity in health care provision remains an issue. Another critical area of concern is equity between the public and private sectors. The provincial inequity should be managed through well-organized structures with budgets and other resources, as well as substantial migrant labor, job creation and spatial development inputs. Nursing Implication The health sector needs a medium term strategy as practitioners take a minimum of 12 to 15 years before achieving competency. Thereafter, they are required to continue with that professional development to keep them updated on new knowledge and interventions. The commitment to appropriately recruit skilled human resources for their health and social care system should also continue (Daniel, Southall, & Lutchman, 2007). References Daniel, J., Southall, R., & Lutchman, J. (2007). State of the Nation: South Africa 2007. Cape Town: Human Sciences Research Council. Department of Health, (2011, March).The Primary Health Care Package for South Africa Heritage Publishers, (2010). How do we measure economic Freedom, South Africa. Retrieved November 5, 2012 from www.heritage.org/index Inter knowledge corp (2005) South Africa, International Knowledge. Retrieved from http://www.geographia.com/South-Africa Merson, M. H., & Black, R. E. (2011). Global Health. Burlington, MA: Jones & Bartlett Learning. Miller, T. (2007, July) South Africa's Health System and Challenges, SA Health. Retrieved November 5, 2012 from http://www.southafrica.info/about/health/health.htm#ixzz2BBomNkE6 Shigman (2011), The South African Nursing Crisis, Interactive blog from the Global Health Counil’s Policy, Research and Advocacy team. Retrieved from http://blog4globalhealth.wordpress.com Pierre-Louis, A. M., Akala, F. A., & Karam, H. S. (Eds.). (2004). Public Health in the Middle East and North Africa: Meeting the Challenges of the 21st Century (WBI Learning Resources Series). Washington, D.C.: World Bank Publications. WHO, World Health Report 2006: working together for health. Geneva: World Health Organization, 2006. WHO 2012, W. (n.d.). Statistics. Retrieved November 5, 2012 from http://www.who.int/hrh/statistics/en/ Zwegenthal, P. R. (2009). Fresh Perspectives: Primary Health Care. South Africa: Pearson South Africa. Read More