The South African Committee of Medical Deans (SACoMD) is an association formed to facilitate the collective interaction of the Medical Deans with other stakeholders in the country on academic matters related to health sciences education, research and health services.
The recent health workers strike in the North West Province and the news article in the Mail and Guardian 'Health Care Under Fire' has brought into sharp focus the challenges facing the health system in South Africa. The Deans are deeply concerned that industrial action by organised labour actively prevented the access to health care by the most vulnerable members of society and patients died. These events follow several significant events in the national health system including the Life Esidimeni tragedy, the ongoing oncology service provision crisis, the increasing burden of non-communicable diseases, which demand some introspection amongst those managing health services. These do not support an environment for realisation of a health system based on the concept of Universal Health Coverage.
The Deans of the Medical Schools are committed to partnering with the National Ministry, the Provincial Departments of Health, the National Department of Higher Education and Training and engaging with civil society organisation and other stakeholders to ensure that our health system delivers accessible and good quality care to all citizens. Graduating high quality health professionals and ensuring that all South African graduates are absorbed into the health system will significantly contribute to the quality of care provided.
The Mail and Guardian article 'Health Care Under Fire' sketches the dire state within six provincial health departments. The impact of the systemic failures in these health departments are (i) on patients where the quality of care is compromised and (ii) the training platform available for the training of medical students and specialist medical doctors, and other health professionals. The Deans have grave concerns about the future of academic medicine because of the chronic underfunding of health professional education and training. The absence of a national integrated and comprehensive health system plan, poor human resource planning, and poor governance & management of the health system continue to destabilise the academic health services. It is the view of the Deans of Medical Schools that the health system in South Africa is in crisis. The Cabinet's recent decision to place the North West Health Department under administration of the national government in the wake of the health worker protests and the appointment of the Intervention Task Team in Gauteng Health Department are indicative of a limping health system that is in deep crisis.
The Deans are calling on Cabinet to take drastic steps to address the systemic failures in the provincial health departments as a matter of priority. An optimal health system in South Africa is a prerequisite for a well-functioning academic health complex to train and graduate quality health professionals at undergraduate and postgraduate level (including specialist and sub-specialist levels).
The constant failure to adequately fund internship and community service placements for graduating health professional represents a serious human resource challenge and ethical concern. The Deans believe that the National Government has a duty to ensure that all South African students and those with permanent residence status should be placed in fully funded posts as this is a legal requirement for practice in the country. A concern is that permanent residency is being treated differently to South Africans in the allocation of internship positions. It is the Committee's view that National Government must consistently make funding available so that annually, all eligible students graduating from our universities are guaranteed funded placements in the South African health system. Government must also similarly commit to find the funding to place all South African students who graduate from the Mandela-Castro Medical Collaboration from 2020 onwards in Internship and Community Service posts.
The Deans are deeply concerned that the additional training sites required to complete the training of the medical students from the Mandela-Castro Medical Collaboration Programme are not fully prepared with only 60 days left before the first group of 720 students arrive in South Africa from Cuba.
The Deans call on the National Minister of Health, in consultation with the National Minister of Higher Education and Training and National Treasury, to urgently:
- (Mandela-Castro Medical Collaboration Programme) Ensure that all the training sites have been assessed and are ready to host the medical students returning from Cuba by 30 June 2018;
- (North West Province Strike) Engage with organised labour to ensure that industrial action does not limit access of patients to health services;
- Initiate a policy development process in conjunction with the universities that will result in the publication of the regulations governing Academic Health Complexes as provided for in the National Health Act of 2003, Chapter 7, section 51(a) and (b). The Deans believe that this process must resolve the issues related to policy, governance, organisation and management, and financing of academic Central Hospitals and the Academic Health Complex;
- Establish the National Tertiary Health Services Committee and National Governing Body for Human Resources for Health (incorporating Training and Development) by end July 2018. These National Health Insurance Implementation Structures will enable the health and higher education and training sector to jointly plan the short, medium and long-term future of health services and health professions education and training. The establishment of a joint workforce planning process will ensure that funding can be made available for guaranteed placements in Internship and Community Service posts;
- Facilitate engagements with the Parliamentary Portfolio Committee on Health to host open and public hearings during June and July 2018 on the crises in provincial health departments. The outcome of these hearings to be addressed by Cabinet and where necessary and appropriate, to use the constitutional provisions in Section 100 of the Constitution to address the systemic failures in provincial health departments.
We call on civil society to play their role to ensure that all South Africans have access to quality health care.
The Medical Deans are committed to the realisation of a health system based on the concept of Universal Health Coverage providing quality health services to all South Africans.
29 May 2018
Professor Martin Veller
Chairperson of South African Committee of Medical Deans
