Admission of Medical Students: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
29 May 2001
ADMISSION OF MEDICAL STUDENTS: BRIEFING

Chairperson: Dr Nkomo

Documents handed out
Statistical summary of students admission demographics
Summary of the presentations

SUMMARY
The Ministry of Health recommended a reduction in medical training from the current six year programme to a five year programme with a one-year internship.

Support systems are being implemented to assist students from disadvantaged backgrounds to address the issue of drop-out rates.

The government is working on a mechanism to re-introduce the provision that allows medical doctors to engage in remunerative work outside the public service.

MINUTES
The government is working with medical schools to scale down the medical training curricular so that students can graduate in the fifth year. According to the Head of Human Resources in the Ministry of Health, Professor RV Gumbi, the government is also pushing for a one-year internship program. She said the two-year internship preferred by medical schools is too costly and unaffordable to the government.

The government is working on a mechanism to re-introduce the provision that allows medical doctors to engage in remunerative work outside the public service. She, assured the Committee that the facility would be structured and strictly monitored to guard against possible abuse.

The Committee expressed serious concern at the high drop out rate and therefore the low completion rate of black students in medical schools. Professor Gumbi informed the Committee that medical institutions are putting in place support systems to help students from disadvantaged backgrounds to settle into the programs much faster.

Discussion
The Chair questioned the classification of blacks, coloureds and Asians as distinct groups instead of grouping them as blacks in the admission statistics presented by Professor Gumbi.

Professor Gumbi explained that this mode of classification was a necessary tool in the government policy of transformation. The government was keen to keep accurate demographics on the transformation and empowerment program.

Regarding the low enrolment of whites students at the Medunsa medical school and whether there are any applications received from the white students, Professor Gumbi agreed that the low rate of white student intake at Medunsa was a cause for concern. Her office had talked to the school to rationalise in tune with the country’s demographics but the pace of change was unacceptably slow. Further that applications to the institution are received across the board.

Dr Cwele (ANC) asked why medical schools are allowed to apply different criteria for admission of students. Was there no uniform national guideline?

Professor Gumbi stated that the various Universities are autonomous and that the department cannot dictate terms to them. There are national guidelines in place but the Universities are not obliged to stick to them.

Dr Cwele (ANC) observed that there were alarmingly high drop out rates for black students. He asked which academic year had the highest drop out rate and the reasons for this. What is the government policy in addressing this issue.

Professor Gumbi explained that the government has set targets for the various institutions to meet in terms of admissions across the board. These targets are attached to the subsidy available to the particular institution. Most institutions have so far tried to meet the targets. Most dropouts occur in the 1^st and 2^nd years. There are lower dropout rates in the 4^th and 5^th years. The main reason for the dropouts was lack of supporting systems in the schools for students from formerly disadvantaged backgrounds. The Ministry was urging institutions to set up these support systems to assist these students. She added that in institutions where these support systems were in place, the pass rate was impressive.

Dr Jassat (ANC) noted that the shortage of medical personnel was an ever-burning issue. Was it not feasible to trim down the curricular so that the course lasts for five and not six years?

Professor Gumbi pointed out that the government was equally eager to have the training program cut down and integrated. The Ministry of Education and the various medical schools had dead-locked on this issue. Medical schools are insisting on a six-year program and a two-year internship. The government position on the matter was that it cannot afford an extra internship year and that it is keen to cut down on the curricular to a five-year program. Research carried out in other countries had shown that, indeed, it was feasible to train medics within a five-year period with a one-year internship. Discussions on the issue are on going and that she was encouraged that some institutions like Natal University and the University of Pretoria had, in principle, agreed to a five year program.

The Chair queried the lack of monitoring and appropriate intervention in the running of medical schools. In Pretoria 17 fifth-year students failed on English language. How could a student fail in language in the final year after all these engagements?

Dr Cwele (ANC) supported the Chair on the question of monitoring which he lamented was a serious omission.

Professor Gumbi maintained that the institutions prefer independence on academic matters. Institutions only seek to partner with government on matters of funding and policy but not on purely academic issues. However, where specific issues are brought to the attention of the Ministry, it takes up the matter with the concerned institutions.

Ms Baloyi (ANC) drew the attention of the Chair to a letter from a University of Cape Town medical student petitioning the Committee on various "unfair" practices perpetrated by the institution against black students. The matter was 'reserved' for consideration by the Committee at a later stage since it was not part of the day’s agenda.

Ms Baloyi queried the figure tabled by Professor Gumbi showing the distributions of doctors in the country as 1 to every 1000 people. This does not reflect the situation in the provinces especially the rural areas where the estimate is one doctor to 40,000 people.
Professor Gumbi acknowledged the discrepancy in the distribution of medical personnel and explained that the program of community service is there to mitigate the situation.

The Chair protested that community service is not the proper remedy for the debilitating shortage of medical personnel. He urged for an integrated project to address the situation once and for all.

Professor Gumbi informed the Committee that the government is going about the problem in a multifaceted manner. There was no simple solution. The government was engaging the rural Medical Associations on ways and means to improve the remunerative package for those employed in the rural outposts. This would include generous hardship bonuses, paying school fees for their children, comfortable housing and proper travelling allowance among other bonus.

Dr Cwele pointed out that the imbalance in white vs black admissions will not level unless the issue of redistribution of medical registrars was first addressed.

Mr. Mpehle (ANC) concurred with Dr Cwele that, indeed, if those chiefly undertaking tertiary instructions are predominantly white, then "we are paying leap services to the greater program of transformation".

Professor Gumbi, however, moved to assuage the fears of Committee members by noting that great strides had been made in this area. The Ministry was encouraged to see Universities going out of the way to recruit black teachers to head department. The University of Pretoria now has a black Dean at the medical school. There is presently some reorganisation at the office of higher education to deal with the question of redistribution of educational posts.

The Chair, nonetheless, warned of the smokescreen of appointing people as figureheads whilst the middle layer remained solidly disproportionate.

Finally, Dr Cwele (ANC) revisited the issue of doctors in the public service engaging in remunerative work outside their terms of service.

The Chair observed that the issue goes to the question of discipline, which was endemically lacking in the public service.

Dr Mbalawa (ANC) noted that the problem of medical personnel moonlighting in the private sector was rampant in the Eastern Cape.

Professor Gumbi explained that the idea of medics seeking remunerative work was introduced to arrest the exodus of medics to the private sector. It was meant to allow them to subsidise their low pay in comparison to their colleagues in the private sector. The facility was terminated, however, when it was noted that the medics give priority to private work at the expense of public duty. They paid lip service to their public service work to the extent that there were no doctors to supervise students.

Professor Gumbi remarked, further, that the government was setting up a structured mechanism to reinstate the facility but on very strict terms. The emphasis would be on the fact that public service work takes precedent over private work. Other issues to be covered would be the area of conflict of interest, not to sacrifice the central responsibility to public service work, how to treat classified information, and with prior permission could be withheld depending on the circumstances.

The meeting was adjourned.