Introduction
The foreword by the Minister of Health highlighted the importance of providing quality health services as non-negotiable. Better quality of care is fundamental in improving current poor health outcomes and in restoring patient and staff confidence in public and private health care system.

The country is faced with enormous challenges in transforming its health care delivery system, not only to meet expectations of quality care, but also to improve critical health care outcomes linked to the Millennium Development Goals. 

Definition of key words
Competency: The term competency refers to a combination of skills, attributes and behaviours that are directly related to successful performance on the job. (United Nations, 1999)
Core competencies: Are defined as the combination of skills, attributes and behaviours which are essential for all staff as well as additional managerial competencies required by all those who manage others. (United Nations, 1999)

DENOSA notes that:

• Lack of adherence to standards and competencies may hinder the delivery of decent and safe quality healthcare service.
• The conception of National Core Standards (NCS) by the National Department of Health (DoH) in 2008 indicates governments’ commitment in ensuring an effective healthcare service provision.
• A series of regulatory documents by the DoH in an attempt to improve the quality of the South African healthcare system have since been drafted and these include the following:
  • National Core Standards
  • The importance of the 10 Point plan for health
  • The Negotiated Service Delivery Agreement (NSDA)
  • Policy on Quality in Health Care for South Africa.
• The greatest challenge facing health professionals is the rate of change and technical innovation in the health sector whilst most health professionals have erroneous, outdated, or no information or skills to keep up with this highly dynamic environment.DENOSA believes that:
• Nurses and midwives cannot function without standards which guide them towards achieving departmental goals and quality patient care.
• Nurses should be continuously trained and skilled in order to keep up with the
• dynamic working environment in health so that they can be knowledgeable and competent practitioners.

DENOSA position on Core standards and competencies:

• Creating an enabling environment in which quality healthcare service may flourish is key to the adherence of core standards and competencies
• Empowering healthcare practitioners through provision of information that they can use to improve on the delivery of quality service is equally important.
• An effective reporting system would also help facilitate adherence to core standards and reduce errors and improve the quality of service provision.
• Capacity building to improve quality through fostering evidence-based practice and innovation require building-up and strengthening expertise in research.
• Skilled managers with a commitment to creating a learning organizational environment are quite essential in driving strict adherence to core standards and competencies. 
• Provision of quality care to patients requires training of skilled healthcare workers and establishing a culture that values lifelong learning and recognises its important role in improving quality.
• The delivery of quality care should be monitored by the consumers of healthcare services through Patient Satisfaction Surveys to measure adherence to defined standards.
• Various stakeholders and governance monitoring structures should play an active role in ensuring compliance and adherence to defined standards. 

Conclusion
Core standards and competencies are essential to the smooth running of any organizational structure. In the healthcare sector core standards and competencies give effect to and are interlinked to the quality of service provision. Without clearly defined standards and competencies, the consumers of healthcare may suffer the adverse effects of health personnel who operate without clear and effective guidelines and standards.