DENOSA has an organisational structure that includes both elected officials and full-time staff. It has a presence in all nine provinces and represents nurses across the country. Although DENOSA has its roots in unionism and in representing the workplace interests of members, it took note of the global developments among nursing unions to include professional development of their members as part of their core focus.
To this end, the DENOSA Professional Institute (DPI) was established with generous funding provided by Atlantic Philanthropies in September 2009, which augmented the internal DENOSA funding used for the programme. DENOSA is not the only trade union for nursing professionals, the choice to register either with COSATU-affiliated unions or non-COSATU-affiliated unions. DENOSA’s membership numbers are extremely important, as they affect its bargaining power with employers, and DENOSA’s credibility as a union. Currently, DENOSA has enough members to be represented in the Public Health and Social Development Sectorial Bargaining Council (PHSDSBC). The dual role of trade union and professional organisation is sometimes a challenging one, as the need for industrial action may conflict with nurses’ professional ethics and work day– DENOSA has proven itself capable of straddling the divide and of managing such situations in a responsible and ethical manner.
The Vital Role of Nurses in Health Care
In some countries, analysts claim that poor service delivery is a result of small national budgets, poor skills development or the malfunctioning of organisations and government departments. Whatever the cause of the problem may be, public citizens all over the world continue to call for an improvement in public service delivery, as they keep on expecting nothing but the best service. South Africa is no different. And the nursing profession is no exception. Therefore, this profession, amongst other professional bodies, continues to search for solutions that will ensure that, at the end of the day, members of the public receive an excellent service.
DENOSA aims to safeguard and promote the dignity, rights and socioeconomic status of all its members and the nursing profession. This is based on its recognition that the provision of quality health care is a demanding and time-consuming undertaking that requires nurses to focus all their energy on the challenges of their profession, which leaves little time for them to consider their own interests. “One of our key differentiators is the fact that we are an organisation for nurses, staffed by nursing professionals,” reveals General Secretary of DENOSA, Thembeka Gwagwa. “All of us have spent time in the field and can identify with the frustrations and needs of members.”
DENOSA is also unique in the sense that it is a professional body with both union and professional-development legs. This gives it the distinctive ability not only to address issues of workplace concern, but also to contribute to the development of nursing professionals. While DENOSA can claim credit for many significant improvements in the working conditions of nurses, as well as notable achievements such as the Occupation-Specific Dispensation (OSD) that led to a meaningful salary review for nurses, the organisation is not resting on its laurels. As part of its strategic focus, it has re-energised the DENOSA Professional Institute (DPI) with the express purpose of making a valuable contribution to the professional development of the nursing profession at large.
DENOSA Supports Nurses in Their Leadership Role
DENOSA epitomises the development of nurses, but, most importantly, it is about making sure that nurses get what is due to them, such as better working conditions. Nurses deserve to be treated in such a way that they can practise their profession without difficulty. For anyone to practise nursing, they have to know what the working conditions should be and also what is best for the industry. “When I initially started at DENOSA, there was no human resources (HR) department, so I made a point of ensuring that we focused on the training and performance of our staff, especially as our survival is dependent on the effectiveness of our people,” says Gwagwa.
Today, there is an HR Department, which has a budget for staff development. “I also make sure that, every year, I sit down with all the staff in management positions and those who head up the units. Together, we identify priorities for the year, and we also evaluate our performance and that of the organisation. At the end of the year, all of those who performed well will receive performance bonuses. Those who did not, are given the reasons and are encouraged to do better.” Gwagwa’s vision is no different from that of DENOSA, and both strive for service excellence. “Nurses are professionals and should be respected as such – they have to have the right attitude, the proper training, and a positive practice environment.” If all of this can be achieved, this will impact positively on the South African health services. DENOSA, which has almost 80 000 members, continues to find a balance between fulfilling the role of a trade union on the one hand, and that of a professional body on the other.
In December 2012, DENOSA hosted a high-powered delegation from National Nurses United (NNU), which managed to advocate for the ratios policy in the state of California in the United States to become law. The delegation had come to South Africa to attend the 29th Congress of Public Services International (PSI), which was held in Durban. Some of the issues discussed with the delegation were nurse:patient ratios in hospitals, and how the workload could be managed so that patients can be well looked after and therefore receive the best care. However, just looking after patients is not everything that is on DENOSA’s agenda.
One of Gwagwa’s key focus areas is to continually position DENOSA as a relevant organisation, as well as to unite nurses as they lead the country towards its socio-political and economic objectives.
Through the provision of relevant, accredited training courses and learning programmes, the DPI will provide for the education and training needs of nurses. The Institute has also set itself the objective of becoming the preferred centre for training excellence within the sector. “It is important to note that the DPI is serving the entire industry, and thus DENOSA membership is not a prerequisite for nurses who want to attend training programmes,” says Gwagwa. “The DPI is also perfectly positioned to make a significant contribution to the 10-point plan of the national Department of Health, which plan underpins the Department’s broader strategic health plan and calls for the development of human resources.”
“The Conference was a very illuminating experience for all attendees. Not only did it reaffirm our views on workplaces challenges, but it also afforded us the opportunity to come to grips with new trends in the workplace and to revisit why we committed ourselves to the nursing profession in the first place,” explains Gwagwa. The outcomes of the Conference provided DENOSA with an important platform from which to address the National Nursing Summit on issues that affect not only its members, but also the entire profession. It also afforded DENOSA the opportunity to show that it has the ability to balance trade unionism and the need for professional development.
“We have always maintained a reputation as an organisation that is proactive and is responsive to the needs of our members and the sector,” maintains Gwagwa. “However, it has long been apparent to us that meeting labour relations challenges is only one part of the equation. We also need to attend to the professional development needs of the sector and, through the DPI, we are going to contribute to getting the balance right.” At a time when the nursing profession is being buffeted by significant winds of change, DENOSA and the DPI offer prospective members and the nursing profession a significant bulwark and an opportunity to refresh their skills and renew their commitment to nursing. Many nurses have examined the role they play in providing health care and have committed themselves to providing quality care for patients. The DPI will play an important role in this regard, as it will help those individuals achieve personal and professional growth, thereby contributing to the sustainability of the profession.
Leadership for Change Programme
The Leadership for Change (LFC) programme is an accredited action learning programme of the International Council of Nurses (ICN) that is intended to develop nurses as effective leaders and managers in a constantly changing health environment. Leadership abilities are critical in managing health service delivery. Yet these skills are not covered in the formal training of most health professionals. The LFC programme is therefore designed to address this shortcoming in formal education and in the training of nurse managers. In November 2010, DENOSA, in collaboration with the ICN, launched the LFC programme in South Africa. Since then, there have been two group intakes. Both groups are being trained by an experienced ICN Leadership For Change facilitator from Geneva.
The overall objective of the programme is to strengthen the capacity for nursing leadership and management in the health services, so that:
- a group of nurses at the senior and middle level of the health services is better equipped to improve the quality of services and meet other critical challenges facing the health sector; and
- that people from this group will help train others in a ‘second-generation’ programme, thus enhancing the capacity for impact across the health-care system.
The specific objective of the programme is to develop nurse leaders and managers in the health services who will have the ability to:
- Influence policy and health-system improvements.
- Develop quality, cost-effective models for delivering services.
- Be effective contributors to the broader health-care team.
“However, how will excellent service delivery be achieved if no one takes the lead?” asks Gwagwa, who believes that someone should take the lead and guide the process of excellent service delivery. She argues that nurses should continue to take their role as advocates seriously, because it is nurses who deal with the most vulnerable individuals in a society, and, therefore, “service delivery in general should be one of the agenda items that we continually focus our attention on,” she highlights confidently. “Relevancy is important. Individuals as well as organisations must find a reason to be a part of DENOSA, and this can only be achieved through unity,” Gwagwa declares. A silo mentality is a thing of the past. In the past, there was a disease that South Africans suffered from: segregation – nurses, in particular, were grouped according to geographical location, and they tended to belong to professional associations in those regions. Today, this trend continues as nurses group themselves according to their specialist areas, which fragments them further.
National Health Insurance
Gwagwa also holds the National Health Insurance (NHI) in high regard, for she believes it will open up health access for South African citizens irrespective of the size of their pockets. According to the national Department of Health, the NHI is a financing system that will make sure that all citizens of South Africa (and legal, long-term residents) are provided with essential health care, regardless of their employment status and of their ability to make a direct monetary contribution to the NHI Fund. Health care is a human right – this is a widely accepted international principle. However, this right should not depend on how rich we are or where we happen to live. The right to obtain health care is written into our Constitution.
But large numbers of our people continue to die prematurely or to suffer unnecessarily from poor health. Treatable conditions are not being treated in time, and preventable diseases are not being prevented. The NHI will offer all South Africans and legal residents access to a defined package of comprehensive health services. The state is committed to offering as wide a range of services as possible. Although the NHI service package will not include ‘anything and everything’, it will offer care at all levels: from primary health care, to specialised secondary care, to highly specialised tertiary and quaternary levels of care. The NHI is not intended to destroy the private sector – it will actually make the sector more sustainable by making it levy reasonable fees. Rather, the intention of NHI is to make sure that citizens are able to use both the public and private sectors in such a way that they complement each other, instead of the one undermining the other.
Participation in the NHI is solely a matter of choice for the individual health-care provider. However, those that choose to participate will need to meet certain requirements that will be prescribed under the NHI policy. These will include compliance with quality standards, provision of a package of services that will extend to the prevention of diseases and the promotion of health, acceptance of capitation as a method of payment instead of fee-for-service, and appropriate pricing mechanisms.
Piloting of the NHI will commence in 10 selected districts. The national Department of Health is busy conducting an audit of all public health facilities in our country. The selection of the 10 districts will be based on the results of the audit. Consideration will be given to a combination of factors, such as the district’s health profile, demographics, income levels, and other social factors impacting on health, health-delivery performance, the management of health institutions, and compliance with quality standards. “Gone are the days when all a nurse had to do was change a bed, give an injection, take a temperature, and view a hospital as a stand-alone entity that operates like an island – a nurse, as a primary caregiver of a society, needs to have a broader perspective of societal issues, both at a local and international level,” Gwagwa pronounces. She continues by saying that “a nurse needs to understand the macrodynamics of the environment of a society”. She believes that the public sector is in need of individuals who are willing to direct the public cause towards on-going change and improvement – and DENOSA is full of such people – individuals who understand that, for change to take place effectively there should be a catalyst!
The launch of the Non-Communicable Diseases (NCD) project is the first time that DENOSA has undertaken a project with a research component attached to it. “We are excited, because, as a professional body, we also need to influence policies by producing evidence based on relevant and appropriate research. We are working with nurses from two hospitals, and with a community that is led by a chief,” says Gwagwa. The Minister of Health, Dr Aaron Motsoaledi, has, on many occasions, made reference to the diseases our country is facing, such as HIV and AIDS and NCDs. The number of people dying of NCDs has reached alarming proportions; hence this project. The Department of Health is also involved, and so is North-West University, as well as the funder, Pfizer.
Gwagwa, who walked into the nursing profession during the 1970s at the King Edward VIII Hospital, where the likes of Steve Biko were also training as medical students at the time, does not see herself solely as a nurse – she sees herself, and the nursing profession as a whole, as a ‘catalyst for change’. “I joined the profession during a highly politicised era in South Africa; therefore, I am always conscious of the political, social and economic issues that impact an organisation and its country,” Gwagwa reveals. Gwagwa openly applauds the current South African Minister of Health, Dr Aaron Motsoaledi, for initiating the Academy in Health programme, which is aimed at empowering and developing chief executive officers and district managers of hospitals. However, she believes that this programme can only become more effective if organisations such as DENOSA play a supportive role. DENOSA is currently rolling out a programme aimed at up-skilling and developing individuals from various health institutions into leaders. In November 2012, 22 nurses graduated from this intensive two-year programme offered under the organisation’s professional wing, the DPI.
Making sure that DENOSA is well represented at regional and international forums is an international relations objective of DENOSA. Other responsibilities include:
- Providing leadership with relevant information on international visits and international guests.
- Disseminating information on global health issues that affect its members and the country.
- Running programmes that are initiated by its international and regional partners.
- Promoting solidarity within the region through the Southern African Network of Nurses and Midwives (SANNAM), and assisting sister national nurses associations and organisations (NNAs/NNOs) to build their organisations.
- Prioritising the strengthening of the Southern African Development Community (SADC) region and Africa.
DENOSA has established regional and international links by affiliating to:
- The East Central Southern African College of Nursing (ECSACON) of the ICN.
- The Commonwealth Nurses Federation (CNF).
- The Regional Network for NNAs/NNOs with Trade Union Status.
DENOSA as a trade union is part of this informal network that is supported by the Norwegian Nurses Organisation (NNO). The network, facilitated by NNO Special Advisor, Michael Vitols, serves as a platform for members to share experiences, knowledge and, further, to introduce strategies to deal with trade union complexities that they face in their respective countries. The network includes members who do not have trade union status but are working towards registering as such. Member countries in the Regional Network are: Botswana, Malawi, Mauritius, South Africa, Swaziland, Uganda, Zambia, and Zimbabwe.
On a Final Note
DENOSA represents a profession which is subject to ongoing challenges. South Africa faces a health-care system burden. The public health-care system is characterised by unsafe infrastructure, shortages of qualified personnel, and a huge demand for services. Nurses provide an essential service, yet, sometimes, they are not treated as such providers. As General Secretary of DENOSA, Thembeka Gwagwa is responsible for making sure that the organisation is kept well informed regarding developments in the industry, and that such developments are in line with the constitution of the organisation and the laws of the country. “I also make sure that the strategic objectives of the organisation are being met. My training as a nurse has helped me understand the roles that my members fulfil and gives me better insight into how I should develop and grow our members.”
Nurses are doing very much under difficult conditions, and the support of patients, service providers and employers is thus required. DENOSA is also doing much to make sure that nurses who are not conducting themselves as expected, are supported and educated to change their behaviour appropriately. “We do so by finding out why such behaviour is occurring and put corrective measures in place. We appeal to the public not to see all nurses as being tarred with the same brush,” pleads Gwagwa. “There are many nurses out there doing more than is required to the best of their ability, and they go far beyond the call of duty,” she concludes.
In Conversation With
The Democratic Nursing Organisation of South Africa (DENOSA) in its current form was established on 5 December 1996. Formed through political consensus after the transition to democracy, it was mandated by its membership to represent them and unite the nursing profession. Prior to this, the South African Nursing Council (SANC) and the South African Nurses Association (SANA) were statutory bodies which all nurses had to join. It was also important after the transition to democracy to incorporate nurses from the homelands under the previous political dispensation, as they were forced to leave SANA and organise themselves into separate professional bodies.
This move to a unified nursing union was implemented shortly after the national Convention for a Democratic South Africa (CODESA) negotiations and the transition to democracy in 1994, when the nurses of the country (then in 10 separate organisations) amalgamated. Sixteen years later, DENOSA has established itself as a well-organised entity that acts on behalf of its members – the biggest union in the country dedicated solely to the interests of nurses.
Leadership for Change