Private medical schools could solve SA’s chronic doctor shortage

According to a Business Day news report by Edward West (SA students set to study medicine in Cuba, 6 Jan), “Students from South Africa will be allowed to study medicine in Cuba while paying their own tuition fees”. For every South African who, no doubt, will require medical attention at some time in their life, this is a very curious development. Especially when one considers that our very own private sector has shown a keen interest in training doctors right here in South Africa. Indeed a few years ago, a private institution applied to establish a medical school in Midrand, Gauteng, but was turned down by government. This, no doubt, has quashed interest by others contemplating the same move.

Every year, thousands of potential candidates, who achieved stellar results in their matric examinations, are turned away due to the limited number of positions available at SA’s eight medical schools. Many capitulate and switch to other disciplines and some find innovate ways to temporarily by-pass the obtrusive entrance restrictions and bide their time by enrolling in other courses before switching to medicine at a later date. Others choose to leave SA and study abroad, perhaps never to return. And now, how many of our bright young South Africans who are determined to work as doctors are being provoked into moving to a despotic country far away in order to get a foot in the door back in their home country, South Africa?

Edward West quotes Dr Vusumzi Mehlo, an intern at the Mahatma Gandhi hospital in KwaZulu-Natal (KZN), who said, “[His] six years of study in Cuba had prepared him well to become a doctor, even though he had to learn Spanish”. However, Dr Mehlo continues, “Cuban doctors concentrated on primary healthcare... the level of care was such that doctors seldom treated patients with HIV/AIDS or tuberculosis...”

According to Econex, South Africa has a “quadruple burden of disease” which is no doubt due to the high prevalence of HIV/AIDS and TB. In fact KZN has the highest number of reported HIV/AIDS and TB cases in the country where over one-fifth (23.1%) of prime aged adults (aged 15-49 years) in the province are infected with HIV/AIDS (compared with the national average of 17%) and there is an estimated 1,163 TB cases per 100,000 population (well above the national average of 820 cases per 100,000 population). But how would an individual who has specifically been trained in preventative techniques be “well prepared” to deal with a disease burden of epidemic proportions? In this case, we require local solutions to local problems.

According to the Health Systems Trust annual publication South African Health Review, in 2010, 42.5 per cent of health professionals’ posts were vacant in the public sector, up from 33 per cent in 2009, and 27 per cent in 2005. Clearly the demand for healthcare services is outstripping supply and the situation is worsening by the day. Of further concern is that the backbone of South Africa’s healthcare system, namely, trained nursing staff, is ageing rapidly. Only 3 per cent of registered nurses are 30 years or younger, whereas over 40 per cent are older than 50 years. These statistics paint a bleak picture and it is obvious that the country is simply not training a sufficient quantity of skilled healthcare personnel.

An obvious short-term solution to the chronic shortage of skilled healthcare personnel would be to allow foreign skilled healthcare personnel to practice in SA, without any restrictions on where they are allowed to work and for whom. A longer term solution would be to relax the restrictions and allow SA’s brightest students to pursue their dreams of studying medicine. Allow the private sector to establish private medical schools. Whether they operate on a for-profit or non-profit basis, their establishment will definitely alleviate the burden.

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 a significant number of internationally recognised lecturers, which will increase the available pool of knowledge, as well as attract international students, who will, potentially, remain to work in SA. The private sector has an economic incentive to ensure that the doctors who qualify at their institutions will measure up to SA’s very high standards and any fears that they will not are unfounded. Privately run medical schools cannot solve the chronic medical staff shortage overnight, but will assist the government’s long-term efforts to increase the number of medical professionals in our country.

AUTHOR Jasson Urbach is a director of the Health Policy Unit (a division of the Free Market Foundation). This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation.

FMF Policy Bulletin / 10 January 2012

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