Medical training programmes need overhaul to address doctor shortage

The South Africa-Cuba medical doctor training programme has been a catastrophic failure, yet during his State of the Nation address, President Cyril Ramaphosa announced that South Africa will continue to send medical students to the despotic island nation.

President Ramaphosa stated, “Through bilateral student scholarship agreements we have signed with other countries, we are steadily building a substantial cohort of young people who go overseas each year for training in critical skills. We have seen the impact this can have with the Nelson Mandela Fidel Castro Medical Training Programme in Cuba, which has produced over 1,200 medical doctors and a further 640 students are expected to graduate in December 2020.”

In 1997, the South African government established the Nelson Mandela-Fidel Castro Medical Collaboration Programme to reduce the chronic shortage of skilled doctors in South Africa and avoid the supposedly high cost of training them here. However, in 2018 South Africa’s former Minister of Health, Dr Aaron Motsoaledi admitted that the Cuban medical training programme is not coping with the numbers of students that South Africa has sent to Cuba to be trained and conceded that it was more expensive than medical training in South Africa. Moreover, when these Cuban-trained students return to South Africa to complete their studies, there were insufficient doctors and specialists at the academic hospitals required to supervise the extra students. To compound matters, South African students going to Cuba must study in Spanish and on their return to South Africa relearn medical vocabulary in English.

Apart from the language barrier, these foreign trained doctors are often also ill-equipped to adequately handle problems unique to South Africa. Our country suffers from a “quadruple burden of disease” made up of communicable diseases such as HIV/AIDS and TB; maternal and child mortality; non-communicable diseases (NCDs) such as hypertension and cardiovascular diseases, diabetes, cancer, mental illnesses; as well as injury and trauma due to violent crime and road accidents. The types of treatment (both in-patient and out-patient), medication, primary and other care needed in South Africa is therefore not like that of other countries.

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 South African government-run medical schools is limited to around a meagre 1,800 positions. This number has increased only fractionally since the early 1970s, despite our rising disease burden and a population that has more than doubled.

Add to this our ageing population, which will require more treatments for chronic ailments in future, you cannot fail to see that the 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 exodus of skilled personnel from the public health sector are poor salaries, high workloads, poor work environments, and few opportunities for any meaningful advancement.

We have long suggested that to tackle the chronic shortage of skilled doctors, rather than sending students off to a far-flung, despotic nation that has a completely different disease profile, the government should allow more skilled healthcare professionals from abroad to practise medicine in South Africa, increase the number of positions available at government-run medical schools, and allow the private sector to train doctors. However, the government not only refuses to allow the private sector to train doctors, it also prohibits prospective doctors from completing their community service and medical internships in the private sector, which would lessen the burden on the budgets of provincial government departments.

South African private hospitals are world-renowned for their excellence and high level of care. Privately run education facilities, conducted in co-operation with private hospitals, would attract internationally recognised lecturers. Such an increased pool of knowledge would lure international students to our shores, who, once qualified, may continue to work in South Africa. Unlike government, the private sector has an immediate economic incentive to ensure that doctors who qualify at their institutions measure up to South Africa’s high standards. Fears that they will not are unfounded.

Private medical schools may not solve the medical staff shortage overnight, but they would assist in increasing the number of medical professionals with skills appropriate to meet South Africa’s healthcare challenges. Students, who wish to become medical doctors, need not be sent to a communist island prison.

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, do not have to queue for hours to see a doctor, and to ensure that, when they do meet the doctor, they are seeing someone able to deal with their ailment.

Author Jasson Urbach

This article was first published in Grey Matter News, first issue of 2020

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