The management of equity in medical schools in South Africa

Abstract

This study explores the management of equity in medical schools in South Africa using both quantitative and qualitative research methods. Notions and models of equity are discussed and student and staff profiles in medical schools are contrasted with national and international profiles. in-depth unstructured interviews are conducted with select senior and executive management members at national, institutional and faculty of medicine levels to identify the challenges and best practices associatd with promoting equity in medical schools in five broad areas, namely, staff, students, curriculum, research, and policies and practices. The study shows significant contextual differences between medical schools and their universities resulting in divergent trends in the student and staff profiles. Historically Black medical schools continue to provide access to aproximately 68% of African MBChB students. Postgraduate students remain predominantly White men and although more female than male students are enrolled for MBChB, the few females entering postgraduate training are segregated in particular areas of specialisation. Redressing the historically determined prevailing inequities in medical schools, in terms of race, gender and class, is inextricably linked to different management ideologies, management policies and practices, economic factors and discipline specific power dynamics. To manage equity inmmedical schools more efficiently, it is recommended that a single, separate budget be allocated to medical schools for staff appointments and student training. The management of academic health complexes should be under the jurisdiction of a national, joint Department of Education/Department of Health structure. Such a structure should, at a national level clarify, co-ordinate and monitor equity in medical schools and ensure that policies and practices in medical faculties are aligned to national strategic transformation frameworks and equity goals of higher education and health. Monitoring could include analyses of student applications, admissions, failure, drop-out and graduation rates of students. The establishment of a comprehensive database of South African medical doctors by race, gender, area of specialisation and location of practice is needed to track trends and shifts.