South African Medical and Dental Practitioners (SAMDP) Chairperson, Dr P J Maelane
Deans of the Faculties of Medicine present
Distinguished guests
Ladies and gentlemen
I am honoured to be invited as guest speaker at this gala dinner of the South African Medical and Dental Practitioners, to address this large audience from the medical and dental profession.
As the minister responsible for ensuring the quality of education and training of professionals in this field as well as ensuring that we contribute to the needs of the sector, we have a strong relationship with the Department of Health. I would like to take this opportunity to congratulate my colleague Minister Aaron Motsoaledi for the sterling work he is doing, particularly to improve the public healthcare sector and in the fight against HIV and AIDS. In particular, I have pledged the support of my department in the HIV Counselling and Testing (HCT) campaign. Last month, I wrote to all the colleges and universities in the sector to support the Department of Health's HCT campaign recognising the vital role that our institutions can play in reaching out to our citizens especially the young and vulnerable.
Education and health have been identified by this government as key priorities and the provision of equitable health care for the citizens of our country is as critical as provision of post-school opportunities. We are responsible for the training of health professionals through our public institutions and it is of paramount importance that the challenges of expansion of health care for all must feature very high on our delivery agenda. I am reminded often that the relationship between these two inter-related goals is strong and thus must be suitably synchronised to ensure that we make progress.
I must commend the remarkable and enterprising work undertaken by the South African Medical and Dental Practitioners (SAMDP), both through its influential capacity with regard to transformation and its policy contribution in health and educational sectors. SAMDP has in the past and now continues to be an active role player in health industry transformation. There is a vital need for an organisation such as this to advance a shared agenda of ensuring ethical standards, quality service and accessible health care throughout South Africa.
The dilemma which faces all of us in government as policy makers and implementers is the very often elusive goal of equity of access to health care. There is a deep consciousness that along with other components of the health system like efficient health care institutions and medical facilities, we need to focus on the production of health professionals that the university sector produces. I am acutely aware of the challenges that we face and am sure that we share the same concerns.
I am sure that you are patently aware of the extent of the shortage of medical professionals and the impact on the system. For instance, research undertaken by Dr Nicholas Crisp of Benguela Health Pty Ltd shows that between the years 1997 to 2006 there has been a decrease of 25 percent in the numbers of specialists on the public sector pay roll from 3 782 in 1997 to 2 928 in 2006. Many of these were academic clinicians involved in the training of doctors and provision of specialist services to the public sector. The number of medical practitioners on the public sector payroll has increased from 9 184 to 9 958 from 1997 to 2006, an increase of 774. These are statistics illustrate why there is an urgency for us to address the supply of appropriately qualified health care professionals at all levels for the country.
In this same period 5 000 specialists and 12 000 MB Ch B students graduated. This indicates that whilst South Africa could and should produce more doctors, employment and retention of doctors and dentists in the public health and education sector and in the country is a problem. This is something we must address as a matter of urgency. Whilst we can urge our universities to expand output, we need to ensure absorption of graduates within the health sector and into the academic sector, to provide career opportunities and a secure working environment for medical and dental professionals and academic clinicians.
South Africa compares unfavourably to other countries on ratios of medical professionals to 1 000 population. World Health Organisation data for 2008 shows South Africa to have 0.77 physicians (medical professionals) per 1 000 population, compared with 1.85 and 1.8 for Brazil and Mexico respectively and 2.47 and 2.3 for United Kingdom and Australia respectively. The United Kingdom has 120 000 doctors for a population of 60 million and South Africa with a population of 50 million has 25 000 doctors. Nine thousand of our medical professionals were practicing outside South Africa in 2006. We need to attract these doctors back to South Africa. This remains a major challenge.
Addressing this shortage requires an integrated strategy and requires cooperation with our colleagues and comrades in the national Department of Health and National Treasury. My department has undertaken important steps towards addressing the shortage and providing the necessary support to universities to strengthen the training of medical and dental professionals. The essence of the strategy has been to restructure the financing of health science education, especially the clinical training component. This year, I appointed Professor Malegapuru Makgoba to Chair the Health Sciences Review Committee to ensure that we have leadership of experts to guide and assist the work of my department.
Stakeholders in this committee include representatives from the Departments of Higher Education and Training and Health, the National Treasury, the Health Professions Council of South Africa and Higher Education South Africa (HESA).
In 2008 the committee was requested to include a review of the Health Professional Development Training Grant (HPDTG) of almost R2 billion per annum on the budget vote of the Department of Health. This grant is an important tool in trying to achieve the goal of improving the number and quality of health professionals. This grant's primary aim is assist in overcoming some of the challenges faced in the training of health professionals. I am confident to say that this grant has assisted the various medical schools in the training of health professionals in various disciplines.
The committee has finalised a report with recommendations regarding the efficient and effective use of this grant that I believe is on its way to me for consideration. Once I have perused the contents and consulted with my Cabinet colleagues from the National Treasury and the Department of Health on the recommendations, we can work together with a common purpose. I am confident that the recommendations of the reviewed HPTDG once approved will assist in the improvement of training of health professionals in South Africa. This is of significance because government's contract to the people is to provide quality services to South African from all walks of life.
Although these clinical training grants have managed to ease some of the difficulties faced by the relevant stakeholders in the training of health professionals, it is common knowledge that the country faces a big challenge in the production of the much needed health professionals and also the availability of supervisors to train students. The already over stretched health sector needs urgent innovative long-term solutions that will ease this pressure on the health sector. In achieving this goal, the public sector, private sector and all relevant stakeholders need to work together if any significant progress is to be achieved.
The Department of Higher Education and Training is committed and will continue to engage all relevant stakeholders and partners in trying to forge away forward in tackling these immense challenges. I am in discussion with Minister Motsoaledi to consider some urgent actions:
* Expand in 2011 the number of specialists and sub specialists in training, as well as undergraduate doctors, dentists and health professionals in training
* Recruit internationally for academic clinicians to fill the current gap whilst we expand training and developing our own bigger pool of academic health professionals
* Improve retention of academic clinical staff involved in Health science education through improved access to funds for academic staff from clinical training grant and health professions training and development grant
* Expand training sites to rural and peri-urban areas thereby improving access to medical and health services in areas of need
* Expand training to the private sector as a mechanism for co-financing and collaboration in line with the Minister of Health's objectives for public private partnerships in health care and reaching the objectives of National Health Insurance.
Success of the implementation of the DHET strategy rests on the cooperation and commitment of our colleagues in the faculties of health sciences, the national and provincial Health departments, the academic hospitals, the private health sector, and in the medical and dental professionals.
Included in the budget vote of my department is a R680 million clinical training grant for 2010/11 and 2011/12 allocated to 22 universities. It is anticipated that the clinical training grant will continue post 2011/12.
The clinical training grant was designed to address the problems in clinical training and is limited to the following uses:
* Appointing additional clinical training staff
* Appointing other staff to support the delivery of clinical training services
* Supporting partnership agreements with public and/or private providers of clinical training services
* Meeting part of the operating costs of clinical training service delivery.
The grant is allocated to Deans of Faculties of Health Sciences based on detailed plans and audited reports that meet the above criteria. Very positive reports have been received from Faculties of Health Sciences on the usefulness of this grant to build health science education.
On the issue of HIV and AIDS, the HEAIDs programme in the university sector is managed by Higher Education South Africa (HESA) on behalf of the Department of Higher Education and Training. With the financial support from international donors and my department, the universities have managed over the past few years to implement a programme that has aimed to:
* To define roles and responsibilities of the universities and the sub-sector in addressing the pandemic and in developing and implementing appropriate policies
* To develop norms and standards for sustainable funding models and mechanisms at institutional level with respect to the challenges posed by HIV and AIDS
* To identify and clarify the specific role to be played by teacher education faculties in addressing the pandemic
* To identify, contextualise and replicate best-practice with respect to, inter alia, prevention, behavioural change, care and support, gender (including masculinities) and curriculum integration
* To support and strengthen knowledge generation, assimilation and dissemination
* To support HEIs' human resource capacities and systems' development with respect to the challenges posed by HIV and AIDS.
I believe the SAMPD is an important partner to government in our mission to improve healthcare in South Africa. You will know that important groundwork is being conducted by government for the introduction of the National Health Insurance (NHI). As important stakeholders, we look forward to your support to ensure that every South African, rich or poor, black or white, employed or unemployed, is covered by this (NHI). We must move away from the current unequal and unjust, regime, where more than 60 percent of resources poured into health services benefit only about 14 percent of the population. We must also ensure that no one is turned away from any health facility or institution, whether it be a public or private institution, whether they have medical aid or not.
Ladies and gentlemen, in closing I would like to thank the SAMDP for giving me the opportunity to speak here tonight. I would like to urge all stakeholders to continue the good work either in the training of health professionals or service provision and also continue the fight against HIV and AIDS.
I thank you.
Issued by: Department of Higher Education and Training
15 May 2010
Source: Department of Higher Education and Training (http://www.education.gov.za/)
