SA needs to invest in nurses to avoid a healthcare catastrophe

Business Day | 04 May 2023

Life Healthcare has the capacity to train 3,000 a year, but the bureaucrats will simply not listen

Nurses hold candles in honor of nurses who died during the Covid-19 pandemic at the Nursing Council offices in Pretoria in this file photo. Picture: VELI NHLAPO

From the rising costs of diesel used to offset load-shedding, to difficult working conditions and the increasing effect of inflation, SA’s healthcare sector is facing a multitude of challenges. But one of the biggest issues is undoubtedly the lack of critical human resources, specifically healthcare workers, who keep hospitals and facilities functioning.  

Today in SA there is just one doctor for every 3,200 people, translating to 0.3/1,000. By contrast, countries such as Australia and the UK have more than three doctors for every 1,000 people. On the ground, there is just one nurse per 213 people. Of these, less than a third are under the age of 40, and within 15 years 47% of all nurses will have retired.

The nursing shortage is estimated at more than 26,000 professionals at present, but we expect this number to reach more than 100,000 by 2030. Nurses are the backbone of the healthcare sector, playing a crucial role in patient recovery and safety. If action is not taken immediately to develop a sustainable pipeline of nursing talent, the problem is going to become noticeably worse. 

As a leading provider of quality health care, we have the facilities and the capacity to contribute to the national pool of skills, especially in the field of nursing, by training as many as 3,000 more nurses every year. Yet we are being denied the opportunity to invest in the next generation of nurses. The bureaucrats will simply not listen.  

New regulations enacted by the SA Nursing Council and Council on Higher Education are turning off the taps of training. Out-of-touch regulations permit us to train just 800 nurses a year — in no way enough to reduce the effect of the shortage. 

Borderless skills

Beyond our inability to train people to meet SA’s future healthcare needs, the regulations risk the sector losing even more talented and skilled nurses by limiting career advancement, prompting nurses to consider their options overseas. According to the World Health Organisation, the Covid-19 pandemic has caused a rapid acceleration in international recruitment of health workers, including nurses. 

We cannot spend more time debating the numbers — the problem is blindingly obvious to everyone. It is now time for public stakeholders to recognise that there is a big bureaucratic problem at play, which if not addressed quickly will have catastrophic long-term implications for all of us.

If the government’s goal is to forge ahead with National Health Insurance (NHI) — which is aimed at making health care more accessible, giving more people the opportunity to receive treatment — more nurses and doctors need to be trained to realise this vision. Private healthcare providers are willing to extend a trusted hand of friendship to the public sector so that we can work to overcome this critical skills shortage together.

It is our intention to have constructive conversations about the practical roles both the public and private sectors can play in addressing this crisis — before it becomes a catastrophe where people’s lives are at stake. Through our accredited, innovative, quality education and training programmes, we can help bridge the skills gap, but we need the government to come on board and collaborate to address the regulatory shortcomings, or risk SA’s pipeline of talent running dry.

The adage “the best time to plant a tree was 20 years ago, the second-best time is now” has never been more true. If we don’t get busy solving the shortage now, I am deeply concerned that SA will not have the skills it needs to address future healthcare demands. That’s why we will not rest until we have permission to train more nurses, who in turn deliver high-quality care to our patients.  

Life Healthcare has the potential and the willingness to invest in a sustainable pipeline of nurses. We need the public sector to work collaboratively to safeguard the ones already on the front line while allowing us to train the next generation. 

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Over half of e-visa applications are rejected, because they were not processed in time 

The poor performance of the department of home affairs in the issuance of e-visas is of great concern to Western Cape finance & economic opportunities minister Mireille Wenger, who says this hampers tourism recovery in the country.

She noted on Wednesday that according to a presentation made by the department in the National Council of Provinces, 58% (3,697) of failed e-visa applications totalling 6,329 were rejected because the date of travel had already passed.

“They simply weren’t got to in time,” Wenger said.

“This follows an earlier revelation by the same department that, at that time, only 48.7% of all e-visa applications received had been processed. It was further revealed that of those that had been processed, only 3.2% of the total received had been granted.”

Wenger said e-visas were intended to provide a convenient option for visitors to make their applications online, instead of having to visit an SA mission abroad. Fourteen countries are eligible for e-visa applications: Cameroon, China, the Democratic Republic of the Congo, Egypt, Ethiopia, Kenya, India, Iran, Mexico, Nigeria, the Philippines, Pakistan, Saudi Arabia and Uganda.

‘Deeply concerning’

“It is deeply concerning that inefficiencies in our e-visa regime continue to add a barrier to our tourism recovery, and our drive to increase connectivity within the African continent and attract more African tourists to our destination. This should be fully enabled by our visa regime, and not restricted, as is currently the case,” Wenger said.

“While the recent commitments from President Cyril Ramaphosa to address the serious issues with the visa system are welcomed, words no longer count. Decisive action is required along with timelines to address the well-known challenges,” she said.

According to another statement, the department said in a presentation to the provincial standing committee on finance, economic opportunities & tourism on Wednesday that it would finalise implementation of the remote working visa next month, and that the state law adviser approval process was under way.

Decisive action is required along with timelines to address the well-known challenges.

Mireille Wenger, Western Cape finance and economic opportunities minister 

A remote working visa was a no-brainer, DA Western Cape MPP and tourism spokesperson Cayla Murray said. “The Vulindlela report on visa reform ... [received only this week], despite already writing to the president in February, confirms as much, and recommends the implementation of a remote working visa with suitable requirements such as proof of employment, a minimum level of income, and health insurance.

“I am hopeful that home affairs will stick to its commitment, as this will help to boost job creation in our province. It must be noted, however, that such commitments from ANC-led national government departments often aren’t worth all that much,” Murray said.

The DA says it will make sure that this shortcut to economic growth is implemented as soon as possible, and will use every mechanism available to hold DHA to account should they not live up to their commitment.

In March the department granted relief to applicants for long-term visas or waivers who were awaiting the outcomes of their applications by extending the blanket concession to December 31. This was due to a backlog in processing waiver and visa applications by foreign nationals. The backlog, which runs into the tens of thousands and extends back to 2016, is due to a lack of personnel in the department and the lengthy procedures involved in processing an application.

The department said in March it only expected to clear the backlog in 15 months’ time.

The total backlog for permanent residence permits in the system amounted to 49,529, with 40,340 of those at end-May 2022 outstanding for more than eight months. Of these, 3,524 date back to 2016; 5,187 to 2017; 7,303 to 2018; 10,621 to 2019; 2,968 to 2020; three to 2021 (when the world was in the grip of the Covid-19 pandemic) and 10,759 to 2022.

With regard to temporary residence permits, the backlog of applications totals 75,814, with 23,988 having been received within eight weeks by March 1.

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The Department of Home Affairs has committed to finalising the implementation of new visa types in June of this year, with the State Law Advisor approval process already underway.

In its annual performance plan for 2023/24, published in April, the department made it clear that the groundwork for new visas was being laid.

In the plan, Home Affairs minister Aaron Motsoaledi said that the department is currently exploring new visa categories, including start-up visas and remote working visas.

The minister has long responded to inquiries about these visas by saying that the current regulatory framework to introduce them does not exist, and had indicated the department had no plans in place to change this.

However, these visas, and a wider push to draw skilled labour to South Africa, have been key points in president Cyril Ramaphosa’s State of the Nation Address (SONA) for the last two years.

“A comprehensive report on the review of the work visa system was recently handed over to the President by the Operation Vulindlela Team, lead by former Director-General of Home Affairs, Mavuso Msimang,” it said.

“The report makes recommendations with regards to the possibility of new visa categories that could enable economic growth.”

Home Affairs has drafted and implementation plan for the introduction of these visas, as recommended by the report.

The department has now confirmed that it intends to have the specific requirements for remote work visas and start-up visas detailed in three months’ time, setting a target for the end of June.

To accomplish this, the department will have to amend regulations 11 and 14 of the Immigration Regulations, it said. This is also set against a three-month timeframe.

A consultation document (green paper) is expected to be completed by the end of the first quarter of the financial year (end June), with a whitepaper expected to be submitted to cabinet by the end of the fourth quarter (April 2024).

e-Visas

In the meantime, the DHA said it will also continue rolling out an e-Visa system, which will place technology at the centre of operations by making it easy and secure to enter and depart South Africa.

According to the department, the e-Visa system has been in place for 14 countries, including Kenya, Cameroon, Iran, Egypt, Philippines, Saudi Arabia, Ethiopia, Pakistan, DRC, Mexico, India, China, Nigeria and Uganda, for nationals that enter via OR Tambo International airport.

It said that up to the end of March 2023, a total of 12,377 visa applications have been processed on this platform.

The department has run into some challenges, it said, particularly with slow network speeds which resulted in backlogs. However, the establishment of an e-Visa hub has assisted in clearing up applications.

Following a series of enhancements on the system, the department said it is now planning to roll out the e-Visa platform to 20 more non-visa-exempt countries.

These new countries include:

• Albania

• Algeria

• Belarus

• Bulgaria

• Cuba

• Comoros

• Congo

• Croatia

• Ghana

• Guinea

• Indonesia

• Ivory Coast

• Lithuania

• Liberia

• Mali

• Morocco

• Niger

• Romania

• Senegal

• Slovak Republic

South Africa is reworking its visa regime in a bid to draw critical skills to the country. However, despite its best efforts, Home Affairs has been hit with multiple issues creating backlogs in visa processing which have made it difficult for companies to do so.

In March, the department announced that it would extend the validity of some standing visas while it tries to process over 62,700 applications and waivers that have backed up.

To put the extent of the backlog in context, the department aimed to have most critical skills visas processed within four weeks of application in 2022, but has estimated that it only managed to process 20% of these applications in that time.

This is down from 57% in 2021. The DHA has now set a lofty goal of having 90% of these visas processed in 2023  however it anticipates only being able to clear the current backlog some time in 2024, so this is looking unattainable

www.samigration.com

Couple wanting to live together separated by Home Affairs delays

Sunday Tribune | 02 May 2023

Durban - A gay couple is being forced to live on different continents since the Department of Home Affairs (DHA) has allegedly failed to process a permanent residence permit application submitted two years ago.

Francois Oosthuizen, a South African from Cape Town, who is married to Bowen Li from China, said he was heartbroken and frustrated by being separated from his husband and their 4-year-old son born via surrogacy on Valentine’s Day in South Africa.

He said it was difficult for him to wake up every morning knowing that his family was thousands of kilometres away.

“I try to video call them as much as I can, because it’s the closest I can get to them, since we can’t be together, but it’s not the same as being around each other.

“It’s very hard for us to accept the fact that only a few people need to sign a document that will allow us to stay together as a family, but they haven’t,” Oosthuizen said.

After being approached by the Sunday Tribune, the DHA reached out to Oosthuizen and said they were investigating. However, there was no response to the Sunday Tribune questions.

The couple met in China in 2014 where Oosthuizen worked as an English teacher. He said it was “love at first sight” and that there was an instant connection which made being around each other comfortable.

The couple was legally married in South Africa in 2017 but lived together in China until Oosthuizen returned a month ago. Oosthuizen told the Sunday Tribune that they first made an application for Li’s permanent residence permit two years ago, but there was radio silence from the DHA.

Francois Oosthuizen and Bowen Li who have been married for six years want to live in the same country, but their fate lies in the hands of the Department of Home Affairs.

“They told us that it would take about eight months, but when that time passed without anything happening, I started contacting them to get information on what was going on. “Only one person responded weeks later, telling me that our issue was not the responsibility of the department,” Oosthuizen said.

He said that his family was separated because of the department’s incompetence and lack of regard for gay rights. “It’s a combination of these two things, the fact that we are a gay couple is definitely a factor. We have had issues before with DHA.

When our son was born they wouldn’t issue us with a birth certificate. “We feel that it’s because we are gay, but we also do realise that it’s because the department is inefficient. We have heard from other people who have been waiting for a long time as well for their permanent residence permits,” he said.

Oosthuizen said the month that he had been away from his loved ones had been unbearable and that he was hopeful that they would be together soon and settle in Cape Town. “It might seem to someone else that a month is not a long time, but it’s very difficult for me. I am so used to being around and spending time with them.

It is frustrating because this is something that shouldn’t be so difficult,” he said. The couple has been receiving support from across the country for their online petition which Oosthuizen started a few days ago for the attention of Home Affairs Minister Aaron Motsoaledi.

www.samigration.com

SOUTH AFRICA – Radiological Report and Police Record Waivers

02 May 2023 | SA Migration

The South African Department of Home Affairs has issued a new directive providing relief to visa and permit applicants from April 11, 2023. It does not apply to those with applications which have already been filed and are currently under adjudication.

Previously, applicants for long-term temporary residence visas (“TRVs”) and permanent residence permits (“PRPs”) had to submit police clearance certificates (“PCCs”) from all countries resided in for 12 months or more since their 18^th birthday, they are now only required to submit PCCs from all countries they resided in for 12 months or more, since having attained the age of 18, in the five years immediately preceding the date of submission of their application. This provides considerable relief to applicants who have resided in many countries, particularly those who did so many years ago. It can be time-consuming, difficult and in some instances, impossible, to obtain police clearance certificates from certain countries, particularly, but not only, when the foreign national lived there a long time ago and they do not have any official records.

Where it was not possible to obtain a PCC from a particular country, prior to the implementation of the directive, it was necessary to apply to the Minister of the Department of Home Affairs to waive (exempt) the applicant from the requirement to provide the document before they could apply. This process could take from 6 to 12 months, if not longer, due to waiver processing delays. This would significantly delay the foreign national’s ability to apply, and it also created a considerable amount of extra work for the Department processing the waiver requests in an already overburdened system.

Also, whereas before – except for pregnant women and children under the age of 12 years – applicants for long-term TRVs and PRPs were required to submit a radiological report completed and signed by a Radiologist, pursuant to the examination of chest X-rays, confirming that they displayed no signs of active Pulmonary Tuberculosis, the new directive exempts them from the requirement to do so. The Department’s rationale for dropping this requirement is not clear; however, applicants are already required to provide a medical report completed and signed by a medical doctor confirming that they are in a good state of health and noting any medical condition(s) from which they might suffer. It is also possible to accurately test for TB using the Mantoux tuberculin skin test, which does not require the individual to be exposed to radiation as is the case with chest X-rays. Thus, the additional radiological report was largely unnecessary.

www.samigration.com