Transforming nursing policy, practice and management in South Africa

H uman Resources for Health (HRH) are critical to health systems development and functioning, and to patient and population health outcomes (1). Nurses in South Africa, as elsewhere, make up the largest single group of health service providers and their role in promoting health and providing essential health services is undisputed (2). South Africa has three categories of nurses: professional (registered) nurses with 4 years of training; enrolled nurses with 2 years of training; and nursing assistants or auxiliaries with 1 year of training. The majority of professional (registered) nurses are also midwives , and the terms 'nurse' and 'midwife' are used interchangeably in the Nursing Act (3). However, the country faces a 'nursing crisis', characteri-sed by shortages, declining interest in the profession, lack of a caring ethos, and an apparent disjuncture between the needs of nurses on the one hand and those of communities served on the other hand (4, 5). The context of this nursing crisis is South Africa's quadruple disease burden (6), the multiplicity of health sector reforms (7), gender stratifica-tion, and the existence of strong professional silos and hierarchies (8). Progress towards universal health coverage (UHC) in South Africa, which aims to ensure that everyone is able to access the health care services they need irrespective of their ability to pay (9), is dependent on addressing these nursing challenges. obtained funding from The Atlantic Philan-thropies (AP) for a four-year research programme to develop and strengthen the research evidence for improved nursing policy development and practice in South Africa. Known popularly as Research on the State of Nursing (RESON), the overall research programme consisted of three focus areas: nursing management and quality of care; nursing policy; and the process of casualisation in nursing, specifically nursing agencies and moonlighting, and how these have an impact on nurses and on the health system. Capacity building and policy influence and engagement were important cross-cutting focus areas. In this Special Issue of Global Health Action, we present a series of papers that describe selected research findings of the various components of the RESON project. The Special Issue brings together 11 scholarly articles that explore themes that are relevant to a global audience of nurses and health policy-makers: nursing education reforms; enhancing the participation of nurses in policy-making; moonlighting among nurses; utilisation of agency nurses in hospitals and its costs to the health sector (both direct and indirect); ethics; quality of care; …