Scientists in Ghent, Belgium have made a major breakthrough in sepsis research. In a study on mice, the researchers demonstrate that vitamin B1 (thiamine pyrophosphate, TPP) restores mitochondrial energy metabolism, drastically reduces lactate production, and increases survival rates in sepsis. The study results were published in Cell Reports.
Sepsis, the body’s runaway reaction to an infection, affects vital organs such as the heart, lungs, liver, and kidneys, while patients experience an excessive buildup of lactic acid in the blood.
Each year, sepsis affects 49.5 million people worldwide and claims 11 million lives. To date, there is still no targeted treatment for this condition. New research from the VIB-UGent Center for Inflammation Research may now represent a breakthrough. In a study led by Professor Claude Libert, a Ghent-based research team has discovered a simple yet powerful therapeutic approach: a combination of vitamin B1 and glucose.
Vitamin deficiency causes an energetic blackout
In 2021, the same research group had already shown that lactic acid accumulates in the blood of sepsis patients because the body can no longer efficiently clear it. Lactic acid is a metabolite that builds up in our muscles after intense physical exercise. Under normal circumstances, lactic acid is processed by the liver, but in sepsis patients, this process comes to a halt. When too much lactic acid remains in the bloodstream, the patient’s blood pressure plummets rapidly, often with fatal consequences.
With a new study, the research group has now uncovered why lactic acid is produced in such large quantities in the first place and how this can be counteracted. The answer turns out to be remarkably simple and clinically relevant: an acute shortage of vitamin B1 in the mitochondria – the cell’s energy factories – forces another molecule, pyruvate, to be converted into lactic acid.
“For the first time, we’ve been able to show that the problem in sepsis is not so much a lack of oxygen, but a fundamental biochemical defect caused by vitamin B1 deficiency,” explains Louise Nuyttens, lead author of the study. “This shuts down the entire energy network in the body and creates a vicious cycle of lactic acid production and organ damage.”
An effective treatment for sepsis
As the next step, the researchers investigated whether they could restore energy metabolism by administering vitamin B1. In mouse models, they observed that such treatment drastically reduced lactic acid production and improved survival rates. But the real breakthrough came when they combined vitamin B1 with glucose.
“Although it seems logical to give severely ill patients extra glucose, this often leads to more lactic acid production, which is undesirable in sepsis patients. Thanks to vitamin B1, however, we were able to reprogram glucose metabolism. Glucose was safely converted into pyruvate and then into energy, rather than into toxic lactic acid,” explains Louise Nuyttens.
“The results are truly spectacular,” says Prof. Claude Libert. “In our severe sepsis animal models, nearly all mice survived with the combination of vitamin B1 and glucose. This is one of the most powerful metabolic interventions we’ve ever seen, acting on very simple mechanisms that make it quickly translatable to intensive care.”
Bad blood
Beyond its scientific impact, the societal relevance is also significant. These new insights may offer a path toward a globally applicable therapy for a condition as deadly as heart attacks or strokes, but far less recognised.
The research group now plans further preclinical studies in larger animal models to test whether this therapy also works in patients already in an advanced stage of sepsis.
As healthcare reform gains momentum in South Africa, value-based care is becoming a hot topic – but meaningful progress has yet to take hold. The biggest hurdle? How care is purchased. Despite clear signs of stagnation, most funders remain committed to the same failed approach and have yet to drive the change that is needed.
“It’s encouraging to see a move away from fee-for-service thinking and a growing focus on value-based care. But to turn that interest into action will require real system reform – starting with strategic approaches to purchasing care that support system reengineering,” says Lungile Kasapato, CEO of PPO Serve, a healthcare management company that has been implementing value-based care in South Africa for more than a decade.
At its core, value-based care flips the script on how private healthcare is purchased in South Africa. Instead of rewarding volume, it prioritises prevention, puts patients at the centre, and ties payment to measurable outcomes. This stands in stark contrast to the dominant fee-for-service model, where doctors and hospitals are incentivised to provide more services rather than focus on delivering effective care.
A leading example of value-based care in practice is The Value Care Team, operationally supported by PPO Serve. This GP-led multidisciplinary programme broadens access while keeping costs in check. Teams are paid a risk-adjusted global fee to provide holistic patient care, along with substantial incentives tied to improved outcomes. The result is a model that aligns payment with patient outcomes – not the volume of services delivered.
To put it simply, Kasapato explains; “With value-based care, you don’t pay for every kilometre run, you pay to cross the finish line. And that finish line means improved health outcomes, prevention, and system efficiency.” For patients, primary healthcare under The Value Care Team looks and feels completely different. With no scheme benefit limits to navigate, patients are supported by a dedicated care coordinator who guides them through decisions made by their nominated GP and allied professionals. Each clinical team member has a complete picture of the patient’s health, working collaboratively rather than competitively to share accountability for delivering better outcomes.
This new approach to delivering primary care in the private sector isn’t just an isolated test run – it’s being developed and refined in real time. “We’re not just talking about value-based care, we’re implementing it,” says Kasapato. “At PPO Serve, we partner with practices to navigate day-to-day challenges, while working with medical schemes to design payment models that enable strategic purchasing. The Value Care Team is proof that value-based contracting isn’t just possible – it’s already happening in South Africa’s healthcare system.”
For this approach to take root and scale, medical schemes and state funders must take the lead by creating the market incentives that encourage providers and hospitals to adopt new ways of working. The Competition Commission’s 2019 Health Market Inquiry warned that without bold reform, South Africa’s private healthcare sector could face collapse – a warning that remains just as relevant today. But there is still an opportunity to change course. By embracing a strategic purchasing role, funders can help drive the system-wide transformation that’s urgently needed.
The Value Care Team is already leading by example, with a presence across Gauteng and KwaZulu-Natal, as well as in Bloemfontein and Gqeberha. Recognised by the World Health Organisation and featured in international peer-reviewed research as a breakthrough case study in emerging markets, the programme is actively driving real change – improving care coordination, cutting waste, and reducing unnecessary hospital admissions. Even so, Kasapato points out, the journey is far from over; “There is still a lot to learn from and with others as we move from talking about value to actually implementing it.”
Pretoria – The Health Ombud, Professor Taole Mokoena, has released the findings of an investigation into the treatment, complications, and deaths of psychiatric patients at the Northern Cape Mental Health Hospital (NCMHH) and the Robert Mangaliso Sobukwe Hospital (RMSH). The investigation revealed that two patients died, and another underwent craniectomy and remains bedridden.
The investigation was initiated following a complaint filed by the Honourable Minister of Health, Dr. Aaron Motsoaledi (MP), regarding the Northern Cape Mental Health Hospitals in October 2024. The reported incidents took place in July and August 2024, during which it was alleged that two patients died at NCMHH, and two others were admitted to RMSH in critical condition.
In response to the Minister’s request, the Health Ombud deployed a team of two investigators in accordance with Section 81(3)(c) of the National Health Amendment Act (NHAA). This investigation report is issued based on Section 81A (11) of the NHAA, 2013 (Act No. 12 of 2013), pertaining to the functions of the Office of Health Standards Compliance and the handling of complaints by the Health Ombud. The report is intended to inform both the complainant and the health establishments as well as the general public of the findings and recommendations derived from the investigation.
ISSUES INVESTIGATED
The investigation was carried out through a detailed analysis and triangulation of information and documentary evidence obtained from the NCMHH and RMSH, as well as through on-site visits. The following issues were identified for investigation based on the analysis of the complaints, allegations, and engagement with both health establishments:
The circumstances surrounding Mr. Cyprian Mohoto’s care at NCMHH and his subsequent death at RMSH;
The circumstances surrounding Mr. Petrus De Bruins’s care at NCMHH and his admission to RMSH;
The circumstances surrounding Mr. Tshepo Mndimbaza’s care and death at NCMHH; and
The circumstances surrounding Mr. John Louw’s care at NCMHH and his admission to RMSH.
The investigation revealed that, at the time of the incidents, NCMHH and several neighbouring health facilities were facing challenges with their electricity supply due to cable theft and vandalism at their power substation. This power loss impacted the communication infrastructure, leaving the hospital without telephone lines.
Electricity supply was restored within days at two of the neighbouring hospitals; however, it took an entire year for the electricity to be restored at NCMHH. The investigation found that the delay in repairing the electricity supply to NCMHH was due to dysfunctional Supply Chain Management processes within the Provincial Department of Health. This delay rendered the hospital’s Heating, Ventilation, and Air Conditioning (HVAC) system nonfunctional, exposing patients and staff to extreme weather conditions during the summer and winter. Additionally, because of the lack of electricity, the available resuscitation equipment was not operational, as it could not be charged, and other necessary equipment was unavailable for use. NCMHH procured poor quality pyjamas and blankets which were inadequate to provide warmth to patients during the severe winter’s cold, especially at night.
It was established that the Clinical Manager at NCMHH had written a complaint letter to the Acting Head of the Provincial Department of Health, detailing the adverse conditions which patients at NCMHH were being subjected to. These circumstances negatively impacted their health and violated their human rights.
FINDINGS
The investigation uncovered several findings regarding the medical care of four patients:
Circumstances surrounding Mr. Cyprian Mohoto’s care and admission to RMSH: The investigation revealed gross mismanagement surrounding Mr. Mohoto’s care, which ultimately led to his death. He was admitted to RMSH on 13 July 2024, with a suspected abdominal or bowel obstruction following complications at NCMHH on 12 July 2024. Admission abdominal X-rays ruled out bowel obstruction while the chest X-ray revealed multi-lobar pneumonia. The pneumonia was never treated during the 3 days that the patient stayed in the Surgical Recovery Unit until his death. His deteriorating clinical status was never attended to by either the nursing personnel nor the doctors. Mr. Mohoto died on 16 July 2024, in the Emergency Centre at the Surgical Recovery Unit at RMSH.
Mr. De Bruin was transferred from NCMHH to the Emergency Centre at RMSH on 30 July 2024, after collapsing and being unresponsive in Ward M2 at NCMHH. He was stabilised and later admitted to the RMSH Medical Recovery Unit for hypoglycaemia, the medical care and investigations conducted in the Emergency Centre were appropriate. However, the monitoring by nursing personnel was found to be inadequate.
The Circumstances Surrounding Mr. Tshepo Mdimbaza’s Death: Mr. Mdimbaza was discovered unresponsive in his bed on 3 August 2024, at NCMHH. The resuscitation process was delayed due to the unavailability, malfunction, or unpreparedness of resuscitation equipment. There was also a lack of monitoring of the patient’s vital signs before and during resuscitation by medical or nursing personnel. Mr. Mdimbaza did not survive the resuscitation attempt. The post-mortem report indicated that he died due to “exposure to the elements” at NCMHH.
The investigation into the circumstances surrounding the care and admission of Mr. John Louw to RMSH revealed that he had an acute subdural haemorrhage. An emergency craniotomy and craniectomy were successfully performed on 07 July 2024 and 23 July 2024, respectively, and he was discharged back to NCMHH on 28 October 2024. Mr. Louw remains bedridden.
The investigation also established additional findings, including leadership instability in the Northern Cape Provincial Department of Health, which negatively affected service delivery, safety, and the quality of patient care at NCMHH and RMSH.
Northern Cape Mental Health Hospital was found to have poor governance and systemic lack of leadership and poor management at all levels, unpreparedness for emergency cases, crumbling infrastructure, poor pharmacy and medicine control management, shortage of staff, poor quality assurance management, non-compliance with patient record keeping, and poor laundry services.
Robert Mangaliso Sobukwe Hospital was found to be experiencing critical staff shortage across the board; lack of oversight with nursing supervision; communication breakdown of reporting systems, non-compliance with guidelines on principles of good record keeping and overcrowding at the hospital emergency centre, aggravated by the absence of a district or regional hospital.
The investigation concluded that the general care provided at the Northern Cape Mental Health Hospital and the Robert Mangaliso Sobukwe Hospital to the patients was substandard, and patients were not attended to in a manner consistent with the nature and severity of their health condition, as required by Regulation 5 (1) of the Norms and Standards Regulations Applicable to Different Categories of Health Establishments, 2018 (Norms and Standards Regulations).
RECOMMENDATIONS
The Health Ombud made clear, actionable recommendations to address the systemic failures observed at both health establishments to improve the overall safety and quality of patient care. Key recommendations include; the Provincial Head of Department of Health must immediately appoint a Task Team to monitor the implementation of the recommendations as outlined in the report, hold accountable officials found to be in breach through formal disciplinary processes, the National Department of Health should initiate a forensic investigation into the procurement processes for the NCMHH, priority should be given to the development, reinstatement, and implementation of an effective and efficient reporting system for continuity of care and effective communication, and the development of comprehensive Standard Operating Procedures (SOPs)/Protocols/Guidelines to guide healthcare personnel in providing healthcare services. The complete set of recommendations is included in the report.
Hepatitis C virus. Credit: Scientific Animations CC4.0
On the 28th of July, South Africa joined the global community in marking World Hepatitis Day 2025, which is observed annually to raise awareness of viral hepatitis and to call for urgent action to eliminate it as a public health threat.
Under the theme “Let’s Break It Down,” this year’s campaign urged governments, healthcare systems, and communities to dismantle the financial, social, and systemic barriers that hinder progress—particularly stigma, underdiagnosis, and lack of access to testing and treatment.1
More than 304 million people globally are living with chronic hepatitis B or C, yet the majority remain undiagnosed until it is too late. In South Africa alone, over one million new cases are reported each year—despite the fact that hepatitis B is vaccine-preventable and hepatitis C is curable with available therapies. 1,2
Dr Neliswa Gogela, hepatologist, commented: “Hepatitis B and C are silent killers. People often do not know they’re infected until severe liver damage or cancer develops. But this is a crisis we can stop. We have vaccines, we have treatment, and we have the tools – we simply need to scale up access, embed hepatitis care into our health system, and break the stigma so people are not afraid to get tested or treated.”
Although hepatitis is preventable, treatable, and often curable, only 45% of babies globally received the hepatitis B birth dose vaccine within 24 hours of birth in 2022—a critical early intervention. South Africa has made notable strides, yet challenges remain in ensuring equitable access, particularly in rural and underserved areas. 1,2
Understanding the Disease
Hepatitis refers to inflammation of the liver, most often caused by a viral infection. The most common types, hepatitis B (HBV) and hepatitis C (HCV), are both blood-borne and can lead to chronic liver disease, liver failure, and liver cancer.
Hepatitis B is spread through contact with infected blood or bodily fluids, unprotected sex, and from mother to child at birth. It is preventable through vaccination, which has been available for over four decades.1
Hepatitis C is commonly spread through unsafe medical practices, contaminated injections, or sharing needles. While there is no vaccine, hepatitis C is curable in most cases with a class of medicines known as direct-acting antiviral medications.1
Because symptoms often only appear in advanced stages, early testing and diagnosis are vital to preventing life-threatening complications.
Time to Act – Before It’s Too Late. Speak to your healthcare practitioner for more information.
Viral hepatitis causes an estimated 1.3 million deaths each year—a figure comparable to that of HIV/AIDS. Yet countries such as Egypt have proven that elimination is achievable through aggressive, integrated screening and vaccination efforts.2
South Africa has the science, tools, and expertise to respond effectively. What is now needed is national commitment, adequate investment, and a public health approach that embeds hepatitis services into primary care.
World Hepatitis Day 2025 served as a timely reminder: the elimination of viral hepatitis is within reach—but only if we act now.
The Nelson Mandela-Fidel Castro medical training programme has been controversial from the start. It’s had high points, low points and many say it should have an end point.
Almost 30 years since the Cuba-SA doctors’ training programme was launched, it still divides opinion.
This year only Gauteng and North West interviewed candidates for the bursary programme that sends students from South Africa to be trained in the island country.
Critics say the dwindling interest shows the Nelson Mandela-Fidel Castro (NMFC) medical training programme has passed its sell-by date. But supporters remain committed to its ideals and some beneficiaries of the programme still think of it as the opportunity of a lifetime.
Between the differing views, what can be glimpsed is a chequered story of three decades of trying to transform South Africa’s healthcare system. The programme has its origins in the ANC’s political fraternity with Cuba and the laudable ideal of boosting doctors numbers in under-serviced rural areas. But it is also a tale of political inertia arguably blurring over time into a blind spot as conditions changed. In the background is the stranglehold of corruption and maladministration in the health sector, shrinking provincial health budgets, transformation of doctors’ training, and changing curricula.
One concern is that little is actually known about the programme’s impact. There is a lack of clear data on the costs and the numbers of doctors produced. Shockingly, for such a long-running programme, no comprehensive evaluation reports have been published, as far as Spotlight has been able to establish.
A comprehensive evaluation would weigh the benefits of the programme against its costs, compare it to other options for training medical doctors, and contextualise it within the current reality of very tight health budgets in provincial health departments – as it is, not all the doctors we are training are being employed.
Given this context, it is not surprising that the National Department of Health recommended a scaling back of the programme a decade ago. While most provinces have taken this advice, the Gauteng and North West health departments have instead pushed ahead with the programme.
Old histories and old allegiances
The agreement that put in place the NMFC medical training programme was signed in 1996, with the first cohort of students leaving for Cuba a year later in 1997. It was a mere two years into democracy and South Africa urgently needed to address gaps in the provision of healthcare. Under apartheid, services prioritised a white minority mostly in urban settings and healthcare had a strong slant towards hospital or tertiary care. There was a shortage of doctors and those with the least access to healthcare services were rural communities made up mostly of black South Africans.
Medical schools mostly had curricula designed for the status quo and there were few academic pathways for underprivileged students who had good marks at school but were not top achievers, leaving them overlooked for scholarships and bursaries.
So the new government looked to Cuba.
With its focus on primary healthcare, preventative medicine, and community-based training, the Cuban approach to healthcare ticked many of the boxes for the South African government then led by President Nelson Mandela.
Since the communist revolution in Cuba in 1959, it has provided free healthcare to all its citizens. While there remains some scepticism over data collection and interpretation, politicisation of medicine, and limited freedom to criticise the state, Cuba’s healthcare system is also widely lauded.
According to the Primary Health Care Performance Initiative, the country registers average life expectancy at 78 years (South Africa is at around 66), infant mortality dropped from 80 deaths per 1000 live births in 1950 to just 5 deaths per 1000 by 2013, and it has one of the world’s highest doctor to patient ratios. In 2021, it was at 9.429 physicians per 1000 people, according to World Bank Open Data. In the same year, South Africa tracked at 0.8 per 1000.
Since the 1960s, Cuba has established itself as a hub for training international fee-paying students and sending them back to their mostly lower-income countries as graduate doctors. One of its biggest universities, the Latin American School of Medicine, graduated over 30 000 students from 118 countries in the 21 years since it was established.
Another tick was Cuba’s staunch support for the ANC. SA History Online emphasises the depth of solidarity. It notes: “Cuba was a state in alliance with provisional governments and independent states in the African continent. Cuba’s military engagement in Angola kept the apartheid state in check, foiling its geopolitical strategies and forcing it to concede defeat at Cuito Cuanavale, and ultimately forcing both PW Botha and FW de Klerk to the negotiating table.”
Costs and benefits
The political and historical bonds sealed the doctors’ training deal. But from the start, the bursary programme, funded from provincial budgets, came under fire. The estimated costs over nearly three decades are massive, but details remain fuzzy.
Spotlight’s questions to the national health department were “answered” in one paragraph by department spokesperson Foster Mohale. “More than 4 000 [lower numbers are quoted by government in other instances] doctors have been produced through this medical programme since its inception. The programme is still relevant today and complements the local medical schools to produce more doctors. Qualified doctors have options of joining either public or private health sector,” he wrote.
But discrepancies have been showed up in government’s own figures. In November 2022, Haseena Ismail, the then DA member on the portfolio committee of health raised concerns about the quality of government data.
Minister of Health at the time, Dr Joe Phaahla, said the preparatory year, including a stipend, cost US$4400 per student, and each of the following five years cost US$7400 per student. But a separate table from the health department listed higher figures – US$8400 for the preparatory year and up to US$15900 per student by the fifth year. Added to this, the department listed annual costs of US$6472 per student for food, accommodation, and medical insurance. There were also expenses for two return flights over six years, plus the cost of 18 months of tuition and accommodation for clinical training at a South African medical school.
Phaahla said that as of November 2022, 3369 students had been recruited into the programme, and 2617 had graduated. However, he noted there was no information on what happened to these doctors or where they were employed. Each bursary student is required to work for the state for the same number of years for which they received funding.
South Africa has 11 medical schools, with the most recent addition of the North West University.
The programme also faced criticism over selection criteria for bursary candidates and for requiring two extra years of training compared to local medical programmes. Students spend one year learning Spanish, five years training in Cuba, and then return to South Africa for an additional 18 months of clinical training at a local medical school.
Controversies have dogged the programme over the years. In 2013, the Afrikaans newspaper Beeld reported that by 2009, only half of the students enrolled in the programme during its first 12 years had completed their studies.
In 2012, government ramped up the numbers of students it sent abroad. In 2018, this backfired when about 700 fifth-year students returned home only to find they could not be accommodated at any of the then 10 medical schools in the country.
It was around this time that the national health department issued recommendations for the provinces to phase out the programme.
Gauteng and North West
Despite all of the above, the Gauteng Department of Health continues to fund students – around 20 last year and an expected 40 this year.
Spotlight’s questions on this to the Gauteng health department went unanswered.
Compounding the administrative and planning blunders for returning students is the impact of deepening corruption and mismanagement in Gauteng’s health department. It has been under routine Special Investigations Unit scrutiny as well as coming under fire for service delivery issues such as the ongoing backlog of cancer patients lingering on treatment waiting lists. In March, the South Gauteng High Court in Johannesburg ruled that the Gauteng health department failed in its constitutional obligation to make oncology services available.
The situation in the North West is also bleak. Its health facilities are routinely facing medicine stock-outs and understaffing. Its health department is regularly struggling with accruals and paying suppliers on time.
Given all these challenges, it is puzzling that these two provinces in particular are so committed to sending students to Cuba, we understand at higher cost than for training doctors locally.
‘Better investments’
Professor Lionel Green-Thompson, now the dean of the faculty of health sciences at the University of Cape Town, was involved in managing returning students from the Cuba-SA programme between the mid-2000s and 2016. At the time, he was a medical educator and clinician at Wits University where he oversaw the 18-month clinical training of more than 30 returning students.
“Some of these students were among the best doctors that I’ve trained and I remain a stalwart supporter of the ideals of the programme. But at this point, there are better investments to be made, including directly funding university training programmes in South Africa,” he tells Spotlight.
“A programme that’s rooted in our nostalgic connection with Cuba and its role in our change as a country is now out of step with many of the healthcare settings and realities we face in South Africa,” says Green-Thompson.
He says a proper evaluation of the programme needs to be done.
There are also lessons to learn, he says, including a review of admissions programmes. How some students who enter a programme at 20% below the normally accepted marks, exit the programme as excellent doctors, he says offers clues to rethink how great doctors can be made.
Green-Thompson also suggests we need to ask why specialisation has become a measure of success for many doctors in South Africa, often at the expense of family medicine. This, he says, takes away from the impact doctors make at community healthcare level as expert generalists.
But changing the perspectives of healthcare professionals requires early and sustained exposure to working in community healthcare settings, says Professor Richard Cooke, head of the department of family medicine and primary care at Wits. Cooke is also director of the Wits NMFC Collaboration since 2018 and serves on the NMFC Ministerial Task Team.
“I’m not in support of further students being sent to Cuba for the undergraduate programme, because these students are not being trained in our clinical settings,” he says, speaking in his Wits capacity.
“The Cuban system is far more primary healthcare based than South Africa’s, but that doesn’t necessarily translate into these students ending in primary healthcare,” says Cooke.
And curricula at Wits is shifting, for instance, towards placing students at district hospitals for longer periods of time, rather than weeks-long rotations, he says.
“When students become part of the furniture at a hospital, they become better at facilitating, at critical thinking, problem solving, teamwork and collaboration,” Cooke says.
But making this kind of transformation in local training takes government funding and commitment. Students and doctors need to be attracted to the programme and need reasons to stay. But the money and resources to make this happen are simply not there – even as the Cuba training programme continues.
Cooke adds: “There hasn’t been definitive data on the NMFC programme. But even if the programme over 30 years has done well and met its targets, it’s not been cost efficient. What’s needed now is to leverage expertise and established partnership in different, more cost-effective ways like in research, health systems science and health science education.”
Up to three times more expensive?
Professor Shabir Madhi, dean of the faculty of health sciences at Wits, says the NMFC programme costs an estimated three times more than it costs to train a student in South Africa. This, he says, should be enough reason for a beleaguered health department like Gauteng’s to stop sending students to Cuba.
He also says: “Government is aware that it simply can’t absorb the number of medical graduates being produced.” Madhi says some trainee doctors are sitting at home while others trying to finish specialisations are being derailed.
Broadly, he pins the blame on the mismanagement of resources, including the department underspending R590 million on the National Tertiary Service Grant meant to subsidise specialised medical treatment at tertiary hospitals.
Madhi says universities have worked hard to close the gaps identified by the NMFC programme 30 years ago, but now student doctors are being let down by government not playing its role.
“Across the universities, there’s been a complete overhaul of the curriculum to be focused on primary healthcare. Students are also getting community exposure as early as first-year training,” he says.
He says that when it comes to admissions, the majority of students entering medical schools across the country are now Black South Africans, and additional changes have been made to the selection process. “We used to have a race quota, but in further revisions, we have introduced criteria that focuses on the socio-economic component, with 40% of the admissions coming from students in quintile 1, 2 and 3 schools [no-fee public schools],” he adds.
South Africa has 11 medical schools, with the most recent addition of the North West University – specifically focussed on rural health – and the University of Johannesburg in the pipeline to join the list. So the number of doctors being trained and graduating is increasing. Madhi estimates the total number being trained is above 900 per year for Gauteng alone.
The bottleneck of getting doctors into clinics and hospitals, he maintains, is not a shortage of doctors, but government’s inability to pay doctors’ salaries or to create functioning, well-resourced workplace environments.
‘You can’t put a price on that’
For Dr Sanele Madela, the ongoing challenges cannot detract from the goal to get doctors into communities – including through the NMFC programme. Today, he’s the health attaché at the Havana Mission for the NMFC training programme. Madela was also at one time a schoolboy with a dream of becoming a doctor.
Growing up in Dundee in KwaZulu-Natal, he remembers almost never seeing a doctor in his community. “Then when we did see a doctor, it was a white person or an Indian person and they never spoke our language – a nurse would have to translate,” says Madela who was part of the 2002 NMFC intake.
The six years abroad, he says, exposed him to very different reasons for becoming a doctor.
“When people finish medical school, they say thank God it’s over, but in Cuba people say thank God for the knowledge and information so they can give back to their country,” he says.
When Madela got back to South Africa, his journey eventually led him to work in Dundee district hospital. It was the same hospital where his mother had worked as a cleaner.
The NMFC programme, Madela says, still plays a vital role because of its objective to get more doctors into rural and township areas – “and you can’t put a price on that”, he adds, responding to criticism over the programmes comparatively high costs.
“We are used to seeing the NMFC programme from the point of view of adding human resources, but it’s also about the impact it makes for a community,” he says. It’s the impact of a community finally getting their own doctor. His argument is that, thanks to the NMFC programme, he got to be that person for his community.
