HEALTH-CARE PROVISION AND SURGICAL EDUCATION IN SOUTH-AFRICA

Apartheid policies have led to inequalities in the delivery of health care and the training of surgeons in South Africa. The nation's popula tion of 33 million is comprised of 73.6% Blacks, 14.8% Whites, 8.8% Co loureds, and 2.7% Asians. Only 17% of the population are covered by me dical insurance (78% of Whites, 28% of Asians, 26% of Coloureds, 4% of Blacks) that funds the private sector which accounts for 46% of the n ation's total health care expenditure of 9.2156 million rand. The rema inder receive care from curative state hospital based services, which consume 77% of the public expenditure on health. Preventive and promot ive health services account for 23%. Only 3.2% of South Africa's gross national product is spent on health care provision for 80% of the pop ulation-well short of the World Health Organization's recommendation o f 5.8%. This figure translates into a per capita expenditure of 138, 3 40, 356, and 597 rands for Blacks, Coloureds, Asians, and Whites, resp ectively. Eight medical schools produce just over 900 graduates per ye ar, 80% of whom are white. The medium of instruction is English at fiv e (Cape Town, Witwatersrand, Natal, MEDUNSA, and Transkei) and Afrikaa ns at three (Pretoria, Stellenbosch, and Bloemfontein). Natal and MEDU NSA are creations of apartheid and have graduated almost all the Black South African doctors, of whom only 15 are practicing surgeons. Many universities are cognizant that dramatic change is needed to redress s uch imbalances, and admission policies are changing. Schools are addre ssing the implications of admitting many more Black African students f rom less privileged educational backgrounds into their medical faculti es. Only then will more nonwhite graduates emerge with excellent, well monitored specialist training in surgery, which until now has been th e domain of mainly white doctors.