COMMENTARIES

 

Vision and future of South Africa's oldest rural medical school as it navigates towards its first century

 

 

W W Chitha^{I, II}; SA Mabunda^{III, IV, V, VI}

^IMB ChB, PhD; School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IIMB ChB, PhD; Institute for Clinical Governance and Healthcare Administration, Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa
^IIIMMed (Public Health Med), PhD; School of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IVMMed (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
^VMMed (Public Health Med), PhD; School of Population Health, University of New South Wales, Sydney, Australia
^VIMMed (Public Health Med), PhD; George Institute for Global Health, University of New South Wales, Sydney, Australia

Correspondence

 

 

Background

Walter Sisulu University (WSU) seeks to be an impactful, technology-infused African university. To be impactful means to be a university of which the core activities contribute to the building of a just, equitable and sustainable world. This includes the extent to which teaching and learning, research and innovation, and community engagement contribute to the pursuit of developmental priorities locally (a thriving province filled with flourishing people), nationally (eliminate poverty and reduce inequality), continentally (the Africa we want), and globally (Sustainable Development Goals (SDGs)).

The WSU Faculty of Medicine and Health Sciences is a leader in problem-based learning, community-based education and community partnerships, and it empowers historically marginalised students (rural and socioeconomically disadvantaged) to graduate, open new doors and gain access to opportunities in society.

 

Faculty vision and mission

The Faculty of Medicine and Health Sciences aims to become the knowledge partner for a healthier society. Our faculty mission (Fig. 1) is to collaborate with our government, partners and local communities to build local health systems, deliver high-quality sustainable healthcare to rural and underserved communities, contribute to better health outcomes, and bring about change in the health status of vulnerable populations. Our motto is 'Excellence Through Relevance', and we have sought to redefine excellence through our mission. Being a knowledge partner for a healthier society entails driving our core business towards the achievement of the SDGs, health equity, and the Africa we want.

 

 

Education

We develop educational programmes in response to societal needs, recruit our students from rural and underserved areas, train our students in rural and underserved communities, and produce versatile future-ready graduates. Our curriculum is problem based, and our faculty has the number one community-based education programme in South Africa.

Research and innovation

With our partners and collaborators, we conduct rigorous research, test new models of care, test new ways or modalities of treatment, find innovative solutions to community challenges, harness knowledge to improve the quality of healthcare, and share our knowledge through publication in peer-reviewed journals to influence national and global health policy.

Community-engaged scholarship

We are firm believers in community engagement, and ensure that all academic and research programmes integrate community engagement within their activities. We learn from the community, we learn in the community, we learn with the community, we serve while we learn, and we conduct research within and with local communities and translate the findings into relevant and/ or co-designed interventions for improving the performance of local health systems and health outcomes.

Continuing training and professional development

We believe that our staff, as teachers, health workers, administrators, leaders, innovators and researchers, should maintain appropriate skills and competencies in their respective areas of practice in order to serve our patients, our students and our communities to the best of their abilities. To maintain skills and competencies, we have set up relevant academic and research infrastructure to strengthen research and innovation capacity, and provide ongoing leadership training, clinical training, continuing professional development and health professions education.

Excellence through relevance

We believe that the best way to guarantee sustainable equitable access to high-quality healthcare is to invest in building capacity in responsive local health systems. This includes producing locally trained health professionals, producing knowledge and translating it into locally responsive interventions, training health administrators, managers and leaders, investigating innovative solutions for local challenges, and implementing community engagement initiatives in response to local population needs.

Partnerships

We believe that strong partnerships are an essential prerequisite for the achievement of sustainable improvements in the health status of underserved communities. We have historically established strong partnerships with the Eastern Cape provincial government, the health facilities and associated communities, academic institutions, and national government. We believe that regional, continental and global partnerships provide a good platform for knowledge exchange, innovation and collaborative efforts towards a just world.

In pursuit of the university's and faculty's vision and mission, we intend to reconfigure our faculty to be fit for purpose, grow undergraduate and postgraduate programmes, improve research infrastructure, productivity, innovation and internationalisation, re-engineer the academic/clinical enterprise, improve revenue generation, record our faculty heritage and memory, empower our staff, and ensure financial sustainability of the faculty.

 

Academic Health Platform

The WSU Academic Health Platform is founded on a 40-year-old partnership with the Eastern Cape Department of Health, the National Health Laboratory Service (NHLS), and Eastern Cape communities. The Academic Health Platform seeks to strengthen health services and improve health outcomes, develop sustainable, equitable and affordable healthcare services, promote the provision of high-quality academic programmes, provide for the ideals of community engagement and social compact, provide a platform for research and innovation, decentralise the platform to include primary and secondary care levels, ensure growth, development and maintenance of academic programmes in keeping with health priorities, and ensure that there is efficient, cost-effective and appropriate utilisation of available resources.

This platform has matured over time to be robust and globally competitive. The WSU-Nelson Mandela Academic Hospital (NMAH) Complex is the headquarters of the WSU Academic Health Platform (where the academic heads of departments are based) and provides academic and clinical leadership over all levels of the platform. The Academic Health Platform involves all levels of care and continues to be decentralised to strengthen the role of regional hospitals, specialised hospitals, district hospitals and primary care facilities. It is divided into two deaneries, namely Eastern Deanery and Central Deanery, with the Western Deanery now surrendered to the nearby Nelson Mandela University. Each deanery is under the leadership of a jointly appointed associate dean. Each deanery supports all faculty programmes. An academic co-ordinator and research co-ordinator are designated/appointed in each academic health facility.

The platform is governed co-operatively within the context of the higher education policy frameworks, national health policy frameworks, the University Statute and the Memorandum of Agreement (MoA). The University Statute defines the role of the University Council, University Senate, Faculty Board and related committees. The MoA, through the Academic Governance Committee and its subcommittees, regulates the relationship between WSU and the Eastern Cape Department of Health. The relationship with the NHLS is governed through the relevant bilateral agreement and umbrella agreement. The University Senate is responsible for the strategic direction of all teaching, learning, research, community engagement and academic functions of the university. It is mandated to provide academic leadership, ensure the quality of academic programmes, research and community engagement, and promote a culture of high academic and ethical standards. The Faculty Board, which is a committee of the University Senate, governs and regulates the activities of the faculty in line with policies and rules of the university.

 

The multiple missions of the Academic Health Platform

The Academic Health Platform pursues multiple missions, namely the educational mission, the clinical mission, the research mission, and the community engagement mission.

Clinical mission

The platform aims to develop sustainable, equitable and affordable primary, secondary, tertiary and/or quaternary healthcare services. It recognises NMAH as the central hospital of the Eastern Cape, where advanced tertiary and quaternary health services are provided. We aim to strengthen clinical services in regional hospitals, specialised hospitals, community health centres and clinics.

A Clinical Training Institute will be developed to champion clinical training, clinical training innovations and partnerships. Centres of Clinical Excellence will be developed to support development of advanced specialised services, training, and research and innovation. Platform Resources and a Development Committee will oversee the implementation of projects and required capacity building programmes within the Academic Health Platform.

Research mission

We have agreed to establish a robust and functional clinical, laboratory and public health research platform in order to strengthen health services and improve health outcomes. WSU is expected to be the hub of all research activities conducted within its platform. Efforts will be made to strengthen clinical research and innovation capacity in the platform. Through the centre for Clinical Research, Academic Development, Leadership and Education (CRADLE), we are committed to enhance the capacity of the platform to conduct clinical research, promote clinical innovations and collaborate with the world. We will provide a hub of clinical research support including training and mentorship, biostatistical support, grants management and research support, and clinical trials across the platform. Research groups and Centres of Research Excellence will be formalised. Centres of Excellence in Public Health (Health Promotion, Health Systems, Health Economics, Health Policy, Academic Governance, Clinical Governance, Measurement Sciences) will be established. A Research and Innovation Hub will be established at Cecilia Makiwane Hospital.

Educational mission

The MoA aims to promote the provision of high-quality academic health programmes. It calls for a well-capacitated preclinical platform (laboratories, teaching facilities, libraries, information and communication technology, and human resources) and clinical platform in order to enable growth in academic programmes and research. It is a common understanding that accreditation of academic programmes is the primary responsibility of the university, and the development and maintenance of an accredited academic health platform is a joint responsibility. Strengthening the platform in regional and district hospitals is key to decentralisation of the clinical training platform. Our aim is to run 70% of our curriculum in non-tertiary settings.

The WSU Rural Clinical School will be established at St Elizabeth Hospital in Lusikisiki. St Elizabeth Hospital will be a hub, with its spokes including Oliver and Adelaide Tambo Regional Hospital (OATRH), Holy Cross Hospital, Greenville Hospital, Bambisana Hospital and surrounding primary care facilities. Although we will start with the medicine programme, all undergraduate and postgraduate clinical programmes are expected to participate. We will develop an integrated technology-infused rural academic health platform, which will drive clinical care, research and innovation, community-engaged scholarship and rural health sciences education. A social compact through undergraduate programmes, registrar training, postgraduate programmes and short learning programmes will be emphasised.

Community engagement mission

The faculty is committed to social responsiveness and infusion of community services into the learning programmes, with emphasis on primary healthcare. The MoA provides for the growth, development and maintenance of academic programmes in keeping with health priorities. The MoA dictates that we provide for the ideals of community engagement and social compact between the Eastern Cape communities, the Eastern Cape Department of Health and WSU. We further envisage a decentralised community-engaged, research-friendly, technology-infused, globally connected and high-quality Academic Health Platform.

We have implemented a successful Community-Based Education and Service (COBES) programme. Our Integrated Longitudinal Community Clerkship (ILCC) is unparalleled in the country. The two programmes have evolved into COBES and ILCC conferences, respectively. We have consolidated a Framework for Community-Engaged Scholarship, which includes adopt-a-school, adopt-a-clinic, adopt-a-district, community-orientated primary care (COPC), and a WSU Clinical Governance laboratory as a space for innovation and creative ideas on clinical governance. We intend to extend the 'adopt-a-clinic' model to registrar training programmes in core disciplines. We have committed to collaborative initiatives to build clinical governance, academic healthcare leadership and clinical skills, and decentralise medical specialist services. The faculty has resolved to 'adopt' the Nyandeni Local Municipality as a laboratory for its community engagement agenda, where all academic departments will be involved. This is called the Nyandeni Community-Engaged Scholarship Development Initiative. From lessons learnt in implementing COPC around Mthatha Regional Hospital, we intend to replicate this approach around Cecilia Makiwane Hospital, St Elizabeth Hospital, OATRH and Frontier Hospital.

 

Faculty signature initiatives

The faculty's transformation agenda is embodied in signature initiatives that have the potential to propel it to be among the best medical schools in the world. These include, among others, CRADLE, the Centres of Research Excellence initiative, the Rural Clinical School, School of Public Health, School of Pathology and Institute for Clinical Governance and Healthcare Administration, the Re-engineering of the Academic-Clinical Enterprise initiative, the Centres of Clinical Excellence initiative, the Centre for Health Professions Education, Research and Development, and Growth and Academic Sustainability programmes. Through these initiatives, we will put together a foundation for community-engaged scholarship, institutionalise excellence in health professions education, and strengthen pillars of clinical excellence. We intend to set up infrastructure for sustainable improvements in research and innovation.

WSU CARES! WSU LIVES! WSU LEADS!

 

 

Correspondence:
S A Mabunda
drskhumba@gmail.com

Received 1 May 2025
Accepted 11 August 2025