• August 18th, 2019
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Shangula retrospection on foreign-trained medical doctors



I rise to speak on the issue of what has become known as “foreign-trained medical doctors” which has captivated the Namibian public as evidenced in print, electronic and social media and of late, in the National Assembly.  My intention is to put this matter in correct perspective thus enabling this Honourable House to debate the Motion before it from an informed perspective if there will be such a need. First of all, I wish to address the narrative of foreign-trained medical doctors.  The University of Namibia established the School of Medicine in 2009.  The first intake of medical students happened in 2010.

 These medical students graduated for the first time in Namibia, in 2016 and completed their two-year internship training in 2017.  As of now, the home-grown medical doctors, who are only 35 in number, have only one-year post internship experience. All the doctors in Namibia who have been and still are working in hospitals, both public and private hospitals and other health facilities, including medical specialists, are foreign-trained doctors.  There is no single medical specialist in Namibia, who is not foreign-trained.  Thus, the use of the phrase “foreign-trained medical doctors should be used with greatcircumspection.

The Medical and Dental Council of Namibia is established under the Medical and Dental Act No 10 of 2004 to regulate the registration of medical practitioners and dentists and to specify the education, training and qualifications of persons practicing such professions.  When a medical graduate or dental graduate wishes to do internship, he or she applies to the Medical and Dental Council of Namibia to be registered as a medical intern or a dental intern as the case may be.  Internship is a prerequisite for a medical graduate to be registered as medical doctor in terms of Section 17 of the Medical and Dental Act.

As provided for under Section 2 of the Regulations Made in Terms of the Medical and Dental Act of Namibia, any person who holds the qualification of medical doctor must undertake training as a medical intern for a period of such years as determined by the Council, which in our case is two (2) years.  That is what the foreign-trained graduates did in 2018.  They applied to do internship. In 2016 the Medical and Dental Council decided to evaluate all foreign-trained medical graduates and have done so ever since.  There has never been any controversy before the 2018 evaluation.  

Evaluating health care professionals who obtained qualifications from other jurisdictions is not peculiar to Namibia but a common practice worldwide.  The University of Namibia School of Medicine medical graduates are exempted from this requirement as its curriculum is approved by the Council. A foreign-trained medical or dental graduate is entitled to three chances of pre-internship evaluations per application.  This is premised on an understanding that not all graduates may pass on first attempt and failing once is not necessarily a sign of poor training.  I believe that many Honourable Members of this House might have taken a driver’s license test to drive a car with people who may be at risk of his or her driving.  If one failed the first attempt, it does not necessarily mean that he or she does not know how to drive a car!

A graduate has a choice to enrol for a twelve (12) months practical training programme, which is a government-initiated strategy aimed at assisting graduates to bridge the knowledge, skills and competence gaps in preparation for the Council pre-internship evaluation.  The practical training programme mainly takes place in the State Hospitals and Health Facilities under the supervision of experienced medical and dental practitioners and specialists who are all foreign-trained. On the 29th and 30th November 2018, the Medical and Dental Council of Namibia conducted a pre-internship evaluation on 207 foreign-trained medical graduates, and not 240 as stated in the Motion, from China, Russia, Ukraine, Algeria, Cuba and South Africa.  Only two of the medical graduates from the one university in Ukraine passed all six modules of the evaluation.  Of the 205 medical graduates, 42 passed three or more modules; 101 passed one or two modules and 62 did not pass any module.  For one to pass the evaluation, one must pass all six modules, that is 100%.  If we set the pass mark at 50%, then 44 would have passed at first attempt.

After the results of the evaluation and the dates of the next evaluation were announced, the aggrieved medical graduates launched an appeal to the Council to disregard the results of the evaluation as in their views, it was a departure from previous evaluations, bias against them and unfair.  I should point out here that the Council was only appointed and constituted in October 2018 and the Appeal Committee was not in place yet to consider the appeal.  

Subsequently, the aggrieved medical graduates approached the High Court of Namibia for stay of the next evaluation which was scheduled to take place on the 21st and 22nd February 2019 until their appeal is heard and further to direct the Health Professions Council of  Namibia to appoint and constitute an Appeal Committee as provided for in the Medical and Dental Act.

I should also state here that the medical graduates understand and accept the evaluation. They have never demanded not to be evaluated.  Before the initial evaluation, they participated in sessions aimed at preparing them for the evaluation.  Their bone of contention is that the evaluation that was conducted was biased against them. They contend that they are not against the evaluation but against the process that was followed.The matter between the medical graduates and the Health Professions Council of Namibia was settled out of court.  The Appeal Committee is now constituted in terms of section 12 (3) of the Medical and Dental Act.  The appeal which was lodged by medical graduates will be heard on the 18th April 2019.

The second round of the evaluation took place on 21 and 22 February 2019 at which all two hundred and five (205) graduates that did not pass the November 2018 evaluation were invited.  One hundred and five (105) turned up for this evaluation out of which twenty-six (26) passed, fifty (50) qualified for supplementary and twenty-nine (29) did not cross the finishing line.

All the medical graduates who did not pass the evaluation and those who are yet to take the evaluation have a chance to take the evaluation.  Those who so wish, will enrol in the remedial programme until they perform to the satisfaction of Council to be admitted as medical interns.  They will then undergo a 2-years internship programme, like anybody else, before they are registered as medical doctors.  There are sufficient safeguards to ensure that those who will be registered as medical doctors have the requisite skills and competence to practice as medical doctors.  This has been the case all the years and it will continue as such.

The Namibia Students Financial Assistant Fund (NASFAF) approved loans and grants on the basis of acceptance letter from a training institution until 2014.  Each institution of higher learning has its own admission criteria which may be different from that of UNAM.  Most medical schools take students from poor academic background through an additional year of training where they are taught subjects that are relevant to medicine, namely, Physics, Mathematics, Chemistry and Biology.  Only those who pass these subjects at those institutions will be allowed to the first year of medicine.  It is not a question of standard of training.  This was confirmed by Teams that went to assess some of these training institutions.

 There may be individual graduates who may not possess the necessary competencies in the same way you have good and bad drivers.  But this cannot be generalised.

Much talk was made about the Grade 12 results that are below the 35 points that are applied by the University of Namibia as a cut-off point.  I must inform this august House that the 35 points are not the only criteria for admission to the School of Medicine at UNAM.  Among those medical graduates who failed the evaluation, there are those who obtained 35, 36, 37, 38, 39, up to 42 points in Grade 12.

Honourable Speaker, I want to believe that the Motion before the House is premised on inadequate information and understanding of the matter, rather than on opportunism.  

The Motion seeks to establish a Parliamentary Inquiry in how the graduates got funded by NASFAF.  Not all the graduates were funded by NASFAF though.  I can assure you that even public funds that were used to train these graduates will have great returns on this investment in human resource as these cadres will complete their internship, become registered medical doctors and serve the Namibian people.  Some of them will even become medical specialists.  There is a lot of benefits in repeating because repetition is the mother of learning. The proposed Parliamentary Inquiry will be a waste of time and resources as it will not unearth anything different from what is already known.  The evaluation of medical graduates, a normal practice in all countries, which the aggrieved medical graduates are not contesting, should not be blown out of proportion.  The Council and the graduates are engaged and are managing this matter at professional level.  It is agreed that there was a communication breakdown as most of these developments happened during the festive season.

Honourable Speaker
Allow me also to address a different but related matter, that of dental graduates. There is no single dentist who is trained in Namibia.  The University of Namibia established the School of Dentistry in 2018.  The first cohort of dentists is expected to graduate in 2022 and are expected to practice as dentists in 2024.  All the dentists in Namibia are foreign trained. On 10, 17 & 29 November 2018, thirty (30) foreign trained dental graduates were examined.  None of them passed the pre-internship evaluation but fifteen (15) qualified for supplementary pre-internship evaluation.  The supplementary pre-internship evaluation took place on 21 January 2019.  Eight (8) graduates passed the supplementary pre-internship evaluation and were cleared for dental internship.

Another pre-internship evaluation for dentistry took place on the 6 February 2019.  Five (5) graduates sat for this pre-internship evaluation.  All candidates passed the evaluation and were cleared for internship.  These graduates came from South Africa and China.  They will be treated in the same way as their medical counterparts.

The Motion before this august House is defective and stands to be rejected unless the sponsor voluntarily withdraws it.  First, it failed to join Algeria, Cuba and South Africa to the list of countries from where the medical graduates studied.  Second, it cited the number of graduates as 240 whereas the number is 207.  Third, it cited a wrong amount of N$125 million based on wrong number of students.  The sum total of these mistakes and the lack of merit render this Motion unacceptable.

Finally, I call on the graduates to focus on their medical and dental careers.  Professional matters are resolved around the table and not in Courts or in the streets.  The Council is ready to take them through this registration process.  The graduates are Namibians and are expected to render their services to the Namibian people.  

• Dr Kalumbi Shangula the Minister of Health and Social Services delivered this speech in the National Assembly.
 


New Era Reporter
2019-03-29 10:25:00 4 months ago

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