The Truth and Reconciliation Commission's (TRC) recommendation that medical schools should increase the intake of black students at undergraduate and postgraduate level has failed to solve racial imbalances in the provision of doctors in the country. Although the recommendation helps set a moral guideline for institutions it lacks the capacity and necessary pragmatism to facilitate demographic change in the health sector.
Tertiary institutions have attempted, through affirmative action policies, to increase the intake of black students. These attempts have been limited by the fact that many undergraduate black students do not make it to graduation in medical schools. The few that do, do not continue at post graduate level. This is due to a variety of problems, most of which are rooted in the past and in some institutions due to a lack of transformation.
A study carried out by Moomal, Pick and Edwards in 1998, showed that historically white institutions are still predominantly white. In addition black students still face major hurdles prior to being accepted into medical schools, such as the entrance procedures that are modelled on education systems that a lot of blacks have not been exposed to. For those that are accepted they continue to face difficulties. The result is that training institutions have high attrition rates. The use of English language, for example, which is not a first language to many black students, remains an ongoing challenge for many black students. Some reasons that account for this attrition, as well as minimal enrolment, include the legacy of the past education system and financial difficulties which many black students continue to face.
According to data received this year, at Stellenbosch University only 1% of MBChB first year undergraduates are African and 69% are white. Coloured and Indian students constitute 30%. At postgraduate level 76% are white and 24% are "others". At the University of Pretoria, 71.5% of postgraduates are white and the remainder are African, Coloured and Asian. According to their 1999 statistics about 33.2% of all undergraduates were black, whites are 62.47%, and 4.3% are Asian and Coloured. The number for black students dropped this year to 21.31% while that of the Asian and Coloured students rose to 6.39% and whites dropping by 0.18% to 62.29%.
According to Moomal et al, in one medical university where African students constituted 13% of first years, 56% of them failed. At another medical school 70% of all African students were excluded because they could not fulfill the academic requirements. The case is somewhat similar at a postgraduate level. At Wits University 61% of postgraduates were white when at undergraduate level they only constituted 42%. At Natal University 18% were black postgraduates while 44% were undergraduates.
There are also arguments that universities that run bridging programmes fall short because they are not financially viable. The students who need these programmes are normally from poor families and therefore cannot afford to pay for these programmes as they can only be partially funded by the universities. The situation becomes blatant financial exclusion and it serves to exacerbate the unequal production of doctors that disadvantages poor black students.
If a poor black student makes it to graduation, soon after that they are expected to take over the roles of being 'breadwinners' in their families. For others corporate attraction after graduation is irresistible. Thus postgraduate education remains therefore a luxury that only the wealthy can afford according to Moomal and colleagues. Even, if one assumes that students from rural areas have the interests of their communities at heart, it becomes easy to conclude that increased intake of black students at medical schools, as the recommendation suggests, does not help alleviate the shortage of doctors in rural areas where the problem is severe.
The University of Western Cape conducted a study in February 2000, which showed that only the three historically black medical schools (Natal, Medunsa, and Unitra) are keeping black students in overwhelming majorities. While the numbers are not declining in the historically white universities, they have been rising at a slow pace. For instance, in 1994 the proportional representation of black students registered for the MBChB nationally were just below 30% and rose to about 32% in 1999. The number of white students declined from 57% to 45% at the same time.
The results of the disparities are that although conditions are changing for many in South Africa, for others they remain the same. The pools of recruitment for the white medical schools remain the affluent regions of the country and the not the rural poor areas. These disparities undermine the processes of entrenching equal rights for everyone. Clearly, although more black students need to be brought into the universities, they also need to be supported once they are there. The fact that the production of more black doctors is in the interests of the nation as a whole is undisputable and the questions that sticks is whether the responsible institutions are doing enough to change.
Sibusiso Ntuli is a former Researcher at the Centre for the Study of Violence and Reconciliation.
Originally published in Mail & Guardian, 29 September-5 October 2000.