Crisis rocks healthcare services
Innocent Selatlhwa | Monday July 3, 2023 06:00
In addition to losing health practitioners to greener pastures especially abroad, the Botswana Nurses Union (BONU) has threatened that nurses and midwives would stop dispensing medicine as of July 1, 2023.
The Minister for Health, Edwin Dikoloti earlier this week told Ntlo Ya Dikgosi that he is aware of the shortage of nurses and doctors in Botswana. This he said is a countrywide problem, which is compounded by significant resignations by staff to seek greener pastures.
He mentioned the following as some of the initiatives the Ministry is undertaking to improve availability of nurses and doctors in the health facilities; rationalisation of available nurses and doctors across all health facilities in the country based on population and the health needs of that particular area; increase in the training of health personnel including nurses and doctors for both pre and in-service training; recruitment of retired nurses with specialised skills on a temporary basis to address the shortage; and recruitment of temporary doctors to address the doctors shortage in DHMTs including Serowe. Kgosi Ngwato Kabelo of Serowe region had asked the Minister of Health to inform the House whether he is aware that there is shortage of nurses and doctors in the Serowe region; and if so, how he intends to address the situation.
The BONU last year struck a deal that will see Batswana nurses flock to the United Kingdom’s National Health Services (NHS). This saw a record number of nurses leaving the country for greener pastures. It was then that the Ministry would admit it could be problematic. They would, however, not anticipate that while they seek to find solutions, the same reduced nurses would refuse doing other duties. Shortly before then, Justice Galesite Baruti of the Francistown Industrial Court had ruled in favour of nurses over the Call-to-Duty Policy. Following failure to reach common ground from engaging the employer, the Department of Labour and eventually getting a certificate of failure to settle from the Commissioner of Labour, the matter was heard by the Industrial Court to determine the outcome.
The nurses wanted government to discontinue Call-to-Duty, where they are expected to report to duty when required to do so beyond their working hours. Through BONU, the health workers argued that Call-to-Duty is illegal, encroaches on nurses' rest period and exposes them to abuse by the Directorate of Public Service Management (DPSM). While government argued that the arrangement is catered for in their fixed 30% overtime allowance, nurses said it is not a reason enough as they also work overtime hours. Justice Baruti ordered that the entire time that nurses and midwives are rostered to be on call constitutes working time for which they must be paid for; the time that a nurse or a midwife accompanies a patient on referral from one medical facility to another medical facility, and back, constitutes working time for which he or she must be paid for. The government has since appealed the ruling, and the matter is yet to be put to rest. The BONU is now back at loggerheads with government over the rights of nurses and midwives who have been engaged to perform pharmacy dispensary function.
In a letter seen by Mmegi, the BONU president Peter Batsalelwang wrote to the Directorate of Public Service Management (DPSM) and the Health Ministry announcing that nurses and midwives would be dispensing medicine for the last time this month. “We write about the persistent practice in healthcare locally where nurses and midwives are dispensing medicines to patients at health facilities. Please take notice that BONU has taken the decision for nurses and midwives to formally cease the duties relating to dispensing of medicines as of 1st July 2023.
The decision has been taken on the basis that the current practice is manifestly unlawful and in breach of the code of ethics for practicing nurses and midwives,” Batsalelwang wrote. BONU states that the conduct is in breach of the Medicines and Related Substances Act of 2013 at Section 26 (1) (a-c). In essence, a person who operates a dispensary without authority commits an offence and is at grave risk of imprisonment and/or a fine. The union further made reference to the Nurses and Midwives Act of 1995 at Section 11 (1) (c) which also independently prohibits for any registered professional to conduct themselves or engage in any practice which is not provided for or differs from the terms and conditions of their practicing certificate. “Finally, the practice is also contrary to the professional ethics for nurses, which provides for Accountability, Fidelity, and Veracity as part of the code of practice. In any event, professionals may not engage in any conduct that is otherwise illegal in terms of the law. The BONU has no doubt that your esteemed office views the above practice to be illegal, as we do, and one that is not only inappropriate, but also stands to tarnish the ethics and the good image of the nursing profession,” Batsalelwang concluded.
The MoH Chief Public Relations Officer Dr Christopher Nyanga said the Ministry of Health received a copy of a letter written to the DPSM from BONU on the issue. He said they are currently in talks with involved parties and called for calm. “The ministry wishes not to make any substantive comments, lest it jeopardizes ongoing engagements and consultations with stakeholders,” he said. He added that the ministry is positive that ongoing engagements with stakeholders including the BONU, will result in all the parties reaching common ground. “The Ministry of Health is positive that an expedited solution will be reached within reasonable time, to avert any possible disruption of services in government health facilities. The Ministry therefore, assures Batswana and all nurses and midwives, of its commitment to an immediate resolution of this issue, to safeguard people’s health and well-being,” Nyanga said.