Access to higher education in the health sciences : a policy implementation analysis.
Access to health sciences education in South Africa is a challenging and contested area of higher education seeped in politics and history within a context of transformation. There are a large number of students wanting to study health science courses but there are limited places. The first democratically elected government in South Africa issued White Paper 3: A Programme for the Transformation of Higher Education with a vision of transforming the higher education system to one that was more representative of the country`s demographic profile. However in the absence of any guidelines for the implementation of this White Paper 3, higher education in many instances has not been transformed as the government envisaged. The aim of this study was to identify the factors affecting access to health sciences education at universities in South Africa and to develop guidelines to broaden access for social redress. This study was conducted within a pragmatic paradigm using a mixed methods sequential exploratory design in the complementarity genre. Universities offering traditional health science courses` including medicine were included in the study. The research consisted of 3 Phases – Phase 1 reviewed existing policies and practices through the review of relevant documents; Phase 2 assessed existing practices through one-on-one interviews and Policy Delphi and Phase 3 developed policy implementation guidelines and two policy briefs to broaden access using the information gathered from the literature reviewed and data collected from stakeholders. The Policy Delphi questionnaire was developed following the analysis of qualitative data collected in Phase 2 and the instrument was subjected to 2 cycles of item content validity index (I-CVI). The results indicated that achieving equity of access is multi-factorial and has diverse and complex challenges. Some of these challenges are ingrained in South Africa`s apartheid history, some are rooted in the process of access and some in the mind-set of the actors involved in access. The research identified eight categories, promotion of health science disciplines; challenges to transformation; competitiveness; health sciences sets the “bar”; alternative access; reason for choosing a health sciences profession; innovation in teaching and learning and retention and throughput rates which were related to access to health sciences education in universities. The data indicated that the student demographic has changed substantially in Health Science programmes but more could be done. Faculties of Health Sciences need to implement some strategies to reach out to the eligible students in rural and remote areas. Student success in Health science courses is relatively good as would be expected as the selection and admission criteria, is generally higher. Health Sciences at many of the universities are committed to the imperative of transformation for social redress but there are others who are caught between facilitating transformation and overwhelming demand for their programmes. Guidelines for the Implementation of the Access Policy in Health Sciences Education and the Access for Success in Health Sciences Education in Universities Policy briefs were informed by the results. Universities have implemented a number of initiatives to address the past injustice in higher education access however the issue of enabling access for those who are socio-economically disadvantaged is very much more complex and challenging to address. Transformation of health sciences education in universities is essential to the transformation of the health service to reflect a health service that is accessible, available, affordable and agreeable, something that every South African citizen.