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South Africa: Training Doctors Who Will Stay in SA 'Is a Dilemma'
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Business Day (Johannesburg)
22 July 2008
Posted to the web 22 July 2008
Sue Blaine
Johannesburg
THE R800m the education department has given to SA's eight medical schools to improve infrastructure and teaching capacity is not enough - nor was it intended to increase the number of doctors graduating each year, which has been stuck at about 1400 for at least the past five years.
This is despite the health department's calculation that SA needs to double the number of doctors (MB ChB graduates) produced each year, bringing the annual number of people graduating with an MB ChB to 2400 by 2014, to meet the country's needs.
While expanding SA's eight medical schools' capacity to train doctors is not only dependent on more money - because the teaching hospitals themselves have only so many patients available for groups of medical students to learn from - the money that has just been handed over by the education department is ring-fenced for improving infrastructure and taking on more qualified staff to train students.
"It's for improving, not expanding, clinical teaching. We (the medical schools) don't know if we'll get more money after this, so we (Stellenbosch University) won't be expanding," says the university's director of the Centre for Health Sciences Education, Prof Ben van Heerden.
The money was made available after a committee of medical school deans entered discussions with Education Minister Naledi Pandor.
They brought to her attention their growing concerns about how clinical training was suffering because of a lack of funding, says Pretoria University's medical school chairman, Prof Gerhard Lindeque.
"There was a shared concern between the committee, the education department and the treasury, but this money (the R800m) is not a magical wand.
"It will be used to appoint clinical trainers and for apparatus and infrastructure. It's redress, and one day, when we are back up to scratch (on training staff numbers, equipment and infrastructure) we will have to ask for more (before we can train more doctors)," he says.
Consideration of how much money was needed to increase the number of students health sciences faculties could train was part of a wide-reaching process through which the education department was determining how it could increase the number of students graduating in scarce and critical skills such as medicine, engineering, teaching and accounting, said the department's chief director of higher education policy, Dr Molapho Qhobela.
The problem of the limited number of patients in teaching hospitals was a constraint mentioned by senior staff at seven of the eight medical schools.
There are discussions afoot on whether Limpopo University should have two medical schools, the current one at the old Medunsa campus in Ga-Rankuwa just outside Pretoria, and another in Limpopo, or whether a satellite medical school should be established in Northern Cape.
"Satellites are less costly," says the University of the Free State's medical school head, Prof Gert van Zyl.
It is important that any new medical training institution is placed in a rural area, says Prof Gonda Perez, deputy dean of the University of Cape Town's health sciences faculty.
"We would like to train generalists who are able to operate in primary healthcare.
"We do need more doctors, but ones who will work in rural areas, so we need a medical school there," she says.
This brings up another enormous problem SA faces - the big loss of graduated health sciences staff, especially doctors and nurses.
"It would be fantastic if people wouldn't leave.
"That's the biggest problem we have," says the University of the Witwatersrand's health sciences faculty's dean of student affairs, Prof Ahmed Wadee.
While migration figures are very underreported because people often neglect to declare that they are emigrating, Statistics SA reported in 2003 that SA had lost 203 doctors.
There has been a steady increase in the number of qualified doctors leaving since 1990 when 30 are recorded as having left, says Human Sciences Research Council education researcher Dr Mignonne Breier.
She says that 1991 "was our best year ever; we lost 23, but in those years (1990-94) we gained a lot of doctors too.
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"It's not clear if these were people returning with the new dispensation, but, for example, in 2003 we lost 203 and gained 54, so our net loss was 156," Breier says.
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