Context, types, and utilisation of decentralised training platforms in undergraduate medical education at four South African universities: Implications for universal health coverage

Abstract

In concert with global developments, South Africa has embarked on an ambitious set of health care reforms towards universal health coverage (UHC) that necessitate the transformation of health workforce education. This study explored the context, types, and utilisation of decentralised training platforms (DTPs) in undergraduate medical education at four South African universities, and the implications for universal health coverage. The study was conducted at the health sciences faculties of Sefako Makgatho Health Sciences University, the University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand. Following informed consent, semi-structured interviews were conducted with 17 key informants who were selected purposively based on their in-depth knowledge of and current involvement in undergraduate medical education. The questions focused on the number and type of DTPs used in undergraduate medical education, benefits of DTPs, innovations or good practices, community engagement, the challenges or constraints of DTPs and institutional investment in DTPs. The interviews were analysed using thematic analysis. The study found that context, notably the history and evolution of DTPs and the expressed vision and philosophy of medical education, influenced the type, characteristics, and utilisation of DTPs. All four universities reported utilisation of various DTPs in the undergraduate medical education programmes, but there were differences in the institutional arrangements on medical education, and the type and nature of investments in DTPs. The DTPs were primarily hospital-based, with the utilisation of PHC facilities constrained by insufficient resources, and competition with clinical disciplines. DTPs are an essential component of transformative medical education, and require an explicit vision, and institutional investments in human resources, finances, and infrastructure to realise the goal of UHC.