Opinionista Michael Fridjhon 9 December 2015

Why can’t we fund the tomorrow’s medical doctors?

You would think that a halfway qualified doctor with pretty decent results would have no difficulty getting her fees paid, and borrowing some money to cover her living expenses. It's taken her months of begging and pleading simply to get a loan lined up. When it comes to real funding, amazingly, the kitty is empty.

Carla Stevens (her name has been changed to protect her identity) has just completed her third year of medicine at the University of Stellenbosch. This is not a unique achievement, though for someone who had to depend on her mother (a primary school teacher) to manage the overheads of a household, and the costs of education for herself and her two younger brothers, it is already a slightly unusual outcome. The game-changer for her was her late grand-mother, who put up the money for her to attend Somerset College when she was ready to go into Grade 8. Unfortunately, her benefactor died at the end of this first year at high school. She might have been obliged to return to a state school in Worcester to complete her secondary education – had she not finished Grade 8 at the top of her class, and had Somerset College not approached Telkom for a bursary which paid her school and hostel fees.

It is possible Carla would have done well – no matter what school she attended. Still, armed with an enviable matric record she was able to apply for a “recruitment bursary” (available for students from previously disadvantaged backgrounds) which has funded her to the end of the first half of her medical degree. Now, despite a decent pass mark in her 3rd year exams, she faces the greater worry of how she will pay for her next few years of study en route to becoming a doctor. “I’ve applied for bursaries and loans wherever I could. Ideally I need a combination of both since with fees and hostel expenses my commitment exceeds R90k per year. I know when I qualify I’ll be earning enough money to pay back a loan – but without some form of bursary my debt, when I’m able to practice as a GP, will be around R500k. I do part-time work most weekends to help cover hostel and food costs. However, I can’t earn enough – and also study – to support myself as a full-time student,” she says.

You would think that a halfway qualified doctor with pretty decent results would have no difficulty getting her fees paid, and borrowing some money to cover her living expenses. It’s taken her months of begging and pleading simply to get a loan lined up. When it comes to real funding, amazingly the kitty is empty. I’ve been in touch with some staff members of the university, and they seemed equally surprised. They made some suggestions and for the moment Carla is following their guidelines. It seemed as inconceivable to them as it did to me that a successful medical student could find herself out of her course for want of funding. By the same token, it also seems inconceivable that even for graduates, the prospect of specialising is more distant than the Kuiper Belt. If a student finishes basic medicine owing half a million rand, another two or three years of study – even fully funded – will see the initial loan balloon by R200k as the interest debt accrues.

Since the #FeesMustFall campaign there have been any number of “experts” ready to offer solutions to the country’s education crisis. I cannot pretend to a particular expertise on the subject – though I set up (and initially managed) the longest running and, to my knowledge, most successful tertiary education funding programme for previously disadvantaged students in the wine industry. I also direct the Wine Judging Academy (which operates under the auspices of the Graduate School of Business of the University of Cape Town) and have made it a matter of policy that no suitable candidate will be turned away for lack of funding. In my admittedly limited experience, a way can be found where there’s a will to find it.

The problems afflicting public education in South Africa appear so enormous that there’s a temptation to shrug shoulders, perhaps even express sympathy with the students (and even those who teach them), and then do nothing about it. However, with very little reflection a number of possibilities present themselves. There may be hundreds of thousands of school kids entering the system every year, but that’s no reason to reduce both performance and outcomes to the lowest common denominator. Some of these kids are – for whatever reason, nature/nurture etc – more likely to succeed than others. If an affordable scheme could be established that enabled the 10000 most talented (but financially disadvantaged) kids to get the best possible secondary education, why would you not embrace it?

There are at least 1000 schools (some ISASA, some so-called Model C) delivering an unimpeachable level of education. Since their annual fees run to less than R50k, R500m per year paid by the state to the schools would cover the annual cost of educating the top 10000 selected through a scholarship exam system. This is a five-year commitment, and peaks when there are 10, 000 such candidates in every grade of high school viz R2.5bn. It is an investment which represents just over 1% of the Basic Education budget. More importantly, while it works out at roughly 2.5 times the average amount government is spending per child in state schools and, therefore, only an additional commitment of R1.5bn annually, it is hard to argue that this investment cannot be justified in terms of the value it will deliver: 10, 000 matriculants (all from impoverished and disadvantaged backgrounds) emerging every year with the same quality of education currently enjoyed by the country’s elites is likely to be more transformative than all the BEE schemes foisted upon the country in the past decade.

This, then, poses the question of how to fund the tertiary education of these 10, 000 students. Here there is a much simpler and entirely cost-free (at least to the state) option. As we know, universities receive subsidies which are effectively a co-funding mechanism provided by the government. If these payments were to dry up, annual first year students fees, at Wits, for example, would typically increase from the R40k – R50k range to R80k+. However, a blanket subsidy is not the optimum way to use the state’s contribution. Students from well-to-do homes leave private schooling (where annual fees can run comfortably to R120k – R200k) and arrive at a highly discounted university environment. Parents who could afford the R100k+ of private schooling could just as easily pay the unsubsidised university tuition fees. On this basis it is worth arguing that the annual subsidy the government pays to places like Wits should really go into a needs-based bursary fund. Those who do not need the money does not get any. Those who could manage R40k per year, but not R80k would get a 50% contribution (pretty much as they do now) and those who simply cannot pay anything, but who qualify on account of the quality of their matric – just like Carla at the Stellenbosch medical school, and like the matriculants in the proposed state-funded secondary school scheme detailed above – would pay nothing at all.

Assuming the logic behind this proposal is sound, it should at least form part of the debate around the way forward for education and how it is to be funded. I am happy to bet that there’s no chance of its even getting a toehold on the agenda. Insofar as secondary education is concerned, the last thing the Department of Basic Education can afford to be doing is putting in place a programme that would reveal the gaping holes in the schooling system it is supposed to direct. The ever-widening discrepancy between the knowledge level of matriculants exiting the state-run school system and those at the top end of the private schooling environment cannot be a function of either nature or nurture (in the parenting sense of the word) because statistical probability would have these pretty nearly equal. The under-performance lies in the quality of the teaching, and this is turn relates to shortcomings in the training, competence and dedication of the staff. It’s hardly surprising that SADTU goes to such extraordinary lengths to ensure that comparative performance criteria can never be properly applied.

The Department of Higher Education is also unlikely to transform its funding prerogative into a bursary scheme. It is an unspoken rule for government departments all round the world that payments should have a discretionary component. A bursary scheme which allocates funding on the basis of performance/need is too objectively quantifiable to have any appeal. In South Africa there is also the small matter of giving up an opportunity for rent-seeking (the kindest interpretation) or outright corruption. This is certainly the subtext to the ANC’s unspoken manifesto – to judge from how little is ever done to root out wasteful or dishonest expenditure. Finally, there is the addiction to the master-slave relationship – between the department and the institutions of higher learning. If the department can’t threaten them with cutting off their cashflow, the universities may not do their bidding – and we all know what happens when the proles get restive and smell the heady scent of liberation. DM

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