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World Quality Day is one of the international observances that annually falls on the second Thursday in November. This year it will be on November 8, 2018. This observance was introduced by the United Nations in 1990, but it didn’t become one of the UN special international days. The purpose of World Quality Day was to raise public awareness of the problems of quality of any product or service, provided by the companies around the world. The focus of this blog is on the quality of health care as a product of health services.

Nurse practitioners (all categories) are the backbone of all health care delivery systems. Nurse practitioners and the nursing profession are however on a continuous basis confronted with challenges such as weaknesses in the policy capacity of the main institution responsible for the leadership and governance of nursing in South Africa, and a nursing environment that is fraught with resources, management quality care problems (Rispel & Bruce: 2014/205).

The above matter is supported by Dr. Wilmot James who wrote: “We have a nurse-based healthcare system and it is no surprise that our clinics are run by them. Today we thank the nurses for the extraordinary care they give to the nations’ ill and infirm (Medical Brief: 2016).

James, the Democratic Alliance Shadow Minister of Health on Politicsweb continued by stating the following: SA faces a crisis in nurse education and training that, unless reversed, will result in a worsening shortage of nurses (Medical Brief: 2016).

A recent oversight visit by the DA to the Joubert Park Clinic in Hillbrow serves to confirm that nurses are at the frontline of health care and yet the nation gives them little resources to carry out their duties or even extend congratulations for tirelessly serving the South African-people despite the many challenges they face every day

James wrote: “For individuals using the public sector, the problems are worse. Half of our 270 437 nurses are in the public sector caring for 84% of the population while the other half are in the private sector providing for the remaining 16%.”

This is because the work environment, conditions of service and morale are simply much better in the professionally run private sector. But it does mean that public sector nurses have work obligations that are beyond the pale: poor wages for hard and thankless efforts to save lives, treat pain and alleviate suffering.

Three fault cracks were identified: tolerance of ineptness as well as leadership, management and governance failures; lack of a fully functional district health system, which is the main vehicle for the delivery of primary health care; and inability or failure to deal decisively with the health workforce crisis.

These fault lines have negative consequences for patients, health professionals and policy implementation. Patients, who are relatively powerless, bear the brunt through negative experiences and sub-optimal care. Health care providers on the front line and at the bottom of the hierarchy also suffer. Faced with an unsupportive management environment, staff shortages and health system deficiencies, they find it difficult to uphold their professional code of ethics and provide good quality of care.

Currently, nursing education is at crossroads and the major concern is the capacity to train new nurse practitioners. Rispel, a professor and head of the Wits School of Public Health, described nursing as a profession is in peril. In this article she referred to the fact that private colleges, who received no state subsidy, trained auxiliary and enrolled nurses according to the old so-called legacy curricula but may no longer do so because better courses have been introduced. According to the author these programs focused fundamentally on a primary healthcare ideology, and are not necessarily better than previous programs, however, these programs have not been accredited because of bungling by SANC and the Department of Higher Education (Rispel & Bruce: 2014/205).