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28 April 2021 | Story Prof Francis Petersen | Photo Sonia Small (Kaleidoscope Studios)
Prof Francis Petersen is Rector and Vice-Chancellor of the University of the Free State (UFS).

You should have seen it coming. In the wake of the recent student protests and resulting suspension of tuition on some higher education campuses throughout the country, management teams from public universities have become used to having this bit of stinging criticism levelled against us from various fronts. 

You should have seen it coming. 

And the implied add-on: You could have done something to stop it.

But as with most crises, foreseeing something and preventing it are often worlds apart. 
That much we have learned from the COVID-19 pandemic. For decades preceding 2020, health scientists and a large section of the informed public had known that the world’s next big health crisis would probably be caused by some variant of the coronavirus. Yet “seeing it coming” could not prevent an eventual outbreak.

In the same way that the COVID-19 pandemic exposed fault lines in the global health system, student protests continue to expose fault lines in our higher education funding model. 

The unfortunate truth is that no single institution’s foresight and ameliorative measures can prevent the outbreak of symptoms of a deeper systemic problem that needs to be addressed in a comprehensive, sustainable way and on a national level.  

Complicating the access challenge

In a post-COVID-19 landscape, it is even more challenging to find solutions for students’ very legitimate demands for access to education. Here at the beginning of 2021, we find ourselves in a fragile society ravaged by illness, loss, fear and uncertainty and reeling from the lingering effects of sweeping economic blows.

It is more important than ever to keep the wellbeing and future of an entire society in mind when making decisions affecting individuals.

It is equally vital to be guided by principles of social justice in every decision, striking a careful balance between different rights. In our case: The right to demonstrate versus the right to safety and protection of property; and the right to education of those wanting to enter an institution versus the rights of those already studying within that institution.

The need to look beyond one’s own rights and also consider the rights of others is aptly reflected in the masked faces we see around us nowadays. A face mask ultimately offers greater protection to bystanders than to the individual wearing it. This attitude of always considering the “greater good” should more than ever guide our decisions in all spheres of society.

And here universities have a continued vital role to play: To not only equip graduates with skills and knowledge, but to help create responsible citizens with a wider vision than just the immediate. 

Current financial model unsustainable

It is clear that the current model of student funding in South Africa is simply unsustainable. 

Student numbers rise each year, as does inflation. Household incomes are not keeping up, leading to more and more families who will qualify for the subsidised free higher education for households with a combined annual income of R350 000 or less, announced by former president Jacob Zuma four years ago. 

Add to that the effects of the COVID-19 pandemic that has placed tremendous extra pressure on the fiscus, plus the apparent challenges that the National Student Financial Aid Scheme (NSFAS) experiences in administering student bursaries, and it becomes clear that government simply will not be able to sustain these financial commitments going forward.

Short term vs sustainable solutions 

It is also clear that government’s reaction to this year’s student protest dilemma, i.e. re-allocating funds originally earmarked for other areas within higher education, was a short-term solution. Continued measures like these will, in the long term, only lead to the steady deterioration of the very institutions these students are trying to access.

Likewise, a cancellation of students’ so-called “historical debt” (at the moment adding up to around R14 billion) will have a devastating effect on South Africa’s higher education institutions. .  

Once again, a well-considered balancing of interests is required – facilitating access to higher education while at the same time ensuring the sustainability of institutions.

Tackling change together

We live in a time where, on different fronts, courage is needed to do things differently.  
When it comes to finding a new financial solution for higher education, we should think beyond a mere tinkering of existing models, tweaking it here and there, and rather consider total transformation.

One of the models that show great potential is the income-contingent loan scheme, whereby students start paying loans back once they have secured a regular income, with specific parameters in place to ensure sustainability. 

But regardless of what model is chosen to replace the status quo, one thing is certain:
it will require a combined effort and commitment from government, higher education institutions as well as the private sector. 

At a time when there is a great emphasis on distancing, there needs to be a huddling and a clustering on another level.  We all need to take hands and move closer together to find solutions for a problem that ultimately affects all of us.

It is abundantly clear that there is an urgent need for significant private sector involvement, not only from potential financers like banks and pension funds, but by all potential future employers in all business sectors.

Ultimately, both public and private sectors are key beneficiaries of the output of universities. The students we deliver represent their future work force. This vested interest should translate into active involvement – not only at the point where students exit our institutions, but also ensuring that they’re able to enter them in the first place.

This is why the National Task team that Dr Blade Nzimande, Minister of Higher Education, Science and Technology wants to establish to address the student funding challenge is so crucial – and should, at least include role players from all three sectors. 

Focus on social justice during Freedom Month

South Africans are currently celebrating our freedom, commemorating our departure from inequality and oppression.  

Maybe this Freedom Month – and particularly Freedom Day – is a time to reflect not only on what makes us free but on what binds us together. A time to build new relationships based on common needs and shared interests and values.  

We have moved away from oppression. We should now move towards greater co-operation and voluntary, mutually beneficial alliances in order to truly ensure access to education for all.

Because if we don’t, student protests will remain as consistent as seasonal flu, characterising the beginning of each academic year.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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