An analysis of the exit competencies required by nurses who have completed their basic training, to implement the national health system at district level.

Abstract

The purpose of this study is to critically evaluate the present nursing curriculum for diploma and degree student nurses with respect to is effectiveness in preparing them to operate within a Primary Health Care-based health system. "The challenges facing the South African health system is to design a comprehensive programme to redress social and economic injustices to ensure that emphasis is placed on health and not just on medical care" (A Policy for the Development of a District Health System, L995:1). The Department of Health has suggested implementing a district health system based on the principles of Primary Health Care. At the Alma-Ata conference in 1978, Primary Health Care was defined as:'..essential health care based on practical, scientifically sound and socially acceptable methods and technologies made universally accessible to individuals and families through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination'. (WHO/UNICEF, 1978: para Vlll). This definition encompasses a lot more than the medical model, which has dominated nursing curricula for years. (Ntoane , 1983: 10) If we are to meet the health needs of the population of South Africa and the World Health Organisation's goal of Health for All by the Year 2000, action needs to be taken to redefine the role of the nurse and her contribution toward establishing a healthier nation. A shift from the present medical driven, curative model to a model of delivery based on health in a broader context, and that emphasizes preventive and promotive dimensions, is a tremendous challenge to our current reality. It is essential that nurses begin to function within a broader scope than that of the present, to facilitate the development of effective district health teams and more effective deployment of nurses within a primary health care-based system (Bierman & Muller, 1994.). Recent assessments of human resource capacity within the health sector have highlighted the inappropriateness of the education provided by training institutions for meeting the service imperatives of the national health system.(National Human /resource Development Policy L996.), The implementation of the district model will require staff with the skills, attitudes and knowledge to perform a range of tasks and functions as part of a multidisciplinary health team. It has been suggested that staff presently are not equipped with the competencies to undertake new or additional roles they are called on to perform in a district-based health system.(praft Provincial Health PIan,1995). Little detailed empirical evidence exists to support these claims. There has been little analysis of the exit competencies of staff who have completed basic training to determine whether they possess the desired competencies for implementing a district-based health service and what the implications are for the curricula of training institutions.