Issued by: Ministry of Education
3 October 2000
Dean of the Faculty, Professor Nicky Padayachee
Staff and Students
Ladies and Gentlemen
Thank you for inviting me to speak on the challenges that face the Faculty of Health Sciences as it grapples with the transformation imperatives in higher education. I would like to apologise at the outset for the fact that I am unable to spend the full hour with you as allocated in the programme. This is due to the fact that the National Assembly is debating amendments to the Higher Education Act this afternoon. The amendments have been introduced to address gaps in the regulatory framework which have impacted on the policy and transformation agenda as outlined in the White Paper on higher education.
Although the details of the proposed amendments are not pertinent for the purposes of this meeting, it would be useful to highlight their main thrust, as they raise important issues related to the appropriate balance between institutional autonomy and public accountability, the implications of which important for this meeting. The amendments give the Minister of Education additional powers to regulate the scope and range of operations of public and private higher education institutions and to ensure that public institutions discharge their fiduciary responsibilities in a sustainable manner. I have no doubt that the opposition will argue in the National Assembly debate, that the amendments tilt the balance against institutional autonomy. This is not unexpected as the opposition argument is based on the premise that the market must be the determining factor in creating the appropriate balance between institutional autonomy and public accountability, especially in relation to competition, which the amendments seek to regulate, between public and private higher education institutions.
However, I am sure that you will agree with me that the future sustainability of the public higher education system cannot be left to the vagaries of the market. This will surely result in the systematic erosion of the public higher education system. The market, driven as it is by the drive for profits cannot sustain the breadth and depth of programmes that are necessary if higher education is to contribute to the social, economic and cultural development of South African society. Indeed, it is unlikely to sustain the comprehensive provision of programmes in the health sciences, in particular, the training of doctors, given the enormous costs involved.
Similarly, I want to suggest that institutional autonomy cannot be a pretext for undermining the transformation agenda, which is critical if the higher education system is to respond to the challenges of reconstruction and development. The government's commitment to institutional autonomy cannot be faulted. It is a central principle of the policy and regulatory framework for the transformation of higher education as outlined in the White Paper and the Higher Education Act. And this commitment has been effected in practice. The government has only intervened in institutional affairs as a last resort, after all attempts to ensure good governance and management has failed. If anything, government is open to the critique that it is not interventionist enough. This is certainly the case with regard to institutions experiencing governance and management crises, but it also applies in the context of the implementation of policy.
Indeed, this criticism has in particular, been levelled at the lack of an interventionist strategy in the health sciences. This should be familiar to those of you who have participated in the debate on the proposals to establish a central admissions system for the health sciences. There is no doubt in my mind that the raison d'Stre for the central admissions system is a sign of the frustration with the lack of change in the modus operandi of health sciences faculties. It is becoming very difficult to defend the principle of institutional autonomy when there is little evidence of, or at least a strong perception that not much has changed in higher education institutions. The point is that the real danger to institutional autonomy comes not from the government, but the lack of institutional commitment to and slow progress in implementing the transformation agenda.
It is against this background, in particular, the need for the previously advantaged; predominantly white institutions to demonstrate a commitment to the transformation agenda that I want to identify the challenges that face health sciences faculties in general and the UCT faculty in particular.
The first challenge that I want to highlight relates to the principle of equity. In terms of access, this refers both to equity of opportunity but also, more importantly, equity of outcome. It is not sufficient for institutions to point to the fact that the demographic composition of the student body is changing, without also showing the relationship between access and outcome. Access that leads to a "revolving door" syndrome for black students is unacceptable. The UCT faculty can clearly demonstrate success in terms of access, at least at the undergraduate level - the information I have suggests that the head count enrolment of black students has increased from 45% in 1996 to 53% in 2000. This has to be commended.
However, it has to be asked whether the progress that has been made is adequate or whether more could be done. In particular, are there blockages in the admissions policies, which if removed could facilitate further changes. In this regard, I want to pose a set of simple but obvious questions: Why is it necessary for democratic South Africa to have to send black students to Cuba for medical training? Why is it not possible for those students to be trained in our medical schools? If they cannot be admitted into our medical schools because they do not meet the criteria for admission, what does this say about the appropriateness of the criteria? What does it say about the learning and teaching methods in our medical schools? I want to suggest that the answers to these questions may say more about the values and ethos of our medical schools than they would about the potential of our students to pursue further study. I leave you to ponder this issue.
The data on graduation rates is however, more worrying with only 18% of undergraduates completing professional degrees in 1998 and 1999. Although I do not have the breakdown of these figures in race and gender terms, I am sure that in line with national trends the attrition rates of black students is likely to be much higher than that of white students. This suggests that much remains to be done to ensure that appropriate support programmes are put in place to ensure that access is coupled with success. However, aside from the equity implications, the low graduation rates are also worrying because they are an indication of inefficiencies and represent a waste of resources, something that we can ill-afford given the resource constraints in higher education.
Furthermore, the problem of access at the postgraduate level remains acute. Although there has been some progress, black students remain under 40% of head count enrolments at the postgraduate level. This is clearly a source for concern both because of the need for specialists in all fields, but also because it effectively precludes the changing of the demographic composition of the staff of the health sciences faculty.
The second challenge therefore relates to employment equity. Although I do not have the relevant figures for the faculty, it is not likely to be different from the national trend in which whites make up 80% of the academic staff at universities and men dominate the senior academic positions with some 90% of professors being men. This is clearly unacceptable. I recognise that achieving employment equity may be more difficult than achieving student equity given that we have a small pool of appropriately qualified black academics and given the competition for qualified blacks from the public and private sectors. It therefore requires that the faculty develops clear plans for achieving employment equity, including attracting more black postgraduate students as a potential pool of recruits. This will require, in addition, not only providing postgraduate scholarships but also creating the conditions that enable blacks students to feel at home in the faculty.
I was struck by a reported input at a workshop earlier this year in which the Director-General of Health, Dr Ayanda Ntsaluba, reflected on his choice of speciality. In reflecting on why he had chosen to specialise in Obstetrics and Gynaecology, he suggested that the only conclusion he could come to was that it was because it was the only department in the Medical School that had black faculty with whom he could readily identify and who served as role models. Dr Ntsaluba is further reported as stating that many of his contemporaries who chose specialities in which there were no black faculty dropped out before completing their studies. This speaks volumes of the impact of race and institutional cultures on the human resource development of our country in general. It provides ample evidence for those who remain sceptical of the government's employment equity policies of the critical importance of institutional cultures and role models in addressing the social and cultural impact of apartheid.
I accept that the role of institutional culture has largely been ignored in our policy framework for transformation of the education system in general. It requires urgent attention if the transformation project is to move beyond the politics of rhetoric. The Values, Education and Democracy Report, which I recently released, provides an emerging framework on which to build and address this critical issue.
The third challenge that I want to highlight relates to the relevance of the training programmes, in particular, the curricula. It goes without saying that if we to successfully address the health problems that face the country, health professionals must not only be trained to deal with the clinical or health aspects of these problems but also the social, economic and cultural context within which they occur. We need to develop curricula that not only create a balance between the preventive and curative health care, between primary, secondary and tertiary services, but also develops the social, communication and managerial skills necessary for health care workers to function effectively in the South African context. Health professionals must understand the life conditions, belief systems and the cultural practices of the rainbow nation and they must be equipped to deal with change and diversity, in particular, the appreciation, tolerance and the embracing of different views and ideas. In short, I want suggest that the curriculum must be embedded and give effect to the fact that that in terms of the Constitution, access to health is a basic human right.
The changes in the curricula must also be accompanied by the development of multiple training sites in urban and rural areas, suburbia and the townships, thus exposing health professionals to the full range of conditions, experiences and needs of different communities. This is essential if we are to produce health professionals who can contribute to addressing the health problems of the country. The fact that the evidence suggests that we are training health professionals, especially in the case of doctors, for emigration is a cause for concern. The need for our training programmes to be of the highest standard is without question. In fact, it must be of an internationally accepted standard. However, quality and standards are not abstract concepts but historically determined and linked to the broader objectives of society. Thus, it behoves our medical schools to define internationally accepted standards in the context of the health needs of country. I want to state emphatically that the curricula and training of health professionals must be linked to the social and economic context of South Africa as an emergent democracy and developing country. The failure to do so would have grave consequences for the health and well being of our people.
The challenges are clear. The choice that you face as a faculty is equally clear. Either you embrace and pursue with vigour, difficult as it may be, the transformation agenda or you remain wedded to past practice and inertia the business as usual syndrome. If you choose the path of transformation, you will have the full support of my Ministry. If not, then you will leave government with no option but to intervene. The choice is yours.
Thank you.
Contact: Bheki Khumalo at 021 465 7350 or 082 781 2660