Nthusang Lefafa speaks to public health experts to find out how a new medical school at North West University will do things differently.
A new medical school that is anticipated to open its doors for learning in 2028 will set out to help trainee doctors better understand the complexities of practicing medicine in rural areas.
The North West University (NWU) Medical School will be the country's 11th medical school in what is considered a rural province with one of the lowest doctor-patient ratios in the country.
There are only 0.31 doctors per 1,000 people in the province - this is roughly a fifth of the one doctor per 1,000 people recommended by the World Health Organisation (WHO) - according to Jannie de Beer, the chief director for strategy and planning at the North West Department of Health.
The new medical school will be located in the university's Faculty of Health Sciences, which already trains pharmacists, nurses, dieticians, biokineticists, psychologists, and social workers. The medical school will add medical doctors to the mix. Spotlight has previously reported on challenges facing the North West health department.
A curriculum designed for a rural setting
The NWU has gone to great lengths to consult various stakeholders in the province to ensure they develop a curriculum that is purpose-built for a rural setting and local facilities, Dr Jurgens Staats told Spotlight. Staats is a specialist family physician and a "module lead" involved in developing the school's curriculum.
"In developing the curriculum, we have taken a holistic approach by involving specialists from various backgrounds. These experts range from curriculum development to healthcare systems, as well as various medical specialists with knowledge of the local facilities and resources. In other words, this curriculum is not a copy-paste exercise, but custom-built to ensure maximum impact," said Staats.
He said that the NWU medical school will improve rural healthcare in three ways.
"Firstly, by the way, students will be trained with early, regular exposure to primary healthcare and rural facilities, and students will gain intimate knowledge of community health and the realities faced by patients in these areas.
"Secondly, academic development and research in rural topics by medical professionals will augment research studies already conducted by other schools within the faculty of health sciences.
"Thirdly, a medical faculty with training opportunities should attract more specialists and academics along with specialists in training."
The complex task of training doctors
Professor Binu Luke, project lead for the NWU Medical School, said the plan is for the medical school to take in its first group of students in 2028 although the groundwork still needs to be laid.
"This includes the development of curriculum (to be completed in October this year), getting the necessary regulatory approvals from Health Professions Council of South Africa (HPCSA) and Council on Higher Education (CHE)," he said, adding that infrastructure would also need to be built and additional staff appointed.
These processes, said Luke, are set to be done and dusted by 2026 so that selection of students can take place in 2027 and the course can start in 2028.
He said that student selection will involve pupils from rural schools. The school will start with a total of 50 students per year, increasing to 100 and then more as the school expands its clinical training programme.
The final costs to establish the NWU medical school will only be determined as the process unfolds, according to university spokesperson Louis Jacobs. When asked about where the budget will come from, he told Spotlight that the funding for the medical school will be addressed only after the process to establish the medical school has been finalized.
But will there be jobs for the new doctors?
Despite South Africa's worrying shortage of medical professionals in public service, some medical graduates struggled to find work. According to the SA Medical Association Trade Union (SAMATU), this is due to budget constraints and administrative hurdles. Another factor cited by the HPCSA was that some students studied at universities abroad, at times sponsored by the government, where the academic curriculum was not compliant with the standards set out by the council.
Earlier this year, SAMATU said their records showed that the country had at least 800 unemployed medical doctors. In January, the National Health Department said there were 825 unemployed doctors in the country. Out of this number, 694 had just completed their community service on 31 December 2023. They said most of these have applied for medical officer posts in the various provinces.
According to the HPCSA database, there were 46,420 doctors registered as medical practitioners in 2019, of which 40.5% were women. Not all doctors registered with the HPCSA are however currently working as doctors in South Africa - they can for example be working in other countries, be unemployed or retired, or be working in other jobs.
Professor Peter Barron from the Wits School of Public Health believes part of the problem of getting doctors employed boils down to poor human resource planning on the side of government.
"A long-term human resource plan is required in South Africa and it hasn't been done properly. This requires planning to be done 10 years in advance so that we do not have an overproduction of doctors and specialist posts that are not funded," he said.
An analysis recently published by Spotlight looked more closely at what some are describing as the overproduction of doctors in South Africa.
Barron says the health budget needs to be increased so that more money can be spent on human resources, infrastructure, and rural health, although he also acknowledged that the country's economy is not doing too well. "An increase in funding the health budget is a challenge due to South Africa's slow economic growth - these factors are linked," he said.
Recruit, train, and retain
Tebogo Lekgethwane, spokesperson for the North West Department of Health, said the department plans to recruit, train, and retain doctors to work, especially in rural areas.
"One of the plans is the Occupation Specific Dispensation (OSD) which looks at ways of improving the remuneration of health workers, especially since it was realized that the public health sector was losing skilled practitioners.
"We also have the Health Professionals Recruitment and Retention Strategy. Rural allowance is one of the incentives used to lure doctors into staying in rural areas," he said.
Lekgethwane added that while remuneration has been identified as a major challenge, there are other challenges too. "We have also improved accommodation of health professionals and make sure they are accommodated closer to where they work."
Fewer students will need to be trained overseas
Another potential benefit of the NWU Medical School, according to Dr. Hanri van Niekerk, is that it will reduce the number of learners who end up studying overseas due to placement issues because of limited space or not being able to gain entry at a particular university in the country.
Van Niekerk is part of the team selected for curriculum development at the medical school. She is a junior specialist physician in the internal medicine department at the Klerksdorp/Tshepong Hospital Complex in the Dr Kenneth Kaunda District. The facility provides primary, secondary, and tertiary services through its two sites which are located in Klerksdorp and Tshepong.
She says many South Africans have to resort to studying in other countries, for instance in Cuba on government-funded bursaries, in order to have an opportunity to study medicine.
"When these students who studied overseas return to SA, they have to write SA board exams. Once they start their internship in South Africa, the gap they have to bridge from being a student to being a doctor is much bigger than for those students who trained in South Africa.
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"The learning curve is a lot steeper for them purely because they were trained differently, less hands-on experience, less exposure to illnesses that are common in South Africa," says Van Niekerk.
'Vanguard of training'
Dr Mosa Moshabela, Professor of Public Health and Deputy Vice-Chancellor for Research and Innovation at the University of KwaZulu-Natal and soon to take up the role of Vice-Chancellor of the University of Cape Town, told Spotlight he is pleased that NWU is setting up a medical school for the training of doctors using a rural and district health lens.
He noted though that the notion of rural training is not new, citing examples in Walter Sisulu University and Nelson Mandela University, which are both primary healthcare oriented, and adopt inter-professional education, where doctors are trained alongside other health professionals.
"I, therefore, believe NWU does not need to feel any pressure to copy other medical schools, but rather stay with their value proposition of a district health system in a predominantly rural province, in an era of the National Health Insurance (NHI).... In this way, NWU could be the vanguard of training doctors who are well-equipped to operate in the context of the NHI," he told Spotlight.
Moshabela said students who have been trained in Cuba have also taught us a lot about the need to emphasise health promotion in a district health system model of education, where doctors look after populations in their living context as opposed to only people who are already sick coming to clinics and hospitals. "A population health approach means the starting point for training is a focus on the needs of the population, or the demand side, versus the emphasis of a 'standard' package of services, or the supply side approach," he said.
Ultimately, said Moshabela, "the NWU will have to measure the success of their medical school on the relevance to the rural context where they are located and ability to cater for the needs of their population".
