Marije Versteeg, Director Rural Health Advocacy Project

Rural Selection and AdmissionPresentation to the Wits Faculty of Health

Sciences Transformation Committee

Introduction and Purpose

• Purpose: Discuss role of rural selection and admission as part of:

–Student Equity–Social Responsiveness?

At Wits Faculty of Health Sciences

Who are we?• RHAP: Partnership Wits Centre for Rural

Health, RuDASA and SECTION27 • RHAP’s overall goal: To advocate for

improved health care in and for rural communities

• Strategic Objective 3: Every rural citizen has adequate access to caring, qualified health care teams

Rural selection and admission: why?External:•Rural students 3-7 times more likely to return to rural practice than an urban student to go rural (1)•South African Research (2)– Cohort of all the medical students who graduated in SA

in 1991-2 from 5 medical schools (UCT, UFS, Medunsa, UP, US):• 14,4%of graduates were rural origin• 38,4% of the rural origin graduates currently in rural practice• 12,4% of urban origin graduates in rural practice

Sources: (1) Wilson et al (2009). A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote.areas. Rural and Remote Health 9: 1060. (Online), (2) De Vries E, Reid SJ. Do South African medical students of rural origin return to rural practice? South African Medical Journal. 2003; 93: 789-793

Rural selection and admission: why?

External:•Of the 1200 medical graduates, only 35 go rural (AHP, 2009)•Unequal access to health care workers for poor, rural communities•Constitutional right to access health care•Benefits of graduates speaking local language & understanding language & cultural nuances

Rural selection and admission: why?• WHO Global Policy Recommendations: Increasing access to

health workers in remote and rural areas through improved retention (2010)

• Strongest Evidence for Education:

Use targeted admission policies to enroll students with a rural background in education programmes for various health disciplines in order to increase the likelihood of graduates choosing rural practice

Rural selection and admission: why?

Internal:•History of social justice (Steve Biko case)•Wits Commitment to Transformation•“The Faculty of Health Sciences at Wits University, acknowledging its (…) responsibility to be relevant and responsive to the health needs of the communities it serves (part of Vision)•Mandate Wits Centre for Rural Health

Rural selection and admission: why?

External + internal environment: Strong motive for rural selection and admission.

Proportion of rural origin students at South African Faculties of Health Sciences

Tumbo JM, Couper ID, Hugo JFM. Rural-origin health science students at South African universities. S Afr Med J 2009; 99(1): 54-56

Challenges• Poor rural student remains disadvantaged in

current system• Defining excellence in the rural student from a

disadvantaged background with poor schooling• Accessing and understanding the enrollment

process• Transformation focus on race only• Need for continued mentoring and support

Proposals for way forwardIncrease % of rural students admitted to Faculty of Health Sciences, through:•Start recruitment process early: develop plans to identify and recruit rural students•Targeted outreach: expand scope of current outreach to more rural high schools across provinces•Bring rural high school students for a week’s orientation prior to enrollment (eg UoS)

Proposals for way forward• “Rural weighing factor” in selection process– Rural origin– Rural intent

• Give preference to students with contractual obligation to return to rural service

• Make admission process as accessible as possible for rural students

Case in point: Ministerial extra 40?

Proposals for way forward

After admission:•Provide ongoing mentoring and support throughout their training to enhance academic outcomes, Eg: – Residence services– Academic support

Thank youDiscussion and Comments

Marije VersteegRural Health Advocacy Project

Cell: 074 106 3800Marije@rhap.org.za

www.rhap.org.za