Laurel Baldwin-Ragaven and Leslie London Conference on Core Competencies

1. Attitudes and perceptions of South African deans towards human rights education and training for health professionals: results of a 2002 survey Laurel Baldwin-Ragaven and Leslie London Conference on Core Competencies in Human Rights for Health Professionals UCT, 5th to 7th July 2006

2. Presentation Overview • Background to the research • Research project and results • Discussion • Current challenges and opportunities

3. Context for the research - 2002 • Four years after the TRC Report (1998) • New deans coming into positions • Movement away from medical schools to faculties of health sciences (FHS) • Educational implications: pedagogy and national health imperatives • Transformation agenda

4. TRC findings re: education & training institutions • Regarding academic institutions Medical schools played a significant role in perpetuating human rights abuses… • discrimination • failure to teach ethics and human rights • dual obligations of professors • failure to protest • Resistance to abuses frequently led to victimisation

5. TRC findings about the services Apathy, acceptance and omission on the part of health care workers led to frequent violations of moral and ethical codes -TRC Report (1998)

6. Research Questions? • What are faculties of medicine and tertiary educational institutions (universities and technikons) doing in response to these pressures? • In particular, how do deans understand the linkages of these pressures to human rights education and training?

7. Why deans? • Deans are in positions of leadership • Potential change agents/gatekeepers of change • Custodians of institutional culture (memory, transition, transformation, balancing pressures) • Obstacles—create or remove barriers • **Powerful force within institutions**

8. What did we do? • Identified 34 institutions total: HSF’s 8 Nursing (Universities) 15 Nursing (Technikons) 7 Schools of Public Health 2 Other (allied health faculties) 2

9. Self-administered questionnaire --Three parts: • Record if and where HR’s appears as an educational offering in the institution • both formal and informal • who is responsible for implementation of this across the faculty • 20 questions on a 5 point Likert scale, indicating agreement with findings and recommendations of the TRC health sector hearings • Select educational priorities among 17 topics for any HR’s training initiative --Opportunities for open-ended comment

10. Results

11. Does the training of health professionals at your institution currently include formal teaching in human rights?

12. Programmes with formal HR’s teaching

13. Would specific core competencies…in health and human rights…work at your institution?

14. Most students in the health professions would not be interested in learning about human rights

15. A human rights approach to health problems in SA is impractical

16. HSFs should develop, implement and teach a single code of conduct…

17. The statutory councils must make training in human rights a requirement for professional qualification/registration

18. Besides formal courses to address human rights, are there other ways that your institution integrates human rights into the learning environment?

19. Programmes to increase black students…with institutional support + programmes

20. Median estimates of where this should come from

21. Besides formal courses to address human rights, are there other ways that your institution integrates human rights into the learning environment?

22. Understanding the past

23. Educational Priorities: essential/very important

24. Educational Priorities: somewhat important/not important

25. Summary Findings • Looks impressive: offerings + TRC • Most deans support common unit standard, with enforcement by councils • Perception that students support HR’s • Other ways of HR’s education: informal • No linkage of ET in HRs to self-study and reconciliation initiatives

26. Summary Findings (continued) • People are ‘saying’ the right things • Is the reality something different? • Formal curriculum v ‘hidden’ curriculum • Many people who attended TTT were noted as working at the ‘coal face’ of implementation

27. Scratching beneath the surface… • Homogenisation of ethics, professional ethos and human rights • Institutional reconciliation committee/self-study initiatives: not quite sure what this means • These questions do not fit the purpose of the study. Was the project approved by your Ethical Committee?

28. Limitations:Additional research • Survey those identified (other methods)-what are the true barriers/obstacles? -institutional mechanisms: how easy is it to whistle blow; what happens to people who complain? -change fatigue? • Students: resistant, allies or combination? • Resource constraints

29. From the change literature • [transformation]…series of phases that, in total, require a considerable length of time Kotter (1995) Leading change: why transformation efforts fail

30. Re-surveying the deans:sobering thoughts • Out of 34 deans identified in 2002, only 10 remain in the same post • Committee of Medical Deans (FHS), only 3 remain in the same post • 5 mergers in the past 4 years involving 13 institutions that no longer exist

31. The commission recommends… that training in human rights be a fundamental and integral aspect of all curricula for health professionals. This training should address factors affecting human rights practice, such as knowledge, skills and attitudes…Knowledge of and competence and proficiency in the standards (both national and international) to which doctors will be held accountable should be a requirement for qualification and registration.

32. Our future…