the launch of the Discovery Foundation, Johannesburg
30 August 2006
Mr Adriaan Gore,
Dr Vincent Maphai and Discovery Foundation trustees,
Vice Chancellors,
University representatives,
Deans of medical faculties and other representatives from the medical
fraternity,
Distinguished guests,
It is indeed a great honour for me to be invited to participate in the
launch of what is to be a remarkable investment in medical education, and in
particular the training of medical specialists who come from disadvantaged
backgrounds.
Ladies and gentlemen, one of the stark realities of contemporary South
Africa is most evident in the limited quality and provision of healthcare,
infrastructure, and services in our poorer communities. South Africa has a
world-class health-care sector with outstanding medical experts, working in
well resourced hospitals and undertaking cutting edge research. Yet far too
many of our citizens do not receive adequate healthcare.
The Department of Health is, as you know, driving a number of initiatives to
remedy this situation. While the Department of Health is in charge of the
public health system in our country, the responsibility for medical education
and training lies primarily with the Department of Education. It is my
understanding that, in general, we do not train too few doctors or other health
professionals.
The challenge lies in encouraging them to practise in the public sector.
Most of the health spending is in the private sector that services only seven
million people, 5,2 percent of Gross Domestic Product (GDP). A smaller share is
spent on 35 million people in the public sector (3,5 percent of GDP). So the
challenge is that there is a skewed distribution of personnel between the
public and private sector. And it is aggravated by the escalating trend of
health professionals leaving the country.
Before and after 2 000 there was a significant unregulated expansion in
university student enrolments, but not in enrolments in our eight medical
schools (1 309 new doctors in 1999 and 1 296 in 2003) which is why there is
such competition for admission. Transformation there certainly has been. One in
four currently registered medical practitioners is a woman but two in four
medical graduates are now women. In time this transformation in our medical
schools will lead to a significant demographic shift in the ratio of women to
men in the profession. In fact, it is becoming common to hear complaints about
the feminisation of the profession and the lowering of standards! The
proportion of black medical graduates has increased in comparison with whites
but the small number of newly trained African doctors is still a cause for
concern.
Any future growth in our universities has to be planned to take into account
our development goals and our scarce-skills requirements. Recently a joint
Department of Finance and Department of Education working group report
highlighted four major resource problems in the public higher education
sector:
* lack of a link between increased volumes of Higher Education (HE) activity
and government funding
* the lack of a capital-funding programme
* the use of tuition-fee increases to balance institutional budgets
* the failure of academic staffing levels to keep pace with student enrolment
expansion.
While we are resolving these matters, initiatives like the Discovery
Foundation Awards will make an important contribution to transformation in the
medical profession. The National Student Financial Aid Scheme (NSFAS), which
has given about R55 million in loans to 3 400 students in the medical field
since 1994, needs strengthening. It takes a long time to become a doctor, five
years study and two years internship; it costs about R780,000 in all (R340,000
to train a nurse). All universities with medical schools provide bursaries for
medical students and provincial government and other institutions and
organisations do the same. The Discovery Foundation�s Excellence Award will
recognise such interventions. The other three awards focus on areas where we
need to encourage doctors to specialise or practise in rural areas as
specialists and in academic medicine.
In closing, let me repeat that our main challenge is to attract our medical
practitioners into the public sector and to retain them there. The majority of
medical practitioners in many public-health hospitals and in specialist areas
are young doctors or community interns or immigrant doctors. There is a general
migration of medical practitioners from rural health centres to urban areas,
from the public to the private sector and from South Africa to abroad.
Although emigration can be a constructive dynamic in terms of international
exchange and skills development we continue to be on the wrong end of an
unequal exchange in terms of international labour mobility. It is targeted and
structured interventions like the Discovery Foundation�s Fellowship Awards that
can begin to assist us in redressing these issues.
Ladies and gentlemen, again I would like to express my admiration of
Discovery�s remarkable initiative and to thank the Discovery Foundation
chairperson and trustees for all their hard work.
I thank you!
Issued by: Department of Education
30 August 2006
