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Friends of Mosvold Scholarship Scheme
Friends of Mosvold Trust
South Africa

The Problem

Many rural areas in South Africa face a myriad of problems – high rates of unemployment and poverty; high HIV infection rates; poor education and low levels of literacy; and poor access to services. This is especially true of access to health services – many areas have no health centres, or only poorly-equipped ones. The poor education levels often also lead to numerous health problems, including teenage pregnancy, high birth rates, poor hygiene and nutrition, and high rates of sexually transmitted infections. The lack of access to services (such as clean water, or adequate education) mean that many people suffer from easily preventable communicable and sexually transmitted infections, including cholera, tuberculosis, and HIV/AIDS. The high unemployment and poverty rates also mean that few people can afford good healthcare; or to complete their primary or secondary schooling. Very few are able to attend tertiary institutions. Because of the lack of job opportunities, those that do become qualified often leave to work in more urban areas. These factors combined lead to a massive burden on the healthcare system, which is exacerbated by the difficulty health centres have in attracting and retaining health staff. In 2006, a situational analysis showed a 46% vacancy rate for professional nurses; 41% for medical officers and community service doctors; and 53% for Senior Medical officers and higher. A 2007 survey of primary healthcare workers found that there are only roughly 1.1 nurses available for every 1000 people (a 50% drop from 1994); and only one doctor for every 4219 people

KwaZulu-Natal is one of the most rural regions in South Africa, and also faces the highest burden of the HIV epidemic. While national prevalence in 2008 was measured at 10.9%, KwaZulu-Natal’s prevalence was 15.8% (Health Sciences Research Council Third National HIV Survey 2009). The estimated number of deaths attributed to HIV in 2006 was around 350 000 (Statistics South Africa). Thus, the burden on all health centres across the country is massive. Jozini District in KwaZulu-Natal (bordering Mozambique and Swaziland) is no exception. The region has 550 000 people, most of whom survive through subsistence farming, and social grants (pensions, child care, disability etc). Most lack access to piped water and electricity; and HIV/AIDS are widespread – up to 40% of women presenting at ante-natal clinics are HIV+, as are more then 80% of patients in the TB wards; and over 50% of patients in the female wards. There are five state hospitals and 45 clinics in the district. However, all of these facilities face challenges in recruiting and retaining healthcare staff, especially those who speak local language. Mosvold Hospital, in Jozini District (serving a population of 110 000 people), had only 12 medical officers in 2007, four of whom were graduates from foreign universities.

All social groups across the country feel the negative impact of these issues. The lack of sufficient medical staff means that many living in rural areas are unable to access quality healthcare; and those that can get to hospitals often face long waits, as the available staff cannot deal with the high demand for services. The lack of opportunities for education (both because of lack of adequate schools, and lack of funds to attend these institutions) means that many children and teenagers will simply enter the cycle of poverty, having to drop out of school to work.

Solution and Key Benefits

 What is the initiative about? (the solution)
In 1998, the Friends of Mosvold Scholarship Scheme (FOMSS) was established, to provide bursaries to local youth who plan to study in the health sciences, on condition that the youth then return to work off their bursary in local hospitals or clinics. They are also required to carry out four weeks of holiday work at local hospitals; and to visit their old schools to give peer HIV/AIDS education. Open Days are also held at local schools twice a year, to encourage youth continue with maths and science, study further in the health sciences, and become involved in the FOMSS programme. By 2007, 33 FOMSS students had graduated. 13 were working at Mosvold Hospital, and another 11 were working at other hospitals in the district. Four were completing medical internships, two had completed their contract time, and one student had passed away. 103 students had been supported by the scholarship scheme at either a university or a technikon. In 2007, FOMSS was supporting 55 students, in 16 different fields. These include medicine, nursing, radiology, physiotherapy, dentistry, dental therapy, social work, medical technology, nutrition, speech therapy, pharmacy, psychology, occupational therapy, optometry, and environmental health. 82% of these passed their yearly exams in 2006 – well above the national average of 20-25%. 250 school learners had done voluntary work in the hospitals prior to the selection process taking place; 80 have been trained as HIV/AIDS peer educators; and over 2500 learners had attended Open Days.

The qualitative impact has also been positive. Most importantly, graduates are returning to work at rural hospitals to provide healthcare to those living in rural areas. This helps to reduce the burden facing all healthcare staff, as well as to improve the health services to residents in areas where it is most necessary. Through the Open Days, learners at the schools are able to begin planning to attend tertiary institutions to study health sciences, where previously this may have been completely out of the question due to poverty in their families. By encouraging students to return to work in their local hospital, the project helps to reduce vacancy rates at these hospitals, and this helps to decrease the burden on the hospital staff. It also helps to improve the ability of staff to delivery quality healthcare services to residents in the area, which can also hopefully help to prevent some infections in the future. The programme also helps the bursary recipients to become positive role models to other local youth – by providing peer education on HIV/AIDS, and by showing that working locally is a viable option. Numerous learners are also involved in holiday volunteer work at local hospitals, even if they do not go on to be involved in the scholarship programme. These learners gain valuable experience through working in rural hospitals, and can also gain a sense of community-mindedness which can have a positive impact on their life choices in the future.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The original Friends of Mosvold Trust (FOMT) was established in 1995 to raise funds for the Mosvold Hospital. Over time, it became clear that the most pressing issue was the difficulty in attracting and retaining health professionals who had experience in rural hospitals. The FOM Scholarship Scheme was therefore established in 1998 to provide bursaries to local youth, on the condition that they returned to work in local hospitals on completion of their studies. A selection committee was established, made up of local community members, staff from FOMSS, members of the local government, representatives from the Departments of Health and Education, and a member drawn from local business. The Departments of Health and Education also support the Open Days, which are held at local hospitals, and attended by learners and teachers from surrounding schools; and provide ongoing support for the students and schools involved. The AIDS Training and Information Centre (ATIC) provides training for students on how to be peer educators on HIV/AIDS. Staff of the FOMSS also carry out mentoring for students while they complete their work at the hospitals, and conduct regular follow-up support while the students are at the universities. The KwaZulu-Natal Department of Health also provides provincial bursaries to students (occasionally supporting those involved in the FOMSS), although those bursaries do not require students to return to Mosvold Hospital.

While studying, the bursary recipients are required to do four weeks of holiday work at a local hospital each year; and to visit schools in the area to conduct peer education on HIV/AIDS. They also act as mentors for newer students at the universities, and provide each other with mutual support. While doing their holiday work, they are mentored by hospital staff. Once they have completed their studying, they are required to “pay back” the bursary by working at the local hospital for an equal number of years as they received the bursary. Numerous private donors provide funding for the project.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The project has a number of objectives, which aim to address a range of the issues facing the local community. These include improving access to education for local youth, encouraging students to work in rural hospitals after graduation, reducing the staff vacancy rate at local hospitals, and improving the levels of healthcare service delivery by those hospitals.

In order to improve access to education for local youth, the FOMSS was established to provide bursaries to local youth. These bursaries cover all tuition, accommodation and food, and also include an allowance. The bursary is also flexible, as different sectors and students will have different needs while studying. In order to improve their chances of success, the students are given ongoing support and mentoring while at university – this is from both the FOMSS staff, and from other students. Students who have already been at the university for more than a year are encouraged to act as mentors for those who have just arrived; and to form support groups so that students can give each other mutual help. In order to encourage these students to return to work in rural hospitals, the bursary requires that each student works in a local hospital for as many years as they were on bursary. They are also required to do four weeks of holiday work each year at local hospitals while they are studying, for which they are paid. This helps them to gain experience of working in rural hospitals, to develop the skills necessary for this type of work, and to develop relationships with the hospital staff and patients. To encourage students to remain in these hospitals into the future, the FOMSS also offers support for postgraduate research (which again would be paid back through working at the local hospitals in the future). By working at these local hospitals, the students encourage other local youth to return to rural areas to work after graduation.

By requiring students to return to their local hospital to work after their graduation, the project also helps to reduce the staff vacancy rate at these hospitals. Hospitals are guaranteed at least one or two graduates each year, and also have students carrying out holiday work each year. Learners at local schools are also required to carry out two weeks of holiday work prior to applying for the scholarship, and are encouraged to do this through the Open Days. This also helps to reduce the workload burden of those at the hospitals. Also, because the project encourages other youth (who are not involved in the scholarship scheme) to return to work in rural hospitals, the project can help to further reduce staff vacancy rates in the future. Because there are more staff at the hospitals, each staff member is less over-worked, meaning they are more able to deliver quality healthcare to patients. Thus, by reducing the staff vacancy rates at hospitals, the project can help to improve the level of healthcare delivered to local residents.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
Friends of Mosvold Trust (FOMT) was established in 1995 as a fundraising body, to help raise money for the Mosvold Hospital. The money was used to purchase a vehicle for the hospital, improve staff accommodation, provide fencing for one of the residential clinics, initiate an HIV/AIDS education programme, and a large-scale sanitation programme. After a while, it became apparent that the biggest challenge facing the hospital was not necessarily a lack of funds, but difficulty in attracting and retaining professional health staff. It was therefore decided by FOMT to select local youth to train as health professionals, provide early exposure to rural hospital conditions to those undergoing health professional training.

The FOMSS was therefore established in 1998, with the aim of providing bursaries to four students each year. Students are required to be a resident of the health district, must gain admission to a professional medical course at a tertiary institution, must work for two weeks in the local hospital, and must undertake to return to the local hospital to work for an equal number of years as they held the scholarship. They are also required to do four weeks of holiday work at the local hospital each year during their studies. Funds for the bursary are raised by the FOMSS; and part of this money is also invested. The initial pilot project only had students working in the Mosvold Hospital; however, this has now been expanded to four other district hospitals in the area as well. Comparable projects have also been initiated in other parts of the country (Tinswalo District in Mpumalanga; North West Province; and Worcester in the Western Cape). Open Days are held twice a year at the local hospitals to attract new learners to the programme, and to provide information about the health sciences as a profession.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The main obstacle in this project was attracting funding from donors. Although the Department of Health does provide provincial bursaries, these are not “tied”, meaning students do not need to return to the rural areas to work after their graduation. Despite this, the project has been able to obtain adequate funding from both local and international donors to provide new bursaries each year, and continue supporting those already involved in the programme. Enough money has also been invested that, should funding lapse, all the students currently being supported would be able to complete their studies. Staff of the FOMSS also carry out all of their work on a voluntary basis (including the selection committee, and visiting and mentoring students on the programme). Although funding has been secure to date, the project has not been able to expand at the rate they would like, as they have not been able to attract additional funding. This process will hopefully be initiated in the future.

Another obstacle is faced by the students when they first arrive at universities – many have grown up in rural areas, and have never attended strictly formal education institutes, or into big cities. Attending university in one of the major cities (eg. University of Witwatersrand in Johannesburg) is a hugely daunting and difficult process, with numerous unknown aspects arising. Working in rural hospitals is also difficult, and is probably worlds away from the training students receive at the city hospitals while studying. To address this, FOMSS established different mentoring schemes to support the students while studying. While at university, students receive ongoing visits and communication from members of the FOMSS, to find problems and help to solve them. Current students also serve as mentors to those newly arrived, which helps them to adjust to the new environment better than they would have otherwise. Students also receive mentoring when they return to work in the rural hospital during their holidays, and this helps them to become comfortable in the surroundings much more quickly.

Getting the support of the community was also initially difficult. However, this was addressed by involving local community members in the selection process, by inviting learners and educators from local schools to attend the Open Days, and by having the students return to work at their local hospitals. This helped to show the local community members that the project was working predominantly for their benefit, rather than being an externally-imposed initiative.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The main financial support comes from different companies’ social responsibility initiatives, with donations from the Anglo American Chairman’s Fund (R265 000); Discovery Health (R200 000); Anglo Gold (R150 000); Oppenheimer Trust (R300 000); and MESAB (R500 000) (all figures are for the 2007 financial year). Additional funding was received from Swiss SA Cooperative Initiative (R400 000); and private funders (R2400). All of the above amounts were mobilised through fundraising initiatives by the FOMSS. The total used for the scholarship scheme in 2007 was R1 459 688. Each student receives around R50 000 per year (as well as payment for holiday work). The annual training provided by ATIC costs roughly R10 000, as does each Open Day. The available support for post-graduate studies is R50 000.

In terms of technical resources, ATIC provides annual training to those involved in the scholarship scheme to become HIV/AIDS peer educators. The students then provide peer education to learners at local schools. Universities hold places for students from designated rural areas with the required grades; however, these are not specifically made available to FOMSS students. Human resources for the project are mainly supplied by the FOMSS on a volunteer basis – staff are involved in the selection, visiting and mentoring of the students. Local community members, local government councillors, representatives from the Departments of Health and Education, and local business members all form part of the selection committee. Staff at the local hospitals provide mentoring for students during their annual holiday work, and help them to adjust to the conditions in the rural hospitals.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
Financially, the project has been able to remain sustainable since 1998 due to ongoing support from a wide range of funders. Money has also been invested, which means that students currently studying would still be able to be supported, even if funding was to cease. In terms of its socio-economic impact, the project is also definitely sustainable. By requiring students to return to their local hospitals to work after graduation, the project ensures that the benefits of the initiative are being felt in the area in which it is implemented. The fact that students also return to schools in the area to provide peer education in HIV/AIDS means that they serve as positive role models to other youth in the area, encouraging them to become involved in the project, and to return to the area to work after completion of their qualifications. A number of the students have also returned to their old schools to provide tutoring in maths and science, which improves the chances for future students to be able to join the scholarship scheme in the future. By involving the local community in selection and support of the students, the project again ensures that its local impact is strong.

The project also has good potential for replicability, as has already been shown. After its inception as a pilot project at Mosvold Hospital, the project was spread to four other hospitals in the district, meaning that five local hospitals now receive graduates on an almost annual basis. The project has also been replicated in other provinces (eg. Mpumalanga, Western Cape, and North West). The main requirements would be sourcing adequate funding (although the project could also aim to provide only one bursary a year, meaning less funding is necessary); and gaining community support. This could be initiated, as FOMSS has done, through Open Days (encouraging learners and schools to become involved in the scheme), involving local community members in the selection process, and requiring students to return to the area to work, and to provide peer education. Providing ongoing support and mentoring to students throughout their studies improves their chances of succeeding in their studies in the minimum required time; and helps them to adjust to the situation at their universities and in the rural hospitals. Thus, this support would be important in replicating the project in other areas.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
The most important impact of the project is that it brings medical professionals back to work in rural areas where they are most needed. This is especially true in KwaZulu-Natal with its high HIV prevalence, which is one of the more rural provinces, and the highest HIV prevalence. Another important impact is that the project enables youth from poverty-stricken rural areas to access an education and a career in the health sciences, and to then encourage them to return to those areas to provide services to other local community members. By also visiting local schools, the students act as positive role models for other learners in the area, and encourage them to become involved in similar initiatives in the future. The project also helps to reduce the staff vacancy rate at hospitals in the district, and thereby improves the delivery of healthcare to local community members. By providing ongoing job experience for the students (by requiring them to do four weeks of holiday work at the hospitals), the project also ensures that the students are well-prepared for the working environment that they will enter. It will hopefully also encourage these students to remain in rural hospitals once their required time there has come to an end.

One of the most important lessons is that programmes which encourage local youth to return to work in rural areas can play a major role in combating the lack of qualified health professionals in rural hospitals. Even if students only work off their bursary time, it means that public hospitals will have guaranteed staff for a number of years. This also increases the number of doctors and nurses available to those using public health facilities.

Contact Information

Institution Name:   Friends of Mosvold Trust
Institution Type:   Non-Governmental Organization  
Contact Person:   Andrew Ross
Title:   Doctor  
Telephone/ Fax:   +27 35 591 0122
Institution's / Project's Website:   +27 35 591 0148
E-mail:   rossa@ukzn.ac.za  
Address:   Mosvold Hospital, Private Bag X2211
Postal Code:   3968
City:   Ingwavuma
State/Province:   KwaZulu-Natal
Country:   South Africa

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