The development of postgraduate students as a potential pool of academic staff for higher education institutions is important [1], but particularly so in underdeveloped countries. Furthermore postgraduate students graduating in a medical speciality are essential for the clinical fields of academia and the health system of a country, as they will provide specialised health care to communities. However, in South Africa the higher education system has a legacy of demographic discrimination emanating from the apartheid era of 1951, during which Black (including Coloured and Indian students) and White students were enrolled at separate academic institutions [2]. This created discrepancies in the provision of higher education, as institutions designated for White students only benefited from the largesse of the apartheid government, while those institutions to which Black students were assigned were inadequately resourced [3, 4].
This applied too, to the training medical students, as Black medical students were clinically trained at hospitals allocated for the Black population only [2, 5]. While medical schools for Black individuals had been set up, namely at MEDUNSA (currently called Sefako Makgatho Health Sciences University), the University of Natal (presently known as University of KwaZulu-Natal) and the University of Transkei (now called Walter Sisulu University), a limited number of Black medical doctors and allied healthcare workers were trained at postgraduate level [6, 7]. Lack of access to postgraduate medical training for Black individuals in South Africa created problems to the already over-burdened health system, as it could not meet the country’s health challenges.
Not only did the system of apartheid in South Africa create disparities between Black and White in the higher education and health sectors, but disproportions were also evident between the sexes. Females were generally excluded from both the higher education and the health sectors as apartheid created White and male dominated systems [7,8,9]. Black females were the most marginalised as they suffered from both the apartheid policies and from sexism [10, 11].
In 1994, when the new democratic government came into power in South Africa, there was consensus that both the higher education sector [12] and the health sector [6] needed to transform with respect to population affinity and sex. Accordingly, the Education White paper 3 was promulgated to address the inequalities created by apartheid in the higher education system [13]. In the health sector, the governing party’s health plan was adopted as the “post-apartheid model for health system change” [6, 14]. The plan was to tackle the demographic disparities in both the health sector and the unequal provision of healthcare to the population [6].
Despite interventions by the government, the process of transformation in both the higher education and the health sectors has been slow [6, 15, 16]. While increasing diversity in the configuration of student bodies in South Africa has occurred, the demographic profile of students is still not reflective of the population in which Black Africans constitute the majority [17, 18]. The disproportions in the demographics of students are said to be most evident at postgraduate level [16] which is the pipeline for future academic staff, and in health for healthcare personnel. If the disparities in the postgraduate student population in South African higher education institutions are not addressed, they will perpetuate the demographic imbalances of the past in both the academic and healthcare workforces.
The Wits Faculty of Health Sciences (FHS), which is one of the largest health sciences institutions in South Africa, services four major academic training hospitals, including the Chris Hani Baragwanath Hospital, the largest hospital in Africa. The Wits FHS trains both undergraduate and postgraduate students in medicine, dentistry, occupational therapy, physiotherapy, pharmacy, nursing, as well as science students majoring in the health sciences. Wits experienced the challenge of segregation during the apartheid era, as the Health Sciences Faculty was forced to use a quota system restricting Black student enrollments [2, 3]. Moreover, its departments such as dentistry, occupational therapy and physiotherapy were not allowed to admit Black students [2, 5]. While a dispensation was provided by the government to admit a limited number of Black African students into medicine, Black trainee doctors were not allowed to examine White patients and thus a dual system of training and patient care existed [2, 3, 5]. In light of this legacy of demographic inequalities and lack of access to higher education and clinical training facilities for previously disadvantaged population groups, Wits and the Wits FHS initiated a policy which addressed transformation issues [19]. In similar vein, Medical Schools in the United States of America (U.S.) also adopted affirmative action policies to redress past discrimination practices which prohibited minority groups particularly African-Americans and females from obtaining medical degrees [20].
The issue of transformation is not only a problem in South Africa but remains contentious in many parts of the world. The United Kingdom (UK) higher education sector is dominated by White and male academic staff and senior management [21]. While female academics in the UK are well represented in fields such as the arts and social sciences, education, health and community studies, and nursing and paramedical studies, White male academics still predominate in senior positions [21]. In the U.S. higher education system, the under-representation in academia of African-Americans, who were previously discriminated against, is an ongoing problem [22,23,24]. Furthermore, females in the U.S., particularly African-American females continue to be less represented at doctoral level although they graduate more frequently with bachelor’s degrees than do male students [25]. Thus, the attempts to transform the higher education sector in relation to sex and population affinity is a international phenomenon which appears to be far from being realised.
Compounding the issue of transformation is student completion of their postgraduate degrees. Student completion and non-completion (drop-out) rates are a serious concern for institutions of higher learning in South Africa [26, 27]. Reports have shown that students, particularly postgraduate students, may encounter barriers that prohibit them from obtaining their degrees, thus impeding transformation of the demographic profile of those graduating [28,29,30].
Thus, the aim of this study was to assess the number of graduations and the time taken to graduate of postgraduate students according to their demographics, over a ten year period (2008–2017) in a Faculty of Health Sciences based in a upper-middle income democratic country [31, 32] which has been undergoing transformation.
