How about private-run education facilities to train doctors in South Africa

Is anyone surprised that the programme which trains South Africans as doctors in Cuba has been a catastrophic failure? According to Business Day, Health Minister Aaron Motsoaledi said, “The Cuban government is not ... coping with these numbers, the provinces in their budgeting systems did not factor it very well, and it is too much for the South African universities to absorb”. (Big headache: Cuba-SA doctor training programme put on hold, Apr. 23, 2018).

For many years we have suggested that to address the chronic shortage of skilled doctors, rather than sending prospective students off to a far flung, despotic nation that has a completely different disease profile and requires students to learn in Spanish, the South African government should allow more skilled healthcare professionals from abroad to practice medicine in SA; increase the number of positions available at the government-run medical schools; and allow the private sector to train doctors.

Everyone is well aware of our growing population, let alone the dramatically increased burden of disease driven mainly by the onslaught of HIV/AIDS and TB, yet, despite greater demand, government has only slightly raised the number of available trainee doctor places at South Africa’s government-run medical schools from what it was in the 1970s. According to Martin Veller, who chairs this South Africa Committee of Medical Deans, “SAs medical schools graduate about 1,800 students a year”. Compare this to the 1970s when SA graduated about 1,200 students per year.

Meanwhile, SA’s population has increased from about 24.3 million in the mid-70s to the current estimate of 56.5 million, an increase of 32.2 million people. When you add to this our ageing population, which will require more treatments for chronic ailments in the future, you cannot fail to see that the current shortage of doctors is going to get even worse. Our poorly performing public healthcare system exacerbates this problem because it is driving our doctors away. Common reasons cited for the mass exodus of skilled healthcare personnel from the public sector are poor salaries, high workloads, poor work environments and few opportunities for advancement.

Yet, government still refuses to allow the private sector to train doctors and prohibits prospective doctors from completing their community service and medical internships in the private sector, which would alleviate some of the burden on provincial government departments’ budgets.

South African private hospitals are well-established centres of excellence and world-renowned for their high level of care. Privately run education facilities, if conducted in co-operation with private hospitals, have the potential to attract internationally recognised lecturers, which will increase the available pool of knowledge, as well as lure international students to our shores, who, once qualified, may decide to 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.

In 2014, 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”. However, as we pointed out at the time, the Minister’s thoughts are confounded.

If the private sector could train prospective students, it would free up space in government-run medical schools and allow more doctors from disadvantaged backgrounds to be trained. Moreover, what would stop the private sector from training poor children? Surely, they would be seeking out the best and brightest minds, irrespective of financial background, and offering financial assistance in the normal way in the form of a bursary.

In 2013, 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). However, the Minister has now revealed that the Cuban programme is more expensive than training in SA (Business Day, Big headache: Cuba-SA doctor training programme put on hold. Apr. 23, 2018). Rather than stopping the programme altogether, the Minister is intent on “scaling it back temporarily” – once again, revealing his true colours. Health Minister Aaron Motsoaledi is ideologically opposed to the private sector, even if the policies he pushes come at great taxpayer expense and threaten the health and wellbeing of SA’s citizens.

Privately run medical schools will not solve the chronic medical staff shortage overnight, but will assist the government’s long-term efforts to increase the number of medical professionals with the appropriate skills set to meet South Africa’s unique healthcare challenges.

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