A new breed: the thinking behind building a new medical school in North West

The plan is for the medical school to take in its first group of students in 2028

30 May 2024 - 12:24 By Nthusang Lefafa
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There are 0.31 doctors per 1,000 people in the North West, which is now set to get a medical school.
There are 0.31 doctors per 1,000 people in the North West, which is now set to get a medical school.
Image: 123RF

A new medical school expected to open its doors in 2028 will set out to help trainee doctors better understand the complexities of practising medicine in rural areas.

The North West University (NWU) Medical School will be South Africa's 11th medical school in what is considered a rural province with one of the lowest doctor-to-patient ratios in the country.

There are 0.31 doctors per 1,000 people in the province — about a quarter of the one doctor per 1,000 people recommended by the World Health Organisation — according to Jannie de Beer, the chief director for strategy and planning at the North West health department.

The new medical school will be located in the university’s faculty of health sciences, which already trains pharmacists, nurses, dietitians, biokineticists, psychologists and social workers.

A curriculum designed for a rural setting

The NWU has gone to great lengths to consult stakeholders in the province to ensure they develop a curriculum purpose-built for a rural setting and local facilities, Dr Jurgens Staats said. Staats is a specialist family physician and a “module lead” involved in developing the school’s curriculum.

“In developing the curriculum, we have taken a holistic approach by involving specialists from various backgrounds. These experts range from curriculum development, healthcare systems, as well as various medical specialists with knowledge of the local facilities and resources. This curriculum is not a copy and paste exercise but custom-built to ensure maximum impact,” said Staats.

The NWU medical school will improve rural healthcare in three ways.

“First, by the way students will be trained 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 and specialists in training.”

The complex task of training doctors

Prof Binu Luke, project lead for the NWU Medical School, said the plan is for the school to take in its first group of students in 2028, though the ground work still needs to be laid.

“This includes development of the curriculum (to be completed in October this year), getting the necessary regulatory approvals from the Health Professions Council of South Africa (HPCSA) and Council on Higher Education ,” he said, adding infrastructure would also need to be built and additional staff appointed.

These processes, said Luke, are to be completed by 2026 so selection of students can take place in 2027 and the course can start in 2028.

A long-term human resource plan is required in South Africa and it hasn’t been done properly. This requires planning to be done 10 years in advance so we do not have an overproduction of doctors and specialist posts that are not funded.
Prof Peter Barron

He said student selection will involve pupils from rural schools. The school will start with 50 students per year, increasing to 100 and then more as it expands its clinical training programme.

The cost to establish the NWU Medical School will only be determined as the process unfolds, according to university spokesperson Louis Jacobs.

Asked about where the budget will come from, he said the funding for the school will be addressed only after the process to establish the school has been finalised.

Will there be jobs for the new doctors?

Despite South Africa’s worrying shortage of medical professionals in public service, some medical graduates struggled to find work. According to the South African Medical Association Trade Union (Samatu), this is due to budget constraints and administrative hurdles. Another factor cited by the HPCSA was 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.

Earlier this year, Samatu said their records showed South Africa had at least 800 unemployed medical doctors. In January, the national health department said there were 825 unemployed doctors. Of these, 694 completed their community service on December 31 2023. Most have applied for medical officer posts in the provinces.

According to the HPCSA database, there were 46,420 doctors registered as medical practitioners in 2019, of which 40.5% were women. Not all doctors registered with the HPCSA are working as doctors in South Africa — they can, for example, be working in other countries, be unemployed or retired, or working in other jobs.

Prof 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 by government.

“A long-term human resource plan is required in South Africa and it hasn’t been done properly. This requires planning to be done 10 years in advance so we do not have an overproduction of doctors and specialist posts that are not funded,” he said.

An analysis recently published by Spotlight looked at what some are describing as the overproduction of doctors in South Africa.

Barron says the health budget needs to be increased so more money can be spent on human resources, infrastructure and rural health, though he also acknowledged the country’s economy is not doing well. “An increase in funding the health budget is a challenge due to South Africa’s slow economic growth — these factors are linked,” he said.

Recruit, train and retain

Tebogo Lekgethwane, spokesperson for the North West health department, said the department plans to recruit, train and retain doctors to work, especially in rural areas.

“One of the plans is the occupation specific dispensation which looks at ways of improving the remuneration of health workers, especially since it was realised the public health sector was 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.”

Lekgethwane added that while remuneration has been identified as a major challenge, there are others. “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 it will reduce the number of students who end up studying overseas because of placement issues such as limited space or not being able to gain entry at a particular university in South Africa.

Van Niekerk is part of the team selected for curriculum development at the medical school. She 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 says many South Africans have to resort to study in other countries, for example in Cuba on government funded bursaries, to have an opportunity to study medicine.

“When these students return they have to write South African board exams. Once they start their internship in South Africa, the gap they have to bridge from being a student to being a doctor is much bigger than for those who trained in South Africa.

“The learning curve is a lot steeper for them purely because they were trained differently, less hands-on experience, less exposure to illnesses common in South Africa,” says Van Niekerk.

‘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 is pleased NWU is setting up a medical school for training doctors using a rural and district health lens.

He noted though the notion of rural training is not new, citing examples in Walter Sisulu University and Nelson Mandela University, which are both primary healthcare orientated and adopt inter-professional education, where doctors are trained with other health professionals.

“I therefore believe NWU does not need to feel pressure to copy other medical schools but rather stay with their value proposition of a district health system in a predominantly rural province, in an era of the National Health Insurance (NHI). In this way, NWU could be the vanguard of training doctors well-equipped to operate in the context of the NHI,” he told Spotlight.

Moshabela said students trained in Cuba 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 coming 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, vs the emphasis of a ‘standard’ package of services, or the supply side approach.”

“Ultimately,” said Moshabela, “the NWU will have to measure the success of their medical school on the relevance to the rural context where they are located and ability to cater for the needs of their population”.

This article was first published by Spotlight

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