ON THE REQUIREMENT FOR, AND THE STRUCTURING OF, A TERTIARY EDUCATION BASED RESERVE OFFICERS’ TRAINING SCHEME FOR THE SOUTH AFRICAN MILITARY HEALTH SERVICE : A PRELIMINARY PROPOSAL.

 

Reference A : SA Military Health Service : Surgeon General’s Command Briefing

and Guidelines for Planning.

B : Strategic Direction Plan of the SA Military Health Service Directorate

Reserve Force.

C : Project PHOENIX Phase One : SA Military Health Service Plan.

D : Department of Defence Human Resources Strategy 2010.

 

Appendix A : Charter of the British Army Officers’ Training Corps

B : Opinion Survey, University of the Witwatersrand Medical School

INTRODUCTION

1. The policy of conscription as a primary source of manpower for the armed forces of South Africa was discontinued in 1992. Subsequently, the White Paper on Defence (May 1996) and the Defence Review (1998) mandated that a contingent-ready and sufficiently large Reserve component be developed as an integral part of the Republic of South Africa’s defence capability.

2. In the decade since the cessation of conscription, however, it is common cause that a steady attrition of the capacity of the Reserve Force (ResF) components of all Services of the South African National Defence Force (SANDF) has occurred. Among the several reasons for this decline have been inevitable budgetary and other constraints resulting from force design restructuring. The ResF of the South African Military Health Service (SAMHS) in particular has keenly felt this decline.

3. Although the voluntary Initial Military Service (IMS) system was instituted to replace conscription, it was designed primarily to feed the Regular Force (RegF). The later Military Skills Development (MSD) system is intended to supply ResF members after the 2 year full-time service period, but the SAMHS ResF is unlikely to benefit significantly due to the unique SAMHS requirement for health professionals with specialized skills.

AIM

4. The aim of this Staff Paper is to determine the role and value of a tertiary education-based system for recruitment of health professionals into the ResF of the SAMHS. An examination of the current SAMHS ResF situation ; the imperatives for training the ResF to combat-readiness ; existing models of tertiary-based schemes in other countries ; and recommendations in this regard constitute the scope of the Paper.

 

 

THE SAMHS RES F AT PRESENT

5. In complying with the requirements of the White Paper and the Defence Review, and in accord with the SAMHS Strategic Direction Plan (Nov 2002), the SAMHS committed itself to creating a full ResF structure within all the elements of its organization. The current force design of the SAMHS ResF has the following components :

a. The Conventional ResF. This consists of three wholly ResF Medical Battalion Groups (Med Bn Gp) in the Mobile Military Health Formation (Mob MH Fmn), namely 1, 3 and 6 Med Bn Gp, and a ResF wing within the RegF Med Bn Gp (7 Med Bn Gp) . This component may be said to be the "cutting edge" of the expansion capability that will provide combat and other operational mil health support.

b. The Territorial ResF. This consists of ResF Wings at the 9 Area Military Health Units of the Area Military Health Formation (Area MH Fmn). The role of the SAMHS Territorial ResF remains to be re-defined pending the restructuring of the Army Territorial ResF.

c. The Base and Support ResF. This consists of pools of specialized ResF members in SAMHS HQ, Dir and Fmn HQs (including the Tertiary MH Fmn and the MH Trg Fmn), and General Support Base Thaba Thswane (GSB TT).

6. Some 2,300 ResF posts have been created from Level 2 to Level 4. These posts require filling by appropriate ResF members in order to give effect to the One Force Model and to permit the SAMHS ResF to contribute meaningfully as the expansion capability across the broad spectrum of the tasks of the Service, and to fulfil the role and purpose of the ResF as providing a combat ready war reserve of trained personnel. This is a formidable goal that is nevertheless attainable if an effective recruiting and training system is established.

7. Thus, "appropriate Res F members" would constitute the following :

    1. Younger, recently-qualified professionals of useful deployment potential to strengthen the leader group and the combat support capacity of the Conventional Res F units of the Mob MH Fmn.

b. More senior and experienced clinicians and educators to provide input to the work of the Military Hospitals of the Tertiary MH Fmn and the training activities of the MH Trg Fmn.

c. Administrators of health care systems to provide managerial expertise within the SAMHS HQ, the Dirs, the Fmn HQs and the GSB TT.

 

PROJECT PHOENIX AND THE SAMHS RES F

8. Project PHOENIX was approved by the Military Council (MC) in 2002 with the aim of renewing and transforming the Res F of the SANDF. As the result of the several constraints referred to above, it is acknowledged that the SAMHS ResF as a whole is at present not combat ready and in some specific instances is even non-existent. .

9. During Phase One of the Project, the Surgeon General directed that an in-depth assessment of the SAMHS ResF be undertaken by the Directorate Military Health Reserve Force (D MH ResF). This review provided an informative illustration of the decline in the SAMHS ResF capability referred to above. The changes in strength between the years 1990 to 2003 are shown below ( see Table 1 ).

    1. Prior to 1990. Up to 1990, 6 ResF (at that time, Citizen Force) Med Bn Gps had a total nominal strength of approximately 4800 members, virtually all of these white males. Following the de-activation of 3 of these Units (1990 – 1992) and upon completion of a subsequent "clearing up" rationalization process in 1998, a total SAMHS ResF strength of 326 members remained (approximately 7 per cent of the 1990 strength).

 

Table 1 : Changes in Personnel Strength cf Number of ResF Med Bn Gps

Pers Strength : in Thousands

Med Bn Gps : 1990 N = 7

    1. N = 4

2003 N = 4

    1. Although being active, experienced and committed volunteers, these ResF members - especially the leader group and the professional medical groupings - were nonetheless ageing, lacking in current mil health training and therefore increasingly unsuitable for deployment. Appro- priately-aged junior leader group remained notably under-represented.
    2. c. Changes after 1998. Since 1998, 648 additional members have been recruited or re-recruited, mostly on an individual or "cherry-picking" basis, for a ResF total strength of 974 at 30 Sep 2003.

      i. Some eminent, influential and highly-qualified South Africans are amongst these new recruits and by their service – mostly as senior officers - add significant value to the SAMHS ResF.

      ii. Moreover, a significant correction and improvement in represen-

      tivity, both by gender and by population group , has been achieved during this phase. The ResF now has a gender composition of 71 % male vs 29 % female. Population groupings are shown in Table 2 .

       

      Table 2 : Percentage Compostion of SAMHS ResF at 2003

      (Population Groupings)

      d. Remarks. These overall numbers are in keeping with the goal of Force restructuring and "right-sizing" and in this respect alone may seem to be adequate for the present tasks of the SAMHS ResF.

      i. However, the serious concerns iro age-rank discrepancy, inadequacy of current training and doubtful deployment potential remain unchanged. Little has been achieved in correcting the under-representation and age-rank skewing of the junior leader group.

       

      ii. In particular, it should be noted that only 6 of the present 974 ResF members are qualified as specialists in Surgery. This is wholly inadequate in terms of the ResF being the expansion capability of the SAMHS.

      IMPERATIVES FOR MODERN MILITARY HEALTH TRAINING

      9. The Nature of Modern Warfare. In this regard, a further aspect of potentially serious concern remains largely unaddressed. The development and application of newer weapons systems which possess an increased lethality and wounding power is producing an unprecedented spectrum of combat-related injury patterns. Moreover, the conduct of recent conventional military operations has seen a shift towards fighting in an urban setting, as opposed to the open battlefield. Recent published and reported mil health experience from the conflicts in the Persian Gulf, Afghanistan and the Former Yugoslavia provide a clear description of these changes.

      10. Remarks. These developments have significant implications for mil health combat support. The capability to provide optimal treatment of these injury patterns at all Roles of Support, but particularly at Roles 1 and 2, requires innovative training of specialized military health surgical teams. Suitable ResF members are required to form part of such teams.

      11. Examples of such innovative specialized training are :

      a. The BATLS & BARTS programme. This course provides training in im- mediate comprehensive care of the injured at Role 1 (on the battlefield). It was instituted in SAMHS training in May 2001 after being modified and adapted for SAMHS requirements.

      b. "Damage Control Surgery" The British " Surgery of War" (SoW) course and the United States Air Force Trauma Refresher Course for Surgeons (TRCS) provide specialized training in early surgical intervention at both Roles 1 and 2 within the Forward Surgical Capability concept. It is an indispensable continuation of the support provided by BATLS & BARTS. A SAMHS version of the SoW / TRCS course still needs to be developed.

      12. As the expansion capability of the SAMHS, it is imperative that the ResF be capable of providing mil health pers trained in this expertise. Furthermore, a civil-military cooperative relationship with the trauma units at civilian University Teaching Hospitals is required to enable SAMHS RegF members of all clinical musterings to gain and to maintain practical experience in the clinical management of severe injury. No such relationship exists at present.

      A RESERVE OFFICERS’ TRAINING SCHEME

      13. It is clear that the present state of affairs is untenable in the medium to long term. The "cherry-picking" recruitment process referred to above must be regarded as no more than a short-term, "stop-gap" measure. A structured, comprehensive and durable long-term system to recruit young medical professionals, paramedicals and nursing pers into ResF service in the SAMHS is required.

      14. The Department of Defence Human Resource Strategy 2010 (HR Strategy 2010) and the Surgeon General’s Guidelines for Planning both require that a system for recruiting and training Reserve Officers and Voluntary Cadets at institutions of tertiary education investigated and developed. For the reasons detailed above, the SAMHS ResF Plan resulting from Phase One of Project PHOENIX proposes to comply with this requirement.

      15. Characteristics of the System. In the context of the "First Principles" of HR Strategy 2010, such a system should have the following characteristics and features :

      a. It should be affordable and be consistent with the present Force design.

      b. It should be appropriate to the needs of the SAMHS and the SANDF ("Right Quantity").

    3. It should be effective in sourcing volunteers of appropriate age, fitness, attitude and professional expertise ("Right Quality").
    4. It should be efficient in providing appropriate and structured military, leadership and professional training to these recruits – which should preferably be portable into the civilian arena - as well as offering appropriate career development opportunities ("Right Place").
    5. It should promote civil-military co-operation (for example as envisaged by Project SHIELD) and therefore ensure its legitimacy and acceptability to the South African community at large.
    6. It should serve to advance transformation and representivity in the SAMHS.

16. Existing Models in Other Countries. Examples of systems with many of the attributes listed above are found in the Reserve Officers’ Training Corps (ROTC) in the United States of America and the Tri-Service Officers’ Training Corps (OTC) in the United Kingdom (UK). These systems are established at various universities and have proved, over several decades of their functioning, to be durable and useful in recruiting for both the Reserve and Regular Forces of those countries.

17. Contacts with Other Countries. Following South Africa’s admission as Associate Member of the Interallied Confederation of Reserve Medical Officers (CIOMR), a NATO affiliated organization, it was possible for D MH ResF to make informal contact with the UK OTC requesting information on the Corps and its activities. The Staff Officer : Officers’ Training Corps (SO1 : OTC) at Headquarters : Land Command, British Army has kindly offered advice and has undertaken to provide assistance to the SAMHS during its investigation of the feasibilty of its own OTC. The UK OTC will therefore be discussed in more detail as follows.

18. The United Kingdom Officers’ Training Corps. Established in 1908, the British Army Officers’ Training Corps is a division of the Territorial Army (TA, ie the Reserve Force). A Royal Navy equivalent has recently been established in the University Royal Naval Units (URNUs) and a Royal Air Force equivalent exists as the University Air Squadrons (UASs).

a. The Army Corps presently has 19 contingents (University Officers’ Training Contingents, or UOTCs) which are named for the Universities at which they are established (eg "Cambridge UOTC" and "University of London OTC").

b. The constituting Charter of the OTC has been supplied to the SAMHS D MH ResF by SO1:OTC of the British Army and is attached at Appendix A. This Charter comprehensively details the purpose, structure and functioning of the OTC.

i. The Aim and Mission of the OTC. The Aim is stated as being "to prepare members for positions of responsibility in the Regular Army, the TA or elsewhere". It will be noted that the Mission of the OTC is "to develop the leadership potential of selected university students through … training in order to communicate the values, ethos and career opportunities of the British Army".

 

ii. The Tasks of the OTC. Amongst the several Tasks of the OTC are " … to recruit into the OTC a broad spectrum of high calibre university students with the potential to be future leaders either within or outside the Armed Forces … to develop leadership and management skills through a challenging programme of training … and to provide a reserve of potential officers for mobilization". A striking consonance with the aims of both the SAMHS Strategic Direction Plan and of Project SHIELD will be noted in these statements.

iii. An important proviso specifically stipulated in the Charter is that

"military training should not interfere with academic studies".

c. Training and Qualification in the OTC. Students join the OTC as Officer Cadets (OCs) and serve for a period of 2 to 3 years during their undergraduate education. Upon completion of the period of service, successful OCs are commissioned as junior subalterns (2Lt). Thereafter, they may elect to take up a RegF commission, transfer to a TA Unit as a ResF member, or leave the service entirely.

i. Training in the OTC is discontinuous and takes place after hours and during weekends, with an Annual Camp of 15 days’ full-time training scheduled during university vacations.

ii. A total annual requirement of 32 Military Training Days (MTDs) is required : the process is thus ResF-friendly. The syllabus and sequence of this graded training are set out in the various Orders and Instructions issued by the HQs and referred to in the OTC Charter.

19. Student Support for Tertiary-Based Training in South Africa. The data gathered by the 2001 opinion survey of attitudes towards voluntary part-time military service among fifth-year medical students at the University of the Witwatersrand Medical School showed unexpectedly strong support for the concept of a SAMHS ResF training programme at that University. The findings of the survey and an analysis and discussion were presented at the XXXIV International Congress on Military Medicine during Sep 02 and are attached at Appendix B. If these findings are reproduced on similar surveys at the other Medical Schools in South Africa, the SAMHS should experience no shortage of appropriate recruits for the ResF, and should be in a position to choose from among the "best and the brightest".

CONCLUSION

20. The requirement for adequate numbers of appropriate and suitably trained mil health personnel to fill the posts in the SAMHS ResF is a matter of fact and is becoming a matter of some urgency. The United Sates of America and the United Kingdom have for some time had success in recruiting and training junior officers utilizing tertiary education-based Reserve Officers’ Training programmes. Initial indications are that South African medical students may be highly receptive to a similar system. An opportunity may exist for the SAMHS ResF to establish a joint training programme with the SA Army ResF.

RECOMMENDATIONS

21. It is submitted that the UK model provides an example which may be readily adapted for the needs of the SAMHS. It is proposed that the UK offer of advice and assistance be accepted and that the invitation from SO1 : OTC to make a site visit to establish further contacts and to observe recruiting and training activities be considered.

22. Given the relative size of the SAMHS, it is proposed that the term "Reserve Officers’ Training Scheme" (ROTS) be adopted in future, rather than the use of the term "Corps" with its specific Force Structure Element connotation.

23. In the interests of cost-effectivity, it is proposed that a generic system for part-time military training be investigated as a joint venture with the SA Army.

a. In this regard, it should be noted that an initiative is being proposed by several of the SA Army ResF regiments to implement a part-time 3 to 4 year infantry officers’ training programme based at Johannesburg. Such a programme would fit the requirements for the military training of SAMHS ROTS recruits well.

b. The "special-to-arm" military health training in basic, intermediate and advanced life support, aviation and maritime medicine and specialized military surgery would be undertaken by the units of the MH Trg Fmn and the MH Tertiary Fmn.

24. It should be noted that the presence and activities of such a Scheme on tertiary education campuses would doubtless serve as a recruiting vehicle for the other Services and Divisions, for example the SA Corps of Engineers and the Military Legal Service.

25. Post-Graduate Recruits. Qualified medical professionals ipso facto require to be handled somewhat differently than undergraduate students.

a. Provision should therefore be made within the Scheme for recruitment of post-graduate trainees at academic teaching hospitals in the specialties of general surgery / traumatology, orthopaedic surgery, emergency medicine and anesthesiology / critical care in order to source the clinical expertise for Forward Surgical Capability as discussed in para 11 above.

b. Furthermore, ongoing problems are being experienced with providing suitable abbreviated military orientation training for more mature, qualified medical professionals already joining the SAMHS ResF. An ROTS may provide a framework within which this this intractable problem may be solved.

26. The details of the constitution, establishment and structure of such a scheme should be determined by a joint working group drawn from all the Services and Divisions, possibly under the auspices of the Division of Chief of Defence Reserves and with ongoing inputs from the Reserve Force Council of South Africa.

Practical issues which will require clarification and approval include the following :

a. Feasibility ito public, university and student support and cost implications for the Services and Divisions.

b. Constitution and Command and Control.

c. The designation and physical location of the Scheme, and badging of trainees.

d. Duration of service in the Scheme ; content and scope of training and training sequence ; generic training and "special-to-arm" training.

e. Financial aspects including budgeting and business plans, incentive bursary and other financial assistance packages as in a Tertiary Education Grant Scheme ; and the resulting obligation to serve resulting from such assistance.

f. Intake numbers per year, ascertained in accordance with the requirements of the SAMHS and taking account of promoting representivity.

27. An initial Pilot ROTS. Finally, in light of significant cost implications, it is recommended that an initial pilot of the Scheme should be established in Gauteng.

a. This Province has a concentration of Faculties of Health Sciences ( a total of 3 ) and the largest Technikon complex in South Africa.

b. As with the University of the Witwatersrand opinion study referred to in para 19 above and detailed in Appendix B, surveys of opinion should therefore be undertaken at the University of Pretoria and the Medical University of South Africa (MEDUNSA) to gauge the level of support for a ROTS amongst the student bodies at those remaining institutions.

c. Preliminary discussions with the academic heads of these medical schools and the paramedical departments of the Technikons to obtain consent to carry out these surveys and to assess administration attitudes to the possibility of a ROTS should be therefore held as soon as possible.

d. Should the pilot Scheme prove to be successful, and should student and community support and acceptance be demonstrated at the other tertiary centres in South Africa, the Scheme may thereafter be extended to these regions.

28. A well-structured and well-administered ROTS, co-operating jointly with the other Services of the SANDF and with the administrations of the civilian tertiary education institutions, and conducting its business in the spirit of Bathopele, should provide a supply of unique SAMHS ResF members : health professionals who are also well-trained soldiers and future leaders of South African society.

 

 

 

 

(G.R. HIDE )

SSO TRAINING D MH RES F : COL

Oct 03