COMMENTARIES

 

A vision for South Africa's only rural academic health complex: The case of Walter Sisulu University and the Nelson Mandela Academic Hospital Complex

 

 

K Mfenyana^I; N Makwedini^II; W W Chitha^{III, IV}; S A Mabunda^{V, VI, VII, VIII}

^IMB ChB, MMed (Farn Med); Department of Family Medicine and Rural Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IIBCur Hons, MPH; School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IIIMB ChB, PhD; School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IVMB ChB, PhD; Institute for Clinical Governance and Healthcare Administration, Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa
^VMMed (Public Health Med), PhD; School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^VIMMed (Public Health Med), PhD; Global Centre for Human Resources for Health Intelligence, Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa
^VIIMMed (Public Health Med), PhD; School of Population Health, University of New South Wales, Sydney, Australia
^VIIIMMed (Public Health Med), PhD; George Institute for Global Health, University of New South Wales, Sydney, Australia

Correspondence

 

 

The Faculty of Health Sciences (now known as the Faculty of Medicine and Health Sciences) at what is now Walter Sisulu University (WSU) was established in 1985 when the Department of Nursing Sciences that was housed within the Faculty of Economic Sciences was combined with the School of Medicine. Later, in 1989, a Department of Health Promotion was established. Programmes in these three fields of study, i.e. nursing, medicine and health promotion, have been the pillars of this faculty ever since. The Faculty of Health Sciences was established mainly to produce more black African doctors in the Republic of South Africa and to produce health professionals trained appropriately for the country's needs. From the beginning, therefore, although the traditional approach was used to teach health professionals in the faculty, the pedagogical approach that was found to be appropriate was that of problem-based learning and community-based education, which was implemented in full force in 1992 and has continued to date. The strength of this faculty, therefore, even today, is to train health professionals who are appropriate for the needs of this country. As a result, the faculty has the highest retention rate of its graduates within the country, and most of these graduates serve SA's underserved communities. The call from the government to increase intake in programmes that produce scarce-skills personnel, which is championed by the Department of Higher Education and Training (DHET) with full support from the Department of Health, enabled the university to intensify its vision for an expanded Faculty of Medicine and Health Sciences that would double or even triple its intake in certain programmes that are key to the improvement of lives of the people in this country. The Bachelor of Medicine and Bachelor of Surgery (MB ChB) programme has grown exponentially over time from a humble 12 students in 1985, nine of whom graduated, to averaging 65 graduates in the late 1990s and the dawn of the 21st century (Fig. 1), and now in excess of 120 graduates (Fig. 2).

 

 

 

 

In 2008, the Institutional Planning Committee of WSU made a commitment to this expansion in line with the faculty's needs. The faculty entered into discussions with the Mthatha Hospital Complex and then with the Provincial Department of Health, reaching the agreement to obtain the piece of land adjacent to Nelson Mandela Academic Hospital (NMAH) (SA's only rural central (quaternary) hospital) for this project, as had been envisaged several years before. Discussions with Public Works were started, and architects were brought in as the project was conceptualised. The thinking was to start small with prioritisation of teaching and office facilities for clinical staff. Following all these preliminary arrangements, a formal letter was received from the Chief Executive Officer of Mthatha Hospital Complex, Mrs Makwedini, on 10 June 2009, confirming the availability of land for the construction of the medical school adjacent to the NMAH Complex. The Faculty of Medicine and Health Sciences, together with the whole university, welcomed the confirmation and worked even harder to establish the faculty as a whole on the identified piece of land, with no objection from the hospital management.

In 2010, the ideas were put on paper, and the key requirements were identified as tutorial rooms and lecture rooms for the clinical students, library facilities, staff offices and student accommodation for phase 1 of the project. An attempt was made to get funding for the project in 2010/11, but things did not work out well. However, the draft sketches were produced by the architects, and there was hope that the project would start again.

Grants (Clinical Allocation Grant and Infrastructure and Efficiency Funding) for phase 1 were received from the DHET. The construction of phase 1 began on 27 February 2014, with sod turning hosted on 24 March (Fig. 3). Phase 1 construction (Figs 4 and 5) began with lecture rooms/seminar rooms/tutorial rooms for teaching of clinical students and offices for the clinical staff. The rationale was that this step would enable clinicians to be close to NMAH for their teaching, research and service requirements and thus eliminate the daily movement of staff and students between the main university campus and NMAH. It would also be ideal for supervision of staff at the hospital by heads of departments, teaching of students, and rendering of clinical services to patients in the hospital setting. It was also envisaged that accommodation for approximately 80% of the faculty's students would be constructed at the same site in later phases. This was because, even at that stage, it was realised that it would be difficult and at times impossible to find student and staff accommodation in Mthatha owing to shortages.

 

 

 

 

 

 

Even though the initial construction period for phase 1 was estimated to take only 18 months, it ended up taking more than 30 months.

This project aligns perfectly with WSU's growth aspirations and scaling up of intake in the health sciences, in line with the 2014 National Minister of Health's calls for universities to scale up their intake in scarce-skills programmes. This stand-alone rural medical school has sufficient capacity for training in both basic and clinical sciences and provides a good platform for multidisciplinary or multiprofessional learning. Over time, there should be enough capacity to double or even triple the intake in some key programmes, e.g. from 100 to 300 medical students and from 24 to 96 Clinical Associate students. Furthermore, the growth of the medical school builds more capacity to support all programmes within the Faculty of Medicine and Health Sciences, not only centrally at NMAH but also peripherally in district hospitals in support of the community-based education component of the university's programme. A stand-alone faculty site also enhances support for research activities in health throughout Eastern Cape Province, as there is more coherence and co-ordination of teams within the same platform. It must be noted that NMAH Complex together with the Faculty of Medicine and Health Sciences is the nucleus of the academic health service complex in the Eastern Cape and must cater for a substantial increase in student intake as part of Vision 2030 of the National Planning Commission. The completed product in terms of the envisaged facility will be a fully-fledged new Faculty of Medicine and Health Sciences with all its departments and research laboratories and with capacity to support all the peripheral hospitals that will be designated as part of the clinical teaching platform for the Eastern Cape. This support should include information technology connectivity, supervision of staff and students, research activities, and patient care that will ultimately improve the lives of the people served by the platform, especially the rural and disadvantaged.

Over the past 40 years, the university has been present through the release of Nelson Mandela from prison to his being able to take residence in his traditional home in Qunu (barely 35 km from the university). We have witnessed the laying of the first stone of Nelson Mandela Academic Hospital (initially proposed to be uMtata Academic Hospital) in June 1998 (Fig. 6), the opening of SA's first (and still only) rural central hospital in December 2004 (Fig. 7), and the burial of Nelson Mandela in Qunu.

 

 

 

 

Figs 8-11 show faculty graduates from the various programmes for 2024, including Health Promotion (Fig. 8), Nursing (Fig. 9), Clinical Associates (Fig. 10) and Medical Orthotics (Fig. 11). Fig. 12 shows the prospective Medical Orthotics graduates for 2025.

 

 

 

 

 

 

 

 

 

 

Unique among South African medical schools, and owing to its rurality, the faculty has benefited from the Nelson Mandela Fidel Castro Medical Collaboration since 1996. Through this programme, Cuban medical doctors from various specialties have been sent to the faculty, mostly as joint appointees with the Eastern Cape Department of Health. Figs 13 and 14 show some images of Cuban colleagues we have had the pleasure of hosting in our faculty over the years. We hope to have more authentic partnerships from the Global South while maintaining all those that have been part of our journey so far.

 

 

 

 

 

Correspondence:
S A Mabunda
drskhumba@gmail.com

Received 25 April 2025
Accepted 11 August 2025