Uncovering SA's ICU crisis

South Africa’s ICU crisis is deepening — too few beds, even fewer trained nurses. Just 25% are critical care qualified. Africa Melane speaks to DENOSA’s Kwena Manamela on staffing gaps, provincial inequalities, and the urgent fixes needed now.

Early Breakfast with Africa Melane is 702’s and CapeTalk’s early morning talk show. Experienced broadcaster Africa Melane brings you the early morning news, sports, business, and interviews politicians and analysts to help make sense of the world. He also enjoys chatting to guests in the lifestyle sphere and the Arts. All the interviews are podcasted for you to catch-up and listen.

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Episode Transcript

Speaker 1 (00:00):
You're with seven eighteen Africa Milani on early breakfast seventeen
minutes night is past five o'clock.

Speaker 2 (00:07):
Professor Fatima Paruka, the head of the Department of Critical
Care Services and Emergency Medicine at the Faculty of Health
Sciences at the University of Pretoria, presented a paper recently
which is titled Carpadium Achieving Efficient and Fair Allocation of
Critical Care across South Africa. In that presentation, she highlighted

(00:29):
the severe shortage of intensive care unit beds in public
health sector, with five ICU beds per one hundred thousand
people at best available and in some provinces that number
goes down to one. But also she highlighted the incredibly
low percentage of nurses who are looking after you and

(00:50):
I when we are in ICU who are not trained
in critical care. That percentage is as low as twenty
five percent, and I thought we'd pick up on that
aspect of her presentation with a General of Denosa, Gen
Manamela Buena. Very good morning and welcome to the show.

Speaker 1 (01:06):
Good morning and thank you for inviting us.

Speaker 2 (01:08):
I was surprised to learn that only twenty five percent
of our ic unesses are trained in critical care are you.

Speaker 1 (01:16):
Yeah, I'm also a little bit surprised, but I think
presentation is spot on. It's correct due to what is
the opening now and what we are observing as well
ourselves in hospitals.

Speaker 2 (01:30):
So what are you observing, what are you doing? And
why do you have such a low percentage of nurses
trained in critical care?

Speaker 1 (01:41):
Yeah? I think the exposure was during the COVID nineteen
pandemic when we realized that the country is actually not
ready for a number of things. One of the things
that we are talking about now is the one of
critical care, is the one of the ICO based. Remember
CONVIC nineteen, there were many that ended up in Ico

(02:04):
and then there were a lot that needed critical care.
Critical care, remember, is it's not only confined to a space.
It's pre hospital, pre hospitalization, during the hospital, and maybe
support after the person has been distarched from a hospital.
That is where we saw that there is a real
serious shortage of these skills, not only these ones, but

(02:28):
the whole number of other ones. But these ones are critical. Remember,
they are the ones that are critical to life because
it's critical moments of an individual or that person really
needs support.

Speaker 2 (02:42):
Is it a case that the universities and colleges if
they still exist, that are training nurses, are not focusing
on this aspect of healthcare. Is that why we are
seeing such a low percentage of those IC unitses trained
in critical care.

Speaker 1 (03:01):
I think it's a decline in the intake. Remember the
innssings to be specific, not other health care providers or
health care workers. Is that in nessing that there's been
a curriculum change in the past five six years where
in the all things that the whole curriculum of the

(03:22):
necess has been shifted to universities, has been shifted to
the mainstream and all that because missing now where we are,
it's no longer hospital based and so on. And the curriculum,
like I'm saying, is the one that was creating a
four year comprehensive person now is the one that, like

(03:46):
I'm saying, is changed to the mainstream and it's shifted
to the university. So the intake in the universities is
not the same as the intakes that were there before.
So that means very few go through these programs of
post basic post basic within through the ICUs, your critical

(04:07):
and so on. So it means now the numbers are
really going down again to add to that is that
remember the institutions now after the curriculum change, the institutions
that must provide these courses, the post basic courses and
the basics for that matter, they have to be accredited,

(04:28):
so all of them. It means they need to apply
to say these are the programs that we need to provide.
But if you're if you're not accredited, or if you're
providing them before, but now after the curriculum change, you
are no longer credit. It means the institutions that provide
that program are going down. The universities. You know, the

(04:48):
intakes in the universities is not as much as that
they're going down. The colleges were actually and those other
private ones, they were able to take a lot of them,
many of them for basic, for post basic. But now
because of this change, I think it affected a whole
lot of other things. In it's west that we've lost
some of our colleagues during COVID nineteen and those that

(05:10):
are also there or maybe through natural attrition, they're not replaced,
and some remember these skills they are also needed elsewhere
if South Africa. Maybe it's not remunerating. Well, I'm just
giving an example, they will go elsewhere United you're noted Kingdom,
you are up in a rage and so on. So

(05:32):
that is where now we're having this problem whilst we're
losing some to other countries to natural attrition so on,
and the others during COVID nineteen are not replaced and
the numbers are going down in the universities and so on,
and the others are not accredited to offer those courses.
And the other thing that I must also put forth

(05:53):
is that now the previous courses that were offered and
for you to bring each or for you to be
able to do it basic, you have to have nq
F level seven Q level seven. I remember that the
program that was offered like the R for to five
what they call a legacy R four two five NQF

(06:18):
level six. So for you to go to NQF level eight,
which is a post basic, you have to have NQF
level seven first. And that's the problem because if a
lot of them are not having the seven n QF
level seven, it means few of them will be able
to do post basics. So those are the other things
that we are observing and seeing that effects the old

(06:39):
thing of the numbers and it might be heading for crisis.
If this situation is not attended to.

Speaker 2 (06:45):
What solutions then are available to us guenna and what
work if it is the ALS are doing to try
and address this challenge.

Speaker 1 (06:57):
I know that we have addressed this with the the
the Minister. We have virelighted since we we realize that
we have this type of a problem. But the other
thing is that the courses that are unabling the necess
to be able to acquire n q F level seven

(07:18):
should be increased, not be one because I know now
the cost that enabled them is me different n q
F level seven and not everybody else will be able
to go through that problem, or it might not accommodate
as many as we think it will accommodate. So maybe
if those problems that enable them to do that are increased,

(07:41):
then it will it will mean that we have a
number of them able to do a post basic especially
the ones that you're talking about, your critical care and
your I see and the others a psychotic and so
on and so on. So I think that that is
one thing that can be done. But the other thing
is to increase the number the intake numbers, because if

(08:01):
the numbers remain as they are, we might have a great, big,
big problem going forward. We need to increase those numbers.
And the other thing, maybe the last one, is the
is the balancing act that we are talking about numbers,
we're talking about the total number of ICE units. Is that,
but you find that the distribution is not the same

(08:22):
between its or it's not equals, or it's not balanced
between private and public. So I know that the numbers
that are talking about, for example, we might we were
having plus minus five thousand all in all in the country,
but you might find the all three thousand something is
in the private sector and the limited number that is
left is in the public sector. And the public you know,

(08:44):
is bigger. They're saving a bigger a number of patients.
While it's the private sector is catering for the smaller number.
It will be those that have and those that have
medical AIDS are the ones that will be have access
to the to the the private healthcare services. So I

(09:04):
think that's the challenge that we have, that we need
to bring that balance between private and public.

Speaker 2 (09:10):
We do, indeed, Gwenna, thank you very much for your
time this morning and for sharing your reflections. Gueno Manamela
General Secretary of DENOSA, reflecting on what we need to
do to address what I think is a worrying stat
of only twenty five percent of our ICUNS is being
trained in critical care, and Gwen, of course, explaining why
we find ourselves in this scenario