Severe underfunding of health students and internships risks quality healthcare, say health professionals

The state entity responsible for providing quality health laboratory services, training and research has been continually underfunded.

The National Health Laboratory Service (NHLS), which is the largest diagnostic pathology service in the country and supports the national and provincial health departments in the delivery of healthcare, was responding to comments made by the South African committees of Dental Deans (SACoDD), Healthcare Sciences Deans (SACoHSD) and Medical Deans (SACOMD) on Monday, 4 December 2023.

The associations facilitate the collective interaction of deans with other stakeholders on academic matters related to health sciences education, research and the health system.

They issued two statements on Monday calling for a meeting with Health Minister Joe Phaahla and Higher Education, Science and Innovation Minister Blade Nzimande to discuss the lack of funding for students and the placement of health graduates in posts.

Higher Education, Science and Innovation Minister Blade Nzimande. (Photo: Gallo Images / City Press / Tebogo Letsie)

They also stated their concerns about the future of academic health platforms such as the NHLS because of the chronic underfunding of health infrastructure and professional education and training.

NHLS spokesperson Mzimasi Gcukumana said the institution received a conditional grant from the National Treasury for teaching, training and research, which has historically been underfunded.

“As a result, the NHLS has been subsidising the teaching, training and research function over the years to ensure that it fulfils its mandate,” Gcukumana said.

However, Gcukumana said, owing to budget cuts, the NHLS would have to shoulder a more significant burden in subsidising the training function.

“The NHLS prioritises and continues advertising positions for pathologists and registrars,” he said.

Despite the budget cuts, he said the NHLS was determined to fill all budgeted positions, prioritising the recruitment of skilled professionals who would contribute to advancing medical science and improving public health outcomes.

The NHLS, he said, was the sole provider of training for pathology registrars in the country.

The training function formed part of the NHLS’s three-pronged mandate to provide diagnostic pathology services, training and research.

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‘Ministers intervene’

The calls from the associations come amid reports that the National Treasury has cut the budget for the National Student Financial Aid Scheme (NSFAS) for the 2024 academic year by a whopping R13.7-billion and that 87,000 beneficiaries could be left unfunded.

In the first statement issued on Monday, the associations stated that the recent developments in student funding, the challenges associated with NSFAS and the implementation and management of stable, consistent monthly payments to health sciences students and all students in general, had brought into sharp focus the challenges facing students in SA.

“The deans are deeply concerned about the impact the NSFAS challenges have on our students, particularly during the very critical stage in their academic calendar at this time of the year. We call on all stakeholders to urgently resolve the situation for all students to allow students to focus on their academic activities,” the statement reads.

They said it was NSFAS’s responsibility to provide an immediate, socially sustainable environment for their students and not exacerbate a situation described in media reports as a “no food and living allowance crisis”.

“The deans have grave concerns about the future of academic sustainability of student life due to a malfunctioning funding system.”

They said they recognised the efforts of senior stakeholders to resolve the matter.

“The deans are calling on the government to take urgent and drastic steps to address the systemic student funding aid failures as a matter of priority and urge all involved to find a sustainable long-term funding solution as a matter of utmost urgency.”

Treasury cuts

In the second statement, the associations cited several reports that they said had brought into sharp focus the challenges facing the health system in SA.

They said the National Treasury issued a letter to national and provincial treasury departments on 31 August 2023 advising accounting officers and accounting authorities on specific measures required to achieve savings and prevent potentially crippling resource constraints in the latter part of the 2023/2024 financial year.

“Budget cuts emanating from this Treasury announcement will most certainly impact on the South African health system and does not create an enabling and supportive environment for the eventual realisation of a health system based on the concept of universal health coverage,” the statement reads.

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In an already-overburdened health system struggling to cope with the health demands of communities, and with existing evidence of staff burnout, the associations said staff morale was likely to worsen because of the lack of financial support, increased stress and feelings of helplessness.

“The deans of Dental, Healthcare Sciences and Medical faculties across the country remain committed to partnering with the National Ministry of Health, the provincial departments of health, the NHLS, the Department of Higher Education, and engaging civil society organisations and other stakeholders to ensure that our health system delivers accessible and good quality care to all citizens.”

They stated that graduating high-quality health professionals and ensuring that all South African healthcare graduates were absorbed into the country’s health system would contribute significantly to the quality of care provided.

Impact

The associations say the systemic failures in the health system have resulted in:

• Compromised patients and communities where the quality of care does not meet the required standard;


• A disproportionate impact on the health and wellbeing of women and children, especially in rural areas, and worsening gender inequity in the country; and


• Inadequate training platforms and clinical staff to produce high-quality health professional education and training.

“The absence of a national integrated and comprehensive health system plan, poor human resource planning and poor governance and management of the health system continue to destabilise these academic health platforms.”

The associations said that despite multiple interventions by Phaahla and his department, it was their view that the health system in SA remained in crisis.

Drastic action

The associations said that the National Treasury’s recent decision and the resultant budget cuts for the health sector would exacerbate the health system crisis.

“The deans are calling on the government to take drastic steps to address the systemic failures as a matter of priority. An optimal health system in SA is a prerequisite for well-functioning academic health platforms to train and graduate quality health professionals at undergraduate and postgraduate level (including at specialist and sub-specialist levels).”

They said that failing to adequately fund internships and community service placements for graduating health professionals represented a serious human resources challenge.

“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.”

The government must also similarly commit to finding the funding to place all students who graduated from the Mandela-Castro Medical Collaboration from 2019 onwards in internships and community service posts.

Phaahla and Nzimande, they stated, should urgently finalise the discussions with the National Treasury so that a commitment was made to protect the health sector from any of the austerity measures and budget cuts.

“The constitutional right to healthcare for all in the country must not be compromised.”

They said the two ministers should convene a meeting with representatives of the deans’ committees to address matters of implementation regarding the filling of posts and employment of health workers to bolster the provision of quality healthcare in the provinces.

Health Minister, Dr Joe Phaahla. (Photo by Gallo Images/Foto24/Lulama Zenzile)

“The healthcare workforce remains a critical driver of the provision of good quality healthcare as well as being a critical driver of inclusive economic growth and a means of addressing gender inequity in the health workforce.”

They said the National Health Forum should be reconvened by 31 December 2023 to facilitate discussions that would enable the health and higher education 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 also ensure that funding can be made available for guaranteed allocation in internship and community service posts across the health professions.”

Nzimande’s spokesperson, Ishmael Mnisi, said Phaahla’s department was best suited to respond to questions.

“What I can mention on my side is that there is a joint management committee led by both the ministers to look at the interface or issue that affects both the Department of Health, Higher Education and Training and the Department of Science and Innovation. The issue of training of medical practitioners is among the priority issues discussed by this joint committee,” Mnisi said.

Questions were sent to Phaahla’s office and NSFAS on Wednesday, 6 December 2023, but neither had responded at the time of writing. DM