Speaking Notes for Hon Dr Zwelini Mkhize’s Opening Remarks at the Society of Private Nurse Practitioners Biennial National Conference

  • President of the Society of Private Nurse Practitioners Siegie Fitzjohn
  • Leadership of the SPNP
  • Leadership of South African Nursing Council
  • Speakers, Presenters and Panelists
  • Members of the SPNP
  • All the Nurses and Midwives of South Africa
  • Members of the Media


Thank you for the kind invitation extended to us to open the Society’s virtual conference today.


I am always overcome by a sense of humility and deep gratitude whenever I am in the midst of nurses and midwives, especially during this defining period of our era. It has been an extraordinary journey for the health sector and, true to form, it has been the nurse who has been at the heartbeat of our resilience as we fought COVID-19.


Today, South Africa is lauded as one of the success stories of COVID-19 combat. We have inspired confidence in African leadership and expertise – a historic shift in African narrative that has often been plagued by doubt or outright condemnation.


Today, we cautiously but optimistically breathe a sigh of relief as we continue to see our detected cases, hospital admissions, deaths and even excess deaths declining. Our recovery rate is now almost at 90% and our mortality rate has remained stable at around 2% throughout the duration of the pandemic thus far.


Mothers affected by COVID-19 have given birth to healthy babies. They are breastfeeding and physically bonding with their children, laying foundations for wholesome upbringing and solid building blocks for a healthy and prosperous society

These Herculean achievements have been possible because of the passion, dedication and sheer diligence of our nurses and midwives.

It is you who have advocated for your patients and fought for your country and her people.

For this we say THANK YOU.

We thank you for your unwavering commitment and your fearlessness.

We thank you for your vocal partnership and support, ensuring that we always meet your high expectations for your patients.

We thank you for braving the threat of being infected yourself, and even of death. To date, over 31,000 health care workers, many of them nurses and midwives, have contracted Coronavirus and we have tragically lost 240 colleagues. May I convey my heartfelt condolences for the loss of your co-workers, friends, family and loved ones. As government, we vow to honour those who paid the ultimate price by committing to quality universal health coverage for all our people, regardless of race, creed, or socio-economic status.


I now invite us all to observe a moment of silence for our fallen heroes in the war against COVID-19


When the World Health Organisation declared 2020 the Year of the Nurse and Midwife in honour of the 200 birth anniversary of the founder of modern nursing, Florence Nightingale, little did we know how timeous that intervention was at that stage.


By shining a spotlight on the state of Nursing and Midwifery, the WHO catalysed a series of events to galvanize worldwide action for focused and purposeful health systems strengthening through fortifying human resources for health. With nursing and midwifery comprising the largest occupational group in the health sector at 59%, it was clear that to address the critical issues around human resources for health, it would be most prudent to begin with the issues that lead to challenges in the nursing and midwifery professions.


In December last year I had the privilege of launching the  #NursingNow campaign- a three year campaign initiated by the global nursing community with the sole objective of improving health care delivery to our people.


As you may recall, this campaign was a response to the United Kingdom All Party Parliamentary Group on Health Triple Impact Report, which demonstrated that increasing the number of nurses and developing nursing will have a wider triple impact of improving health, promoting gender equality and supporting economic growth.


As I reflect on the five key areas of focus for the #NursingNow global campaign, I am convinced that this mobilization was nothing short of divine intervention for the unknown storm that was to descent on this earth and wreak havoc on our way of living, our environment, our economies and even our state of mental and psychological well being.


To recap, the five key areas focused on the following interventions:

  • Ensuring that nurses and midwives have a more prominent voice in health policy-making
  • Encouraging greater investment in the nursing workforce;
  • Recruiting more nurses into leadership positions;
  • Conducting research that helps determine where nurses can have the greatest impact and
  • Sharing of best nursing practices


Indeed, these key focus points align perfectly with the objectives of the Presidential Health Compact, The Quality Improvement Plan and, ultimately, the National Health Insurance. But not even with this foresight could we have predicted the enormous demands the COVID-19 pandemic would place on all of us to accelerate the implementation of these concepts.


Following the launch of the #NursingNow campaign, the first State of the World’s Nursing Report was published by WHO in April 2020. This revelatory document highlighted the critical and leading role played by nurses and midwives the world over, yet without the commensurate recognition and support by the health sector, governments, and society itself. It is no secret that somehow, despite the fact that nurses are the very architects of building and maintaining a healthy society, their status in society has somewhat diminished over the ages. Nurses experience neglect, verbal and physical and even sexual abuse from both patients and colleagues, financial disenfranchisement and workplace harassment.


As a workforce comprising 90% women, our nurses are subjected to gender based disparities financially and professionally as well as gender based violence both in the workplace and in society.


In fact, the State of Nursing Report cited several gender specific issues affecting nurses: despite the vast majority of the workforce being female, few leadership positions in health are held by nurses or women. There is some evidence of a gender-based pay gap, as well as other forms of gender-based discrimination in the work environment. Legal protections, including working hours and conditions, minimum wage, and social protection, were reported to be in place in most countries, but not equitably across regions. Only about a third of countries (37%) reported measures in place to prevent attacks on health workers.


To aggravate these phenomena, with the world currently in need of 9 million nurses worldwide to achieve Universal Health Coverage by 2030, nurses are working under the extreme pressures of staff shortage and therefore often suffer from exhaustion, depression and hopelessness which leads to irritability, compromised mental and psychological well being and ultimately, compromised delivery of quality care. Never has this been more highlighted than during the Coronavirus pandemic.


As government, we dip our banner to the Nurse and celebrate the accomplishment of this professional despite of all these adversities they face on a daily basis. As such, we are determined to identify and action opportunities for improved nursing education and advancing policy that enhances professional roles. Put simply, we must make it attractive for nurses to stay here in the country and for foreign trained nurses to choose South Africa as a preferred professional destination.


During the COVID-19 pandemic, we simplified our recruitment drive- it was simply come one and all! I must congratulate the provinces for collectively employing 13 135 nurses across the categories during this time. Now that they have proven that it is possible to achieve such numbers in such a short space of time, I must declare that they have set a bar that we dare not descend from.


The paper also calls for increased investments into and massive acceleration of nursing education. This includes investing in faculties, infrastructure and students to address global needs, meet domestic demand, and respond to changing technologies and advancing models of integrated health and social care. The world needs to create at least 6 million new nursing jobs by 2030, primarily in low- and middle- income countries such as ours, to offset the projected shortages and redress the inequitable distribution of nurses across the world. In addition, it is critical to recognize and strengthen nursing leadership which, truth be told, already exists but requires capacitation and support from various sectors of society, led by government intent. For our health care system to thrive we must ensure that we harness the inherent knowledge and experience of the nursing community so that nurses have an influential role in health policy formulation and decision-making


The Department of Health will very soon publish the STRATEGIC DIRECTION FOR NURSING EDUCATION AND PRACTICE which outlines a roadmap for strengthening nursing and midwifery in South Africa for the next five years. I am told that some of the issues faced by private nursing practitioners are difficulties navigating regulations and policies, which can frustrate your ability to forge public private partnerships, and the legal barriers posed the current Nursing Act, which prevents highly skilled Primary Health Care qualified nurses from practicing to their fullest potential, as they are not employed by a government entity.


I am pleased to say that much work has been done to promulgate and subsequently proclaim various sections of the Nursing Act. This ensures that we provide a requisite regulatory framework to effect change so that we meet the demands posed by the re-organisation of health services toward Universal Health Coverage. Relating to this, is that the amendments enable the reforms of the post-school education landscape that have been driven by the recent changes to the post school legislation introduced by the Department of Higher Education and Training (DHET) which require a repositioning of all nursing education institutions (NEIs) within the new milieu. Chief amongst these was the creation of new categories of nurses that made it mandatory for the South African Nursing Council (SANC) to redefine the competency framework for nursing; review and update the scopes of practice and related regulations; and determine educational requirements leading to registration in any of the new categories prescribed in the Act while ensuring that qualifications obtained are commensurate with the prescribed scopes of practice.


Last year the Department of Health and Higher Education and myself with the Minister of Higher Education worked extremely hard to ensure integration, alignment and streamlining of the post school education pathway to ensure that it makes sense for our future health care within NHI. I am taking the opportunity now to introduce the paper to you conceptually and we look forward to engaging with yourselves as stakeholders when it is published to ensure that indeed it does address your concerns. Ultimately we want what you want- to be capacitated to perform at your very best, harnessing the enormous wealth of talent and skills that South African nurses are so famous for.


Having learnt from the COVID-19 pandemic and its augmentation of the existing non-communicable disease pandemic, the models of nurse driven public health management systems are going to be critical in managing the rising levels of non-communicable diseases. Risk mitigation for this spectrum of pathologies rests with prevention and lifestyle modification- practices that require an enormous amount of well choreographed community motivation and advocacy to encourage a culture of testing when one is feeling quite well and maintaining a lifestyle that keeps you well. Whilst this requires a multi-sectoral, multidisciplinary approach, we know well that it is nurses in the community who inspire the most confidence and who foster trust between patients and carers across the health professions categories.


Having discussed all the above, it is therefore patently clear that Investment in nurses will contribute not only to health-related Sustainable Development Goal DG targets, but also to education (SDG 4), gender parity (SDG 5) and decent work and economic growth (SDG 8).


In conclusion, I with to express my humble gratitude to the nursing community for making my job easier as Minister of Health. I want assure you that I share your aspirations of a better world through the work that we do to secure a healthy population for quality of life and prosperity for all. To quote the mother of modern nursing Florence Nightingale “Mankind must make heaven before we can ‘go to heaven’ (as the phrase is), in this world as in any other.”

May we always strive to make heaven on earth together.

I thank you.