The training of healthcare professionals: An expense or an investment?

Abstract

Many South Africans living in rural areas do not have access to affordable, quality, comprehensive healthcare, despite considerable government investments in programmes to strengthen the healthcare system. In their study, Pillay et al. [1] found that the burden of poverty and disease in South Africa (SA) is highest in rural areas, while Benatar et al. [2] confirmed that public and private health resources are skewed towards urban areas. Within the context of free primary health services, substantial barriers to receiving care remain, as accessing health services can be a challenge [3] owing to high transport costs. More than 15% of poor rural households live >1 hour away from the closest clinic, and 20% >1 hour away from the nearest hospital. [4] Compounding these challenges, is a critical shortage of health workers in SA, as cited by Moyimane et al. [5] In 2013, it was estimated that SA had 60 doctors per 100 000 population compared with a global average of 152/100 000. [4] Large inequalities also exist in the distribution of healthcare resources between rural and urban areas, which exacerbate the challenge of accessing quality healthcare. In 2004, a study conducted by Hamilton and Yau [6] estimated that only 12% of doctors and 18% of nurses were serving 46% of the national population who lived in rural areas. These challenges are acknowledged in many government strategies, and are the focus of the proposed National Health Insurance (NHI) and Human Resources for Health strategy, which aim to provide a comprehensive and equitable health service to all South Africans. [7] However, there can be no healthcare without a health workforce, and the dream of universal health coverage cannot be achieved without a considerable injection of resources into the training of healthcare professionals (HCPs). [8] A few studies have investigated the cost of educating HCPs in SA, and have tracked the resources and efforts required to maintain an adequate supply nationally. [9-11] The aim of this article was to assess the financial return on investment of HCP education using data from the Umthombo Youth Development Foundation (UYDF) scholarship scheme to determine whether the costs associated with their education should be viewed as an expense or as an investment. The UYDF has been supporting rural youth to train as HCPs since 1999, and by the end of 2017, had produced 337 graduates across 16 health disciplines, with an annual pass rate of >90% for the past 10 years. [12,13] The aim of the scheme is to address the shortages of qualified HCPs at rural hospitals by identifying, training and supporting rural youth to graduate in various disciplines. The UYDF education and training process involves an integrated model of recruitment at school level, selection at rural hospitals, support during education and training, and employment support and retention on return to the local rural workplace (Fig. 1), the details of which have been previously described by MacGregor et al. [14] Methods A desk-top economic analysis was undertaken to calcu...

Are return-of-service bursaries an effective investment to build health workforce capacity? A qualitative study of key South African policymakers

“…For instance, South Africa's public health sector has 0.64 anaesthetists per 100,00 population, compared to 9.69 in the private health sector whereas the country only needs 5 per 100,000 population [5]. The country's public health sector also only has 33 per 100,000 medical practitioners compared to a global average of 176 per 100,000 population [5][6][7]. Similarly, public sector primary care facilities are only serviced by 29.1% of the required professional nurses and midwives [5].…”

“…Cuba with an agreement that after their training, they will return to serve their provinces for a specified period of time [13,14]. Some NGO RoS schemes like the Umthombo Youth Development Foundation [6,15] and the Friends of Mosvold Scholarship scheme [16,17] have previously been reported on in more detail and found the schemes to have a good return on investment [6,[15][16][17]. However, to date, there is little literature scrutinising the challenges, implementation process and sustainability of the government sponsored schemes [4,13,[16][17][18][19][20][21].…”

Reflections on a rural road to family medicine

“…Where FP posts do not yet exist, tertiary or regional posts may be well repurposed and deployed to district level to facilitate this process. Finally, to extend an existing model, 2 – recruiting candidates from rural communities for later inclusion in local FP programmes might present exciting prospects.…”

The Curriculum Ideologies Underlying the AfriMEDS Curriculum Framework for Undergraduate Medical and Dental Education in South Africa

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