Orton, I declare that this thesis entitled “Access to Tertiary Education in the Health Sciences – A Policy Implementation Analysis” is my original work and has not been submitted to any university other than the University of KwaZulu Natal (Durban). Access to health education in South Africa is a challenging and contested area of higher education that has permeated politics and history in a context of transformation.
Introduction
Background
- South Africa`s plans for higher education transformation
- Access and success of disadvantaged populations in higher education 4
- Health outcomes and qualified health professionals
- Shortage of all health professionals
- Health professionals` education programmes
- Nursing education programmes and the need for university education 12
The transformation of higher education, as envisaged in White Paper 3 (1997), did not happen as quickly as desired and no implementation guidelines were included in White Paper 3 (Fourie, 2001). Attention to this would go some way towards achieving equity in the South African higher education system, as well as addressing some of the inequities of the past.
Research questions
Aims
Research objectives
Significance of the study
It is anticipated that the guidelines developed from this study will assist Faculties of Health Sciences to implement the South African governments vision of transforming higher education by increasing access to talented students in the health sciences.
Operational definitions
The health professions registered with the Health Professions Council of South Africa (HPCSA), the South African Nursing Council (SANC) and the South African Pharmacy Council (SAPC) but exclude allied health professions such as; Higher education refers to education offered by tertiary academic institutions that offer qualifications on the Higher Education Qualifications sub-framework.
Conclusion
Policies refer to statements of long-term or intended courses of action adopted by the South African government and/or the universities surveyed (Gillies, 1982). This study refers to White Paper 3 (1997), the National Plan for Higher Education. in South Africa (2001) and the White Paper on Post-School Education and Training (2013).
Literature Review
The international context for higher education
The massive expansion of higher education has created enormous pressures on national governments to deal with the problems arising from crowding (Guri-Rosenblit et al., 2007). Countries around the world continue to develop their higher education systems to meet the growing demand for higher education.
Predictors of participation in higher education
In Portugal, students in the highest socio-economic group are ten times more likely to enter higher education than those in the lowest group (James, 2007). This is an example of the disadvantage that rural students in China face in accessing higher education.
The context for higher education in South Africa
South Africa does not escape the worldwide trend of low socio-economic status being a predictor of higher education participation. In light of the urgent need to address the critical health human resource deficit in South Africa, expanding access to higher education is imperative.
The policy and legislative framework which govern higher education for
In the African higher education context, where a secondary education system with diverse resources produces many underprepared students (CHE, 2001), access involves, among other things, development of flexible admission requirements and selection mechanisms, assessments for recognition of prior learning, program-specific admission tests and alternatives. The Pharmacy Council of South Africa, which regulates the education and practice of pharmacists in South Africa.
Equity in higher education
All three professional councils accredit institutions that offer training for medicine and health science professionals, nurses and pharmacists. Providing higher education to all its citizens means a nation confronts many of the social disparities, deeply rooted in history, culture, and economic structure, that affect an individual's ability to compete (Altbach et al., 2009).
Social justice in higher education
Conceptual framework
- Theories of the policy process
- Frameworks used in policy analysis
- Walt and Gilson Policy Analysis Triangle
- Context analysis
- Content analysis
- Actor analysis
- Process analysis
Within the perspective of this research policy content referred to the policy goals and the actions necessary to achieve these goals - the goal of transformation of the higher education environment in South Africa. In this study, the process analysis addressed the translation of the governments' transformation of higher education policy into access policy at the university level.
Review of the current access criteria to university health sciences
- University of Limpopo
- University of Pretoria
- University of the Witwatersrand
- University of KwaZulu Natal
- University of the Free State
- Walter Sisulu University
- University of Cape Town
- Stellenbosch University
The University of the Witwatersrand (Wits) makes their admissions policy available on their website, which advocates diversity with respect to: race, gender, socio-economic background, urban and rural geography, culture, ethnicity, disability, religion, sexual orientation and national origin (University of the Witwatersrand, 2014). They actively seek to admit students who may not have been admitted previously, but who have the potential to succeed – the tension between adhering to equality and diversity, but also with the recognition of academic excellence (University of the Witwatersrand, 2014). In keeping with their principle of recruiting from communities of greatest need, WSU includes community members on the selection panel (Walter Sisulu University, 2014). The information is readily available on the website and includes the Health Sciences Prospectus 2014, which is 139 pages and 1.59 MB to download.
The criteria for admission to programs at the Faculty of Health Sciences at UCT are readily available on UCT's website. The Faculty of Health Sciences offers five (5) bachelor's degrees and the admission criteria are readily available on SUN's website.
Conclusion
Introduction
Research paradigm
Pragmatism emphasizes the practical problems experienced by people, the research questions posed, and the effect of the inquiry (Giacobbi, Poczwardowski & Hager, 2005). It allows the selection of methods based on the best way to answer the research question and the ongoing phase of the inductive-deductive research cycle (Teddlie & Tashakkori, 2009). The pragmatic position was chosen for this study as the researcher believes that the problem of transforming higher education in an attempt to address the inequalities of South Africa's apartheid past requires an open and pluralistic approach to inquiry (Badley, 2003).
The problem of access to health science programs offered in higher education requires recognition of the social, historical, and political context of the past to understand the need for recovery and how best to achieve it. The use of the pragmatic paradigm allowed the researcher to describe and analyze the complexity of the factors associated with access to health science education in universities as they “could best be described” (Badley, 2003, p. 302 ) in the context of recovery, practical answers to the issue of access.
Study design
- Mixed methods sequential exploratory design
The use of a mixed method for the current research was justified by the research questions, which required the exploration, identification and description of factors. In the current study, the researcher has endeavored to be true to the research language of each method and use mixed methods terminology to report the philosophical. If the researcher is not particularly aware of whether the research has an inductive (reasoning from specific observations to more general (Polit & Beck, 2012)) or deductive (reasoning from the general principles to the specific (Polit & Beck, 2012) drive, a mixed methodological examination can compromise the validity of the research (Morse, Niehaus, Wolfe & . Wilkins 2006).
The mixed methods design allowed for the identification of factors associated with access to health science education in universities, and then to determine whether these factors were perceived as important for access to health science education in a larger and more diverse sample of universities. A mixed methods research design was used to promote a deeper and more comprehensive understanding of the phenomenon under investigation.
Objectives, methods and outcomes
Phase 1 –review of existing policies and practices
- Research setting
- Sampling
- Research participants
- Qualitative Phase 1 data collection methods
All eight (8) universities in South Africa offering health science education were included in the quantitative phase of the study. 4 Potential students are well informed when choosing the health sciences profession. Potential students are well informed when choosing the health sciences profession.
However, a ministerial review by NSFAS (2010) reported that of all students funded over the years, 33% were still studying and 67% were no longer in higher education, and of those no longer studying, only 28% had graduated, 72% had dropped out or not completed their studies (DoHET, 2010). In the current study, the majority of participants discussed poor schooling as a characteristic of access to health science education at universities.
Phase 2: Assessment of existing policies
- Research setting
- Sampling of participants
- Phase 2 data collection tool
- Phase 2 data collection
- Policy Delphi Method
- Data reduction
- Data display
- Data transformation
- Data correlation
- Data consolidation
- Data comparison
- Data integration
Phase 3: Guideline and policy brief development
The overall objective of the guideline is to provide guidance to those responsible for access to health sciences education in universities in the context of social redress to facilitate greater transformation in the health sciences in universities. The research questions for this study were used as the questions from which the guideline was developed. Resources for Health and the universities' policy documents were part of the data collection that contributed to the guideline.
Seventy-five percent were considered supportive of the factor and twenty percent were deemed not important enough to include in the guideline. The results of Phase One were . integrated with the results of Phase Two and the literature to form recommendations. f) Writing the guideline.
Rigour
- Qualitative rigour
- Verification strategies
- Quantitative rigour
- Rigour in mixed methods
- Design quality
In this study, verification occurred incrementally throughout the qualitative phase of the study to ensure validity and reliability. Further purposive sampling of participants across eight universities offering health sciences was conducted in the second phase of the study (quantitative phase). Both the first phase and the second phase of the current study addressed the same research questions.
Both the qualitative and quantitative phases of the study paid homage to methods appropriate to these designs and were conducted with rigor. This criterion is based on accepting the most acceptable conclusions from the results of the study (Tashakkori & Teddlie, 2008).
Results
Qualitative method
- Document review
- Interviews
- Description of the participants
This review led to the development of the nine guide questions (appendix 2) that were used to conduct interviews with the health science program leadership. Scholars and especially rural children do not have enough knowledge of the health science disciplines. The results of phase 1 are presented according to the categories that emerged from the qualitative data analysis.
Most health sciences are oversubscribed: thousands of applications for only hundreds of places. The transformation of the data allowed the qualitative data to be compared with the quantitative data in the final report. The third round of the Delphi was sent via email using Survey Monkey to 87 administrative staff at the 8 universities offering health sciences.
There was little difference between the deans and vice deans of Health Sciences and the administrators in rating the questions in this 3rd round of the Policy Delphi.
Conclusion
Discussion of the findings of the study
The factors related to access to health sciences education in universities
- Promotion of the health science disciplines
- Challenges in transformation
- Poverty
- Poor schooling
- It is very competitive to get into health sciences
- Health sciences sets the bar
- Matriculation scores and other criteria
- Alternative access
- Reason for choosing a health science profession
- Innovation in teaching and learning
- Retention and throughput rates
- Retention rates
- Completion in minimum time
- Student support
Recruiting health science students in the context of the competing priorities of transformation, limited places and the financial funding formula is complex. The participants in the current study believed that English as a second language was an important factor in access to health science education. This is enshrined in the law, where Higher Education Act 101 of 1997 provides for higher education.
However, in relation to success, eighty-three percent of participants believed that student-focused curricula improved student success, which was an important to very important factor in access to health science education at universities in South Africa. Teacher-centred curricula were endorsed as important to very important in the implementation of access to higher education by 83% of participants in the current study.
Implications of challenges and facilitators on access to health sciences
Conclusion
Summary of the study, development of the guideline, Policy Briefs,
The context
The actors
The content
The process
The Guidelines
Policy Briefs
Researcher`s reflections
Recommendations
Limitations
Conclusion
