Meeting the Challenges of Training in the Health Professions

Working as an independent consultant has many benefits. One of the most significant benefits is the freedom to attend meetings and assimilate information, without necessarily having a specific agenda in mind. I am able to analyse what occurs from an independent perspective, and then tailor it to suit the needs and values of the people and companies that I am advising.

An example of this was when I attended the Portfolio Committee (PC) on Health at Parliament recently. This was a joint meeting with the PC on Higher Education and Training.

The meeting was chaired by Ishmael Malale, head of the PC on Higher Education and Training. The purpose was to discuss with the Health Professions Council of South Africa (HSPCA) how enrolments for medical practitioners should be dealt with.

This is an area of great concern, especially in the light of the shortage of health professionals in South Africa. And it is an issue which is being taken very seriously by the PC, as was made clear when the chair stated that they “are here to help HPCSA improve the situation,” and that it is even possible to change relevant Acts to assist the HPCSA.

Kgosi Letlape, the Acting/Stand in Registrar of HPCSA, explained that the vision of the organisation is the provision of quality health care standards for ALL Members of the population of South Africa.

He pointed out that while the HPCSA sets minimum standards for education and training in medicine, and determines the maximum number of students who can be trained, enrolment planning in higher education is the function of the Department of Higher Education and Training.

Each accreditation application from a University is viewed by a committee of seven people. The information includes the NQF points as well as the racial mix and the facilities for learning which are available at the institution.

In terms of teacher – learner ratios, 4 to 1 is good, 12 to 1 is the maximum acceptable.

Dr Letlape pointed out that South Africa loses many of its qualified doctors within five years of qualification, and the universities are struggling with a greater demand than student positions available.

The accreditations have been agreed:

  • Limpopo: 200 agreed in 2009
  • Wits: 220 in 2010 down from 240 in 2006 (160 for GEMO in 2010)
  • Pretoria: 220 in 2007
  • Free State: 140 in 2010
  • Walter Sisulu: 120 in 2011
  • UCT: 200 in 2007
  • Stellenbosch: 250 in 2011
  • KZN: 210 in 2010

That makes the total only 1560 students a year.

When the floor was opened for questions, it was clear that there was a wide ranging interest in the challenges facing the health profession in South Africa.

With the shortage of doctors, there was concern over the accreditation of foreign doctors. Dr Letlape explained that the doctor has to submit their proof of qualification and proof of registration. The doctor must also be listed on ECFG, an international database in the USA.

In addition, they must have internship before being registered in South Africa. General practitioners must pass the board exam and must serve for three years in the public sector before being allowed to register to go into private practice.

In reply to a question about raising the student numbers to the maximum of 12 to 1, Dr Letlape explained that it is not the role of the HSPCA to do this: it is up to the universities to raise the numbers by improving capacity.

“You need to change the paradigm in order to help South Africa with its needs for more qualified doctors. Wits took up this challenge and also received additional resources from the Minister of Health,” he said.“You can’t do medicine by correspondence. It is a contact sport!”

Dr Letlape admitted that some errors of judgement were made when the government decided to close certain nurse training institutions.
“Nursing is the career choice of many women of previously disadvantaged communities. We need training institutions. We hope the PC will help to correct this.”

He also pointed out that more women than men are being accepted into medical schools, and they are outperforming their male colleagues.

The biggest influencer of dropouts from medical school is a lack of social skills to cope with their new freedoms and independence.
“Before, you could not afford cold drink, but now you can afford Johnny Walker from your bursary. This is a problem,” he said.

It is clear that there are still many challenges facing the health profession in South Africa, but it is equally clear that there is a commitment and the political will to make the changes that are needed.

We just need to cast our minds back to 2010 to see what can be achieved with the right sense of commitment. I am encouraged by the moves by our Health Minister, Dr Aaron Motsoaledi, to ensure that more nurses are trained.

We are on the right track. Things can only get better.

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