It costs more than twice as much to train medical students in Cuba than in SA, health minister Joe Phaahla has revealed in parliament.
SA has been sending medical students to Cuba since 1997 under the Nelson Mandela-Fidel Castro training programme, with the costs borne by provincial health departments.
The programme has been controversial from the outset and is under fresh scrutiny from the DA in light of the budget constraints facing provinces. Students spend their first year in Cuba learning Spanish and then do five years of training at Cuban medical schools. They complete their training with 18 months at a medical school in SA.
In a detailed response to questions asked by DA MP Haseena Ismail, Phaahla last week revealed that it costs on average $20,180 a year, or more than R370,000 at current exchange rates, for tuition, meals, accommodation, insurance and a monthly stipend, for six years of study in Cuba.
This figure does not include the cost of at least two sets of return flights, or sending officials or psychologists to Cuba to deal with emergencies, he said.
The Cuban-trained medical students also have to complete three semesters, or 18 months of training, at an SA medical school at a cost of more than R400,000.
The annual costs in Cuba are $14,872 for the preparatory year learning Spanish; $21,422 for each of the first two years at medical school; $20,422 for years three and four; and $22,522 for the final year in Cuba, he said. On their return to SA, it cost R130,348 per semester at a local medical school for the year to June 2022, and R138,820 per semester in the year to June 2023.
By contrast, it costs the government about R150,000 per year to train medical students in SA, according to the most recent publicly available figures, set out in a reply to questions the DA posed in the Gauteng provincial legislature in 2019.
“We should rather open more medical [training] places in SA, so that money can be more appropriately used in the country,” said Ismail.
SA students who go to Cuban medical schools face numerous challenges, including having to learn Spanish and contending with shortages of essential goods, she said.
Budget
Phaahla said 3,369 students had been recruited to study medicine in Cuba, and 2,617 have graduated to date.
UCT deputy dean for undergraduate education Kerrin Begg said SA’s 10 medical schools are projected to graduate about 1,900 locally trained doctors in 2023, and slightly more than 450 who had participated in the Cuban training programme.
While SA needs more doctors to serve its population, the budget pressures facing provincial health departments mean they are struggling to absorb medical graduates, she said.
All doctors have to complete a year of community service and two years of internship before they can practice.
“When you have an austerity budget and 70% of the budget is salaries, you cut salaries, and the easiest ones to cut are contract posts like internships,” she said.
Finance minister Enoch Godongwana’s medium-term budget policy statement, tabled in parliament last week, sees health expenditure shrinking in real terms over the next three years.
Consolidated government expenditure on health is projected to rise by a nominal 2.6% over the medium-term expenditure framework, significantly below the Treasury’s inflation forecasts.
The Treasury projects inflation will come in at 6.7% in 2022, 5.1% in 2023, and at 4.6% in both 2024 and 2025.
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