Health Profession Council of South Africa

Meeting report

HEALTH PORTFOLIO COMMITTEE
2 October 2001
HEALTH PROFESSION COUNCIL OF SOUTH AFRICA:

Chairperson: Dr Nkomo

Relevant Documents
Health Profession Council of South Africa Powerpoint Presentation
[This information can be found on the Health Professions Website ]

SUMMARY
The moratorium on the registration of foreign doctors has now been lifted. Measures have been implemented to administer and monitor the registration of foreign practitioners.

The Acting President of the Health Profession Council of South Africa informed the Committee that the internship programme has been extended from one to two years. Students should now be adequately equipped with life skills necessary for the realities of practice.

The new regulation had been put in place to ensure that disciplinary cases brought against medical personnel are finalised expeditiously.

MINUTES
Professor Mariba (Acting President of the Health Professions Council of HCPSA)
Prof Mariba informed the Committee that the Council’s purpose is to develop frameworks for the establishment of universal norms and values of the health profession. The Council promotes health for the population by determining standards of professional training, setting and maintaining fair standards of professional practice.

Functions
The Council’s core function was to protect and safeguard the public through determination and enforcement of ethical standards.

The primary functions of the Council and the professional boards in broad terms relate to training and maintenance of standards of professional practice.

The Council recognises professional qualifications by laying down the minimal standards of training, inspection of training and conducting certain examinations. In terms of professional practice the Council sets, maintains, and applies fair standards of professional conduct and practice. These measures are aimed at effectively protecting and safeguarding the public interests.

Prof Mariba said that the functions of the Council are mainly to control the professional conduct through its disciplinary duties.

Patients are not only free to lodge a complaint with the Council but that they have access to avenues of civil litigation as well. The Courts are legally bound to inform the Council of proceedings in which registered professional persons are found guilty.

The Council is a statutory body that it is not funded by the State. The Council’s major funding comes from members of the medical profession and donors. He gave the structure and composition of the Council and the people registered in the Council.

Academic Institutions
Prof Mariba stated that there have been concerns that the number of admissions to medical schools had decreased. While this concern has some truth, the country does not have shortage in the supply of doctors. The problem lay with the distribution of these personnel throughout the country. It was, therefore, a distribution problem and not a quantitative one. There is an obvious concentration of medical practitioners in the urban centres due to its developmental attractions.

On the issue of the widening gap between black and white medical students most medical schools are moving to address this concern. The University of Pretoria has a 25% black student population. Although 25% was not good enough it was an encouraging number.

The Ministry of Health has promised to introduce quotas to address the issue but nothing has come of this. Without clear-cut legal sanctions progress would be expected to be minimal. Academic institutions were autonomous and that all have different admission policies.

Prof Mariba sited some of the constraints that keep black students out of medical school as cultural in terms of language and failure on the part of students from disadvantaged backgrounds to cope with the academic standards in most of these schools.

The University of Pretoria would introduce English language as a medium of instruction to address the language barrier, which he blamed for the low black student enrolment in the institution’s medical school.

Urban and Rural Disparities
There were concerted efforts to rationalise the distribution of medical personnel throughout the country to address the rural urban disparities.The Department of Health’s exercise in recruiting Cuban doctors was part of that program. The Council had advocated for and that plans were underway to increase the period of internship from the current one year to two years. This was meant to adequately equip young medical personnel with life-skills to be able to withstand the many surprises that so often crop up in practice. The internship program is broad and covers all disciplines in the medical curriculum.

Prof Mariba informed the Committee the moratorium on foreign practitioners had been lifted. Foreign doctors can now enter and run a private practice in the country. The reason the moratorium was effected was due to the fact that a structured system had not been worked out to administer and monitor the registration of such practitioners. Apart from the terms of the regulations, there are no other restrictions to encumber the practice of such foreign doctors. Admission exams are run twice per annum but that this time frame is being reviewed.

In administering the process of such registration, Prof Mariba said the Council faced the challenge of verifying the information and credentials given by the candidates. This has been solved by shifting the onus on the candidates to satisfy the Council beyond any doubt that they are qualified.

In conclusion, the Council is trying to promote awareness to the public of its existence through various media outlets including the radio.

Discussion
Ms Baloyi (ANC) asked whether the Cuban doctors are on the same terms as the local doctors.

Prof Mariba replied that there was no discrimination against the Cuban doctors or any other doctor for that matter. Cubans are treated on the same terms like locals save that, since they are on contract, they do not qualify for pension but that a portion of their salaries is retained and surrendered to their embassy. This money is sent back to Cuba where the doctors will claim after the expiry of the contract.

Ms Baloyi (ANC) asked why many misconduct complaints against medical personnel remain unresolved by the Council.

Prof Mariba admitted that there has been a problem in expediting settlement of disciplinary cases against doctors in the past. He sited an example where his Council has recently dealt with a 1981 pending case. The Council has now put in place stringent mechanisms to deal with disciplinary cases within reasonable speed. In the new regulations the Council monitors closely and takes regular audit of settled and pending cases.

The Council has set 21 days to be the maximum period within which medical personnel must submit a reply to a complaint. This procedure, he added, ensures that cases are finalised within six months minimum. It is for the same reason that the Council has gone on radio to educate members of the public on their rights in case of misconduct by medical personnel.

Ms Baloyi (ANC) asked whether Cuba was the only country from which the government recruits foreign doctors.

Prof Mariba replied that there was no deliberate policy on the part of the government to recruit doctors from Cuba alone. The government once tried to recruit doctors from Germany but the failure rate was too high forcing it to abandon the exercise plan. Cuban doctors are recruited on government to government basis and that his Council had no role to play.

Dr Jassat (ANC) asked when looking at the supply of doctors the Council put in consideration the massive exodus of doctors from the country every year.

Prof Mariba replied that the Council is very much aware of the recurrent problem of doctors seeking greener pastures abroad. It was not the intention of the government to train people who will abandon the country soon after qualification. The Council is looking at the selection criteria to ensure that those trained put their skills to the benefit of the local people.

Ms Dudley (ACDP) asked why most qualified medical doctors resist going to work in the rural areas and whether it was anything to do with lack of adequate incentives.

Prof Mariba replied that most doctors fear to work in the rural areas because they fear that they do not have enough training to cope with challenges posed by life these places. Most prefer to work in urban centres where there is ready assistance if necessary. In his view, it was the fear of the unknown that drives these young doctors to dread the rural establishment.

Dr Jassat (ANC) asked why Parliamentarians, who are qualified doctors, are not admitted back to practice without having to undergo refresher courses.

Prof Mariba replied that no medical practitioner is admitted back to practice after having spent considerable time away without undertaking refresher courses. This is an ethical issue and it is for the good of the practitioner since it evolves the lives of people.

The Chair asked why the process of Community service is not taking root in most medical institutions. He suggested that the Council consider introducing the requirement of Community service as a condition for registration.

Prof Mariba said that most institutions have implemented the Community service requirement but that he does not rule out the possibility of introducing the suggestion by the chair.

Dr Mbulawa (ANC) enquired who was responsible for supervising interns at the rural hospitals.

Prof Mariba replied that the Council has a system where it inspects the supervision of interns every six months. The purpose of the inspection is to ensure that the level of training being offered to the interns is to the Council’s set standards.

Dr Jassat (ANC) asked whether the Council has ever considered monitoring the fees charged by private practitioners who tend to over-charge the poor.

Dr Rabinowitz (IFP) said that the reason why most doctors shun working in rural areas was mainly due to the poor access to basic amenities. Has the Council considered any incentives in this regard. She also lamented the huge backlog in the registration of foreign doctors and asked what the Council is doing to address this concern

The Chair said that there were some expatriate doctors who wished to stay but that the immigration had declined to renew their papers on the ground that the Council had not cleared them. What was the Council’s position on this matter?

Dr Rabinowitz (IFP) asked about a special dispensation for those not in active practice, like the parliamentarians, to be accredited to certain institutions in order to give service whenever it was convenient even if not for monetary gain.

Ms Njobe (ANC) asked whether the Council is satisfied with the Department of Health's implementation of legislation. What is the Council doing about inferior facilities in some medical schools. Has the Council implemented the policy not to take medical personnel from African countries where this resource is scarce and in dire need? Who monitors doctors in the rural areas?

The meeting was adjourned.