South Africa has a chronic shortage of skilled physicians, yet, at a pre-election debate organised by the Soul City Institute in Johannesburg, health minister Aaron Motsoaledi dismissed the idea of the private sector training doctors when he stated, “We can do it, but the day you implement it forget about poor children going to study medicine. Medicine would be a degree for the super-rich. If we do it, we’ll kiss goodbye to the training of children from rural areas. They will never become doctors. That is the danger” (Business Day, Doctor plan may exclude poor from training. Apr. 14, 2014).
How confounded can the minister’s thoughts be! If the private sector were allowed to train prospective students, it would free up space in government-run medical schools and allow even more doctors from disadvantaged backgrounds to be trained. And, why would the private sector not train poor children? Surely they would be interested in attracting the best and brightest minds irrespective of their financial background – and offer financial assistance in the normal way in the form of a bursary.
South African private hospitals are well-established centres of excellence and world-renowned for their high levels of care. Privately run education facilities, if conducted in co-operation with private hospitals, have the potential to attract internationally recognised lecturers, which, in turn, will increase the available pool of knowledge as well as international students, who quite possibly will continue to work in SA. Unlike government, the private sector has an immediate economic incentive to ensure that doctors who qualify at their institutions measure up to SA’s high standards. Fears that they will not are unfounded.
Last year the minister said, “It costs R750,000 to train a South African medical student in Cuba, but double that to train them here (in SA)” (Business Day, Minister mulls Russia training for SA doctors. Mar. 14, 2013). Importantly, if the number of students per class were to increase, the cost for training each student would decline. So the first action should be to lift the barriers to the admission of more students. Also the minister glosses over the fact that South African students going to Cuba have to study in Spanish and on their return to South Africa have to relearn medical vocabulary in English, let alone that SA with a “quadruple burden of disease” has a very different disease profile to Cuba which renders medical training in Cuba virtually useless and requires doctors returning to SA, to be effective, to undergo further training on the job anyway.
Allowing the private sector to train doctors right here in SA will free up scarce taxpayer resources and give government more bang for its buck – more doctors for the same amount of money. The Minister seems intent on sending prospective students off to despotic nations at the South African taxpayers’ expense rather than training them here where they will receive a more appropriate education.
Every year, thousands of potential candidates, even those who achieve distinctions in their matric examinations, are turned away because the number of positions available at SA’s eight government-run medical schools is limited to around a meagre 2,000 positions. This number has increased only fractionally since the early 1970s, despite our rising disease burden and a population that has more than doubled.
The reason a country trains doctors is not for the sake of production but for the sake of consumption – so that patients, rich and poor alike, don’t have to queue for hours to see a doctor and to ensure that, when they do, they are seeing someone able to deal with their ailment. Indeed, Adam Smith wrote over 200 years ago, “Consumption is the sole end and purpose of all production; and the interest of the producer ought to be attended to, only so far as it may be necessary for promoting that of the consumer. The maxim is so perfectly self-evident that it would be absurd to attempt to prove it”.
The minister once again has revealed his true colours – he is for some reason that only he can explain, opposed to the private sector even if it comes at the expense of the health and wellbeing of this country’s citizens. When you’re ill, you don’t care whether your doctor was trained at a private or government-run facility, only that he is there and that he can do the job.
This article was first published in the May edition of IPA News.