PSI affiliate in South Africa calls for intervention in plight of health workers

In an open letter, the Democratic Nursing Organisation of South Africa (DENOSA) calls on the Presidency’s intervention in the devastating plights of frontline health workers. PSI affiliate explains how the COVID-19 pandemic has had devastating effects on nurses in South Africa.

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FROM: Simon Hlungwani. DENOSA President.
DATE: 11 September 2020

Dear Mr President.

SUBJECT: Calling for your intervention on the devastating plights of frontline health workers

As the president of the Democratic Nursing Organisation of South Africa (DENOSA), in writing this letter I share the feelings and views of the majority health professionals in the country’s health sector: nurses.

More than 27 300 healthcare workers have contracted the virus and, of this, no less than 240 have died

As a country we can breathe a sigh of relief, albeit for some time, that the numbers of COVID-19 infections are going down. But the devastating effects of the pandemic are just too glaring to underplay, especially for the frontline caregivers.

Mr President, majority of these devastating effects on nurses are brought about because they are working for government. More than 27 300 healthcare workers have contracted the virus and, of this, no less than 240 have died. This is out of the total of over 640 000 infections recorded in South Africa.

Despite this high death rate among healthcare workers and many challenges that confront them in the workplace daily, they have continued to throw themselves in their work selflessly. The results of their hard work can be seen in the form of high recovery rate that we have experienced amongst those who got infected.

Many countries have acknowledged this tremendous work of healthcare workers who have saved many lives.

  • Ghana gave healthcare workers tax break for three months starting from in April.

  • Zimbabwean government started to pay healthcare workers a Covid-19 risk; allowance;

  • The State of Louisiana in the US has passed legislation giving healthcare workers who were on the frontline in fighting Covid-19 a rebate of $250.

In South Africa, Mr President, the environment is completely different. It has been six months since government has defied paying public servants their salary adjustment for the 2020/2021 financial year in line with Resolution 1 of 2018 that was signed at the PSCBC between labour unions and government. The costs of living and of goods and services rose by far more than CPI already in the country.

The salary increase for public servants for this financial year should have been paid on 1 April 2020 in line with the collective agreement that was signed by both government and labour representatives in May 2018.

Despite this failure by the employer to honour its side of this agreement, government workers have continued to do their work diligently.

In hospitals and clinics, nurses continue to do their work to the best of their abilities despite severe shortages of staff and equipment. Many have paid with their lives as they contracted COVID-19 in the line of duty due to poor protection in the workplace, and many nurses have succumbed to COVID-19.

Nurses have carried their work diligently and in line with the nurses’ pledge of service. They were there at the time when the nation needed them the most at the peak of COVID-19 despite the heartless and inconsiderate attitude of government.

Even with greatest feelings and willingness to remain optimal in service, there comes a time when nurses will not be able to do the work they are so passionate about because of lack of means, power and ability to do so.

They can no longer borrow money for their transport fare to and from work.

They can no longer borrow money for their lunch and to augment their budgets for milk, medical aid and shelter.

They are not volunteers, and they do their work that they must be paid for.

As a matter of context to the non-adjustment of workers’ salaries, the Labour Court is the third avenue that labour unions like DENOSA are going through to force government to be honourable and pay salaries of public servants.

The first two avenues, the dispute resolution processes within PSCBC, namely 1. Conciliation and 2. Arbitration, have not yielded anything after months and months of endless delaying tactics by government.


The month of May celebrates nurses around the world. Here at home, the Democratic Nursing Organisation of South Africa or Denosa used the commemoration to reflect on challenges faced by nurses. The union says the success of the delayed National Health Insurance relies on the nurses' involvement. SABC's Tumelo Machogo spent the day with nurses in Volksrust, Mpumalanga.. For more news, visit:

Denosa celebrates nurses, reflects on challenges faced

Mr President, we would like to bring to your attention the following as some of the most difficulties faced by healthcare workers at this hour, and appeal to your office to intervene as all the platforms set to resolve these have merely taken technical and frustrating routes.

The nurse to patient ratio, according to reports from our members in facilities, is at an alarming rate of 1:45 (one nurse per 45 patients)

The following is the dichotomous environment that confront healthcare workers in the country at the moment despite the great outcomes of their work:

  1. The collective bargaining platform is the only way that nurses can get their bread and butter issues addressed. But the technical route this platform has taken recently, often because of government representatives, no longer inspires confidence that it will resolve this urgent matter.

  2. Nurses have sacrificed with their lives acquiring HIV, XDR, TB, Ebola (one case) and now COVID-19 in the line of duty. Meanwhile health workers not belonging to other government departments other than health get both danger allowance and full uniform for executing their duties

  3. Nurses work with insufficient and poor quality PPE.

  4. Long hours of work without over-time payment.

  5. Shortage of human resource, leaving staff working on skeleton levels at the time when we have longer queues in facilities. The nurse to patient ratio, according to reports from our members in facilities, is at an alarming rate of 1:45 (one nurse per 45 patients). In public hospitals the ratios range from as high as 1 nurse per 20 patients to as low as 1 in 45 patients. Anecdotal evidence from a province like the Eastern Cape suggests that it has reached 1 in 50 patients in some general wards, 1 in 10 patients in some postnatal ward and 1 in 80 patients in clinics.

    The direct translation of this, Mr President, is a severely compromised quality healthcare service for patients.

  6. Persistent shortage of equipment and medication. There is often no medication for chronic conditions like ARVs, TB, hypertension and others. Often, there are no oxygen gouges and BP machines in clinics.

  7. Currently, there is no Nursing Strategy in place within which the nursing profession in the country operates. We are operating willy-nilly.

  8. In the absence of a strategy, there is no way that recommendations by evidence-based research could be accommodated in the country’s healthcare system. For example, on World Health Day on 7 April 2020, the World Health Organization (WHO) released a Report on the State of World of Nursing, which it had worked on it with the International Council of Nurses (ICN) which looked at the astute shortage of 8 million nurses in the world, which has hit the Southern African region the most. The Report recommended that, for every country to avoid a crisis level in terms of shortage of nurses by year 2030, it must increase its production of nurses by at least 8% a year.

    As a country, Mr President, we are going through a different direction to the recommendation of this study. In fact, our situation is likely to worsen far quicker than 2030. Instead of increasing the numbers of student nurses every year, Mr President, we are decreasing the numbers, due to lack of funding for nursing education.

  9. Furthermore, the findings of a joint study by the Human Sciences Research Council (HSRC) and University of KwaZulu-Natal on psychological and emotional impact of COVID-19 on healthcare workers were released on 6 August 2020. The study interviewed 7 600 healthcare workers, 40% of whom were nurses.

On the health and wellbeing of healthcare workers in the face of COVID-19, the study found that:

  • Nearly half of nurse practitioners interviewed were extremely concerned about family members and personal health;

  • 2 in 5 health professionals have extreme concern for their family wellbeing, whilst 1 in 5 health professionals have extreme concern for their own personal wellbeing;

  • 3 in 5 nurse practitioners were concerned about passing infection to family members;

  • A quarter of nurse practitioners experienced severe psychological distress with health professionals working in the public sector experiencing higher psychological distress than those working in the private sector;

  • Health professionals who reported high psychological distress reported low levels of general health and well-being whilst health professionals who reported high general well-being reported low levels of psychological distress.

With the above grey areas, we appeal to your ear and conscience to make right of this deteriorating situation. The persistence of these without any solution risks the country in various ways:

  • Loss of interest to nursing by those in the practice already and by those who dream of becoming nurses in future;

  • Mass exodus of skills from nursing practice to other fields; and

  • Crushing of the healthcare system with no power to fight even easy diseases, which could potentially crush the country’s economic recovery hopes as well.

  • Loss of experienced health professionals through brain drain to developed countries

We hope you receive this letter in the same spirit in which it was written.

Yours Sincerely

Simon Hlungwani
President of the Democratic Nursing Organisation of South Africa (DENOSA)