Health Professions Council's regulation of higher education qualifications & enrolments in medical programmes

Meeting report

Chairperson’s opening remarks
The Chairperson welcomed Dr B Goqwana (Chairperson, Portfolio Committee on Health) and the Health Professions Council of South Africa (HPCSA or the Council) to the meeting.

He noted that Portfolio Committee on Higher Education and Training had undertaken oversight visits to various institutions, including medical schools, and in its interactions with academics and leadership, it noted constant references to the Health Professions Council of South Africa and the Provincial Health Administration, in regard to the enrolment of medical practitioners. Medunsa claimed that the regulations relating to lecturer:student ratios were the basis for capping of enrolments, and further said that the inadequate numbers of hospital beds also affected the availability of posts after training. For these reasons, the Committee felt that it would be useful to interact with the Portfolio Committee on Health and the Council to understand how enrolments of medical practitioners were handled, to get a perspective on the shortage of medical professionals in the country and the efforts to address that. There was also a shortage of nurses, technicians and other categories of personnel under the auspices of the HPCSA.

Dr B Goqwana thanked the Chairperson for arranging the joint meeting. The HPCSA was a very important body and he hoped Dr Letlape could give some insight into the problems in the health sector. If the Council had challenges, the legislature could assist.

Health Professions Council of South Africa (HPCSA) briefing
Dr T Kgosi Letlape, Acting Registrar, Health Professions Council of South Africa, said that section 3(f) of the Health Professions Act (as amended) stipulated that the HPCSA controlled and exercised authority in respect of all matters affecting education and training within its jurisdiction. Section 15A(c) further stipulated that Professional Boards controlled and exercised authority in respect of all matters affecting the education and training of persons in any health profession falling within the ambit of the professional board. The Health Professions Council was the overarching body, but on matters of education the professional boards had absolute authority.

The HPCSA had twelve Professional Boards operating under its auspices, representing 29 major professions. The main focus of this presentation would be the Medical and Dental Board (MDB). There were other professions that did not fall under the ambit of the HPCSA, including the Nursing Council, the Pharmacy Council, the Allied Health Professions Council, and the Dental Technicians Council.

The MDB was responsible for regulating health professionals in medicine, clinical associates, dentistry and medical science. He explained that “clinical associates” were a new grouping, and the first batch had graduated a couple of years ago from Walter Sisulu University. The mandate of the MDB was to determine and ensure maintenance of minimum standards for professional practice and professional conduct, and to determine and ensure upholding of minimum standards for education and training in medicine, dentistry and medical science. MDB would grant certification to compliant practitioners to practise their professions, would register graduates for internship, and graduates for community service. The MDB also registered candidates for specialisation.

The setting of minimum standards for education and training in medicine ensured that practitioners were competent to practise the medical professions safely, ethically and professionally. These standards were used to measure compliance to education and training, including undergraduate education and training, clinical training (through internships) and postgraduate education and training. Separate committees dealt with medical science and dental science, with further distinctions between undergraduate and postgraduate education and training for both.

The purpose of accreditation was to promote excellence in educational preparation while assuring the public that graduates of accredited programmes were educated in the core knowledge and skills required for competent, safe, ethical, effective, and independent professional practice.

He set out the main focus of the accreditation process, covering a number of areas from the vision and mission of the university programme to monitoring of students (see attached presentation for details).
The MDB accreditation cycle was five years, which was followed by a follow up visit. Limited accreditation surveys were conducted to support improvement. Universities must submit annual reports to the boards to report on recommendations. If the facilities or curricula did not adhere to minimum standards there would not be continuing full accreditation.

Dr Letlape set out the history of accreditation at the various universities (see attached presentation for details) noting that the accreditation related to the number of students each university was permitted to take.
The regulation of the medical qualifications at higher education institutions (HEIs) was done in terms of the Health Professions Act (HPA). The HPCSA evaluated and accredited the institutions, their clinical training and professional practice facilities. It would register students enrolled at the HEIs for qualifications leading to registration with the HPCSA, and conduct Board examinations to ensure that graduates were fit for registration. He explained that HPCSA gave recognition to the examinations set by the different institutions, because they had submitted the standards, but anyone who had not studied at a registered institution would have to sit a board exam, after evaluation by the relevant committees.

Dr Letlape explained that capping of enrolments in medical programmes determined the maximum number of students who could be enrolled for programmes, and was dependent on the extent to which an institution met minimum standards for delivery of graduates. Whilst HPCSA did not cap the number of students itself, it did set staff to student ratios and assessed the facilities. At one time, there had not been enough posts available to absorb all graduates in professions such as medical technology and environmental health, and at this time, HPCSA had regulated the size of the first-year student intake. There was currently no professional board that restricted the number of first year students due to employment opportunities.

The planning for enrolment in HEIs was the function of the Department of Higher Education and Training (DHET). The DHET set enrolment targets for institutions, to guide student admissions. HPCSA had no direct input in this enrolment planning at HEIs.

The HPCSA played a role in higher education by offering quality assurance of the education and training in fields that were registered with the Council under the HPA. Its Education Training Quality Assurance (ETQA) Standing Committee guided and monitored performance of the Professional Boards, and all twelve boards were represented on the ETQA Standing Committee.  It protected the public by ensuring delivery of competent practitioners who were safe to practise their professions.

Dr Letlape outlined the internship registrations for 2009–2011. Intern students rose from 939 in 2009 to 1 049 in 2011, but he explained that there would be about 2 000 interns at any one time because the intern programme was two years.

Dr Letlape said that each HEI had to complete a comprehensive self-evaluation questionnaire, which must be submitted three months prior to the evaluation. The Evaluation Task Team comprised seven members appointed by the MDB. Areas of evaluation by HPCSA included the consistency of courses offered, staff complement, and National Qualifications Framework (NQF) points. He said a wide range of questions were asked, including admission criteria, spread of demographics in first year students, demographics of students finally qualifying, pass rates, support given to students, e-learning and library facilities, computer assessments, existence of tutor and mentor groups, and student participation in matters like selection of staff. The task teams also looked at support to staff and staff training, the research component of the curriculum, exposure of students to research and whether the HEI taught research methodologies.

Dr Letlape then explained the learner:teacher ratios. The HPCSA thought that in the clinical years, a 4:1 learner:teacher ratio was excellent; 5 to 9: 1 was good; 8 to12: 1 was acceptable, and above 13:1 did not meet standards. Not all institutions could offer this ratio, with traditionally disadvantaged HEIs showing higher ratios, whilst long-established and wealthier medical schools had better ratios. HPCSA, however, paid attention to the detail, to ensure that provided the ratio was acceptable, the quality of practitioners produced posed no public safety concerns. Where the ratio of learners:teachers was on the high side, the emphasis would be on clinical skills, and where it was lower there were stronger inclinations to research, academic backgrounds and more specialisation. He stressed again that every graduate would have undergone a medical education conducive to becoming a safe practising medical practitioner. South Africa’s graduates were well-regarded internationally, and South Africa found the majority being lured to other countries within five years of qualification.

Dr Letlape assured the Committee that HPCSA took the responsibility of maintenance of standards and protection of the public very seriously. There were challenges in getting access to medical schools, where the demand was high, and there were difficulties in selecting those who would be most suitable, as a straight-A student may not necessarily make a better dentist or doctor. The admission criteria of HEIs were continuously reformed. Witwatersrand University at one stage took many people from historically disadvantaged backgrounds, with supporting programmes in their preliminary year, which, over time, were phased out as the quality of matric education improved.

HPCSA did set standards around bed availability and posts, although it was not in control of how many beds were actually available, as that related to the funding and services offered by government. Although the post establishment was also not under the Council’s control, it had a duty to ensure that an institution had enough posts filled for the number of students taken on, to avoid compromising the quality of education. Enrolment and selection of medical students was not under the control of the HPSCA, but under the HEIs. However, Council did monitor the demographic diversity and the gender distribution of the student population.

Discussion
Dr K Dikobo (AZAPO) was interested in the board examinations and asked how these affected a South African student.

Dr Letlape responded that successful completion of examinations conducted at South Africa’s own HEI institutions was regarded as sufficient for qualification and registration purposes.

Dr Dikobo also asked whether the board examinations were intended for South African graduates, and how those from other jurisdictions would be assessed. He noted that one person was alleged to have been permitted to practise as a neurologist, although this person did not even qualify as a general practitioner.

Dr Letlape responded that a medical graduate from a recognised jurisdiction would go into a non-exempt stream. A person who had qualified, for instance, at a United Kingdom university and was registered with the General Medical Council of the UK would need to supply the HPCSA with notarised certificates of graduation, curriculum, registration with the UK council and, if s/he claimed to be a specialist, with appropriate notarised papers, plus a certificate of good standing in the country where s/he had worked, and a recent curriculum vitae. HPCSA would, on a monthly basis, verify registrations with the Education Committee for Foreign Medical Graduates (ECFMG), an organisation in the United States that offered an independent credentialing service. Any foreign practitioner who needed to be registered with the HPCSA would have to meet all requirements, at their own cost, and ensure their verification also with the ECFMG. Once the notarised documentation and the ECFMG verification was given, each candidate would have to appear before the relevant committee; there was one for general practitioners and one for specialist education. These committees would assess whether the person should sit an exam, but generally, if the person was from the UK, with all relevant papers, s/he would be registered.

He stressed that no foreign graduate would be given a licence to go into private practice; all foreign graduates would be licensed for public service. If the person came from a country where they would need to follow the exemption stream, a board examination would be needed for general practice, and a pool of examiners would look at the standards and moderation. A person wanting to register as a specialist would have to pass the appropriate College of Medicine examination.

Dr Letlape then addressed the position of South Africans who held foreign qualifications. The Department of Health (DOH) did not offer internships for any foreign-qualified graduates. There was exemption for ten countries in Africa that did not have medical schools, such as Swaziland, and a Swazi national who had been educated in the UK and needed to do an internship could apply for arrangements with the DOH. Some South Africans who could not get admission to local medical schools might study outside the country, but wish to do their internships in South Africa, and these matters would be referred to the Foreign Workforce Management Programme of DOH for adjudication.

Dr Letlape, in reply to the question about the standards for foreign graduates, said that a foreign graduate who had passed the South African board examination for general practitioners would be registered to practise in the public service for three years. After that period, s/he would apply for renewal of registration and could make application to practice independently. Governments in Africa had agreed not to poach each others’ graduates. A doctor or dentist from another African country would firstly have to apply to DOH for permission to apply for registration. The DOH would apply to the Foreign Workforce Management Programme. The HPCSA would not consider registration unless the DOH gave permission, but graduates from other continents could apply directly to HPCSA.

Dr Dikobo referred to the comments on the learner:student ratio, and asked if some HEIs were responding to the call to train more doctors, whilst other were not because they were keeping to ratios.

Dr Letlape said that HEIs would be accredited every five years. However, if a HEI changed its programme it would have to inform the HPCSA and ad hoc accreditation would be done, and this applied when the numbers of students increased. Institutions could decide for themselves how many students they could train. HPCSA decided whether the system could carry those numbers. However, if a HEI only had capacity to train 50 students, but tried to take on 100, the HPCSA would regard it as not having met minimum standards. He reminded Members that student intake required a balance of responsibilities between teaching, service, research, and the number of posts that the institution was able to fill.

Mr S Makhubele (ANC) asked whether there were challenges in the relative status of the Council and professional boards.

Dr Letlape responded that historically the Medical and Dental Board used to have its own council, but the new dispensation decided to have an overarching Health Professions Council, although the nursing and pharmacy boards decided not to fall under this. The MDB and eleven other boards agreed to fall under the HPCSA. Each board retained full authority on professional matters, and the Council did not intervene in those matters. The boards were populated by members of that profession, who remained in control of professional matters. HPCSA had a dual function: to guide the professions, and protect the public, and the latter was non-negotiable. Although there were sometimes tensions between the professionals and Council about protecting the public, these were necessary tensions in the system. There was nothing wrong with the current structures.

Mr Makhubele noted that the Chairperson, in his overview, also mentioned the shortage of nurses in the country, and asked if the HPCSA could address this point.

Dr Letlape replied that the Minister had spoken about those issues, noting that the shortage had arisen through technical mistakes. Originally there were no artificial barriers to entry to the nursing profession, and it was a profession, which complied with professional ethics. However, it was then decided that university education should be required for nurses, and the nursing colleges were closed. He thought this had been a mistake, and that the Committee would enable a return to the model that had worked for many historically disadvantaged women, who could earn their living while training, did not have to apply for bursaries, promoted good ethics and allow women to raise their families and undertake professional work. However, these were matters within the domain of the Nursing Council and for public debate.

Mr Makhubele noted that the Council looked into governance and organisation of HEIs and asked if the HPCSA could make any input where candidates failed or were not permitted re-registration.

Dr Letlape responded that the HPCSA played no part in how the university councils were constituted, as this fell under the DHET. However, HPCSA must ensure that there were proper structures to run the HEIs, including an effective Dean’s Office, good administration, proper funding accountability and proper criteria for applications and training of a variety of students.  

Mr Makhubele referred to accreditation for the intake of students, pointing out that the time lines were different, and did not appear to address the five-year cycle. He asked what would happen if a HEI applied to expand its intake in mid-cycle.

Dr Letlape said that HEIs could apply to take an increased intake but this had major implications, including whether posts were filled, professionals would be adequately remunerated, whether this would allow sufficient time for research and whether it would not impose undue burdens on staff, quality of training and supervision. There were challenges around work conditions in the HEIs, and it was necessary to find better funding if HEIs were to build capacity to take on more students. Other practical considerations included the number of dissection halls, or cadavers available, or laboratory spots. The HEIs also had to look at all their other responsibilities, since the Council for Higher Education was demanding research output, before specialisation was allowed, which increased the burden of responsibility on supervisors. Even though a number of challenges existed, this did not mean that a HEI would not be able to increase student intake, but there would have to be a paradigm shift of how the HEI operated. Institutions should be challenged to increase their numbers.

Mr Makhubele said that Members were informed, when doing an oversight visit to Medunsa, that a student was not permitted to study privately without prior authorisation by HPCSA, and asked if this was correct.

Dr Letlape advised that there was no guarantee of quality achieved from private study. Medical students needed contact time, in a clinical and supervised environment, with an experienced, ethical and dedicated teacher, and also had to learn from real-life patients. Some graduates from other countries, although they had academic qualifications on paper, could not even set up a drip. Medicine could not be studied by correspondence.

Mr Makhubele interjected that his question was misunderstood, and that Medunsa had referred to a student who offered to pay privately.

Dr Letlape noted that studies in medicine and dentistry were heavily subsidised by the State, and the fees paid were not commensurate to the cost of training. A student must either get a bursary, or pay fees. He did not quite understand the question.

Dr B Goqwana (ANC) said that a similar question had been put to him, and he suggested that it be discussed outside the meeting with Mr Makhubele and Dr Letlape.

Dr Letlape agreed that the issues needed to be clarified. Institutions should consider deserving students, without considering their financial ability, as there should be concerted efforts to support deserving students who could not pay from their own funds.

Ms M Segale-Diswai (ANC) queried why University of Pretoria was accredited for 2007, and why the numbers were reduced for University of Free State.

Dr A Lotriet (DA) also referred to the history of accreditation and noted that the Council did not cap student numbers, which implied that universities could register more students, but she wondered if such registration would impact negatively later on, because part of the accreditation looked at lecturer: student ratios.

Dr Letlape had explained that the accreditation cycles were five years, but there could be ad hoc evaluations of any changes. Free State had challenges in filling the post of Dean, and sufficient staff complement, so the HPCSA limited the numbers of students it could take.

Ms Segale-Diswai asked how HPCSA was involved in the accreditation of hospital and clinical students doing practical training.

Dr Letlape responded that HPCSA was involved. For instance, in regard to the proposed new medical school in Limpopo, the HPCSA would examine, for the basic sciences, the lecture halls, the tutorials to support the breakaways, the size of the class and the number of lectures given, and the staff complement. On the clinical side, it would look at the beds available, the number of consultants available, the number of medical officers, the theatres, the laboratory and other facilities. A comprehensive analysis would be done of the facilities and readiness to teach. He reminded Members that the HPCSA accredited HEIs as teaching institutions. Licensing to operate as hospitals and provide services fell under the DOH.

Ms Segale-Diswai also asked how involved the Council was with students who had trained in Cuba, and why they had to do another year of training on their return.

Dr Letlape explained that the same standards applied under the government-to-government agreement on training in Cuba. An accreditation team accredited the training facilities in Cuba. However, there were some deficiencies in some aspects of clinical effectiveness, partially because of the language barrier, because their training was in Spanish, and they had to adapt to English and other languages. Cuban-trained doctors had to do a final assessment in South Africa before being integrated into the South African health care system. The agreement was that they would undertake their final year medical student training in Cuba, but do their internships in South Africa.

Ms D Robinson (DA) asked about HPSCA’s role in checking ethical behaviour and standards, and asked whether it played any part if a doctor had defrauded the system or insurers, or failed to meet the required levels of competency.

Dr Letlape explained that any member of the public could lodge a complaint about any health practitioner registered with the Health Practitioners Council, and the Council was bound by law to look into that complaint. The Council’s Public Relations department even helped people who struggled with literacy to frame their complaints. Once a written complaint was received, the Council would notify the practitioner of the complaint, and call for a response, and that response would be submitted to a committee. The Ombudsman would resolve minor cases. More serious matters would go to a preliminary Committee of Inquiry. There were four committees of inquiry, of which three dealt with general medical issues, and the fourth with sexual misconduct complaints, which were on the increase, and required a specialised committee. A preliminary committee could conclude the matter by either accepting the practitioner’s explanation and advise the complainant, or finding the practitioner guilty and either issuing a warning or fine. Other steps – such as remedial education, or anger management – could be taken.

If the preliminary Committee felt that the matter was very serious, and perhaps even warranted de-registration, a formal Inquiry would be set up, and then the HPCSA would prepare a charge sheet, which would be sent to the doctor, and a formal and full hearing would be held, where the doctor would be permitted to bring legal representatives. A prosecutor would be appointed, and three members of the HPCSA would adjudicate on the matter. The powers of the HPCSA included removing the doctor from the register. HPCSA could also press criminal charges. At the moment, people removed from the register were removed altogether from the jurisdiction of the HPCSA. There were now proposals that perhaps a practitioner would be registered, then licensed to practise – they were separate issues because registration was based on qualifications, whereas licence to practice was based on competence.

Dr L Bosman (DA) said that the figures seemed to indicate that there was no real increase of medical practitioners, and he asked what plans there were to increase the numbers. He asked if the two new universities would be expected to improve the figures. He wanted to know what the real shortages were.

Dr Letlape responded that the current schools could take in more students, and the new universities would also increase numbers. It was hoped that the new medical school in Limpopo would meet the requirements and be accredited this year. He said that there would always be a shortage of medical doctors, given that South Africa was not retaining its graduates. He noted again that there was massive subsidisation of training of medical doctors and dentists, and suggested that perhaps it would be appropriate for students to train for five years and be required to do in-service training for another five years or pay back the full costs of their training. Many medical practitioners remained on the register but were not practising, having moved across to other areas that were more profitable and offered greater opportunities and appreciation, and working conditions would need to be improved before they would return to practice.

Ms B Ngcobo (ANC) asked whether the number of doctors that the Council registered each year was different to the 1993 figures. She asked why the figures were not improving despite the needs of South Africa increasing. She asked if those who left the country de-registered from HPCSA.

Ms M Dube (ANC) asked if there were drop-outs, and what the reasons were.

Dr Letlape said that would require a separate report, as there were many reasons, including lack of preparedness for university, lack of preparedness for medical schools, or the social atmosphere, where people may not be accustomed to so much social freedom and had no skills to cope with their new-found freedom and achieve a balance. Real academic incompatibility was not the main problem.

Ms Dube was concerned that the geographic spread and quality of universities were linked, and wondered if she would be able to register in one province if she was brought up in another.

Dr Letlape said there was no restriction imposed in terms of a person’s home province.

Ms Dube was also interested in how many people of gender and of colour qualified as doctors.

Dr Letlape said the females outnumbered the males, and also outperformed them. That was a challenge in terms of workforce preparation, as the environment must change to accommodate a largely-female workforce.

Ms Dube was also interested why the numbers for Stellenbosch University had increased while the others had declined.

Mr D Kganare (ANC) understood that the HPCSA played a role in capping the number of students taken in, and noted that in the past the numbers of medical technologists taken in were limited, but this was no longer the case. He asked if any universities had approached the Council or if there were discussions to address challenges that blocked universities from increasing their intake.

Ms T Kenye (ANC) noted that the role of the Council was also to protect the public by ensuring delivery of competent practitioners. She asked whether foreign doctors were evaluated. There were reports of a foreign, bogus “doctor” in Eastern Cape who had performed operations, and she asked how HPCSA would deal with this, and whether the patients would be compensated.

Dr Letlape responded that there were complex issues around this doctor, and a full report must still be submitted to the Minister of Health. This gentleman had trained as a doctor and qualified in the Democratic Republic of Congo (DRC). He worked there as a general practitioner, in private practice. He then moved to Belgium, where he studied and worked for two years as a registrar in surgery, then for further years as a trainee neurologist and neurosurgeon at a Catholic University in Belgium, completing four years of training in 1991. He worked in Zimbabwe as a neurosurgeon but was expelled from there, then worked in Botswana, where he was also expelled. In 2001 he applied to work as a neurosurgeon in South Africa. HPCSA assessed him and required him to write an examination to register as a neurosurgeon. Although he supplied documentation, it was not notarised, and he did supply his training logbooks, but did not supply a certificate of registration as neurosurgeon in Belgium. He wrote the HPCSA examination in 2004, and failed it. He tried to register for the General Practitioners Board Examination in 2005, but this was refused by the Department of Health’s Foreign Workforce Management unit. He applied again in 2006 and 2007.

He apparently then started working for Baragwanath Hospital, and a complaint was levied against him for incompetence. When this happened, HPCSA discovered that the minutes of the Post-Graduate Education and Training Medical Committee meeting of January 2007 stated that he had passed the board examination and had been registered as a neurosurgeon. This was not impossible, because to register as a neurosurgeon he would have to have passed the HPSCA examination (which he had failed in 2004), and could not have used a Board examination to register as a specialist. It seemed that staff members in HPCSA had colluded to falsify his registration. He was asked to supply the documentation proving this, failed to do so, and was de-registered. He still threatened to sue HPSCA. After the Ministerial report had been prepared, Dr Letlape would supply more details.

Mr B Bhanga (COPE) asked whether HEIs were producing quality research and specialisation of research.

Dr Letlape responded that the greatest challenge with quality research was the service requirement, and the lack of time. A person on a joint academic and service post had responsibilities to do their own ongoing research, support research students, teach medical students, teach registrars and provide services. There was simply not enough time in the day to achieve all that to the fullest extent. Something had to fall away, and that was usually the research component. A person could not register as a specialist if s/he had not done research.

Mr Bhanga referred to the lecturer:student ratio and asked to what extent there was commitment to expand the intake of medical practitioners, both general practitioners and specialists in areas of particular shortage.

Ms P Kopane (DA) asked how many doctors had been deregistered and how many cases were still pending.

Dr Letlape had explained that a doctor who had been deregistered could only practice legally after re-registering (if the time period of de-registration had expired). An application for re-registration would be sent to the relevant committee, who must examine it, and who could impose restrictions. A Health Council would examine applications of those with impairments, ranging from physical impairments to substance abuse or addiction, and, where necessary, a psychiatrist would be assigned to assess the practitioner. Depending on the report, that practitioner may be placed under a restriction of supervised practice.

The Chairperson said important issues had been raised. It was disturbing to note that a Municipal Manager probably earned more than a medical practitioner. The Registrar of the University of Pretoria had named some of the challenges affecting academics as including the use of contract posts, and much higher salaries being offered for administrative than academic posts, meaning that professionals would move away from practising.

He said that the National and provincial departments, as well as deans of HEIs, had responsibility to increase numbers. HPCSA must ensure that its standards were met, but a collaborative response was needed and resources had to be increased to ensure compliance with HPCSA standards. That highlighted the importance of joint meetings. This Committee could make recommendations to the House, but the problems would recur unless they were addressed by collaborative efforts. South Africa must enhance access to the medical sector, but clearly this could not be approached in a merely academic way. This Committee had been empowered by the presentation and discussion, and had a better idea of how the issues had to be tackled. Academics were quick to defend total autonomy of their institutions, but government promoted openness, transparency and accountability. Over the last few years, billions of rands had been pumped into public institutions, yet proper interrogation of how it was used was not done. Parliament must engage with the reports and look at the inherent structural limitations of the various institutions, in order to increase the intake of new entrants in the Health sector. Public institutions were funded massively by the State, and every dean, principal and student should understand that the milestones of the country must be achieved, particularly on the human resources side.

Dr Goqwana agreed that this was a very intricate matter and thanked Dr Letlape for a clear presentation. He noted that the numbers of health practitioners did not reside with the functions of the HPCSA. However, HPCSA was concerned with quality, and it was achieving good quality, as evidenced by the high demand for South African health professionals. Another key issue was transformation, and Members were interested in how historically disadvantaged South Africans were promoted. Consideration had to be given to whether HPCSA had sufficient staff, and, as shown by the examples of the apparent staff collusion, whether they were corruptible. Parliament could assist if it knew of the challenges. It was noted that people left the practising profession, but not always because of the lure of salaries elsewhere, and the DOH needed to hep them, particularly where there were appalling working conditions and lack of equipment. He agreed that further meetings would be useful, to see how the quantity and quality of our professionals could be improved. He noted that lawmakers could assist the HPCSA with matters that were causing frustration, including whistle-blowing.

Other Committee business
Draft Committee Report on Study tour to the Federal Republic of Germany
The Chairperson noted that at a previous meeting it was decided to give Members time to study the Draft Report on the Committee’s Study tour to the Federal Republic of Germany. He now tabled that report again, and noted that he believed it to be a correct reflection.

Mr Makhubele agreed that it was accurate, but said that there were more issues that needed to be included in the “Recommendations” section. These were:

- on page 15, under item 5.1.3, an issue had to be followed up with the Mpumalanga Provincial Government.
- on page 17, under 5.4.6, the first sentence had to be taken forward
- under item 5.4.9 he pointed out that the partnerships were limited to those with the best performing Western Cape institutions, and more needed to be explored with historically disadvantaged universities.
- under 5.6.3, he wondered if this was something that the Committee could attend to
- under 5.8.4, he said a recommendation was needed on FET college lecturers
- under 5.9.9, the Committee needed to take this matter forward.

If these were not specifically recorded under recommendations, the Committee would need to ensure that they were incorporated into the programme of action.

Mr Makhubele thought that more had to be done about the Year of Science partnership with Old Mutual.

Ms N Gina (ANC) also agreed that this was otherwise a good reflection of the Study Tour, and proposed its adoption, as amended, and said that the Committee would then need to come up with a programme of action.

Members adopted the Report, as amended.

Draft Committee Report on Meeting with the Cape Peninsula University of Technology (CPUT)
The Chairperson recapped that the Committee had visited the Cape Peninsula University of Technology (CPUT), where there were demonstrations by students, and had also visited other universities and FET Colleges in KwaZulu-Natal. There was one main factor that accounted for high drop-outs, namely the inability of students to pay fees after their first year. This was not given enough focus in order to resolve the issue. At CPUT, although there was apparently a policy that students would not be excluded on financial grounds if they were academically excellent, in practice every student was stopped by a security guard, at the entrance, and asked to show proof of payment.

He said that the Committee would consider, and make recommendations, on strategic interventions to address the habitual interruption of academic programmes at the beginning of the new academic year, in HEIs. He wondered if the Committee should engage with stakeholders to ensure better preparation for smooth registrations, and to consider how students who were performing well would be assisted to progress, or to streamline funding of the National Student Financial Aid Scheme (NSFAS) with bursary offices at the HEIs.  

Mr Makhubele said the Committee seemed to be of the view that no academically deserving student should be excluded from HEIs, particularly when they qualified for NSFAS funding. They were supposed to be covered. The challenge lay with students who either failed their course, or who had to pay for their next year’s fees themselves because NSFAS would not pay. HEIs must work out mechanisms for supporting those students. He did not think they should simply be allowed to drop out, but something should be done to support them academically and financially.

Mr Bhanga suggested that the Minister should continue to remind HEIs that upfront payments were dealt with through NSFAS, and that students who qualified academically should be allowed to register without that upfront payment. He did not entirely agreed that HEIs should find a mechanism for students who were not performing. Institutions must translate their academic support programmes, as Dr Letlape had emphasised, into both academic support and social support of students. However, he thought it would be irresponsible for this Committee to insist that HEIs must find financial mechanisms for students who were not academically deserving.

Dr Dikobo suggested that HEIs should be morally rather than legally obliged to try to assist. They should not be given an unfunded mandate; they had their own problems. Students were often allowed to repeat a year, at own cost, but they often ended up in debt to the HEIs, and such students would complete their studies with a debt to NSFAS and a debt to the HEIs, with the result that the HEIs would withhold the certificates. NSFAS was no longer insisting on withholding results, only the final certificate, and would provide students with money to work, so it had responded to recommendations from CPUT.

The Chairperson noted Members’ suggestions that the Committee should restate its position on non-exclusion of academically-performing students by HEIs. The Minister, in order to monitor implementation, should set up a responsive task team at the beginning of the year.

Dr Dikobo agreed that students must not be excluded. However, he queried who would carry the burden. If NSFAS provided an amount to support 2 000 students, but 2 005 applied, who was to support the non-deserving five students?

The Chairperson said public universities had a duty to serve the nation, by providing education. The duty of NSFAS was to give funding. NSFAS must find creative ways of replenishing its resource base, to continue the mandate of funding. Government must explore increased resource streams, including the National Skills Fund (NSF), which had reserves. The Minister also apportioned R200 million to relieve the debt of HEIs, but consequences would accumulate. Ultimately higher education was the collective responsibility of the State and universities, who must be regarded as public institutions, because they were subsidised.

Mr Bhanga agreed that there was a very critical need for an intervention committee. In some instances universities were entitled to assist students, but there was nobody to monitor this. Sometimes NSFAS regulations were not implemented properly. In some instances the Minister had to look into the emergency fund at the beginning of the year. It was irresponsible to expect the universities to use reserves, as those were to cater for other matters.

Dr Dikobo said the recommendation should be that the Ministry and all parties should do everything possible to ensure that academically deserving students were not excluded.

Members agreed and agreed to adopt the Report on the visit, with the recommendation that the Ministry and all parties should do everything possible to ensure that academically deserving students were not excluded.

Adoption of minutes
The Minutes of Committee meeting held on 7 February 2012, dealing with the Further Education and Training Colleges Amendment Bill [B13D-11], were tabled. The Chairperson announced that the Bill had been passed the previous day.

Mr Mpontshane asked that if any Members’ parties had a declaration, they should warn other Members, noting that there had been some embarrassment on the previous day.

The Chairperson agreed. Raising issues in advance only helped to enhance discourse in the House. Members of Parliament contributed fundamentally to shaping and changing society.

Dr Lotriet noted that the logistical and practical ways in which parties dealt with matters must be taken into account. It may be that a Member could not declare at a meeting because the Party position on this may be taken at a later caucus, and this would be conveyed in the programming committees by the Whips.

Dr Dikobo agreed and noted that the Committee’s Report was not a report by the ruling party, so there should not be anything that criticised any other parties. He asked the Chairperson to be careful that this did not happen.

Mr Makhubele commented that on page 2, items 3.1 should read “similar legislation” instead of “legislation”. On page 3 a typographical error must be corrected.

Members adopted the Minutes, with technical amendments.

The meeting was adjourned.