South Africa’s new medical school that is expected to open in 2028 at North West University plans to help trainee doctors to better understand the complexities of practising medicine in rural areas, writes Nthusang Lefafa in Spotlight.
The North West University (NWU) Medical School will be built in an area that has one of the lowest doctor patient ratios in South Africa, with only 0.31 doctors per 1 000 people in the province – roughly a fifth of the one doctor per 1 000 people recommended by the WHO, said Jannie de Beer, chief director for strategy and planning at the North West Department of Health.
The facility will be in the university’s Faculty of Health Sciences, which already trains pharmacists, nurses, dieticians, biokineticists, psychologists and social workers, and which will add medical doctors to the mix.
Curriculum designed for a rural setting
The NWU has extensively consulted provincial stakeholders to ensure a curriculum is developed that is purpose-built for a rural setting and local facilities, said Dr Jurgens Staats, a specialist family physician and a “module lead” involved in developing the school’s curriculum.
“We have taken a holistic approach by involving specialists whose expertise ranges from curriculum development and healthcare systems, to experts 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.”
The NWU medical school would improve rural healthcare in three ways, he added.
“By training with early, regular exposure to primary healthcare and rural facilities, students will gain intimate knowledge of community health and the realities faced by patients in these areas.
“Second, 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.
“Third, a medical faculty with training opportunities should attract more specialists and academics as well as specialists in training.”
Complex task of training doctors
Professor Binu Luke, project lead for the NWU Medical School, said they planned to take in the first group of students in 2028, although the ground work still needed to be laid.
“This includes development of curriculum (to be completed in October this year), and getting the necessary regulatory approvals from the 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 were hoped to be completed by 2026 so that student-selection can be done in 2027 and the course can start in 2028.
Student selection would involve pupils from rural schools, starting with 50 students per year, increasing to 100 and then more as the facility 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 the source of the budget, he said the funding would be addressed only after the process to establish the medical school has been finalised.
But will there be jobs for doctors?
Despite South Africa’s worrying shortage of medical professionals in public service, some medical graduates still struggle to find work. The SA Medical Association Trade Union (SAMATU) attributed this to budget constraints and administrative hurdles.
Another reason was that some students studied at universities abroad, at times sponsored by government, where the academic curriculum was not compliant with the standards set out by the council, said the union.
Earlier this year, SAMATU 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 these, 694 had completed their community service on 31 December 2023, and most of them have applied for medical officer posts across the provinces.
The HPCSA database shows 46 420 doctors registered as medical practitioners in 2019, of whom 40.5% were women. Not all of the registered doctors, however, are working in South Africa. They might, for example, be living in other countries, be unemployed or retired, or 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 government’s part.
He said the health budget should be increased so that more money could be spent on HR, infrastructure and rural health, although he also acknowledged that the economy was depressed.
“An increase in funding the health budget is a challenge because of the country’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 was focusing on recruiting, training and retaining doctors to work, especially in rural areas.
“One of the plans is the Occupation Specific Dispensation (OSD) which looks at how to improve the remuneration of health workers, especially as the public health sector is 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.”
While remuneration has been identified as a major challenge, there are other issues as well. “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 would reduce the numbers of those who study abroad because of placement issues in SA due to limited space or not being able to gain entry at a particular university.
Van Niekerk, who is part of the team selected for curriculum development at the medical school, 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 in Klerksdorp and Tshepong.
She said many South Africans have to resort to studying in other countries, like Cuba, on government bursaries.
“When they return to SA, they have to write SA board exams. Once they start their internship here, the gap they have to bridge from being a student to being a doctor is much bigger than for those students who trained in this country.
“The learning curve is a lot steeper for them purely because they were trained differently, with less hands-on experience, less exposure to illnesses that are common in South Africa,” she added.
‘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, said he was pleased NWU was establishing a medical school using a rural and district health lens.
He noted, though, that the notion of rural training is not new, citing 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.
Moshabela said Cuban-trained students “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 – going 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, the NWU will have to measure the success of its medical school on the relevance to its rural context and ability to cater for the needs of its population.”
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