Information from a parliamentary reply (included below) shows that, in total, the number of doctors qualifying in South Africa actually fell between 2004 and 2008, from 1 394 to 1 306, despite our country's desperate need for more doctors.

Put together with the fact that 17% of doctors leave South Africa after they have qualified, and South Africa faces a grim scenario in terms of improving its health system.

The drop in graduates was largely the result of a decline in output at universities in provinces where the need for doctors is most acute - Limpopo, the Eastern Cape (Walter Sisulu University) and the Free State.

At the University of Limpopo, for example, the number of graduates fell by more than a third, from 238 to 150.

Research shows that medical staff tend to remain and practice in the areas where they live and study.

What is notable about the reply is the complete inadequacy of the Minister of Higher Education and Training's proposed solutions.

Three scenarios are presented, involving increases to output by the various universities ranging from 3% to 6%.

But not only is this increase inadequate for South Africa's needs, but it fails to take into account the obvious capacity problems at several medical schools, indicating that even maintaining the status quo is difficult or impossible.

The most obvious solution is to bring in the private health sector to assist. South Africa's private health care industry is large and vibrant and is very willing to be involved more constructively in solving the problems of the private sector. But the state-centred ideology of the ANC government, and this minister in particular, appears to automatically exclude this option.

WRITTEN REPLY

QUESTION 270

DATE OF PUBLICATION OF INTERNAL QUESTION PAPER: 19/02/2010

(INTERNAL QUESTION PAPER 2 OF 2010

Ms P C Duncan (DA) to ask the Minister of Higher Education and Training:
(1) How many medical graduates graduated from each medical school in each of the five most recent specified years for which information is available;
(2) whether his department has any plans in place to increase the number of medical graduates; if not, what is the position in this regard; if so, (a) what plans, (b) how many additional medical graduates will result from the implementation of these plans and (c) at what stage of development are these plans? NW286E
REPLY:
(1) Number of medical graduates from 2004 to 2008
Institution 2004 2005 2006 2007 2008
University of Cape Town 159 150 185 160 164
University of Limpopo 238 294 239 200 150
University of KwaZulu-Natal 178 298 201 189 224
University of the Free State 167 106 105 129 109
University of Pretoria 180 197 207 198 200
University of Stellenbosch 148 150 170 149 167
University of Witwatersrand 205 247 170 175 189
Walter Sisulu University 119 69 89 97 103
TOTAL 1394 1511 1366 1297 1306

(2) (a) The preparing of growth projections in the health sciences is part of the brief of the Health Sciences Review Committee. This is a joint committee of the Departments of Finance, Heath and Higher Education and Training. It is administered by the Department of Higher Education and Training, and includes as members representatives from HESA and the HPCSA.
The Review Committee has concentrated its work on enrolment and graduation models for those undergraduate health sciences programmes which require access, for clinical training purposes, to provincial hospital services. These programmes include the MBChB.
The Health Sciences Review Committee's enrolment and graduation models for the MBChB have allowed it to construct three scenarios for the period 2008 to 2020 for the eight universities which offer MBChB degrees.


Scenario 1
(b) The Department of Higher Education and Training has allocated infrastructure and clinical training funding to five universities which had indicated that they could increase their new intakes of MBChB students by 3% per annum. On this low growth scenario, the number of clinical students requiring access to provincial hospital services would, by 2020, be 665 (or 16%) higher than the total for 2008. The total of MBChB graduates would increase by only 175 (or 14%) in 2020 compared to 2008.
Scenario 2
This is a medium growth scenario. It assumes that all eight universities will increase their new undergraduate intakes by 3 percentage points above scenario 1. So the first five universities would be given 6% new intake growth targets, and the remaining three 3% growth rate targets. On this growth scenario, the number of students in the clinical years would, by 2020, be 1843 (or 43%) higher than the total for 2008. The total of MBChB graduates would increase by 504 (or 40%) in 2020 compared to 2008.
Scenario 3
This is a high growth scenario. It assumes that all eight universities will increase their new undergraduate intakes by a further 3 percentage points above scenario 2. On this scenario, the number of students in the clinical years would, by 2020, be 3059 (or 72%) higher than the total for 2008. The total of MBChB graduates would, on the scenario, increase by 800 (or 63%) in 2020 compared to 2008.
The Health Sciences Review Committee has begun to determine what the costs would be of these and other enrolment and graduate growth scenarios in health sciences programmes. It has noted that the initial cost demands of growth in the MBChB will be high, even in the years before increased totals of graduates begin to emerge from the system. Costs will have to be incurred in employing additional academic staff as enrolments in the preclinical years begin to grow. Provision will have to be made for additional academic teaching space, particularly class rooms, class laboratories and staff offices.
A major bottle neck in the system will be the demands which increases in clinical training will place on provincial hospital services. As enrolments grow in the clinical years (which would be three years after intakes increase), provision would have to be made for rapid increases in new training beds in provincial hospitals services. Provision would also have to be made for additional clinical supervisors and for additional service staff and running costs in those hospitals which are involved in the training of students.
(c) The Health Sciences Review Committee will complete its work on these enrolment and cost models during the 2010/11 financial year. Its report will be submitted in the first instance to the Minister of Higher Education and Training.
Compiler/ contact persons: JE Skene