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Address at the National Conference on the Financing of the Health Sciences Education, 16 May 2005, Minister Naledi Pandor speeches


Address by the Minister of Education, Ms Naledi Pandor, MP, at the National Conference on the Financing of the Health Sciences Education, Cape Town

Premier of the Western Cape, Mr Ebrahim Rasool
Deputy Minister of Health
MECs of Health
Vice-Chancellors and Deans
Distinguished Guests
Ladies and Gentlemen

I would like to thank you for inviting me to this national conference on the financing of health sciences education. I don’t have to spell of the importance of this conference to you, as all of you gathered here have in one way or another been involved in grappling with the complexities of the financing of health sciences education and, in particular, the impact of the current model, on the day-to-day running of health education training.

However, while all of the stakeholders here have been grappling with the issues, I understand that this is the first time that we have all come together to discuss and find solutions to the challenges of funding health sciences education.

I would therefore like to commend the Health Deans’ Forum of the Western Cape and the National Committee of Health Sciences Deans for taking the initiative in organising this conference.

I should confess at the outset that I accepted the invitation to speak with some trepidation, as I have not had the opportunity to familiarise myself or to engage with the issues relating to the funding of health sciences education.

This is both an advantage and disadvantage. It is an advantage because it allows me to listen and engage with the issues as they emerge without any pre-conceptions and positions to defend. It is a disadvantage, because I may well, in the issues that I raise and the comments that I make, risk boring you.

Therefore, what I raise today is more in the way of identifying issues and challenges, rather than presenting well-formulated views and perspectives.

I want to begin by stating the obvious, that is, that it is not possible to discuss the funding of health sciences education without linking it to the broader question of the responsiveness of the higher education system to the education and training of health professionals.

There are two questions that need to be addressed in relation to the responsiveness of the higher education system.

The first question is “training for what?” At the heart of this question is the issue of the curriculum and its relevance in the South African context.

It goes without saying that if we are to be successful in addressing the health problems that face the country, health professionals must not only be trained to deal with the clinical or health aspects of these problems but also the social, economic and cultural context within which they occur. We need to develop curricula that not only create a balance between preventive and curative health care, between primary, secondary and tertiary services, but also develops the social, communication and managerial skills necessary for health care workers to function effectively in the South African context.

Health professionals must understand the life conditions, belief systems and the cultural practices of all our people and they must be equipped to deal with change and diversity, in particular, to appreciate different views and ideas.

The changes in the curricula must also be accompanied by the development of multiple training sites – in urban and rural areas, suburbia and the townships, thus exposing health professionals to the full range of conditions, experiences and needs of different communities. This is essential if we are to produce health professionals who can contribute to addressing the health problems of the country.

The need for our education and training programmes to be of the highest standard, internationally accepted, is without question. However, quality and standards are not abstract concepts but historically determined and linked to the broader context of society and its development. I am sure that we can all agree that addressing the health needs of our people requires that the curricula and training of health professionals must be linked to the social and economic context of South Africa as a developing country.

I am aware that there have been a number of initiatives at the institutional level focusing on curriculum transformation in health sciences education. These are to be welcomed. However, it does seem to me, that it may be appropriate to consider undertaking, if this is not already happening, an assessment of the impact of these changes and, indeed, whether they have been far-reaching enough and are addressing the skills needed by health professionals.

The second question relating to responsiveness is this: is the higher education system producing the health professionals that we require and in the numbers that we require to meet the health needs of South Africa?

It is my understanding that in general the challenge we face is not that we are not producing enough health professionals, but rather that there is a skewed distribution of health professionals between the public and private sectors, with some 31% of posts in the public sector vacant in 2003. This is further compounded by what seems to be an escalating trend of health professionals leaving the country.

The underlying reasons, aside from historical factors relating to health service provision under apartheid, as well as the strategies to address this problem, can best be addressed by the Ministry of Health. What I am interested in assessing is whether, irrespective of the numbers that we are producing, the demographic composition of the students is changing in line with the equity goals of the transformation agenda in higher education.

In this regard, I am pleased to note that there has been steady progress. The available data for three professional fields, that is, medicine, dentistry and pharmacy, indicates that in total black enrolments have increased from 54% in 1999 to 65% in 2003. In the case of African students, their numbers have increased from 30% in 1999 to 40% in 2003. These changes are also reflected in the proportion of first-time entering students in 2003. This is to be welcomed. But clearly more needs to be done, especially in the case of increasing the representation of African students.

The progress in graduation rates is, however, slower and more worrying. In 1999, 48% of black students graduated in the three fields and this increased to 57% in 2002. This suggests that much remains to be done to ensure that appropriate support programmes are put in place to ensure that access is coupled with success. However, aside from the equity implications, the low graduation rates are also worrying because they are an indication of inefficiencies and represent a waste of resources, something that we can ill-afford given the resource constraints in higher education.

There has also been steady progress at the postgraduate level. The enrolment of black students in the three fields has increased from 40% in 1999 to 58% in 2003, with African students increasing from 24% to 32%. Furthermore, although black student enrolments at the doctoral level have increased from 26% in 1999 to 43% in 2003, this remains a source for concern, because it effectively precludes the changing of the demographic composition of the staff of the health sciences faculty.

As far as employment equity is concerned, although I do not have the relevant figures for the health sciences, it is not likely to be different from the national trend in which whites make up 80% of the academic staff at universities and men dominate the senior academic positions with some 90% of professors being men.

It may be more difficult to achieve employment equity than achieving student equity given that we have a small pool of appropriately qualified black academics and given the competition from the public and private sectors. It is therefore imperative that clear plans are developed for achieving employment equity, including attracting more black postgraduate students as a potential pool of recruits. This will require, in addition, not only providing postgraduate scholarships, but also creating the conditions that enable blacks students to feel at home in the faculty.

How does this broader issue of the responsiveness of the higher education system to the education and funding of health professionals relate to the funding of health sciences education? The answer to put it simply is this: is the funding of health sciences education adequate to enable higher education institutions to respond to the range of issues that they are expected to address?

I cannot answer the question directly. However, I can indicate that I am concerned about the overall level of funding for higher education and, as I have announced recently, the Department of Education jointly with the Treasury will be undertaking a detailed investigation of the costs and funding of higher education to assess whether the funds available are adequate to enable higher education institutions to discharge their teaching and research mandate.

Furthermore, because of the priority attached to the training of health professionals and recognising the concerns raised by the Committee of Deans of Health regarding the funding of health sciences education, this will form a specific sub-component of the investigation.

I want to turn now, albeit briefly, to the critical issue that this conference is addressing, that is, the appropriateness or otherwise of the current funding for health sciences education, in particular, the complexities involved given that it cuts across different state departments, as well as different levels of government.

It is my understanding that there are two inter-related issues that are at the core of the problem that needs to be addressed. The first relates to the tension between the teaching and research mandate of higher education institutions and the service delivery needs of the provincial health departments. This is a natural tension but it seems that increasingly the pressure is to focus on service delivery at the expense of teaching and research.

The Committee of Health Deans have evidence to indicate that there has been a 12% decline in research publications between 1999 and 2004 in the field of clinical medicine, which is dependent on and takes place in hospitals. This suggests that staff time for clinical research and teaching is being reduced as a result of service delivery pressures, which in all probability is compounded by the fact that there are significant vacant posts in the public sector.

I do not want to underplay the importance of service delivery given the health needs of our country. However, it seems to me that unless we ensure that service delivery is underpinned by teaching and research, we stand the risk of compromising our ability to extend quality health care to all our people. I am sure that we can all agree that teaching and research in a clinical context is critical to understanding the pathology of disease and therefore to developing appropriate treatment regimes.

The second issue relates to the tension between the funding of pre-clinical training nationally through the higher education budget vote and the funding of clinical training through the health vote based on a conditional grant that is administered provincially. Aside from the issue of service delivery, this arrangement is further complicated by the fact that there is no national framework to inform the joint agreements between higher education institutions and the provincial departments of health that underpin the teaching and research platform, including staffing.

This arrangement is fundamentally flawed. It seems to me that given that higher education is a national competence, the clinical aspects of health training should also be located at the national level, especially as there are only eight medical schools, which service the country as a whole.

I am not suggesting that the funding of clinical training should be transferred to the education vote. On the contrary, given the service delivery imperative, it should remain with the health vote but located and administered at the national level. This will enable the development of a single framework and set of principles that would underpin the establishment of appropriate teaching and research platforms across the country as a whole.

In conclusion, I look forward to the outcomes of your deliberations over the next two days. I am confident that if we work together and apply ourselves to the tasks at hand, we will find the solutions to ensure that we develop a high quality health education and training system of which we can all be proud.

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Written By: Administrator Account
Date Posted: 6/30/2008
Number of Views: 649

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