Thanks to a partnership between the Holland Stellenbosch Medical Foundation (HSMF) and Stellenbosch University (SU), medical care is available to thousands of people in rural areas for whom it would not otherwise have been possible.

The foundation was established by two Dutch pulmonologists, Drs Stijn Mol, HSMF chairman, and Maarten van Nierop. It was the brainchild of Mol, who decide to plough back into South Africa after receiving training at SU's Faculty of Medicine and Health Sciences (FMHS).

One initiative that has resulted from this is a bursary programme for medical students. For 2021, the year in which the HSMF commemorates its twentieth year of existence, the total funding amounts to R2,4 million.

The HSMF bursary project is coordinated via the Ukwanda Centre for Rural Health by Ms Lindsay-Michelle Meyer.

The HSMF has been supporting Ukwanda financially since 2007 but was initially involved in various projects. After a visit in 2009 by the Dutch ambassador to South Africa and other dignitaries, a more focused approach was decided upon. At a later summit in Amsterdam, which Meyer also attended, bursaries for senior medical students were identified as the greatest need. “Many of our top achievers have recruitment bursaries that are only valid for four years. That is why they struggle financially in their final years," she explains.

Doctors with student debt often end up in the private sector or go abroad, she adds.

One condition of the HSMF bursary is that students must work in a rural environment or underserved area for the same period that the bursary was made available to them. “It therefore fits in with our retention strategy for rural doctors," says Meyer.

The HSMF's aim is greater access to medical care in rural areas and informal settlements in South Africa's largest cities. It is estimated that at least 200 000 people for whom it would otherwise not have been possible, gain access to medical care each year thanks to these bursaries.

The bursary period varies between one and three years, and students must indicate annually whether they are still in need of support.

Among the nine students who were awarded the first bursaries in 2012, four were quite aptly also amongst the second cohort of the Rural Clinical School in Worcester.

The HSMF funding initially applied to all FMHS programmes. “Because many therapists have struggled to find work and therefore also to meet their bursary conditions, is it is now available to medical students only," says Meyer. Over the years, 58 medical students, six occupational therapists, three dieticians, two physiotherapists and two speech therapists have benefited. The vast majority (69%) are female.

Between 2012 and 2021, R13,7 million was paid out for 174 bursary years. A total of 24 students – 14 pre-existing and 10 new – will each receive R100 000 this year.

Meyers describes it as an incredible partnership between a university and a non-profit organisation. “And is has a huge impact on our retention strategy, especially in rural health where we are struggling to retain health professionals."

“While I cannot exactly say what I plan for my future … I know that I will be staying in South Africa," says Nicole Petersen, a HSMF scholar. “I grew up in a family dependent on the public health sector for all their medical needs. One of my family members lost his sight because of uncontrolled diabetes mellitus at the young age of 47 and his livelihood as a result – he was the breadwinner. In a case such as this, prevention of end organ damage is the responsibility of primary health care facilities and it is often these centres – the first contact point of patients with the health care system – that are most under-resourced and understaffed.

“Our clinical rotations are mainly in state facilities, and the need of the patients is overwhelmingly obvious, and therefore it is not something that I could just easily turn my back on. So, while I do not know exactly where I will be able to find work, I strive to work in my community where I can serve those whose health is affected and influenced by factors other than just the pure pathophysiology of diseases."

According to Ukwanda Director Prof Ian Couper there is international evidence of the success of these types of programmes. “Bursary programmes that require graduates to give service in return for their funding, have been shown internationally to make a difference to rural care, and are suggested as one of a range of recommendations that can make a difference to the rural health workforce by the World Health Organisation," he says.

​Caption: Members of the Holland-Stellenbosch Medical Foundation met with FMHS management and staff during a visit some years ago.