After eight years of negotiation, an historic bilateral agreement was reached between Stellenbosch University (SU) and the Western Cape Department of Health (DoH) that guides the relationship between these training and service delivery partners.
The agreement was signed by the former Head of the DoH, Dr Beth Engelbrecht, and SU Rector and Vice Chancellor, Prof Wim de Villiers, on March 31, 2020 – just as the country went into lockdown.
“I would like to congratulate our colleagues on their commitment to finalising this agreement, which recognises the importance of fairness and equity in our partnership. The principles underpinning the agreement will further strengthen the working relationship between the parties involved, and will also benefit the patients and communities we serve," said Prof Jimmy Volmink, Dean of SU's Faculty of Medicine and Health Sciences (FMHS).
This strengthened partnership really came to the fore during the Covid-19 pandemic and it enabled the signatories to successfully navigate numerous challenges during this time, said Dr Therese Fish, Vice Dean: Clinical Services and Social Impact of the FMHS. Fish, along with Dr Dimitri Erasmus, former chief executive officer of Tygerberg Hospital, led the negotiations between the different parties.
“There were many obstacles along the way and challenges for us to overcome, but it was an important process for us to go through, because we depend on each other and we have to work together," said Fish.
SU depends on the DoH to fulfill its statutory requirement to train students in a clinical environment, while the DoH relies on SU to train skilled healthcare professionals and produce health research in order to deliver evidence-based care.
“The agreement governs the relationship in terms of our staffing and funding arrangements, our access to clinical settings for training, as well as for research," explained Fish. Among other things, the agreement enables experts to work in both an academic and a clinical capacity as joint staff members of SU and the DoH; the training of medical and health sciences students in health facilities around the province; and research conducted within healthcare facilities.
An updated agreement for changing times
The bilateral agreement replaces a 43-year old agreement reached between SU and the provincial DoH in 1977, and takes into account the transformation that the University, the healthcare sector and the country has undergone since then.
The need for an updated agreement was cemented in a 2012 multilateral agreement between the Western Cape Government and its four university training partners in the province – SU, the University of Cape Town, the University of the Western Cape and the Cape Peninsula University of Technology.
“The bilateral agreement took us eight years to conclude. Part of the reason why it took us so long was because there was mistrust between the parties and issues to be resolved around the use of resources that was fair to all the parties. We had to rethink how we relate to each other," said Fish.
Dr Terrence Carter, a former chief executive officer of Tygerberg and Groote Schuur Hospitals, was called upon to facilitate negotiations and helped navigate many of the conversations regarding historical inequity and differences. Under his leadership the parties had tough, but courageous conversations and developed 12 foundational principles upon which the bilateral agreement is based (see below).
“There were many difficult conversations, and a lot of water flowed under the bridge for us to be in the position to sign the agreement. This agreement now puts us in a position where we can work together as equal partners for the benefit of our communities, for the benefit of our students and future graduates, and for the benefit of SU and the Western Cape Government," Fish concluded.
According to Erasmus the signing of the agreement “is indeed a historic and significant event. It cements the partnership around a shared vision of excellence in healthcare and in the teaching and training of health professionals, as well as creating a supportive environment for furthering the frontiers in medical research.
“Now the work begins on institutionalising the agreement through embracing a new way of doing business together."
12 foundational principles of the bilateral agreement
- Building trust through openness and transparency
- Commitment to fairness, in the light of historical inequity
- Adopting an enabling approach
- Commitment to the spirit of partnership
- Commitment to building a positive organisational culture
- Commitment to collective change management
- Realistic expectations, in the light of resource constraints
- Commitment to address power imbalance and control
- Acknowledgement of the “medical model bias" in the multilateral agreement
- Commitment to the spirit of the multilateral agreement
- Sharing technical expertise across parties
- Commitment to fundamental transformation and equity
Caption: Drs Therese Fish and Dimitri Erasmus. Photo by Stefan Els
