Financing Health Science Education in South Africa
10.2 Funding of health sciences education in South Africa
10.2.1 Public funding of higher education: the university funding framework
The current funding framework is designed to give the Minister of Higher Education and Training the ability to reprioritise funding allocations in line with priority areas and policy incentives. Ideally funding allocations should take into account
growth in student enrolments in existing programmes; student enrolments in new programmes addressing the social and economic needs of the country; the capacity of institutions in terms of human and capital resources to deliver on their planned mandate; and, fiscal and other available resources. In practice, however, funding allocations are driven by the principles of affordability (government decides how much it can afford to spend on higher education and then allocates funds to institutions, according to national needs and priorities); distribution (a distributive mechanism to allocate government funds to individual institutions in accordance with available budget and taking into account policy priorities and plans); and, cost-sharing (higher education costs shared by government, students and households, and private donors).
As shown in Figure 10.1 the university funding framework comprises three distinct sources of income: government subsidies, student fees and third-stream income.
government subsidies take the form of block and earmarked grants. Block grants are designated as HEI Council-controlled and are mainly used to fund operational, and teaching and learning activities. Earmarked grants fund specific programmes or policy priorities and currently include the infrastructure and efficiency grant, clin- ical teaching grant, teaching development grant, research development grant, historically disadvantaged institutions development grant, veterinary sciences grant, and a grant for the development of the two newly established universities, Sol Plaatje university and the university of Mpumalanga. The relative split in the funding between block and earmarked grants changes annually, and is influenced by uni- versity enrolments and the policy direction of DHET. The DHET budget for universities has increased from R9.9 billion in 2004/05 when the existing funding framework was introduced, to r30.3 billion in 2015/16 – including funding for the National Student Financial Aid Scheme (NSFAS).
State Appropriations (40%) Block Grant Conditional Grants
Student Fees (33%)
Registration Tuition Fees Student Accommodation
Third-Stream Income (27%) Income from contracts for research Sales of goods and services Private gifts and grants Finance income Block Grant (78%) allocation is base on audited submitted higher Education Management information System (HEMIS) data
Teaching input grant (64%)Teaching output grant (16%)Research output grant (15%)Institutional factor grant (6%) Approved Teaching Input Units based on approved enrolment plan
Non-research graduates & diplomats
Research Masters, doctorates and
scholarly publications
a) Enrolment size b) Disadvantaged students
generated by
Earmarked Grants (22%) are based on project proposals and in some instances on audited HEMIS data
Infrastructure & efciency improvements
Research development grant
Teaching development grantHDI development grant
Foundation provision
Clinical training of health professionals
Veterinary Sciences African Institute for Mathematical
Studies Other: Establishment of new universities and phasing out of national institutes, interest & redemption on loans
generated bygenerated bygenerated by
Institute for Human and Social Sciences
THREE MAJOR STREAMS OF INCOME (NSFAS Excluded)
Source: DHET, 2015
Figure 10.1: Structure of university funding framework, 2015/16
In 2013, a Ministerial Committee on the review of the Funding of universities examined the effect and impact of the government-funding framework of universities since its introduction in 2004/05 (DHET, 2013). The committee found that improvements have been made in achieving a more representative student body; a higher growth rate in graduates than enrolments; increasing research publication units;
more funds being channelled towards universities with a higher share of students from disadvantaged backgrounds; and, increasing access to higher education students through increased provision of student financial aid.
The funding framework for HEIs was designed to align with government’s planning process. It is based on student enrolments although there are also performance- output allocations that influence total funding levels. Enrolment planning is key to accessing funding: each university prepares an enrolment plan for a six-year period (which can be revised every three years) and negotiates their estimates with DHET until an agreement is reached. The final enrolment plan is signed off by each university council for approval by the National Minister of Higher Education and Training.
In 2013, universities received about 40% of their income from government subsidies, 33% from tuition and residence fees (with some of this being subsidised by NSFAS), and 27% from third-stream income generated through research contracts, donations, investments and facilities rental. There are, however, substantial differences between the HEIs in terms of the percentage contribution of total income from the various sources. For instance, third-stream income as a proportion of total income ranges from 1% at Walter Sisulu University to 45% at the University of the Witwatersrand in 2015. Some universities, typically previously advantaged universities, are better placed to attract additional sources of funding such as donations or endowments. Figure 10.2 shows the distribution of the three income sources by institution.
Source: DHET 2015 Figure 10.2: Percentage distribution of sources of income by university, 2013
SubsidiesFeesOther
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
UJ NMMU Unisa Univen WSU UZ CPUT CUT DUT MUT TUT VUT UCT FH FS KZN UL NWU UP RU SU WC Wits National
10.2.2 Health sciences: student enrolment an d graduate numbers
The numbers of health science enrolled students and graduates by academic programme for the period 2009 to 2013 are shown in Table 10.1. There were 55 962 health science students enrolled in HEIs and 12 368 graduates. graduates by discipline for the same year are shown in Table 10.2. Table 10.1: Student enrolment and graduate numbers: Health professions and related clinical sciences 20092010201120122013 EnrolledGraduatsEnrolledGraduatsEnrolledGraduatsEnrolledGraduatsEnrolledGraduats Undergraduate37 5057 45535 9707 29836 4037 75438 8717 61240 3128 131 Pg <Masters5 5162,6885 4652 7105 4642 6545 7222 8495 2112 652 Masters8 5981 0848 1161 0848 3171 1698 5581 3118 6691 370 Doctorate1 2661681,0641111 2851551 4851861 770216 TOTAL52 88411 39650 61511 20251 46911 73354 63611 95855 96212 368 Source: HEMIS 2016 Table 10.2: Number of graduates in health professions and related clinical sciences by programme, 2013 2013 GRADUATESUndergraduate PG <MastersMastersDoctorateTOTAL Health professions and related clinical sciences8 1312 6521 37021612 368 Chiropractic75-48-123 Communications Disorders Sciences and Services15125373216 Dentistry, Advanced Dentistry and Oral Sciences26169374370 Dental Support Services and Allied Professions285-1-286 Health and Medical Administrative Services6644715-725 Medicine6036812629 Medical Clinical Sciences1 603255383672 308 Nursing1 4361 193158302 817 Optometry10251-1082013 GRADUATESUndergraduate PG <MastersMastersDoctorateTOTAL Osteopathic Medicine/Osteopathy-----
Pharmacy, Pharmaceutical Sciences and Administration
74999213862 Podiatric Medicine/Podiatry13---13 Public Health516407265321 219 Rehabilitation and Therapeutic Professions708203107261 043 Veterinary Medicine1434--48 Veterinary Biomedical and Clinical Sciences351143213193 Medical Illustration and Informatics----- Dietetics and Clinical Nutrition Services13215217175 Bioethics/Medical Ethics--5-5
Alternative and Complementary Medicine and Medical Systems
37117156 Somatic Bodywork and Related Thereapeutic Services13912-141 Movement and Mind-Body Therapies and Education11---11 Energy and Biologically-based Therapies----1
Medical Raiologic Technology/Science (Radiography)
406783424
Health Professions and Related Clinical Sciences, Other 1952631336596 Source: HEMIS 2016
Ideally a data and information management system should exist which links enrolment and graduation data with sectoral human resources for health planning.
In addition, the budget allocation should be aligned with enrolment planning numbers by discipline and scarce skills. Such data are currently not available for planning purposes.